Building a Data-Driven Care Ecosystem: Five Lessons for Medicaid Leaders

A unified approach to coordinated care is essential for improving health outcomes for populations and driving value for state and commercial healthcare sectors. When it comes to operationalizing state-specific programs, however, there are a number of factors for leaders to consider in building an effective and sustainable infrastructure for their initiatives. What’s happening in California offers valuable lessons and a successful model to follow.

California’s Department of Health Care Services (DHCS) launched CalAIM’s population health management program as a coordinated, statewide approach to improving clinical outcomes and quality of life for Medi-Cal members. It focuses on wellness, prevention, and care coordination across healthcare delivery organizations and community partners.

The goal? To create a healthcare system that works for all Californians.

Holistic Healthcare Requires Holistic Data

An ambitious initiative like this requires extensive collaboration. The way the healthcare ecosystem works together for members will change in exciting and profound ways. And data is the cornerstone of it all.

This is why Medi-Cal Connect is such an important part of Medi-Cal’s program transformation. This pioneering data solution aggregates specific ecosystem partner data for a comprehensive picture of members’ health and benefits. It also provides population-level insight to shape programs and policy decisions.

Not Your Traditional Implementation

As the team implementing Medi-Cal Connect in partnership with DHCS, we’re excited about how it can improve healthcare, enhance care coordination, and reduce healthcare costs across California. Drawing from our experience, there are invaluable lessons for other states as they develop their program approaches.

At a fundamental level, making progress toward efficient, whole person care will require agencies to go beyond traditional procurement and implementation approaches designed for transactional systems and fit-for-purpose solutions.

Here are five lessons to consider for implementing impactful state-specific policies and programs:

1. Shift from a Big-Bang to a Start-Small Implementation Mindset

Supporting population health goals can seem like an everything-all-at-once undertaking. It’s complex, comprehensive, and nuanced. States also face the pressure of quickly demonstrating progress and outcomes. Even so, resist the temptation to approach your program initiatives with a big-bang mindset that doesn’t allow for flexibility.

An incremental approach has served California well. It allows state agencies to pilot and refine solutions while improving coordination with key partners when required. It’s about working at a pace and scale that ensures the ecosystem has the grounding to make the most of the solution. There is room for experimentation and refinement — and you can bring stakeholders along the journey. Start with what you can do relatively easily and build momentum from there.

2. Build Data Literacy Capacity Across All Users

Data is the foundation of program enablement, and data literacy is a critical factor for success in improving care coordination, increasing value-based payments, and enhancing program oversight. This involves more than training individuals to use a new dashboard; it requires introducing a range of competencies to workforces across various organizations. Starting with how data is sourced, aggregated, and normalized, program analytics require a transition from a regulatory and reporting approach to data to using data to enable insights. This necessitates cross-disciplinary collaboration to address data silos and build trust in data that has been transformed for healthcare insights.

Consider data literacy an organizational skill. Unite the data team with those designing your program to foster a shared understanding of optimal service use from various perspectives such as programmatic, technical, operational, and human.

3. Think Broadly in Developing the Change Management Strategy

Strong governance is key to change management in a statewide program initiative. In California, DHCS made it a priority early on. From the start, ensure that all critical parts of your organization understand the vision and have a shared sense of ownership. A framework with defined roles and responsibilities enables individuals to effectively contribute their unique expertise. Don’t underestimate the scope of change management needed for this type of initiative. Change management needs extend beyond the walls of your agency to managed care organizations, providers, community-based partners, and members themselves.

4. Engage Stakeholders Around Value — Early and Often

We have been relentless about considering stakeholder impact. There is no single organization that addresses all the healthcare and social needs of Medi-Cal members. DHCS, managed care plans, and social services, and behavioral health agencies all play vital roles, each with unique requirements.

Engage stakeholders early to assess their needs and collaboratively shape solutions that align with the state’s broader healthcare strategy. This approach allows for the development of tailored value propositions. It’s essential that stakeholders do not perceive new tools as additional burdens, but rather as valuable resources that can be integrated seamlessly into existing workflows to enhance outcomes for members.

5. Center and Recenter Around Member Outcomes

DHCS ensures we keep members as our touchstone. We encourage you to do the same. While addressing challenges and milestones is important, stay focused on your core purpose. Rally your team and stakeholders around your vision and realign around it regularly and passionately.

The journey towards effective care at scale is multifaceted, requiring strategic alignment and collaboration across various efforts. By adopting a start-small implementation approach, fostering data literacy as an organizational competency, implementing robust change management strategies, actively engaging stakeholders, and continually prioritizing member outcomes, you can establish a resilient foundation that can adapt and thrive amidst the complexities of healthcare delivery. By staying committed to these principles, we can ensure each initiative not only meets its objectives but also advances the overarching goal of improving health outcomes for your members and lowering the total cost of care.

Contact us to learn more about our work on Medi-Cal Connect, or to start a conversation on how we can support your goals.