Policy Innovation Is Outpacing Technology at the Intersection of Health Care and Human Services

The stereotype of the technology sector designing bright shiny objects that usher the rest of us into the future is deeply ingrained in our culture. However, health care and human services tend to be policy-driven markets, with technologists seeking to keep up and frontline organizations caught in the middle. We’re seeing this dynamic — and the profound opportunities and challenges it generates — play out at the intersection of these two systems today.

Last September, at an invite-only gathering of policy and technology leaders in California, Micky Tripathi, the Director of the Office of the National Coordinator for Health IT, and Marko Mijic, Undersecretary of the California Health & Human Services Agency, shared two distinct visions. Tripathi articulated ONC’s goal of integrating health care and public health data, an ambitious and important objective from D.C. and the CDC to local communities. Mijic then saw Tripathi’s bet and raised him: California had committed to integrating not just health care and public health data, but human services data as well. To which Tripathi responded that the ONC would cheer on California and watch and learn.

California is not alone in staking out this position but is backed by a different federal body: the Centers for Medicare & Medicaid Services (CMS) with billions of dollars of support for the state’s effort to integrate the health care and human services delivery systems through what is now called Medi-Cal Transformation. New York recently embarked on a similar Medicaid transformation initiative, with Pennsylvania next, and North Carolina previously took important steps in this direction. As Mijic described, health improvement and equity require addressing social needs, and so California is using its position in a policy-driven market to advance the connection of human and social services with health care and public health systems.

For this vision to succeed, human services data must become interoperable with health care and public health data. California’s Data Exchange Framework (DxF), led by Mijic’s Health & Human Services Agency, makes this explicit. As stated on the DxF website, “Every Californian, no matter where one lives within our state, should be able to walk into a doctor’s office, a county social service agency, or an emergency room and be assured health and social services providers can access the information they need to provide safe, effective, whole-person care — while keeping our data private and secure.” Palav Babaria, the leader of the state’s Population Health Management Service, which is being developed to support Medi-Cal Transformation, has said, “We really see this service as a critical way to provide access to whole-person care data for people who are serving Medi-Cal members and really being able to share this integrated data at multiple levels, whether that is the plan level, the provider level, or individual care management user levels, appropriately, following all sorts of privacy and state and federal regulations.”

From my experience supporting organizations across the state that embrace Medi-Cal Transformation, I’ve seen a handful of key data exchange use cases emerging. These include eligibility determination for Enhanced Care Management and Community Supports, medically tailored meals eligibility verification and care management, transition support for short-term post-hospitalization housing, referral pathways for ECM providers linking clients out to community-based organizations addressing their social needs, and psychosocial assessments/screenings. Important data that needs to be shared across sectors for these use cases includes data from Housing Management Information Systems, hospital event notifications, enrollment and eligibility information, assessment/screening responses, and services offered and provided by community-based organizations. 

Actualizing such cross-sector data-exchange is hard and takes even the most seasoned health care data exchange organizations — whether HIEs, vendors, health systems, or payors — beyond their data exchange comfort zone for several reasons. 

First, emerging use cases need more than the exchange of read-only clinical data, but in spite of the pioneering efforts of the Gravity Project, for instance, we lack data standards for social data such as health-related social needs (HRSNs), which are gathered through assessments/screenings. In California, Community Based Organizations must submit slightly different HRSN data to different Medicaid Managed Care Plans because the plans have not adopted a single standard. In addition, emerging use cases benefit greatly from care management tools with read-and-write capabilities, but many traditional data intermediaries have shied away from offering such collaboration platforms (e.g., for closed-loop referrals). 

Second, health care data exchange actors got comfortable in the HIPAA tent, but it’s not big enough anymore. Even with California waiving all of its laws that might restrict data exchange for Medi-Cal Transformation services, communities have begun to adopt multipurpose consent to support cross-sector collaboration use cases — but the numbers are still a drop in the bucket. 

Third, governance of HIOs, quality-improvement networks, and similar organizations at both the state and local levels likely need to be opened up. Are there any new folks around the decision-making table? If not, then people from human services must be invited in or the inequities between health care organizations and their community partners will erode trust and effective collaboration to serve shared populations.

What, then, are the options for organizations fostering data exchange in states undergoing Medicaid transformation efforts?

• Just say no to change — stay in the clinical lane and risk losing value and market share in the Medicaid delivery system.
• Get fluent — invest in interoperability across sectors to become the data backbone for an integrated health and social care delivery system; this will require work and rework as national standards emerge.
• Break the read/write barrier — go further than interoperability and integrate collaboration tools that support cross-sector use cases into your service offerings.

Helping care managers, for instance, move beyond reliance on phone and fax will require much more investment in cross-sector interoperability and collaboration tools.

Just as we’ve seen the market for closed-loop referral systems take off, a policy-driven market for broader and deeper interoperability and collaboration tools connecting health care and human services is creating tremendous opportunities for positive impact. The question is: Are technology and data exchange providers reading these signs fast enough to develop, pilot, and scale quality solutions at sustainable prices to communities tackling the challenges of integrating health and social care?

Photo: Raycat, Getty Images

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