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CENCAL HEALTH NEWS
CenCal Health NEWS HUB:
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What is CalAIM and how does it affect patients and providers on the Central Coast?
The California Advancing and Innovating Medi-Cal program – known as CalAIM – is the far-reaching, multiyear plan to transform Medi-Cal. The long-term mission of CalAIM is to offer 14+ million Californians a more equitable, coordinated, and person-centered approach to maximizing their health and life trajectory. CalAIM will provide expanded services that go beyond traditional medical care, addressing social factors that affect human health from birth to end of life, including homelessness, behavioral health, care of older adults, services for individuals transitioning from incarceration, and beyond. The comprehensive program was developed by the State of California’s Department of Health Care Services (DHCS). CalAIM is the State’s largest overhaul of how MediCal services are delivered and paid since the implementation of managed care in the late 1970s.
“Our community partners have continuously been at the forefront of innovation, providing person-centered care to our members and underserved neighbors,” said CenCal Health
More information about CalAIM on the Central Coast is available at www.cencalhealth. org/calaim. Additional information about CalAIM can be found on the DHCS site at www.dhcs.ca.gov/CalAIM
CEO Marina Owen. “With the opportunities afforded by CalAIM, we are pleased to support our providers’ efforts to enhance, expand, and strengthen local services.”
CenCal Health, the Medi-Cal health plan for Santa Barbara and San Luis Obispo counties, has implemented two new initiatives under the CalAIM framework. They are:
• Enhanced Care Management (ECM) is a benefit for members with complex needs requiring seamless coordination between multiple doctors and other care providers. With ECM, enrolled members are assigned a lead care manager who helps coordinate doctors, specialists, pharmacists, case managers, and social service providers, among others, in order to comprehensively manage a member’s primary care, acute care, behavioral health, developmental health, oral health, and community services and supports.
• Community Supports provides medically appropriate and cost-effective alternatives to traditional medical services.
Community Supports comprehensively addresses the needs of members — including those with the most complex challenges affecting health such as homelessness, unstable and unsafe housing, food insecurity, and/or other social needs.
CenCal Health currently offers two Community Supports – Medically-Tailored Meals and Recuperative Care. Medically Tailored Meals provides meals to members with diabetes, congestive heart failure, or chronic kidney disease, and who have had a skilled nursing facility stay, inpatient hospital visit, or emergency room visit within six months.
Recuperative Care is medically-supervised respite care for patients who have just been released from the hospital due to serious illness or injury, and are experiencing homelessness or at risk of homelessness. Community partners, shelters, and local hospital providers Dignity Health, Cottage Health and Tenet Health have been offering Recuperative Care since 2019. Through CalAIM, CenCal Health will continue to support these critical services.
“We are addressing homelessness among the most vulnerable individuals in the community,” said Dr. Lynn Fitzgibbons, Cottage Health’s Medical Director of Population Health. “The Cottage Recuperative Care Program at PATH is dedicated to helping those experiencing homelessness access vital services to address their medical needs, improve their health, and transition to stable housing.”
Good Samaritan Shelter, PATH Santa Barbara, and Community Action Partnership of San Luis Obispo partner with the area hospitals to ensure an integrated referral and care coordination structure for members moving in and out of respite services. “Ending homelessness for individuals, families and communities requires partnerships across many sectors, including healthcare,” said Jennifer Hark Dietz, CEO of PATH. “That is why, at our Santa Barbara interim housing site, we provide people experiencing homelessness with access to services they need to improve their health, increase their income, and transition to stable housing.”
Julie Fallon, MD
President Internal Medicine Templeton
Douglas Murphy, MD
President-Elect Psychiatry San Luis Obispo
Todd Engstrom, MD
Treasurer Internal Medicine Santa Barbara
2023 CCMA BOARD OFFICERS
Rachel May, MD
Secretary Emergency Medicine San Luis Obispo
Samira Kayumi-Rashti, MD
Immediate Past President Pediatrics Santa Barbara
Kevin Casey, MD
Vascular Surgery Santa Barbara
Michael DiBiase, MD
Nephrology San Luis Obispo
Priti Gagneja, MD
Internal Medicine Santa Barbara
2023 CCMA BOARD DIRECTORS
Jennifer Hone, MD
Endocrinology Santa Barbara
Bindu Kamal, MD
Nephrology Santa Barbara
Christopher Quijano, DO
General Surgery Santa Barbara
Rahim Raoufi, MD
Gastroenterology Lompoc
Daniel Roshan, MD
Pain Medicine Santa Barbara
California’s Big Move on Data Exchange
With a combination of mandates, a new governing board, and publicly funded WITH A COMBINATION OF MANDATES, A NEW GOVERNING BOARD, AND PUBLICLY FUNDED assistance, the California Data Exchange Framework (DxF) is set to pull health ASSISTANCE, THE CALIFORNIA DATA EXCHANGE FRAMEWORK (DXF) IS SET TO PULL HEALTH information exchange into the 21st Century. INFORMATION EXCHANGE INTO THE 21ST CENTURY.
