At the heart of California’s healthcare innovation lies Enhanced Care Management (ECM), a Medi-Cal benefit designed to holistically address the needs of its highest-need members. This statewide program goes beyond traditional healthcare, building trusting relationships with members and providing intensive coordination of health and related services, Uniquely, ECM’s lead care managers meet members in various settings – whether on the street, in shelters, at their doctor’s office, or in their own homes – ensuring care is accessible and tailored to individual circumstances. ECM also plays a cruical role in connecting members to Community Supports services, which focus on health-realted social needs like access to nutritious foods and safe housing.
In the ever-evolving world of healthcare, digital health is revolutionizing how services are delivered and accessed. Medi-Cal’s Enhanced Care Management and Community Supports programs are prime examples of this transformation. Since their launch in January 2022, these programs have not only bridged gaps in traditional healthcare but have also embraced digital technologies to expand their reach and efficacy. This blog post explores the latest updates in these programs, with a particular focus on their digital health and telehealth components.
ECM and Community Supports: Embracing Digital Health
The integration of digital health into the ECM and Community Supports programs marks a significant advancement in California’s healthcare system. It reflects a shift towards more accessible, efficient, and patient-centered care.
Digital Inclusion: A substantial portion of the 141,000 MCP members enrolled in ECM and the 76,000 members utilizing Community Supports services are benefiting from digital health solutions.
- Telehealth Utilization: The usage of telehealth services within these programs has surged, reflecting a broader trend in healthcare delivery.
- These numbers highlight the growing importance of digital health in enhancing patient care and service accessibility.
HCPCS Coding Guidance: Incorporating Telehealth
DHCS’s new HCPCS coding guidance includes specific provisions for telehealth services within ECM and Community Supports. This update is crucial in standardizing and recognizing telehealth as an integral component of healthcare delivery.
Specific Codes and Dates:
- Telehealth Coding: Effective immediately, providers must use specific DHCS-established HCPCS codes and modifiers for telehealth services.
- Prohibition of Additional Codes: DHCS has prohibited the use of codes or modifiers beyond the established guidance to streamline the process and reduce administrative burden.
- Updated Codes for Outreach: Codes like G9008, U8 (for in-person outreach by clinical staff) and G9012, U8, GQ (for telephonic/electronic outreach by non-clinical staff) reflect the inclusion of telehealth efforts in ECM outreach.
Empowering Providers and Patients through Telehealth
Staff Definitions and Telehealth:
- Clinical Staff: Now include those providing ECM services via telehealth.
- Non-Clinical Staff: Also encompass roles supportive of telehealth services.
The expanded definitions acknowledge the vital role of digital health in ECM.
ECM Outreach: A Digital Approach
The new outreach codes for ECM reflect the growing role of digital communication methods in engaging patients. Telephonic and electronic outreach efforts, essential in the digital age, are now appropriately coded and recognized.
Advancing Community Supports with Digital Solutions
The updated coding guidelines also cater to digital and telehealth services within Community Supports, offering multiple coding options to reflect the diversity of digital services provided.
Housing-Related Digital Outreach:
New codes for digital outreach in housing-related services highlight the importance of digital engagement in reaching vulnerable populations.
The Future: Digital Health-Centric Codes and Guidance
The upcoming release of new codes and the Coding Options Guide will further solidify the role of digital health in California’s healthcare framework. With these changes set to take effect on January 1, 2024, and additional codes becoming effective from March 31, 2024, the state is preparing for a future where digital health is at the forefront of care delivery.
The integration of digital health and telehealth in California’s ECM and Community Supports programs is a testament to the state’s commitment to modernizing healthcare delivery. These updates not only enhance service efficiency and accessibility but also ensure that healthcare keeps pace with technological advancements. As digital health continues to grow, California’s approach offers valuable insights into the future of integrated, technology-driven healthcare systems.