This is the time for Medi-Cal to build the data foundation for population health to proactively help people stay well.
By Claudia Williams, Special to CalMatters
Claudia Williams is CEO of Manifest MedEx, a nonprofit health information network.
The big summer health care budget news was the passage of Assembly Bill 133, which expands Medi-Cal eligibility, improves behavioral health access and requires providers, hospitals and health plans to share complete health records by 2024. The bill underscores the importance of transparency and data.
Embedded in this legislation is a new $315 million population health management service for Medi-Cal. Population health management is about proactively helping people stay well – the work of making sure people with diabetes get the right screenings or those who are pregnant are supported in their prenatal care.
This new platform will help health plans, providers and the Medi-Cal program identify people who need health services based on analysis of clinical, claims and other data. With one-third of California residents – 14 million people – now enrolled in Medi-Cal, this will be one of the largest and boldest data initiatives our state has ever launched.
This is exactly the right time for Medi-Cal to build the data foundation for population health. We are coming out of the pandemic year, facing ever-larger health equity and public health challenges, and the state is launching sweeping new changes to the Medi-Cal program through CalAIM.
Visionary government projects of this size and scale can often falter in implementation. Here are three ways to ensure California’s population health vision succeeds:
- Analytics is not the hard part. Our ability to analyze and draw insights from health data is growing by leaps and bounds every year. That is not the hard part. The hard part is connecting data from thousands of physician practices, hospitals, labs and health plans – all with different technologies – and then combining, matching, cleaning, storing and securing the data so that we can get those insights.
California should look to use, not replicate, the data capabilities of California’s nonprofit health information exchanges, expanded in the last two years using taxpayer dollars. If these nonprofits take on the burden of collecting, combining and cleaning needed data from thousands of sources, the process of putting that data to work becomes manageable.
- More data is needed. The legislation recognizes that claims, clinical and social service data will be needed to provide timely and accurate insights about patient health and risk. It will be tempting to focus first on the medical claims data – e.g., information from medical bills – that is already available. That would be a mistake.
Claims data are too old to identify emerging health issues or support real-time care coordination for patients. And reliance only on claims for risk prediction exacerbates health equity issues. The richer clinical data from patients’ medical charts must be included from the start.
- Incentives are needed. To get needed data moving quickly in the required timeframe, California should offer financial incentives to providers to encourage universal sharing of important clinical data. Arizona Medicaid adopted this approach, offering up to a 2.5% payment bump to hospitals and other providers that share required clinical data with the state’s nonprofit health data network. The incentives dramatically increased hospital data sharing within months.
This population health management service can be a game changer. But with partial data it will struggle. It will identify patients who were high-risk a year ago but not today. It will produce a fraction of the information needed for quality reporting. Relying on incomplete data is dangerous for patients and frustrating for care teams.
The population health management service is an important investment in our state’s future. California can deliver on that promise by including needed clinical data, leveraging existing infrastructure and offering incentives to get data moving quickly.
Claudia Williams has also written about how a statewide health information exchange would strengthen public health, preparing for a vaccination campaign of unprecedented scale and four ways California can improve our health data challenges.