Closing Medi-Cal’s digital divide is key to health equity

Those on the ground caring for Medi-Cal patients—the small health care practices, behavioral health and safety net clinics, skilled nursing facilities, county health and human services, and hospitals that form the safety net—need help sharing meaningful patient information to improve health and reduce health disparities. Because of a lack of resources, however, only a small portion of Medi-Cal’s primary care providers are able to share quality digital health data.

We need to address what the California Health and Human Services Agency identified as substantial gaps in the capacity to store, electronically share and use health and social service information. We need to close this digital divide that has left behind more than a third of our state’s population—the 13.6 million Californians supported by Medi-Cal health insurance, CalFresh food assistance and CalWORKs cash assistance (three of the largest programs working within the safety net). 

While almost every hospital, clinic and health plan today has digitized records, the majority are not yet sharing that electronic information with others or using shared data from others. It is health information organizations that can guide health care providers in this final mile of connectivity. They are nonprofit and California-based, which means their common mission is helping their communities experience better care. These organizations, however, require but do not receive dedicated public funding to connect with each other on the statewide scale that Medi-Cal demands.

The first step toward a more robust data infrastructure took place this summer, when the state released its data exchange framework—a statewide agreement among nearly all health-care organizations to digitally share and use information. Now the state needs to take the next steps.

Earlier this year, a coalition of health information organizations and their most important users within Medi-Cal—local health care practices, health systems and community health plans—requested $95 million in state general funds from the governor to develop health data sharing and infrastructure for Medi-Cal. These funds would be matched with up to $9 in federal money for every $1 of state funding invested in health information infrastructure.

In its letter to the governor, the coalition of health information organizations recommended:

• Performance payments that encourage Medi-Cal providers to share data with health information organizations. In Arizona and Michigan, such incentives have boosted the level and value of participation. While this year’s state budget includes one-time technical assistance for small or under-resourced providers new to health information exchanges, providers will need more ongoing support and motivation to share data. Thanks to regular federal matching funds for Medi-Cal provider payments, California only needs to provide half of the funds to make this happen.
•  Using health information organizations’ strengths to build lasting, impactful data infrastructure for California. A health information network can securely aggregate, clean and deliver health information when it is needed most across every care setting in our state. That data infrastructure, however, requires investment. 

A multibillion-dollar state commitment for sweeping Medi-Cal delivery system reforms will not succeed without timely clinical and other health data. Without robust plans for health data infrastructure and incentives for frontline Medi-Cal providers to participate, California is missing the real potential in our evolution to achieve health equity.