California Integrated Care Management (CICM)
What is CICM?
California Advancing and Innovating Medi-Cal (CalAIM) is an initiative by the Department of Health Care Services (DHCS). CalAIM works to improve the quality of life and health outcomes of Medi-Cal members by implementing a broad delivery system, program, and payment reform across the Medi-Cal program. CalAIM establishes the framework to address social determinants of health and improve health equity statewide.
California Integrated Care Management (CICM) is a whole-person, interdisciplinary approach to care. CICM addresses the clinical and nonclinical needs of members with the most complex medical and social needs. CICM provides systematic coordination of services and comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered.
What are CICM Services?
The goal of CICM is to coordinate all primary, acute, behavioral, developmental, oral, social needs, and long-term services and supports for members, including participating in the care planning process, regardless of setting. CICM is intended to be interdisciplinary, high-touch, person-centered, and provided primarily through in-person interactions with members where they live, seek care, and prefer to access services.
CICM eligible members will be identified by the SFHP Care Plus Care Management team. Members receiving CICM will be paired with a CICM Care Manager at North East Medical Services (NEMS) who can assess their health and social needs.
See below to learn more about the core services offered through CICM.
Outreach and Engagement: Outreach and engagement includes active and progressive attempts to connect with and engage with members who are eligible, demonstrating a culturally and linguistically competent approach to build trust.
Comprehensive Assessment and Care Management Plan: Following successful engagement with the member, CICM Care Managers complete a comprehensive biopsychosocial assessment of member needs and engage the member in creation of a person-centered care plan that outlines the member’s strengths, risks, needs, and goals.
Enhanced Coordination of Care: Enhanced Coordination of Care includes the services necessary to implement the care plan, including ensuring care is continuous and integrated among all service providers. CICM Care Managers support coordination across the continuum of care, including primary care, physical and developmental health, mental health, SUD treatment, LTSS, oral health, palliative care, and necessary community-based and social services, including housing, as needed.
Health Promotion: Health promotion activities encourage and support members to make lifestyle choices based on healthy behavior, with the goal of motivating members to successfully monitor and manage their health. Examples include services like coaching, health education, teaching new skills, and connection to resources.
Transitional Care Services: Transitional care services are intended to support members as they transition between care settings or from one level of care to another, from the point of discharge planning until they are successfully connected to all needed services and supports. This can include discharges from hospitals, institutions, other acute care facilities, and SNFs to home or community-based settings, Community Supports, post-acute care facilities, or LTC settings.
Member and Family Supports: Member and Family Supports include activities that ensure the member and family/support are knowledgeable about the member’s conditions, with the overall goal of improving their adherence to treatment and medication management.
Coordination of and referral to Community and Social Support Services: Coordination of and referral to community and social support services involves determining appropriate services to meet the needs of members and ensure that any present or emerging social factors can be identified and properly addressed.
Who can receive CICM services?
DHCS has established specific criteria for CICM eligibility. To be able to enroll in CICM, individuals must meet criteria for at least one of the CICM Populations of Focus. CICM is only available for adults; families and children/youth are not eligible.
CICM is available for the following Populations of Focus:
- Adults experiencing homelessness
- Adults with or at risk for avoidable ED and hospital utilization
- Adults diagnosed with SMI or SUD
- Adults living in the community who are at risk for long-term care institutionalization
- Adult nursing facility residents transitioning to the community
- Adults who are transitioning from incarceration
- Adults who are pregnant or postpartum and subject to racial and ethnic disparities
- Adults who have a formal Alzheimer’s or dementia diagnosis
- Adults who have documented dementia care needs
Who can I contact for questions about CICM for Justice-Involved populations?
To contact SFHP Care Plus about CICM services for Justice-Involved populations, call the SFHP Care Plus Care Management Line at 1(415) 615-4545 or email [email protected].
How can I refer an SFHP Care Plus member to CICM?
To contact SFHP Care Plus about referring a member for CICM services, call the SFHP Care Plus Care Management Line at 1(415) 615-4545 weekdays from 8:30am to 5:00pm.
CICM referral forms are available here: Adult CICM referral. For additional questions about CICM, please contact SFHP Care Plus at [email protected].
Who provides CICM Services?
SFHP contracts with North East Medical Services (NEMS) to provide CICM services for SFHP Care Plus members. If an SFHP member is receiving ECM services at the time of enrollment to SFHP Care Plus, we will ensure they continue to receive the same services with SFHP Care Plus.