Probably every physician practice has had the frustrating experience of trying to deliver the best possible care to a patient, only to be hampered by the inability to access relevant health information. Important pieces of a patient’s history, such as prescriptions, chronic conditions, or previous diagnoses may be trapped in data silos held in a million different places, inaccessible to the patient or the physician at the point of care. Myriad studies of the health care system have shown that lack of health information at the point of care often leads to duplication, waste, and delay.
Despite the widespread adoption of electronic health records (EHRs) across the state, this problem persists. A combination of technology challenges, competitive forces, and some legal uncertainty has kept data locked away from both patients and physicians.
Starting in 2020, the federal government began working to address this problem through the 21st Century Cures Act Final Rule, often known as the “Information Blocking Rule.” This rule clarified in federal regulation that patients have the right to access their own medical information through the technology of their choosing. For the first time, physicians, hospitals, and health plans must make that information available. This rule started the country down the path of widespread and seamless data exchange.
Now, the California Medical Association (CMA), is working with the State of California to build on the federal regulations to accelerate and expand data exchange efforts here in the state. After a year of legislative negotiations, State Budget appropriations, and stakeholder meetings, the California Health and Human Services Agency (CHHS) on July 5, 2022, published the Data Exchange Framework.
The Data Exchange Framework, usually abbreviated “DxF”, will require all actors in the health care system – physicians, hospitals, health plans, skilled nursing facilities, etc. – to make patient data available to all other actors within the bounds of federal and state privacy laws. It will do this by requiring all those actors to sign the Single Data Sharing Agreement (described below). Once they have signed the agreement, practices and others will be contractually obligated to share data across the health care system.
Importantly, the Data Exchange Framework does not require practices to utilize any particular data sharing technology. The state is not building a “Statewide HIE.” When the law that created the framework was being written, CMA’s position was that physicians should have the flexibility to choose the technology that works best for their practice. Based on CMA’s advocacy, the law prohibits the state from forcing physicians into one system.
Instead, the Framework is intended to be “technology agnostic,” meaning that practices are free to choose the method of data exchange that works best for them. This could include a local health information organization, a national data sharing network, or other data sharing technology.
Now that the Framework has been published, the timeline for implementation is going to move quickly. It will be important for practices to familiarize themselves with the requirements of the Framework and begin their preparations as soon as possible. To help practices prepare, this article will give a high-level overview of the Framework, describe some things practices can do to prepare, and point them to some helpful resources CMA is developing.
The Data Exchange Framework
The Data Exchange Framework consists of four major components:
2. SINGLE DATA SHARING AGREEMENT
To govern the Framework, the state has created the Single Data Sharing Agreement (DSA). This document is a contract that all practices are required by law to execute by January 31, 2023. The intent of the DSA is to act as a contract between physician practices, hospitals, health plans, etc., that they will WHEN THE LAW THAT CREATED THE FRAMEWORK make data available to WAS BEING WRITTEN, CMA’S POSITION WAS each other upon request. The DSA lays out the THAT PHYSICIANS SHOULD HAVE THE FLEXIBILITY parameters of how that TO CHOOSE THE TECHNOLOGY THAT WORKS data exchange should BEST FOR THEIR PRACTICE. BASED ON CMA’S happen, predominantly via ADVOCACY, THE LAW PROHIBITS THE STATE FROM accompanying Policies and Procedures that describe FORCING PHYSICIANS INTO ONE SYSTEM. what data elements need to be exchanged, privacy and security standards, and permitted uses of health data. The DSA also lays out practices’ responsibility to comply with the HHS Data Exchange Board (see below).
