A local task force has developed a strategy for Michigan healthcare providers to better use technology to enhance the care they’re providing and improve health equity.
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The Community Information Exchange Task Force recently released a report that features its final recommendations for a statewide community information exchange (CIE). Efforts to build a CIE are underway across the state at the local level, but the Michigan Department of Health and Human Services (DHHS) has engaged the task force to develop a statewide strategy to support and align local efforts.
Molly Welch Marahar manages DHHS’ Strategic Alignment and Engagement Section, which has been shepherding the work of the task force.
“A lot of organizations use a lot of different technologies to collect information about the people they serve,” Welch Marahar said. “CIE is about creating the infrastructure so that the right information is with the right individual at the right time, so we can enhance the care we’re delivering, with a focus on including social care information.”
The task force convened community-based organizations (CBOs), healthcare professionals, health payers, and government entities whose aligned work and interests are best served by a coordinated approach to CIE. Welch Marahar said the team surveyed over 600 CBOs about their ability to participate in a CIE, and identify barriers to participation.
“The biggest barriers were not related to technology, they were related to funding, resources, community partnerships, and staffing. Funding was the most frequently ranked barrier. We really need to think about how to leverage the tools at our disposal to better serve folks with social services so those organizations are freed up to participate in these efforts.”
— Welch Marahar
The task force developed a set of recommendations with strong consensus alongside a high-level roadmap for implementation. Its recommendations included:
- Establishing core technical capacities necessary to enable interoperability at a statewide scale, including standards for data exchange and identity management services.
- Establishing a reliable supply of resource directory information to be provisioned as a public good.
- Establishing a statewide framework for legal agreements that aligns with existing regulatory frameworks while addressing data collection in contexts that are not otherwise regulated, and establishing an ethical framework in the form of a “Bill of Rights” for consumers and communities.
- Ensuring that aggregation of longitudinal data about people and populations can occur with the informed consent of data subjects.
- Designating and supporting “coordinating entities” in the process of facilitating activity among CBOs, government agencies, and healthcare institutions, and ensuring that these entities uphold fiduciary responsibilities for the people and organizations they serve.
- Establishing federated systems of governance through which standards and policies are set statewide, while priorities and implementations can be decided and evaluated locally.
- Leveraging a variety of financing mechanisms to build and sustain these capacities, including the capacity to provide more social services.
Theresa Anderson, strategic alignment and engagement senior specialist at DHHS, said sustainability will be key.
“Effective CIE requires additional resources and capacity to support the existing network of social services, incorporating feedback from impacted partners and parties in designing these recommendations, with an emphasis on CBO experiences. What we’re trying to do is take input from healthcare payers, health information technology, all the community-based organizations, meeting them where they’re at, and connecting them with the goal to move toward a fully-integrated approach.”
Welch Marahar noted that the state’s work to develop policy to incorporate community health worker services as a fee-for-service benefit to Medicaid enrollees could help as well. DHHS submitted a state plan amendment to the Centers for Medicare and Medicaid Services in July requesting the policy change, and is currently awaiting a response.
“We are finalizing a policy to reimburse community health workers,” Welch Marahar said. “This is a step forward toward leveraging staff that have better connections to the community. It’s certainly important as we think about ways that the CIE is going to be operationalized. Medicaid is a key tool in the toolbox.”