Full Circle Health Network is the bridge needed between Health Plans and Community-Based Organizations to realize the CalAIM vision for vulnerable children and families.
MANAGED CARE CONTRACTING
• Outreach & coordination with all payers
• Certification & readiness process
• Facilitate completion of all MCP requirements
• Certification & readiness process
• Facilitate completion of all MCP requirements
CLINICAL AND QUALITY MANAGEMENT
• Standardized, complaint P&Ps and model of care for all providers to adopt
• Referral coordination
• Referral coordination
TECHNOLOGY PLATFORM
• Support data exchanges
•Interoperable with Provider EHRs
• Optional CM Platform
• Eligibility verification
•Interoperable with Provider EHRs
• Optional CM Platform
• Eligibility verification
TRAINING & TECHNICAL ASSISTANCE
• Core curriculum; training of new ECM staff
• Ongoing training & T.A.
• Ongoing training & T.A.
ADMINISTRATIVE SERVICES
• Revenue Cycle Management
• Bridge between MCPs & Providers
• Bridge between MCPs & Providers
ANALYTICS AND REPORTING
• Data warehouse for data collection & reporting
• Exchange of all CalAIM reports (MIF, OTF, RTF)
• Build foundation for population health (risk stratification, outcome tracking, etc)
• Exchange of all CalAIM reports (MIF, OTF, RTF)
• Build foundation for population health (risk stratification, outcome tracking, etc)
Service LinesRoles & ResponsibilitiesCurrent Health PlansCommunity PathwaysFAQsJoin Our NetworkContact Us
Core Services
Enhanced Care Management (ECM)
Comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered
Community Health Workers (CHW)
Preventive services provided via individual or group settings related to health promotion, such as Health Education & Navigation
Community Supports*
Medically appropriate, cost-effective services or settings offered in lieu of other Medi-Cal services or settings.
Roles and Responsibilities
FCHN
- Data Exchanges (SFTP, MIF)
- Outreach and Engagement
- Provider Assignment
- Claims Submissions
- Payment
- Ongoing Training and Provider Support
- Quality Management
- Reporting to Health Plan
- Contract Management
- Cross NLE Referral Management
Providers
- All Direct Service Delivery
- Capacity Reporting
- Assessment and Care Plan
- Core Enhanced Care Management Services and Documentation
- Audit Support
- Participate in Health Plan Rounds
- Ongoing Training
Current Health Plans
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Community Pathway Referrals: Keeping Clients with Trusted Providers
Improve Access to Services
Referrals from community members help clients navigate and access appropriate services
Provide Culturally Appropriate Care
Community referrals connect clients to care aligned with cultural values and practices
Build Trust Between Communities and Systems
Referrals demonstrate that system value and collaborate with communities
Community referrals strengthen connections between communities and systems to improve client care.
What sort of training will we receive on the web-based system?
Every provider will be required to participate in overview trainings, system demonstrations, and service specific trainings. There will be additional supports available to all providers including office hours, IT tickets, and direct contact with FCHN representatives, with the goal being provider success.
Does Full Circle provide training for providers?
Yes, Full Circle does provide trainings and materials to support our providers. Trainings, desk references, and user guides are available to providers 24/7 on our learning management system.
Do providers have to contract with all Health Plans that Full Circle contracts with or can they pick and choose?
Providers are not required to contract with all health plans that Full Circle contracts with. We hope to work with providers to pursue an all-payer strategy so you can serve all members.
Can we only add the county that we have a physical service location or can we add a county that we serve with our location in a neighboring county?
Because this is primarily a field-based services, you are able to provide services in a county where you do not have a physical office, especially if you have an office in an adjacent county. Furthermore, many providers that operate in multiple counties are centralizing their operations for CalAIM services.
Does participating in this contract with Full Circle prevent us from providing ECM under our current contracts with MHPs?
No, with Kaiser being the exception. Kaiser has delegated ECM, CS, and CHW services to its Network Lead Entities (NLEs). Full Circle is the only NLE that works with Children, Youth, and their families for Kaiser
Are there any other fees that will be charged by Full Circle?
Full Circle charges providers on a percent of revenue basis.
My agency operates in many counties. Will we have different contracts for each location and/or health plan served?
You will have one agreement for all geographies and services. As Full Circle adds more health plans in your geographies, you will get amendments to this base agreement. Our goal is to have an expansive network for all managed care plans, but it is not all or nothing. You may choose not to participate in specific health plans and not others based on rates and operational requirements.
There are two other NLEs partnering with KP for CalAIM services. Will you have access to Kaiser’s full network of members in each of the counties, or are you only contracted for a portion of their membership?
The goal/idea is that you can contract with the NLE that represents the main portion of what you do and they can also help ensure you can deliver all the rest of the services. So in this case, if children, youth and families for ECM is your main service then you would contract with Full Circle for that, as well as CHW, ECM for adult populations and Community Supports.
Join Our Network of Providers
If your organization is interested in working with Full Circle to provide any CalAIM services previously mentioned, please fill out our online interest questionnaire.
The questionnaire helps Full Circle learn more about your organization, specifically:
• Where you operate
• Types of services you deliver today
• Whether you are a Medi-Cal provider today
• What CalAIM services you want to operate and potential capacity
• Where you operate
• Types of services you deliver today
• Whether you are a Medi-Cal provider today
• What CalAIM services you want to operate and potential capacity
Contact Us
If you are interested in learning more about Full Circle or contracting with us, please contact us.