3. HHS DATA EXCHANGE BOARD
The State has proposed to create a 5-to-7-member governing body that will oversee data exchange in California. This board will be charged with overseeing and updating the Data Sharing Agreement, ensuring compliance with the DxF, and qualifying health information organizations. The details about this board will be included in a legislative proposal that will be introduced next year.
4. TECHNICAL ASSISTANCE FOR SMALL AND SAFETY NET PRACTICES
The 2022-23 State Budget included $50 million for providing technical assistance to small practices and other safety net providers. As of the writing of this article, there are no additional details to share. CMA is actively engaged in ensuring that the funding will reach physician practices quickly and efficiently, to help them prepare for the DxF.
1. DATA SHARING REQUIREMENT
As described above, the Framework includes a legal requirement that physician practices and other health care entities make data available to other signatories of the Data Sharing Agreement. The date by which practices must comply with this requirement depends on the size of the practice. In general, practices of more than 25 physicians will need to be engaged in data exchange by January 31, 2024. Practices smaller than 25 physicians will have 2 additional years, until January 31, 2026.
For more details on these components, CMA members can access the CMA DxF Fact Sheet on the CMA website.
Timeline
A GENERAL TIMELINE FOR THE DATA EXCHANGE FRAMEWORK IS LISTED IN THE TABLE BELOW:
DATE
JULY 5, 2022
REQUIREMENT
+ CHHS PUBLISHED THE FINAL DATA EXCHANGE FRAMEWORK
FIRST QUARTER 2023 + THE GOVERNANCE ENTITY (SEE ABOVE) BEGINS THEIR WORK
JANUARY 31, 2023 + ALL HEALTH AND HUMAN SERVICES ORGANIZATIONS (INCLUDING PHYSICIAN PRACTICES) MUST EXECUTE THE DATA SHARING AGREEMENT
JANUARY 31, 2024 + MOST HEALTH CARE PROVIDERS (SEE TABLE BELOW) MUST IMPLEMENT THE DATA EXCHANGE FRAMEWORK
JANUARY 31, 2026 + SMALL AND SAFETY NET PRACTICES (SEE ABOVE) MUST IMPLEMENT THE DATA EXCHANGE FRAMEWORK
As you can see, practices are required to execute (sign) the Data Sharing Agreement in just a little over five months from the writing of this article. The state has not yet announced how that process will take place, so please watch for further announcements from CMA or the State of California. In addition, it is important for physicians to know that you must sign the agreement by January 31, 2023, even if your practice is small enough to be in the cohort that does not have to comply until 2026.
What Practices Can Do Now
With these new requirements coming down over the next four years, practices will want to get started on building their game plan for compliance as soon as possible.
If you participate in a medical group or an IPA, a good place to start is by contacting that entity to inquire about their plans for compliance with the Data Exchange Framework. If you get access to an EHR system or population health platform through the group or IPA, and they already engage in data exchange, an individual practice may not need to sign their own DSA.
The organization will sign the Data Sharing Agreement on your behalf, and data exchange will be handled at that level.
For more independent practices, now is a good time to familiarize yourself with the health information organizations (HIOs) that serve your community. Members of the California Association of Health Information Exchange (www.ca-hie. org/about/members/) represent the largest and most wellestablished HIOs in the state. They have already signed an agreement to work together. As more entities become aware of the requirements of the DxF, lead times to sign up with an HIO may become longer; it will help to approach them soon.
Finally, be sure to work with your EHR vendor, especially if you work with a smaller, specialty system. These systems can require custom interfaces to onboard to an HIO, which can be both time-consuming and costly. On the plus side, some EHRs connect through a national data sharing network, allowing you to comply without adding a new vendor. Either way, it helps to include your EHR vendor early and often.
CMA is Here to Help
To help practices get ready for the DxF, CMA is developing resources as quickly as information becomes available.
On June 28, 2022, CMA held an online briefing on the Data Exchange Framework. A recording of the briefing is available on the CMA YouTube Channel (www.youtube.com/c/CMAdocs).
In addition, CMA has published a Fact Sheet that is available to all physician members on the CMA website (www.cmadocs. org and search “data exchange framework”). The Fact Sheet summarizes the requirements and components of the DxF and includes a Frequently Asked Questions document that will be updated regularly as more information becomes available.
Finally, CMA members can always call the CMA Member Helpline at 800-786-4262 for assistance.
