In mid-January, California Gov. Gavin Newsom submitted his budget proposal for 2020-21 to the state Legislature, including significant changes to Health & Human Services, including the creation of a new Center for Data Insights and Innovation.
California is often a pace-setter in terms of state-level healthcare innovation, and Newsom’s budget recommends several organizational changes that recognize the significance of better data sharing and interoperability. “Central to the success of making healthcare affordable are efforts to reduce administrative burdens and improve data interoperability,” the budget statement notes. “The Administration is committed to continuing to work with providers, health plans, and other stakeholders to make these improvements.”
The budget proposes to consolidate existing resources to establish a Center for Data Insights and Innovation within the Agency. The Center will focus on leveraging data to develop knowledge and insights to improve program delivery and drive system transformation across health and human services. The Center will integrate the Office of Innovation, the Office of the Patient Advocate, and the Office of the Health Information Integrity to achieve the following outcomes:
• Improve the operational use and quality of integrated data for program planning, policy development, and rigorous research and evaluation;
• Increase the state's ability to create evidence-based programs and maximize federal reimbursements;
• Enhance the capacity of state staff to use linked data to inform policy and decision making;
• Increase collaboration between university-based researchers and state staff to translate data into knowledge; and
• Improve the rigor, transparency, and reproducibility of research with agency data in order to create better services that generate more equitable outcomes for all Californians.
Office of Healthcare Affordability
The Administration will propose the establishment of the Office of Healthcare Affordability in spring 2020. This office will be charged with increasing price and quality transparency, developing specific strategies and cost targets for the different sectors of the healthcare industry, and financial consequences for entities that fail to meet these targets. The ultimate goal is for savings to return to consumers who are directly impacted by increasing costs. The office will also create strategies to address hospital cost trends by region, with a particular focus on cost increases driven by delivery system consolidation. To improve health outcomes, the office will also work to establish standards to advance evidence-based and value-based payments to physicians, physician groups, and hospitals, as well as to advance administrative simplification.
Medi-Cal Healthier California For All
The Budget document notes the fragmented nature of care in California’s Medicaid system. “Today, some Medi-Cal enrollees may need to access six or more separate delivery systems, including managed care, fee-for-service, mental health, substance use disorder, dental, developmental, and/or in-home supportive services. The need for care coordination increases with greater system fragmentation, greater clinical complexity, and/or decreased patient capacity for coordinating their own care.”
To improve clinical outcomes and assist beneficiaries with navigating this complex system, the department is seeking to better coordinate between and integrate these delivery systems. It is launching a Medi-Cal Healthier California for All initiative (formerly known as CalAIM, or the California Advancing and Innovating Medi-Cal initiative), which builds upon the waiver demonstration programs such as Whole Person Care, the Coordinated Care Initiative, Health Homes, and public hospital system delivery transformation.
Medi-Cal Healthier California for All proposes to provide a wider array of services and supports for patients with complex and high needs. Medi-Cal Healthier California for All has three primary goals:
• Identify and manage member risk and need through whole person care approaches and addressing social determinants of health;
• Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
• Improve quality outcomes and drive delivery system transformation through value-based initiatives, modernization of systems, and payment reform.
Transformation of the delivery system is necessary to improve outcomes for Medi-Cal beneficiaries as well as to achieve long-term cost avoidance, the Administration said. The reforms proposed through Medi-Cal Healthier California for All represent a comprehensive approach to achieving these goals, it added. These changes will position the state to better connect individuals—including children and youth in foster care, individuals experiencing homelessness, individuals with substance use disorders, and individuals involved in the justice system—to the services they need. Attaining these goals will have significant impacts on an individual’s health and quality of life, and through iterative system transformation the Administration hopes to reduce the per-capita cost over time.
The Administration mentions again that these improvements include enhanced data-sharing capability for care coordination and establishing the foundational elements of value-based payment such as data collection, performance measurement, and reporting.