California is the most populous state in the nation, with close to 40 million residents in its 58 counties. More than 15 million of these people, including 4 in 10 children, one in five working-age adults, and two million seniors and people with disabilities, are eligible for Medi-Cal, the state’s Medicaid program for people with low incomes. Due to the scale and complexity of Medi-Cal, individual counties take on a large portion of the responsibility for administering the program and providing safety-net health care services to people in need. While this approach makes sense for a state where the geography, economics, and population patterns vary widely from region to region, it can also pose challenges for creating a coordinated, equitable, and seamless health care continuum. To ensure a uniformly high-quality experience for Medi-Cal enrollees, the California Department of Health Care Services (DHCS) has introduced CalAIM (California Advancing and Innovating Medi-Cal): a long-term commitment to turning Medi-Cal into a person-centered, holistic health care delivery system. The overall CalAIM initiative is made up of a series of programs involving county Medi-Cal stakeholders, including the Behavioral Health Quality Improvement Program (BHQIP). Robust, seamless, and compliant health information exchange (HIE) is at the heart of CalAIM’s goals. From offering insight into population health risks to enabling timely follow-up on referrals for housing or other social needs, HIE is crucial for supporting appropriate allocations of resources, smooth transitions of care, and successful coordination between providers. Santa Cruz County, just south of San Jose, is one of the state’s leaders in leveraging HIE to improve care delivery for behavioral health clients. With a well-established HIE infrastructure, a clear roadmap for health system transformation, and a strong commitment to change, the county has become a case study in impactful innovation across its behavioral health services. This paper explores how programs like BHQIP and other CalAIM initiatives can provide a framework for improving data-driven collaboration in county health care settings, using Santa Cruz’s challenges and successes as a guide for addressing future reform efforts.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)