Enhanced Care Management
Santa Clara Family Health Plan (SCFHP) offers a Medi-Cal benefit called Enhanced Care Management (ECM). ECM provides extra services at no cost to SCFHP Medi-Cal members that qualify based on meeting eligibility criteria for one or more of the ECM Populations of Focus.
What is ECM?
ECM is a whole-person care approach that addresses the clinical and non-clinical needs of SCFHP’s most vulnerable Medi-Cal members. ECM provides intensive and comprehensive care management services. ECM is a community-based, interdisciplinary, and high-touch in-person intervention, that focuses on person-centered, goal-oriented, and culturally appropriate models of care.
The goals of ECM is to improve care coordination, integrate services, facilitate community resources, address social determinants of health (SDOH), improve health outcomes, and decrease duplication and inappropriate utilization of services.
ECM services available to SCFHP members:
| Assessment & Care Management | Care Coordination | Health Promotion |
| Develop and update a Health Action Plan (HAP) to guide services and care | Coordinate care across ALL providers | Educate members about and support them in adopting healthy behaviors |
| Transitional Care | Member and Family Support | Referrals to Community and Social Support Services |
| Facilitate care transitions between the hospital, nursing homes, other treatment facilities, and home | Support the self-management and decision making efforts of members and their family and/or support team | Connect members to community and social services, as needed |
ECM Providers and Lead Care Managers
SCFHP identifies members who are eligible for ECM and assigns them to contracted ECM providers. ECM providers conduct outreach to specific SCFHP members to enroll them into ECM and deliver ECM services.
A Lead Care Manager oversees the delivery of ECM services and can help SCFHP members:
- Enroll in ECM
- Find doctors and schedule appointments
- Better understand their prescription drugs
- Set up transportation to doctor visits
- Receive follow-up services after a member leaves the hospital
- Find and apply for food benefits and housing
- Connect to other community programs and services
ECM Populations of Focus:
| ECM Populations | Adults | Children & Youth | |
| 1a | Individuals Experiencing Homelessness: Adults without Dependent Children/Youth Living with Them Experiencing Homelessness |
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| 1b | Individuals Experiencing Homelessness: Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness |
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| 2 | Individuals At Risk for Avoidable Hospital or Emergency Department Utilization |
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| 3 | Individuals with Serious Mental Illness (SMI) and/or Substance Use Disorder (SUD) Needs |
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| 4 | Individuals Transitioning from Incarceration |
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| 5 | Adults Living in the Community and At Risk for Long-Term Care (LTC) Institutionalization |
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| 6 | Adult Nursing Facility Residents Transitioning to the Community |
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| 7 | Children and Youth Enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS Condition |
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| 8 | Children and Youth Involved in Child Welfare |
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| 9 | Birth Equity Population of Focus |
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How do eligible SCFHP Medi-Cal members access ECM?
- Most eligible members will be contacted about ECM. SCFHP will identify members who are eligible for ECM and those members will receive a notice from SCFHP about their eligibility. SCFHP will also share the Member Information File (MIF) with contracted ECM providers so they can do their own outreach to the members.
- A provider submits a referral form for eligible members. Providers can submit a referral form to SCFHP if a member has not been pre-identified as being eligible for ECM. This may be necessary if the individual is newly enrolled in Medi-Cal. Providers can email a completed referral form to ECM@scfhp.com or fax it to 1-408-874-1469.
- A member asks to join. Individuals can contact SCFHP Customer Service at
1-800-260-2055 (TTY: 711) and ask if they qualify for ECM.