There’s a stereotype ingrained in our culture that the tech industry is designing the shiny new products that will carry us into the future. But health and human services tend to be a policy-driven market, leaving technologists playing catch-up and frontline organizations caught in the middle. We’re seeing this dynamic, and the enormous opportunities and challenges it creates, play out at the intersection of these two systems today.
Last September, at an invitation-only meeting of policy and technology leaders in California, Mickey Tripathi, Director of the Office of the National Coordinator for Health IT, and Marko Mizik, Under Secretary of the California Department of Health and Human Services, shared two clear visions. Tripathi articulated ONC’s goal of integrating health and public health data, an ambitious and important goal from DC and the CDC to the community. Mizik saw Tripathi’s bet and backed him up: California had committed to integrating not only health and public health data, but also human services data. Tripathi responded that ONC was rooting for California and would watch and learn.
California is not alone in asserting this position, but is supported by another federal agency, the Centers for Medicare and Medicaid Services (CMS), which is currently providing billions of dollars in support of state efforts to integrate health and human services delivery systems through a program called “Medical Transformation.” New York recently launched a similar Medicaid transformation initiative, with Pennsylvania expected to be next. North Carolina has taken important steps in this direction. As Mizik noted, improved health and equity require addressing social needs, which is why California is using its policy-driven market position to promote collaboration between human services, health care, and public health systems.
For this vision to succeed, human services data must be interoperable with health and public health data. California’s Data Exchange Framework (DxF), led by Midge’s Department of Health and Human Services, makes this clear. The DxF website states, “No matter where Californians live in the state, when they walk into a doctor’s office, county social services office, or emergency room, they should be assured that health and social service providers have access to the information they need to deliver safe, effective whole-person care, while keeping the data private and secure.” Palav Babaria, who leads the state’s Population Health Management Service, which is being developed to support Medi-Cal transformation, says, “We see this service as an important way to provide access to whole-person care data to those who serve Medi-Cal members, and to ensure that this integrated data can be shared appropriately at multiple levels—at the plan level, the provider level, and the individual care management user level, in compliance with all privacy and state and federal regulations.”
From our experience supporting organizations across states adopting Medi-Cal Transformation, we have seen several important data exchange use cases emerge, including eligibility determination for enhanced care management and community supports, eligibility verification and care management for medically tailored meals, short-term residential transitional support after hospitalization, ECM provider referral pathways linking clients to community-based organizations that address social needs, and psychosocial assessments/screenings. Critical data that needs to be shared across sectors for these use cases include data from housing management information systems, hospital event notifications, enrollment and eligibility information, assessment/screening responses, and services offered and provided by community-based organizations.
Achieving this type of data exchange across departments is challenging and requires even the most experienced health data exchange organizations – HIEs, vendors, health systems, and payers – to step outside their data exchange comfort zones for several reasons.
First, emerging use cases require more than just the exchange of read-only clinical data, but there is a lack of data standards for social data such as health-related social needs (HRSN) collected through assessments/screenings, for example, despite pioneering efforts by the Gravity Project. In California, community-based organizations must submit slightly different HRSN data to different Medicaid managed care plans because the plans have not adopted a single standard. Additionally, emerging use cases would greatly benefit from care management tools with read-write capabilities, but many traditional data intermediaries are hesitant to provide such collaboration platforms (e.g., closed-loop referrals).
Second, health data exchange stakeholders are comfortable within the confines of HIPAA, but not at scale anymore. Despite California’s exemption from all laws that could limit data exchange for Medi-Cal Transformation Services, the community has begun to adopt multi-purpose consents to support cross-sector collaboration use cases, but the number is still very small.
Third, we likely need to open up the governance of HIOs, quality improvement networks, and similar organizations at both the state and local levels. Are there new talent at the decision-making table? If not, we need to bring in talent from the human services sector. Otherwise, inequities between health organizations and community partners will undermine trust and effective collaboration to serve our shared populations.
So what options do data exchange organizations have in states working to transform Medicaid? Consider these three recommendations:
Say no to change. Stay in the clinical lane and risk losing value and market share in the Medicaid delivery system. Be fluent. Invest in cross-sector interoperability to become the data backbone of an integrated health and social care delivery system. This will require work and revision as national standards emerge. Break down read/write barriers. Go further with interoperability and integrate collaboration tools that support cross-sector use cases into service delivery.
For example, helping care managers move away from reliance on phone and fax will require greater investment in interoperability and collaboration tools across departments.
Just as the market for closed-loop referral systems is booming, the policy-driven market for broader and deeper interoperability and collaboration tools that connect health and human services is creating a tremendous opportunity to make a positive impact. The question is whether technology and data exchange providers can read these signs quickly enough to develop, test, and scale sustainably affordable, high-quality solutions for communities grappling with the challenges of integrating health and human services.
Photo: Raycat, Getty Images
Mark Elson, CEO of Intrepid Ascent, leads a dynamic team that strengthens community collaboration for health. His company builds new connections between more than 500 partners each year, supporting coordinated and equitable health and social services for more than 7 million people. With an interdisciplinary background in anthropology, technology, and policy, Mark leads integrated, local approaches to address global challenges.
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