5 Things California: Health data sharing agreement, Population Health Management, Medicare Med-Cal Plans

I hope you’re gearing up for a great holiday season!

In today’s edition of “5 Things,” you’ll find information about California’s new, first-of-its kind Data Sharing Agreement, the large-scale Medi-Cal Population Health Management program slated for January, and how dually eligible Californians can be more effectively served through DHCS’s upcoming Medicare Medi-Cal Plans.

Thanks for reading!

Eli Kirshbaum
State of Reform 

 

1. Statewide health data sharing agreement now live

In the most recent step on California’s journey to a statewide health data sharing network, the state’s first-ever Data Sharing Agreement became available to sign last month. An integral part of CalHHS’s Data Exchange Framework, healthcare entities are required to sign the agreement by Jan. 1st, 2023, per the requirements of 2021’s AB 133.

CalHHS is providing grants to support signatories of the agreement by funding nonprofit organizations who educate signatories about the agreement, covering the initial costs of connecting signatories to qualified health information organizations, and supporting other operational and technical changes. Manifest MedEx’s Erica Galvez and LANES‘s Ali Modaressi also recently wrote an op-ed for State of Reform describing how digital equity for providers is an important part of California’s health data sharing conversation.

 

2. CalAIM Population Health Management program launching next month

Medi-Cal Managed Care Plans will be required to implement the CalAIM Population Health Management program next month. The program will reformulate the state’s approach to data collection for Medi-Cal beneficiaries in order to more effectively tailor services and achieve optimal health outcomes for the population. The state’s MMCPs were required to submit an attestation of their preparedness to implement PHM to DHCS in October.

The PHM program will require MMCPs to carry out less frequent but more thorough needs assessments of their beneficiaries, emphasizing collaboration with more local stakeholders like providers and local mental health authorities. DHCS will simultaneously launch a PHM Service—a technology platform designed to help MMCPs meet the various requirements of the PHM program, such as increased access to more comprehensive data and support conducting risk stratification among the Medi-Cal population.

 

3. What They’re Watching: Bill Barcellona, America’s Physician Groups

In this edition of “What They’re Watching,” Bill Barcellona, Executive Vice President of Government Affairs for America’s Physician Groups, describes his vision for a statewide, accessible provider registry through which stakeholders can see where providers are located and which payors they’re contracted with.

“From there, we can create the supply curve to match the demand curve, which is what we always talk about in health policy, is the demand side of it. I want to focus on the supply side.” He explains that COVID-19 brought to light the inadequacy of California’s current provider network, namely due to “complex contractual relationships” that prevented the open sharing of provider information. He hopes that this much-needed provider registry can be achieved in 2023.

 

 

4. CHCF details benefits of CalAIM’s soon-to-be-implemented dually eligible plans

In January 2023, new aligned Medicare Medi-Cal Plans will replace the expiring Cal MediConnect plans in California’s CCI counties for dually eligibles—the first step in the CalAIM effort to streamline care delivery for this population. In a recent report, the California Health Care Foundation explains the benefit of these MMPs, citing increased use of HCBS in place of institutionalization, decreased duplication in care coordination, and improved care outcomes.

“As the state rolls out this new model, stakeholders should prioritize clearly communicating the benefits of an aligned approach to dually eligible Californians and their providers, monitoring how these new plans operate, and evaluating the impacts on enrollees’ experiences…” the report says. CHCF recommends that MMPs improve their quality scores and thoroughly assess beneficiaries’ needs to ensure sufficient reimbursement from the state as they operationalize next year. Following the CCI counties’ transition, all Medi-Cal Managed Care plans in the state are required to adopt an MMP by January 2026.

 

5. California Medical Association advocates for better Medicare reimbursement

Back in October, the California Medical Association wrote an open letter to Congress requesting that they block Medicare physician payment cuts for 2023, among other recommendations. With Medicare reimbursement being a key policy item on the table during Congress’s lame-duck session, State of Reform Reporter Soraya Marashi spoke with CMA’s President Donaldo Hernandez about how current low payments are preventing physicians from providing needed care to older Californians.

Hernandez explained that while 50% of the state’s physician practices’ patient population is enrolled in Medicare, over 75% of physicians say current reimbursement rates cover the costs of providing care to these patients. CMA contends that current reimbursement rates are forcing many physicians to not accept Medicare, leaving patients to receive more costly care at hospitals and EDs. “[It is] incredibly important that the Medicare system becomes reformed, but also that we don’t keep experiencing this annual risk of having cuts,” Hernandez said.