This week my colleague Mark Hagland is covering the Strategic Health Information Exchange Collaborative (SHIEC) Conference in Atlanta. At last year’s SHIEC conference, Mark covered a panel session featuring executives of 2-1-1 San Diego. In that talk, William York executive vice president, said the key to its work is “connecting the dots to create a social snapshot of a client’s situation, and matching that with a database of social service providers and referrals.”
I was reminded of Mark’s story from last year because last week I saw another fascinating presentation on 2-1-1 San Diego’s Community Information Exchange in a webinar co-hosted by the Center for Health Care Strategies and Nonprofit Finance Fund.
Lots of health systems are starting to work on a better understanding of social determinants of health and better connections with social service agencies. I think the effort in San Diego is really a leading model. Its Community Information Exchange (CIE) platform shares client-level data and has participating organizations use a common risk rating tool. The CIE also facilitates community case planning, and care team communications to better address the social determinants of health.
Camey Christenson, senior vice president at 2-1-1 San Diego, said that when people hear the phrase community information exchange, they focus on the technology platform, “but the important piece of the CIE is that it is not just a technology platform, but rather a collective movement of what we are trying to accomplish in our region.”
She said the 2-1-1 organization was motivated to create the CIE by seeing regional system failures. “We receive 1,500 calls a day. We saw every day how the system of getting people resources was not working and was putting the onus on clients in crisis. Putting prescription pads in doctor’s offices telling them to call 2-1-1 wasn’t sufficient,” she said. “We needed to move to a proactive model to have helpers working more closely together to use data to break down data silos between sectors, especially including health and social services.”
The 45 network partners are connected by the technology platform, the bidirectional referrals and a shared language using a risk rating scale. “We have leveraged our role in the community as a resource hub, worked with our partners to build trust, and created a network of diverse, cross-sector partners who were willing to take the leap and redefine what a client is – that it extends just beyond their four walls,” Christenson said. They had to change their business processes —accepting and confirming referrals, and sharing client-level data, and having that shared language. “We had to make sure we understand and agree on definitions of social determinants of health and how we measure them, and that is why we created a risk rating scale using 14 different domains of a social determinants of health framework. That creates a shared language about where the client is in terms of risk for each domain, and shows changes over time with a longitudinal client record.”
Several organizations are contributing client-level data into the CIE, and clients are consenting to the use of their data for ongoing care coordination across sectors. “This is changing our field to move to more proactive, person-centered work, which is starting to have an impact on community health,” she said.
The 2-1-1 San Diego team worked closely with San Diego Health Connect, the regional HIE, to learn about data sharing and what agreements and authorizations are required. “It was a learning curve for us,” Christenson said. They also worked to leverage technology in different sectors. For instance, they focused on understanding the systems that county governments use and how to connect to them. Housing providers use a system called the Housing Management Information System (HMIS). “We directly connected that HMIS system to the CIE, which was really useful information for healthcare providers,” she said. “We also leverage our existing 2-1-1 database so we could create closed-loop electronic bidirectional referrals using our database.”
The 2-1-1 organization is working with local universities to study whether the interventions are having an impact on outcomes such as reduced hospital readmissions. It is governed by a board of directors and has an advisory committee with work groups made up of nonprofit CEOs, and executives from health plans and local universities.
There are many examples of groups working together on systems that link social services agencies and health systems. In fact, later this week I am going to interview people working on a community health record in Alameda County, Calif. But it sounds like this effort in San Diego has already tackled a lot of the technology and governance challenges, and is really starting to reap some of the benefits.
