Data sharing is critical to the achievement of CalAIM’s goals, according to a group of experts who spoke at our 2022 Los Angeles State of Reform Health Policy Conference last week. Experts on our “CalAIM implementation issues” panel also spoke about their organizations’ successes and challenges so far with the statewide CalAIM initiative to reform Medi-Cal.
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Many of these points were also brought up in the Insure The Uninsured Project’s 2022 regional workgroups on stakeholder experiences with the first year of CalAIM implementation.
Mimi Hall, Vice President of Public Health Innovation at Manifest MedEx, emphasized the importance of the statewide exchange of health information in order to fulfill the requirements of CalAIM.
“We’re trying to reach this lofty vision of a healthier California for all. [For] many of the requirements of CalAIM, [like] coordinating care, identifying the highest risk patients that we have across the Medicaid system, integrating physical and behavioral health, and caring for patients across the continuum, we don’t have great data,” Hall said. “We have data all over the place, but we don’t have a great way across the state to unify and provide timely access to that data.”
She said that for CalAIM to succeed, Medi-Cal plans and the Department of Health Care Services (DHCS) need clinical data to be curated, cleaned, and analyzed by health information organizations (HIOs), which are currently the only entities in California with the capacity to do so.
Hall added that hardly any providers in California are currently sharing data with each other due to the expensive and difficult nature of data sharing, as well as the lack of necessary technology and infrastructure. She recommended that Medi-Cal plans establish a provider data sharing incentive program for clinical and lab data.
“The data we get out is only as good as the data we put in, and if the majority of Medi-Cal providers aren’t providing data because they don’t have the capacity, we don’t have the information that we need to serve the CalAIM population,” she said.
Hall also recommended that the state invest in statewide health information technology infrastructure for Medi-Cal providers through incentive payments or a grant program to not only develop the technological infrastructure, but to actually connect with one another.
“Unlike other states, California has not provided public funding as part of CalAIM for this infrastructure that the state has noted is essential for carrying out some of their goals,” she said. “This has been demonstrated in many other states like Colorado, Maryland, [and] Nebraska. Other states have done this, so it should definitely be possible in California.”
Susan Mahonga, Director of CalAIM at Blue Shield of California Promise Health Plan, echoed Hall’s comments about the necessity of having high quality data sharing between plans and providers, stating that this was a major lesson learned in Blue Shield’s first year of CalAIM implementation.
“Being able to have data-driven insights that inform how we come up with initiatives, programs and services that serve our members—I think that’s a big takeaway and something that we’re seeing improvement on, and there’s a lot of work that is [being done],” she said.
Other panelists highlighted the benefit of the unprecedented levels of collaboration among Medi-Cal managed care plans and community-based organizations (CBOs) during the first year of CalAIM implementation. Cynthia Carmona, Senior Director of Safety Net Initiatives at LA Health Plan, said this has especially been the case in Los Angeles County.
“There are 6 Medi-Cal managed care plans in LA County. I know the providers out there know, from working with Medi-Cal, how challenging it can be to work with 6 different plans that have 6 different ways of doing something,” Carmona said. “So we’ve really put a lot of effort into meeting together and becoming very close partners to try to align on as much as possible with the implementation of CalAIM.”
She explained that one of the key challenges with implementation so far has been communication between organizations.
“The provider networks themselves are really varied in terms of who’s participating,” Carmona said. “We’ve got CBOs, we’ve got some traditional Medi-Cal providers, we’ve got the counties there with us as well. So lots of different moving parts. Things are still evolving and there’s so many diverse partners at different levels. How do we make sure that we are communicating adequately as those changes take place?
As we’re trying to collaborate and improve upon things so that everyone is informed as much as possible in terms of what’s going on, what’s live today, [and] what’s going live tomorrow. So that’s something we have to make sure that we’re staying on top of as health plans when we look at implementation across our members and across our provider networks.”