The Alameda County Care Alliance (ACCA) is a mission-driven, community-based organization delivering Enhanced Care Management (ECM) services to some of California’s highest-need Medi-Cal populations. With a multidisciplinary team of care navigators, case managers, and clinicians, ACCA provides intensive support to high utilizers of emergency department or hospital services and adults and older adults at risk of long-term care institutionalization.
Like many community-based providers, ACCA faced challenges in managing complex client needs while meeting documentation and reimbursement requirements. Legacy systems and manual workflows made it difficult to track services efficiently, ensure compliance, and submit accurate claims. ACCA needed a digital solution that could empower care teams and streamline billing without compromising the quality of client care.
To meet this need, ACCA partnered with two technology providers:
- Dimagi, which configured a tailored care management solution on its CommCare platform to support real-time documentation and structured reporting
- Health Roads, whose SocialRCM™ product translates care data into Medi-Cal–compliant claims for submission to managed care plans
The result: an end-to-end system that connects referral, service delivery, and reimbursement—all while keeping the focus on client care.
A Collaborative Solution
The integrated workflow enables ACCA to streamline ECM services from intake to billing:
1. Client Identification
Clients are referred by a Managed Care Plan (e.g., Anthem or Kaiser) or identified through community outreach. Referrals are entered into CommCare to begin the intake process.
2. Engagement, Assessment & Care Planning
Care Navigators conduct outreach and a comprehensive intake to confirm ECM eligibility. An Individualized Care Plan is created and documented in CommCare.
3. Ongoing Service Delivery
Care teams deliver ECM services and document each encounter at the point of care using structured digital forms aligned with billing requirements.
4. Reporting & Billing Prep
CommCare generates pre-configured service reports. These are securely shared with Health Roads, where SocialRCM™ validates and codes the data for claim submission.
5. Claim Submission & Reimbursement
Claims are submitted via MCP billing portals. SocialRCM™ supports submission and resubmission as needed. Approved claims are reimbursed.
6. Case Closure
When care goals are met or the client is no longer eligible, the case is closed in CommCare. All services remain linked to care plans for audit readiness.
This ECM workflow is designed not only to support high-quality, person-centered care, but also to ensure that every eligible service is documented in alignment with Medi-Cal billing requirements and prepared for reimbursement from the start.
Key Stakeholders
- Alameda County Care Alliance (ACCA): Delivers ECM services, documents care, ensures compliance
- Dimagi: Configures a solution built on their CommCare platform to enable care teams to document services, track client progress, and generate structured reports for billing
- Health Roads: Billing partner that uses its SocialRCM™ solution to convert structured reports into invoices
- Anthem & Kaiser Permanente: Managed Care Plans (MCPs) that review and reimburse ECM claims
Impact to Date
Although full implementation is still underway, ACCA is already seeing measurable benefits:
- Reduction in missed billable encounters during the pilot phase
- Faster invoice generation, improving cash flow cycles
- Fewer billing errors and smoother coordination with MCPs
- Better visibility into service delivery trends for leadership and funders
A Full-Circle Approach to ECM Services
From referral to reimbursement, this model makes ECM easier to deliver, and easier to bill. Interested in exploring how this approach could work for your organization? Let’s talk.
