Op-Ed: California needs clinical data to see the most vulnerable


Eli Kirshbaum


Accessing health care in California can be a hurdle in itself. For our low-income, unhoused and vulnerable citizens, many of whom make up the 14 million Californians enrolled in Medi-Cal, finding and returning regularly to a usual source of care can be challenging. In my region of Riverside and San Bernardino counties, about 30% of our population live in an official Health Professional Shortage Area. People residing in the high desert and other communities may not be seen and supported when it matters most for their health.


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Our state’s policy reforms have set out to repair this. The California Department of Health Care Services (DHCS) issued a draft of their Population Health Management Strategy and Roadmap, and have emphasized the health and well-being of people through prevention, early identification and optimization. It’s a big step forward in the right direction, and we’re excited to see the state make this important investment. And to make this work and implement the vision of DHCS, we must harness the opportunity to act on the promise of a longitudinal patient record.

The state’s population health strategy as currently envisioned relies on the claims data that DHCS and Medi-Cal health plans, including the one I lead, receive when providers bill for services. Claims represent a significant source of information, but alone, they don’t tell the full story. Claims contain limited payment-related information that could take months to be delivered. Additionally, a patient’s under-utilization of preventive services—which DHCS Director Michelle Baass has highlighted as a historic driver of disparities— are not readily captured by claims data alone.

Without the detailed care histories populated by physicians, nurses and pharmacists, the state’s approach to population health will be inequitable. Local health information exchanges (HIEs) are often the critical source of this comprehensive clinical data. As I’ll describe below, HIEs have built networks to close data gaps for programs like what the state is proposing. And, there is a huge opportunity for HIEs and the clinical insights they can provide to support DHCS’s population health plan.

HIEs today can securely piece together clinical records across thousands of health care settings, inside and outside the Medi-Cal network. In the Inland Empire, with the exception of Kaiser Permanente, all of our short-term acute hospitals and hundreds of primary care providers are connected and share data with Manifest MedEx, a nonprofit HIE.  For example, we have leveraged data from the HIE to support safe care transitions, improve seven-day post-discharge follow up for high risk members and reduce readmissions.

California needs to expand this approach statewide. Our policy leaders must take a closer look at working with HIEs and providing these data networks with resources to achieve the state’s population health goals at scale before it is too late. That’s why a wide coalition of health plans, HIEs and provider groups have come together to sound the call for a robust investment in this year’s state budget to make this happen.

We urge DHCS to hear community leaders like myself and include clinical data supplied by HIEs in its population health plan. And as final budget negotiations take shape, we advocate for the Governor and Legislature to adopt our funding proposal for HIE data sharing and infrastructure. Without action on both fronts, these programs cannot succeed in the state’s bold mission toward health justice and equity.

By Jarrod B. McNaughton, Chief Executive Officer of Inland Empire Health Plan (IEHP) and Chairman of the Board at nonprofit Manifest MedEx.