What kind of technological infrastructure does a county government need to support a data-sharing effort across health, criminal justice, and housing agencies? A report released by the California Health Care Foundation described two counties’ early experience in California’s Whole Person Care (WPC) pilot project.
The WPC is a five-year, $3 billion waiver program that includes 25 counties and one city pursuing pilot projects to integrate care across sectors for a subset of Medi-Cal patients. The report, prepared by consulting firm Intrepid Ascent, examines the technological challenges the pilots have faced in selecting and implanting a platform for data sharing. The tech platforms the WPC pilots choose have to support a wide array of county partners — including criminal justice and housing — as well as healthcare and social service agencies.
Intrepid Ascent’s report identified several technological capabilities as especially critical to fulfilling the core competencies required of WPC pilots, including care coordination and case management, data quality monitoring and improvement, flexible data analytics and reporting, identity management, data sharing across sectors, social service referrals, and real-time communication for team-based care. Some pilots have sought out care coordination tools with robust consent management features to help with disclosure compliance and transparency, the report adds.
The tech tools “must be accessible and functional for a wide range of users, in both clinical and social service settings, and often must operate alongside existing systems for care and service documentation, such as EHRs and Homeless Management Information Systems (HMISs),” the report notes.
The partnering organizations in a regional pilot must agree on a shared technology approach to facilitate the coordination of services, the report notes. “Generally, pilots have chosen one of two paths. They have either added features and users to an existing EHR system — generally the county’s EHR — or implemented a new care coordination platform for all entities to learn and use. Some pilots have also procured additional niche technology tools to fill in feature gaps, such as real-time care alerts.”
The report takes an in-depth look at the approaches of two counties — Marin and Contra Costa, whose varied size and experience led to different technology decisions. “Contra Costa County has an extensive, integrated, county-run health system and a population about five times the size of Marin’s. In contrast, Marin County’s WPC services are provided through a broader network of community partners, and their budget is approximately one-tenth the size of Contra Costa’s.”
Contra Costa Health Services (CCHS) runs a hospital (Contra Costa Regional Medical Center), 13 community clinics, a behavioral health division, county detention health, a managed care health plan, school-based health center programs, healthcare for the homeless, public health home visiting nurses, mobile health units, and communicable disease programs. CCHS also has a robust IT department, which began a technology transition to a county-wide Epic EHR and an internally managed data warehouse in 2012. In addition to the EHR, the data warehouse gathers data from multiple county systems.
“Contra Costa County saw the WPC pilot as an opportunity to make better use of these robust data made available by the existing IT and EHR infrastructure and to close data-sharing gaps that existed in the system,” the report notes. “Areas of focus in the pilot have included using data to automate time-intensive processes, sharing data with a more diverse range of partners, and equipping frontline workers with data to target and improve the services they provide.”
Marin County does not have an internally integrated health system, and so did not have a shared EHR system on which to do the bulk of their WPC work. The report notes that the county identified the need to find and implement a care coordination system that could be accessed by both county staff and diverse external partners. In April 2018 the county selected a vendor, ACT.md, and the first version of the system went live in early October. The county is calling their ACT.md tool “WIZARD,” which stands for WPC Information Zone: Access to Real-time Data. Currently, case managers, social service workers, and the epidemiology and administrative team that manages WPC eligibility manually enter information in WIZARD. As the county moves into phase 2 of implementation, the report notes, they will establish a data exchange with HMIS to eliminate duplicate data entry and verification workflows, and with the Marin Health Gateway HIE for clinical alerts and a curated set of health information.
Progress and challenges
Intrepid Ascent’s report notes that the process of implementing new technologies has both catalyzed positive changes and highlighted persistent challenges. “On the positive side, requiring partners to implement and collaborate using new, shared tools has helped break down silos and forge new relationships. It has also motivated entities to reckon with vital questions about data, such as what should be shared, with whom, and how. Organizational challenges that remain barriers both to the implementation of technology specifically and to WPC more broadly include building consensus among many distinct entities, adapting to rapid transformational changes, and navigating complex questions related to regulations, risk, and sustainability.”