Enhanced Care Management Providers

Enhanced Care Management (ECM) is delivered primarily by community-based entities that hold contracts with managed care plans (MCPs). 

ECM Structure

L.A. Care assigns each potentially eligible ECM member to an ECM provider. ECM Providers are required to assign a Lead Care Manager to each ECM enrolled member. The Lead Care Manager serves as the member's primary point of contact and works with all their providers – such as doctors, specialists, pharmacists, social services providers, and others—to make sure everyone is in agreement about the member's needs and care. 

The ECM Provider's multi-disciplinary care team consists of the following roles and/or functions, at a minimum
  • Lead Care Manager(s) — a paraprofessional or non-licensed professional or licensed professional
  • ECM Director — can manage multi-disciplinary care teams
  • ECM Clinical Consultant(s) — a licensed professional who can act as a clinical resource for the care team, specifically to support non-licensed Lead Care Manager(s)
  • Community Health Worker — not required, but strongly recommended; a paraprofessional or peer advocate and/or administrative support to the Lead Care Manager(s)  Sometimes stakeholders refer to ECM’s function as “air traffic control” – the ECM Lead Care Manager must know every component of the Member’s needs and services and ensure that they are coordinated. 
ECM Provider Assignment

Each ECM-eligible member is assigned to a contracted ECM provider for outreach and engagement. This provider would also be able to provide the other ECM services should the member opt-in to the ECM benefit.  

Members are matched to ECM providers based on many different characteristics, such as primary care, behavioral health, or specialty. For example, if the member's Primary Care Provider is a contracted ECM provider, the member could be assigned to their PCP for ECM services.  

If a member would like to change ECM provider and/or Lead Care Manager at any time, they can call L.A. Care Member Services at 888 839-9909 (TTY 711). L.A. Care Member Services is available 24 hours a day, 7 days a week. 

Becoming an ECM Provider

ECM Providers are community-based entities with experience and expertise in providing intensive, in-person care management services to individuals in one or more of the Populations of Focus, with which they have experience and expertise. ECM will be offered primarily through in-person interaction where Members and their families and support networks live, seek care, and prefer to access services. Managed Care Plans (MCPs) are required to contract with ECM Providers to deliver ECM to Members.

To become an ECM Provider, your organization must be one of the following
  • City/county government agency
  • County behavioral health provider
  • PCPs or Specialist or Physician groups
  • Federally Qualified Health Center
  • Community health center
  • Community Based Organizations
  • Hospital or hospital-based physician group or clinic (including public hospital and district and/or municipal public hospital)
  • Rural health clinic and/or an Indian Health Service Program
  • Local health department
  • Behavioral health entity
  • Community mental health center
  • Child Welfare Organization
  • Private non-profit organization
  • Substance use disorder treatment provider
  • Community Based Adult Services (CBAS) Providers
  • Skilled Nursing Facilities (SNFs)
  • Organizations serving individuals experiencing homelessness
  • Organizations serving justice-involved individuals
  • California Children’s Services (CCS) Providers
  • Regional Centers
  • First 5 County Commissions
  • School-Based Health Centers
  • Other qualified provider or entity that are not listed above, as approved by DHCS 
To qualify for consideration, an ECM Provider will have
  • Strong, engaged, organizational leadership who agree to participate in learning activities, including in-person sessions and regularly scheduled calls.
  • Capacity to provide appropriate and timely in-person care management activities, as needed in various settings that are most convenient and desirable for the Member (i.e., in-person, telephonically, etc.) to assist in achieving the participants health, medical, and social determinants of health.
  • Capacity to serve all referred members with timely outreach for engagement and care coordination activities.
  • Ability to transition, accept, perform outreach activities and enroll ECM members assigned by the health plan, according to the ECM Provider contract with the MCP.
  • Demonstrated engagement and cooperation with area hospitals, primary care practices, behavioral health providers, Specialists and other entities, including housing support and other Community Support providers, through the development of agreements and processes, to collaborate with the ECM Provider on care coordination.
  • Capabilities to link member to ECM services and share relevant information between the ECM Provider, PCP, and MCP and other providers involved in the member’s care.
  • Ability to meet MCP data sharing, care management documentation system or process, and reporting requirements.  

L.A. Care is committed to the Enhanced Care Management (ECM) benefit and will assist potential ECM Providers to meet the qualifications and requirements. All new ECM Providers receive a Welcome Packet with supporting documents to support with their onboarding. If you are interested in becoming an ECM Provider, please contact L.A. Care ECM team for more information at ECM@lacare.org.