June 1, 2021
To transform the future of health care, we must understand current care. This is especially true when it comes to tackling the multiple socio-economic and other factors that drive health disparities, which the COVID-19 pandemic has amplified. Right now, our ability to reduce these inequalities and improve the quality of care for those who need it most is limited because we lack accurate and comprehensive information on how our most vulnerable patients access health care. We also lack comprehensive knowledge about the types of conditions that affect vulnerable patients.
A new Health Net initiative is designed to help overcome this limitation. Considered by the California Department of Managed Health Care (DMHC) as part of its approval of the acquisition of Health Net by managed care company Centene Corp, this $ 50 million program will help identify and overcome barriers to timely submission of complete and accurate patient health data.
This critical information, called encounter data, is reported with every patient visit or interaction with the healthcare system. It is a record of the services provided to patients and the health conditions they experience. This information is not only used at the individual patient level; it can also help identify common conditions and population health trends statewide and help track health care costs across the medical system. This information is essential to understanding how patients most at risk access and navigate care. Yet today there is a lack of standardization in how dating data is reported, and the data is often incomplete, inaccurate, and difficult to collect and submit for many providers, especially those who serve. Medi-Cal patients.
To better address health equity, we need to better understand and address the reasons why certain patient populations suffer from higher rates of illness, injury, disability and death, and discover and help fill the gaps and obstacles in access to care.
Better data will help address these realities, which disproportionately impact communities of color and residents of rural California. In 2017, we launched the Encounter Data Improvement Program to strengthen the collection and reporting of this data. As a result, the program improves the health outcomes of our most vulnerable patients.
The Encounter Data Improvement Program is grounded in evidence-based research to inform solutions that can address our fragmented data infrastructure. Health Net has worked with providers in the field to understand the barriers they face in collecting data, which range from outdated technology to insufficient staff capacity, and piloted strategies to overcome them. We also convened high-level representatives from hospitals, health plans, local government, clearinghouses and other parties to review research, discuss new strategies, and make recommendations for improvement.
Throughout this multi-year collaborative process, one solution became clear: the need for a more unified effort to clarify, standardize, and monitor state-wide dating data collection and reporting.
In March, that effort turned into action. Health Net has contracted with the Integrated Healthcare Association (IHA) to act as the governance entity to monitor, implement, and standardize dating data improvement efforts statewide. This one-of-a-kind investment will ensure that we remain focused on improving the collection of accurate patient health data, and that we have a single entity that vendors, plans and stakeholders can rely on to deliver. implement improvement efforts, oversee system-wide changes, and troubleshoot a highly fragmented system.
There is no magic solution that will solve this problem overnight, but the creation of this new role and this significant investment represents another step forward in bridging the gap in access and quality of care for women. our most traditionally underserved patients. We also know that the changes to meet data collection shouldn’t stop with Medi-Cal. To foster more equitable and affordable care, we must apply these solutions industry-wide to continue to innovate and advance our health care delivery system to better serve all Californians. Data is, and will continue to be, a key piece of the puzzle.
Brian Ternan is President and CEO of California Health & Wellness and Health Net of California, one of the oldest and most experienced managed care plans in the state.
Mary Watanabe is director of the California Department of Managed Health Care, the state’s largest health plan regulator.
California Health Report focuses on social and environmental justice issues and their impact on the state’s most vulnerable people. Their work has spurred legislative action and changed conversations – in Sacramento, at community meetings, and around dinner tables.