Arizona to Roll Out Statewide Closed-Loop Referral Platform

The State of Arizona is laying the foundation for its Whole Person Care Initiative by adding a closed-loop referral system from vendor NowPow. In a recent interview, executives from the state’s Medicaid agency and health information exchange described some of the benefits they are expecting to derive from a single statewide platform.

Jami Snyder, director of Arizona Health Care Cost Containment System (AHCCCS and pronounced Access), oversees Arizona’s Medicaid and CHIP program, including the provision of acute, behavioral health and long-term care services and supports to more than 1.8 million Arizona residents at an annual cost of $14 billion. She explained that the Whole Person Care Initiative was launched to focus on the social factors that have an impact on individual health and well-being, such as housing, employment, criminal justice, non-emergency transportation, and home and community-based services interventions. Her organization contracts with 15 managed-care organizations (MCOs) to administer various services.

Snyder mentioned that Arizona has been working on social determinant issues for several years, particularly housing, but also medical transportation and social isolation issues.

“One of the programs I'd like to highlight is our targeted investments program, which we established under our current CMS 1115 waiver, to provide incentive dollars to providers that were committed to integrating care — the provision of physical services or acute care services and behavioral health services at the point of care within clinic settings, including the establishment of 12 justice clinic sites, where we offer parole and probation services, acute care services and behavioral health services in one setting for individuals when they leave that correctional environment or are trying to get back out into the community,” she explained. “But with the new waiver, we're extending our framework around our targeted investments program to include milestones that are attached to providers’ work in connecting with community-based organizations and effectively referring individuals to community-based organizations.”

For the statewide closed-loop referral system for community-based organizations, AHCCCS teamed with statewide health information exchange Health Current and 2-1-1 Arizona/Crisis Response Network, a nonprofit organization that offers a continuum of crisis, referral and data services.

“We are lucky in Arizona that we have an advanced Medicaid agency, a robust health information exchange, and a very robust 2-1-1 program that has a lot of those relationships with the community-based organizations,” said Melissa Kotrys, CEO of Health Current.

She said that when they began talking about the establishment of the closed-loop referral platform, “one of the baseline understandings was that we needed a system that could accommodate different types of screening tools, although we want to be able to standardize where it's possible But we need to be able to meet providers where they are and EHR integration is critical,” she said. “We want to ensure that as much as possible, we can incorporate these processes into the workflow and into the system of the providers within their organization. That is something we have worked with NowPow on and planned for this initiative. I know that the different managed care organizations within Medicaid have certainly worked to address how social determinant information is captured and how it's reported. But they are really looking forward to a single platform that can help transmit this information and standardize it as much as possible so that the community is working with complete information.”

Snyder said that for providers that are currently enrolled with the Medicaid program, “we are also offering a differential adjusted payment, which is essentially an incentive payment for connecting to the closed loop referral system. So if they provide evidence, no later than Nov. 1 of this year that they are going to enter into an agreement to connect to the closed-loop referral system, we will provide them with incentive funding.”

There also is contract language that requires that the MCOs extend their reach beyond traditional clinical services, and that they do work in the areas of housing, transportation, and employment. “In a couple of cases, in particular related to housing and employment, we actually asked that they have specific staff dedicated to that work,” Snynder said.

Kotrys added that while Health Current will be hosting the NowPow solution, it will be doing much more. “We at Health Current pride ourselves on being a community-based organization that serves as the data trustee for the community. Because we have been successful in the traditional HIE space of connecting systems to exchange clinical data, there's an established trust with the community as a whole, and a real desire to identify different functionality, different connections and different data sets that can help the healthcare community —including the community-based organizations in the social service arena.”

Health Current will be “connecting NowPow to the HIE, establishing patient identification across our system, and working to onboard the community-based organizations and the healthcare providers to this system and making sure it works within their workflows.”

Kotrys said Health Current already has dedicated staff on board to help clients move this initiative forward quickly. “We are working with NowPow currently on the details of the initial pilot implementations and we expect those to kick off in the first half of this year. Then on the heels of that we will be doing a broader general rollout, so we anticipate being very busy this year, and really rolling that full program out throughout the course of 2021.”

NowPow has worked with several regions on implementing closed-loop referral technology platforms. Rachel Kohler, the company’s CEO, identified three key success factors. “First is building trust with high-quality referrals — and that's really ensuring high-fidelity information. We are really excited about co-parenting that information with 2-1-1 Arizona,” she said. That trust is bolstered by referrals that don't waste people's time. “They’re personalized, they're smartly managed by the technology and have a high probability of success.” They also allow people to engage in the manner of their choosing, whether it's self-serve, or anonymously, or in a more supportive way.

Second is helping to create meaningful partnerships that are intervention-based and outcome-focused, and that can really span the whole person needs spectrum, not just basic needs, and they may be interventions that do not always involving health systems, Kohler said. “There are some CBO-centric ones involving or providing a digital infrastructure that can take advantage of the great work CBOs are already doing with each other in a community is important to support,” she said. “And then last, I'd say an ability to sustain the work. We pride ourselves on being sensitive to all stakeholders across the community, not just serving the largest. But having configurable workflows that allow organizations to engage based on their ability to resource the work is really key. And also providing them data on process and referral outcomes that are important for their own grant applications and report writing and overall capacity building.”

Snyder said her organization is excited about this effort. “We feel that it's foundational to our work around whole person care, in that it will connect individuals who are served by our programs to those critical social services,” she said. “And we know that that has a real impact in terms of quality of care, and cost of care for our membership and for our program.”