December 20, 2022

On November 7, the Connecting for Better Health Coalition and Insure the Uninsured Project (ITUP) hosted a workshop bringing together healthcare and social service experts from Los Angeles County to discuss data sharing to support people experiencing homelessness.

California’s new Data Exchange Framework (DxF), established in 2022 under Assembly Bill 133, requires the exchange of information between organizations and systems, and necessitates collaboration between health and non-health agencies, such as community- based organizations (CBOs) that provide homelessness services. As California simultaneously launches CalAIM to better address the social determinants of health and center whole-person care, the exchange of information between organizations will be at the core of state efforts to advance health equity.

Glen Hilton and Claudia Garcia of People Assisting the Homeless (PATH) and Michelle Charime and Rosario Trejo of the Downtown Women’s Center (DWC) joined the workshop to provide an overview of their roles as Los Angeles County homelessness service providers who conduct outreach and case management to support individuals in

LA experiencing homelessness. Each organization spoke to their data sharing experiences and highlighted the challenges faced by non-healthcare agencies in accessing necessary data to support the populations they serve.

Data Sharing Challenges

1. Leaders from PATH and the DWC spoke to the lack of access to necessary information about the individuals they serve. To avoid duplication and to provide appropriate, informed care PATH and DWC need access to an individual’s health care coverage status, certain clinical information, and records of prior social services received.

For example, PATH highlighted the difficulties with not being notified of Medi-Cal coverage changes, as staff will invest time and resources into CalAIM-related Enhanced Care Management (ECM) or Community Support (CS) services for a client and then learn those services are no longer covered for the individual. They also spoke about issues accessing clinical data that can be useful for facilitating smooth transitions of care from inpatient settings to housing services.

“We tend to hear about hospitalizations once a person is no longer at the hospital. But what would it look like for the health care provider to be able to say ‘hey, you know, this person is connected to PATH, they’re connected to both ECM and

community supports…they have a care team.’” -Claudia Garcia, PATH

• The multiple systems and portals across the county lead to the duplication of data entry. Homeless service providers in Los Angeles County enter data in many different systems–HMIS, CHAMP, Clarity, and other internal systems–which contributes to fragmentation and inefficiencies. These systems usually do not communicate with each other.

“Having one place where we can all [social service providers] interface with each other would really simplify things when we really need it…the confusion of going through different platforms takes away from the work we’re meant to be doing.” – Michelle Charime, Downtown Women’s Center

• Managed care plans (MCPs) have different requirements and highly variable data entry systems. Consequently, organizations like PATH have to silo their internal care teams by plan to ensure staff are well-trained to utilize the data portal and adhere to data requirements for one particular MCP.

“We’re working with only two managed care plans and there [are] so many differences between the two: their requirements, their portals, their platforms, their notes, and authorizations…” -Michelle Charime, Downtown Women’s Center

Recommendations

Jenn Behrens of the Los Angeles Network for Enhanced Services (LANES), Matt Moyer of the Community Clinics Association of Los Angeles County, and Alison Klurfeld, a consultant with L.A. Care Health Plan joined the conversation to discuss opportunities and potential solutions to address the identified challenges. Recommendations from the panel participants are outlined below.

1. Shared portal or data clearinghouse: Participants highlighted the need for a “one stop shop” that would include health care data, housing data, and other social service information necessary for aligning services to best serve individuals experiencing homelessness.
2. Program alignment among managed care plans: The panelists recommend greater alignment among plans, particularly in regard to CBO data requirements. MCPs collaborating on their work in a system such as LANES or other HIE would strengthen the ability of CBOs to work across plans to best serve their clients.
3. Trauma-informed data sharing: DWC highlighted how having a centralized information sharing system represents patient-centered, trauma-informed care, as it reduces the need for individuals to repeat their personal information and traumatic experiences to different service providers.

Acknowledgements

Connecting for Better Health thanks Blue Shield of California and Cedars-Sinai for their support of this event series. We also thank Insure the Uninsured Project (ITUP) for their partnership in organizing this workshop.