A Regional Blueprint for High-Impact Enhanced Care Management in California: by Melody Shedlosky, RN MBA
Executive Summary
Enhanced Care Management (ECM) under California’s CalAIM initiative is reshaping health care for Medi-Cal members with the highest needs. By addressing both clinical conditions and social determinants of health, ECM aims to improve health outcomes and reduce avoidable utilization.
Presidium Health, a leader in ECM delivery across Los Angeles, the Inland Empire, and San Diego, exemplifies how structured compassion, field-based care, and operational discipline can produce real, measurable change. This paper outlines five core strategies behind Presidium’s success, informed by Melody Shedlosky, RN, MBA—Presidium’s Chief Operating Officer and a champion of whole-person care.
Design Care Around Real-Life Barriers—Not Just Diagnoses
“We don’t just manage cases—we manage context. Every workflow is built to remove friction, whether that’s paperwork, food insecurity, or getting someone a ride to their specialist.”
— Melody Shedlosky
Presidium’s ECM teams know that comprehensive care means more than managing diabetes or scheduling a doctor’s office visit—it means stabilizing the day-to-day environment around the patient. In Enhanced Care Management Los Angeles and the Inland Empire, housing insecurity, food access, and transportation barriers often block engagement.
That’s why Presidium uses a combination of daily team huddles, real-time triage tools, and strategic partnerships to remove these barriers. The model integrates tightly with Managed Care Plan systems, enabling ECM teams to act quickly, especially when mental health or substance use concerns emerge.
Build Trust in the First 30 Days—or Risk Losing the Patient
“Our first visit isn’t to ask—we go to listen. We show up with dignity in our hands, not forms.”
— Melody Shedlosky
In Enhanced Care Management San Diego, where patient mistrust and disengagement are common, trust is the currency of care. Presidium’s field-based model ensures that the lead care manager or health worker initiates engagement where the patient feels safest—whether that’s a motel room, homeless encampment, or their cousin’s couch.
Rather than pushing paperwork, teams deliver early value through tangible support: hygiene kits, groceries, transportation. Within the first 30 days, nearly every patient has received services that reinforce Presidium’s credibility and commitment.
Use Data to Guide—Not Dictate—Care
“Our dashboards tell us where to look, but it’s our team’s eyes and ears that tell us what matters.”
— Melody Shedlosky
Across ECM sites in Los Angeles, San Diego, and the Inland Empire, Presidium uses acuity scoring and patient engagement metrics to inform outreach, not replace it. Algorithms flag rising risk—from ER spikes to missed appointments—but the lead care manager uses clinical judgment and rapport to shape what happens next.
This flexible, team-empowered model is especially valuable in tracking trends in mental health, substance use, and housing instability—issues often missed in traditional health care systems focused only on episodic events.
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Invest in Culture: Your Team Is Your Model
“We don’t burn out—we check in. That’s built into our rhythm. You can’t give care if you’re running on empty.”
— Melody Shedlosky
Presidium’s ECM success in the Inland Empire and Enhanced Care Management Los Angeles rests not just on smart workflows but on an internal culture of care. Weekly emotional debriefs, trauma-informed supervision, and ongoing coaching foster resiliency across roles.
Frontline staff—including community health workers, peer specialists, and care managers—are trained to recognize their own stress, share burdens, and collaborate. This emphasis on comprehensive care for both patients and staff is what allows Presidium to sustain high-touch relationships even in high-acuity caseloads.
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What New ECM Providers Must Know
“Build trust, back your staff, and stop trying to fix people—stabilize them first. That’s how you build health.”
— Melody Shedlosky
Melody’s advice for new ECM providers launching in regions like San Diego or the Inland Empire is straightforward:
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Start with stabilization. Housing, food, and emotional safety come before medication adherence or follow-ups.
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Hire for empathy and grit. The ECM model lives or dies with the quality of your lead care managers and support staff.
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Respect the patient’s timeline. Transformation doesn’t come from pressure—it comes from feeling seen, heard, and supported.
By focusing on real-world needs and measurable health outcomes, Presidium’s approach transcends conventional doctor’s office-based care models.
Conclusion: A New Standard for Enhanced Care Management
Presidium Health is setting the standard for Enhanced Care Management in California by proving that comprehensive care, rooted in human connection and supported by smart systems, can deliver extraordinary results. Whether it’s helping unhoused patients in Los Angeles, supporting behavioral health needs in San Diego, or stabilizing complex families in the Inland Empire, Presidium brings a real-world blueprint to ECM success.
Providers looking to replicate this model must start with what Presidium has long known: Better health outcomes begin with trust—and trust begins with showing up.
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About Melody Shedlosky
Melody Shedlosky, RN, MBA, is the Chief Operating Officer of Presidium Health. A Lean Six Sigma Black Belt, Melody brings deep operational expertise and frontline empathy to her leadership. Previously the nurse manager of the most active emergency department in San Diego County, she now applies those same principles to driving excellence in Enhanced Care Management across California.
Contact: melody@presidiumhealth.com
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