Data-driven partnerships between MCPs and CBOs to transform CalAIM ECM

The California Department of Health Care Services (DHCS) is implementing CalAIM, a major reform effort to transform Medi-Cal, California's Medicaid program, into a more equitable, coordinated, and person-centered system. CalAIM is a partnership between the state's health plans, providers, and community-based organizations.

One of the critical components of CalAIM is Enhanced Care Management (ECM), which aims to comprehensively address the clinical and non-clinical needs of highest-need enrollees. ECM ensures that beneficiaries receive essential support regardless of their location, whether on the streets, in shelters, at healthcare provider offices, or within their homes.

ECM presents a unique opportunity for Managed Care Plans (MCPs) and community-based providers to collaborate. By forming these partnerships, they can combine their expertise and resources to improve health outcomes, particularly for vulnerable populations.

Data-Driven Partnerships to Improve Health Outcomes

Successful collaboration between MCPs and community providers relies heavily on the effective exchange of timely and relevant data. Data sharing enables valuable insights into patient populations, identification of high-risk individuals, and tracking of health outcomes over time. By leveraging data analytics and interoperable health information systems, this partnership can generate actionable intelligence that informs care coordination efforts. This seamless exchange of information ensures that community providers comprehensively understand members' medical histories, social circumstances, and service utilization patterns, enabling targeted interventions and personalized care plans.

Challenges to Data Exchange

Despite these opportunities, challenges exist in the realm of data exchange. Incompatible systems and fragmented data hinder the smooth flow of information. Currently, MCPs share data through Member Information Files (MIFs), but significant variations in MIF structure between MCPs create complexities in integration. Standardizing protocols and data structures is essential for streamlining data exchange. Furthermore, data quality and accuracy pose significant issues. For instance, a notable number of phone numbers, around 30%, are often missing or incorrect. Inaccurate or incomplete data undermines the effectiveness of collaborative efforts.

Addressing the Challenges

Addressing these challenges requires standardization of data formats, enhanced interoperability, secure data exchange protocols, and a culture of trust and collaboration. By undertaking these efforts, seamless data exchange between MCPs and community health providers can be achieved. This, in turn, contributes to improved care coordination, better health outcomes, and enhanced patient experiences—a collective result that holds significant value for all Californians.