Enhanced Care Management

IEHP Enhanced Care Management (ECM) is a no-cost Medi-Cal benefit that addresses the clinical and non-clinical needs of high-need, high-cost IEHP Members through systematic coordination of services and comprehensive care management. ECM is a collaborative and interdisciplinary approach to providing intensive and comprehensive care management services to individuals. It serves to build on the Health Homes Program (HHP) and Whole Person Care (WPC) pilots and transitions those pilots to one larger program to provide a broader platform to build on positive outcomes from each program.

For further programmatic questions about ECM, please send emails to ECM@iehp.org for additional information. 

ECM provides Members who qualify for this benefit an additional care team to help coordinate and manage their care. The care team consists of the following:

• Nurse Care Manager
• Behavioral Health Care Manager
• Care Coordinator
• Community Health Worker 

These specially trained professionals collaborate with IEHP Members' Primary Care Physicians, Specialists, and family support systems to create a personalized plan of care.

To be eligible for ECM, Members must be enrolled in a Medi-Cal Managed Care Plan and meet at least one of the ECM Populations of Focus (PoF) definitions described below:

*Please Note: In the Populations of Focus (PoF) definitions, “adult” is defined as an individual who is 21 years of age or older, and a “child or youth” is defined as an individual under 21.

For more detailed information regarding the Populations of Focus (PoF) definitions and eligibility criteria you can refer to the CalAIM Enhanced Care Management Policy Guide available in the "Additional Resources and Information" section below. 

Member Self-Referral

As of January 1, 2022, Providers can instruct eligible IEHP Members who need ECM services to call IEHP Member Services directly at (800) 440-4347, Monday - Friday, 8am - 5pm. TTY users should call (800) 718-4347.

Provider Referral Option

In addition, IEHP Providers have the option to submit a referral on behalf of Members who qualify for one or more of the identified ECM Populations of Focus (PoF) and that are not enrolled in duplicative services. 

The three step ECM screening and referral process includes:

• Verifying the Member's Medi-Cal Eligibility.
• Complete the appropriate ECM Referral Form to determine if Member meets in one or more Population of Focus (PoF). 
  • ECM Referral Form (For Non ECM Providers)
  • ECM Referral Form (For Contracted ECM Providers & Internal IEHP)
• If based on the responses the Member meets ECM criteria for at least one PoF, then send the ECM Referral Form securely through the designated method listed below. IEHP will review and verify the Members eligibility and respond within five (5) business days. 

Email completed ECM referral requests to ECMCareExtenders@iehp.org.

For current IEHP Providers who qualify and are interested in joining our ECM Prospective Provider interest list, please complete and submit the following assessment and application to the IEHP ECM Team at ECM@iehp.org. 

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.