The California Department of Health Care Services (DHCS) is launching the Population Health Management Initiative (PHM) as an integral part of California Advancing and Innovating Medi-Cal (CalAIM). PHM will allow managed care plans and their networks to respond proactively to members’ needs by uniting plans, providers, counties, and members. 

According to DHCS, CalAIM has three primary goals, which include: 

1. Identifying and managing member risk and need through whole-person care approaches and addressing social determinants of health (SDOH)
2. Moving Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility
3. Improving quality outcomes and driving delivery system transformation through value-based initiatives, modernization of systems, and payment reform

Pivotal to the success of this initiative: Plans need to gather and share data in a timely, accurate manner to provide care management, care coordination, and care transitions across all phases of care. 

Gainwell Technologies is a healthcare consulting firm that helps agencies improve individuals’ health outcomes. Larry Carlos from Gainwell Technologies joined the February 9 Connecting for Better Health (C4BH) coalition meeting to share perspective on his organization’s progress with DHCS’ program.

Gainwell Technology’s PHM service offers eight functions and services to assess an individual’s needs, understand their conditions, and determine the multiple actions that come from that, including admission, transfer, and care coordination. Gainwell Technology plans to utilize data collected from numerous services, which involves potentially thousands of interfaces, and proposes to connect them through health information organizations (HIOs), said Carlos. 

But data silos are often standing in the way. ”Folks are in silos,” said Carlos. “We’re looking to bring them all together so we can all be under the same roof and work collaboratively towards improving patient outcomes.” 

The state is optimistic about launching a pilot related to this work in July, and expects that the service will be rolled out by the end of the year or early next year, Carlos told meeting attendees.

Specific information about the geography or populations that the pilot will be focused on have not been finalized, and Carlos urged C4BH meeting attendees to submit thoughts, comments, and questions to track the direction of the project and guide the process. 

Coalition meeting attendees voiced support for receiving a larger volume of more accurate data to put into their existing frameworks. Many expressed hope that the influx of information will allow plans and providers to provide better care for individuals. 

Following Larry Carlos’ presentation, C4BH’s Robby Fransceschini presented the California Health and Human Services (CalHHS) Center for Data Insights and Innovation’s (CDII) recently updated qualified health information organization (QHIO) application requirements, which include: 

• Functional capabilities to manage more than 250,000 identities
• Clearly defined processes to assess and improve patient matching
• Managing participant registry with import and export capability
• Participation in eHealthExchange, CareEquality, or CommonWell Health Alliance 
• Two references confirming the ability to construct and respond to a query and deliver information consistent with Data Exchange Framework (DxF) standards 
• Ability to share and receive admission, discharge, and transfer (ADT) notifications with at least one other QHIO by 2024 
• Agreement to offer services to every capable signatory and be able to manage grant progress reports
• Provide audit trails, growth plans, monthly reports of activity, and annual attestations to the state 

Tom Schwaninger, senior executive advisor of digital interoperability at L.A. Care Health Plan, told C4BH meeting attendees that while the ability to perform functions required by the Data Sharing Agreement (DSA) makes sense, the requirements regarding the amount of cash flow, audits, attestations, and less than 10 hours of unscheduled downtime may present a burden.

”This is getting very heavily regulated, and these new requirements will have the chilling effect of disqualifying some entities that we might want to be qualified,” he added

Mary-Sara Jones, senior business development executive of health and human services at Amazon Web Services, proposed that QHIOs partner with community information exchanges (CIEs) to share the burden of the work and to provide participants with a full suite of options.