California to Launch Population Health Management Service in July

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 Gainwell Technologies to implement the PHM Service. The initial contract will be for three years, with the option to extend for an additional three years. An initial set of PHM Service capabilities will be launched during a pilot phase beginning in January 2023. By July 2023, DHCS will begin rolling out the PHM Service statewide.

In a transcript from the October meeting, Babaria outlined the vision: “First and foremost, we know that to provide whole person care, we really need to synthesize and aggregate information from across a member's various behavioral, physical health, dental, pharmaceutical, social service, developmental, and other community-based needs,” she said. “And right now, a lot of that information is siloed in various data systems and repositories. So we envision that the PHM service will help us aggregate all of that data and make it available to the people who are serving our members.”

Babaria said DHCS also envisions that this Population Health Management Service is going to help the department perform key population health functions at the state level — things like screenings and assessments, risk stratification, segmentation and tiering. “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.”

She noted that because what they are trying to accomplish with this service is pretty expansive, it would be unrealistic that a single vendor could provide this solution. “Gainwell has really pulled together a broad team of partners who provide all the various components of the service that we will need 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 intention of launching all of the functionality in July 2023. “This is really going to be an iterative process over time. So what we are really aiming for in July are those functions that are critical to the successful launch and scale-up of our population health management program,” she said.

She added that even though the population health management program is being launched via managed care, the service will have data on everyone, including those in fee-for-service, those in carve-out programs, those in waivers, and those in managed care so that it really can serve the entire Medi-Cal population and not just the managed care subset. Initially, it will have largely claims and encounter data, but there are other pieces of information such as Medi-Cal enrollment and redetermination dates. “We already get information from some of our state partners like public health that includes vital records and immunization registries and other disease registries,” she said.

Babaria added that they are working to get additional data from other state partners. “We're particularly interested in things like CalFresh and WIC enrollment and leveraging the service to identify gaps in enrollment where we think people are eligible. We're working with our other public health and social services and other departments to figure out what other streams of information would be helpful so that we can all better collectively take care of this population.”

She wanted to make sure people understood that the Population Health Management Service is not a health information exchange. “We probably need to put that in flashing lights somewhere on our slides. It will definitely build upon, hopefully over time, the Data Exchange Framework that our Health and Human Services agency is leading. But at the outset, as discussed, it really is just going to use data that we have today in the department, which is retrospective data, it's claims data, it's six-plus months old in most cases and not have access to electronic health record or health information exchange.”

Babaria said they do hope to connect to health information exchanges, probably not EHRs directly because there's thousands and thousands of them across the State of California — but to leverage health information exchanges and the Data Exchange Framework to get more clinical information that is more real-time because they recognize the value in that.