Enhanced Care Management (ECM)
Enhanced Care Management
Enhanced Care Management (ECM) is a whole-person, interdisciplinary approach to care that addresses the clinical and non-clinical needs of Medi-Cal members with the most complex medical and social needs. It provides systematic coordination of services and comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered.
Innovation
ECM replaces previous initiatives (WPC and HHP) with a statewide, standardized care management approach that formally considers the impact of social drivers of health (SDOH) and coordinates care across physical, behavioral, and social service delivery systems.
The Problem
High-need Medi-Cal members often experience fragmented care across multiple delivery systems, leading to reduced quality of life, unmanaged conditions, and high utilization of avoidable, costly services in emergency departments and inpatient settings.
The Solution
ECM offers comprehensive, whole-person care management to high-need, high-cost Medi-Cal Managed Care Members. It provides a trusted Lead Care Manager who coordinates and integrates care and services, bridging across delivery systems and addressing social drivers of health.
Expected Outcomes
Successful outcomes include improved care coordination, integrated services, facilitated community resources, addressed social drivers of health (SDOH), improved health outcomes, and decreased inappropriate utilization and duplication of services.
Strategy
ECM is an integral component of DHCS' Population Health Management (PHM) Program under CalAIM, scaling up interventions from Whole Person Care (WPC) Pilots and Health Homes Program (HHP) to form a statewide care management approach.
Model Goals
- Improving care coordination
- Integrating services
- Facilitating community resources
- Addressing SDOH
- Improving health outcomes
- Decreasing inappropriate utilization and duplication of services
Patient Eligibility
Medi-Cal Managed Care members who meet the criteria for at least one of the specific ECM Populations of Focus.
- Individuals Experiencing Homelessness (Adults, Homeless Families, or Unaccompanied Children/Youth)
- Individuals At Risk for Avoidable Hospital or ED Utilization (e.g., 5+ ER visits or 3+ unplanned hospital/SNF stays in 6 months for adults)
- Individuals with Serious Mental Health and/or SUD Needs
- Individuals Transitioning from Incarceration
- Adults Living in the Community and At Risk for LTC Institutionalization
- Adult Nursing Facility Residents Transitioning to the Community
- Children and Youth Enrolled in CCS or CCS WCM with Additional Needs Beyond the CCS Condition
- Children and Youth Involved in Child Welfare
- Birth Equity Population of Focus (Pregnant or postpartum individuals subject to racial and ethnic disparities)
Provider Eligibility
ECM Providers must be community-based entities contracted with MCPs, capable of providing culturally appropriate and timely in-person care management activities.
- Must have the capacity to provide culturally appropriate and timely in-person care management activities.
- Must use a care management documentation system or process that supports the documentation and integration of physical, behavioral, social service and administrative data.
- Must be vetted by the MCP to ensure they can meet the standards and capabilities required to be an ECM Provider.
- Must have formal agreements and processes in place to engage and cooperate with area hospitals, primary care practices, behavioral health Providers, Specialists, and other entities.
- Must enroll as a Medi-Cal Provider only if there is a state-level enrollment pathway for them to do so.
Care Categories
Care Management and Coordination
Populations of Focus
Performance Metrics
Cumulative ECM Members Served
Total unique Medi-Cal members who received Enhanced Care Management since launch, showing 5.8x growth from 2022 Q1 to 2025 Q2.
Active ECM Members (Past 12 Months)
Total number of unique members who received ECM services at any time in the past 12 months ending Q2 2025.
Top Adult ECM Populations (Past 12 Months)
The highest volume adult member populations receiving ECM services in the past 12 months.
Top Child & Youth ECM Populations (Past 12 Months)
The highest volume child and youth populations receiving ECM services in the past 12 months.
Active ECM Provider Contracts
Total number of active ECM provider contracts in 2025 Q2, representing a 5.2x growth from 681 contracts in 2022 Q1.
Top ECM Provider Capacity by Population
The highest volume of ECM provider contracts in the past 12 months, categorized by the adult populations they serve.
ECM Members and Services (Membership and Service Provision)
This domain tracks member-level enrollment and utilization data for the Enhanced Care Management benefit. Sub-elements reported include member demographics, assigned Populations of Focus, benefit start and end dates, reasons for discontinuation, and the number of in-person and telehealth interactions.
ECM Requests for Services and Outreach
This domain monitors the pipeline of members identified for, and engaged in, Enhanced Care Management. Sub-elements include the number of members identified as eligible, outreach attempts made, and the volume of ECM service requests received, approved for authorization, or denied by the Managed Care Plan.
ECM Provider Capacity
This domain assesses the availability and bandwidth of the Enhanced Care Management provider network. Sub-elements include provider types, specific Populations of Focus served, the number of adult and child/youth members currently being served, and the total overall capacity to serve members.
Grievances and Appeals
This domain captures member dissatisfaction and disputes specifically related to Enhanced Care Management and Community Supports. Sub-elements include ECM-specific grievance and appeals data submitted through the revised Managed Care Program Data file to monitor member protections and access issues.
Quality Performance
This domain evaluates the health outcomes for Managed Care Plan members who received Enhanced Care Management services. Sub-elements include specific quality measures and demographic characteristics of those served to evaluate the overall impact of the statewide Population Health Management strategy.
Operational Friction
Identified risk vectors and execution hurdles based on model structure.
ECM is a no-cost Medi-Cal benefit, but delivery depends on Managed Care Plans (MCPs) identifying eligible members across nine Populations of Focus and successfully referring them to an ECM Provider. Member identification is the single biggest bottleneck — a member the MCP never flags never gets outreach.
DHCS requires ECM Providers and MCPs to submit quarterly reports on Membership, Service Provision, Provider Capacity, Grievances, and Quality. The data feeds into CMS 1115 waiver monitoring, and gaps delay federal match.
ECM is paid as a PMPM capitation to the MCP, who sub-contracts with ECM Providers on negotiated rates — not fee-for-service. The financial window is the engagement period: members only generate revenue while actively engaged, and engagement definitions vary by MCP contract.
ECM sits at the intersection of MCP, ECM Provider, county behavioral health, PCP, and social services. Each entity has different payment structures (capitation, FFS, block grant) and different accountability to DHCS, creating misaligned incentives around who owns the member.
Is this model right for your organization?
Answer three quick questions about your facility and get matched to the VBC models that fit your profile with verified benchmark context.
Start Your Analysis