Last September, the California Department of Health Care Services (DHCS) announced its intent to award a $340 million contract for population health management (PHM) services to Gainwell Technologies as part of the California Advancing and Innovating Medi-Cal (CalAIM) initiative. DHCS officials have been providing regular updates to stakeholders about timelines and how the new service will work.
On Oct. 24, Palav Babaria, M.D., M.H.S., chief quality officer and deputy director of quality and population health management at DHCS, spoke in detail to a PHM Advisory Group about the service.
DHCS will partner with GainwellTechnologies to implement the PHMService. The initial contract will be forthree years, with the option to extendfor an additional three years.An initial set of PHM Servicecapabilities will be launched during apilot phase beginning in January 2023.By July 2023, DHCS will begin rollingout the PHM Service statewide.
In a transcript from the October meeting, Babaria outlined the vision: “First andforemost, we know that to provide whole person care,we really need to synthesize and aggregateinformation from across a member's variousbehavioral, physical health, dental, pharmaceutical,social service, developmental, and other community-based needs,” she said. “And right now, a lot of that information issiloed in various data systems and repositories. So weenvision that the PHM service will help us aggregate allof that data and make it available to the people whoare serving our members.”
Babaria said DHCS also envisions that this Population HealthManagement Service is going to help the department perform keypopulation health functions at the state level — thingslike screenings and assessments, risk stratification,segmentation and tiering. “We really see this service as a critical way to provideaccess to whole person care data for people who areserving Medi-Cal members and really being able toshare this integrated data at multiple levels, whetherthat is the plan level, the provider level, or individualcare management user levels, appropriately, followingall sorts of privacy and state and federal regulations.”
She noted that because what they are trying to accomplish with this service is pretty expansive, it would be unrealistic that a single vendorcould provide this solution. “Gainwell has reallypulled together a broad team of partners who provideall the various components of the service that we willneed to achieve the vision that we just articulated,” she said. Among the companies listed as partners are Arcadia, Briljent, Collibra, HealthTrio, InterSystems, McKinsey & Co., and the Partners in Care Foundation.
Babaria stressed that the department has no intentionof launching all of the functionality in July 2023. “This is really going to be an iterative processover time. So what we are really aiming for in July arethose functions that are critical to the successful launchand scale-up of our population health management program,” she said.
She added that even though thepopulation health management program is being launched via managed care, the service will have dataon everyone, including those in fee-for-service, those incarve-out programs, those in waivers, and those inmanaged care so that it really can serve the entireMedi-Cal population and not just the managed caresubset. Initially, it will have largely claims andencounter data, but there are other pieces ofinformation such as Medi-Cal enrollment andredetermination dates. “We already get information fromsome of our state partners like public health thatincludes vital records and immunization registries andother disease registries,” she said.
Babaria added that they are working to get additional data from other statepartners. “We're particularly interestedin things like CalFresh and WIC enrollment andleveraging the service to identify gaps in enrollmentwhere we think people are eligible. We're working withour other public health and social services and otherdepartments to figure out what other streams ofinformation would be helpful so that we can all bettercollectively take care of this population.”
She wanted to make sure people understood that the Population HealthManagement Service is not a health informationexchange. “We probably need to put that in flashinglights somewhere on our slides. It will definitely buildupon, hopefully over time, the Data ExchangeFramework that our Health and Human Services agencyis leading. But at the outset, as discussed, it really isjust going to use data that we have today in thedepartment, which is retrospective data, it's claimsdata, it's six-plus months old in most cases and nothave access to electronic health record or healthinformation exchange.”
Babaria said they do hope to connectto health information exchanges, probably not EHRsdirectly because there's thousands and thousands ofthem across the State of California — but to leveragehealth information exchanges and the Data Exchange Framework to get more clinical information that is morereal-time because they recognize the value in that.