El Dorado County Client Spotlight: Collaborating to Meet the Unique Challenges of CalAIM Reform

El Dorado County is a tiny area in California, home to a cluster of small communities between Lake Tahoe and Sacramento, with a total population of just under 200,000. When the bulky and complicated CalAIM reform guidelines were released, it looked like a daunting task to the small but resourceful team at the county’s Public Health Division. However, this was a group with a high rate of claims acceptance who understood how to meet California regulations. They weren’t afraid to ask questions. And they also had a secret weapon at their disposal––their technology provider, Netsmart.

Solution — The proactive El Dorado County staff teamed up with Netsmart to execute CalAIM reform successfully.

“Because we were in a time of uncharted territory, we came to in-person gatherings wanting to know what Netsmart could do,” said Lisa, who works in IT. “We had a lot of concerns in the beginning, and then it became clear.”

Fundamentally changing the billing and claiming structure that their organization depended on was a lot of pressure, but Netsmart answered any questions they had––and set up their EHR system to handle the new requirements. Some new forms were custom created, and others had already been developed by Netsmart proactively in advance of CalAIM.

And their size didn’t matter when it came to getting time and attention from their technology partner.

“Being so small and being heard, Netsmart valuing what we had to say, listening and providing feedback––it’s been huge for us and other counties as well,” said Kristin Gula, Billing Administrator.

• CONNECTIONS conference allowed the small team to meet directly with Netsmart and ask questions about CalAIM
• Collaborated to get ahead of needed expansions to technology
• Netsmart created custom coding to help execute the transition
• Updates were already built into the EHR, lessening the burden on IT staff
• El Dorado County took the lead in educating larger counties about CalAIM
• Improvements were made quickly with a lean workforce

When it comes to collaboration and technology, El Dorado County has the right idea.

“The more we can get our vendor to do for us, the less burden is on us to figure out nuances or things we aren’t aware of behind the scenes,” said Lisa. Essentially, Netsmart became El Dorado County’s strategic advisor––and the team’s size wound up being an advantage, since everyone wore a lot of hats and could see the bigger picture.

“Our team sees the claim structure from the record start to that claiming process. These responsibilities at larger organizations are separated across teams, so it was easier for us to connect the dots from start to finish,” said Kimberly McAdams, Assistant Director of Administration and Finance.

Ultimately, the CalAIM rollout was a success. “This was a lot of work for our staff, but to say that we have been able to successfully claim out of the gate speaks to the success of this partnership between Netsmart and El Dorado County staff,” observed Nicole Ebrahimi-Nuyken, Director of Behavioral Health.

“Netsmart listens to us. And doesn't just listen, but also hears us when we say that there are things that affect our system based on the information that we're receiving as requirements from the state of California. And the conversation is a partnership, because we work together on determining solutions that will help the greatest number of people who are also using the system, not just in our county but across the board.”

Lisa, Department Systems Analyst