Comprehensive Enhanced Care Management Under CalAIM for High-Risk Medi-Cal Members

Starting soon · Not applicable

Conditions studied: Complex Care, Post-Acute Care Utilization, Housing Instability, Residential Care Transition, Population Health Management, Care Transitions

In brief

This pragmatic, cluster-randomized trial will evaluate whether a comprehensive CalAIM-aligned care model consisting of Enhanced Care Management, selected Community Supports, Transitional Care Services, and residential care coordination improves population health outcomes among high-risk Medi-Cal managed care members in California compared with usual CalAIM service delivery. The intervention is intended to improve continuity of care after discharge, reduce potentially avoidable utilization, increase successful linkage to outpatient and social supports, and improve community tenure and patient-reported outcomes.

Key facts

Study ID

NCT07587073

Run by

StratiHealth

People needed

1200

Starts

2026-10-01

Expected to finish

2028-12-31

Last updated by the study team

2026-05-14

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Adult Medi-Cal managed care member in California.
• Identified as high-risk for poor outcomes based on plan stratification or qualifying CalAIM criteria.
• Eligible for ECM and at least one of the following: Transitional Care Services, Community Supports related to post-acute recovery, housing/residential stabilization, or nursing facility transition/diversion.
• Recent discharge or active transition from hospital, emergency department, skilled nursing facility, post-acute facility, recuperative care, assisted living, residential behavioral health setting, or other qualifying level-of-care transition.
• Able to provide informed consent, or eligible for waiver/alteration of consent if approved for cluster-level pragmatic implementation research.

You may not qualify if…

• Enrollment in hospice or expected survival less than 6 months at the time of the index episode.
• Long-term custodial institutional placement without an anticipated community transition plan.
• Current incarceration or detention is preventing intervention delivery.
• Previous enrollment in this study during the same observation window.
• Any condition that, in the investigator's judgment, makes participation infeasible or data interpretation unreliable.

Where it is running

• StratiHealth — Los Angeles, California, United States

Full record on ClinicalTrials.gov

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