Archstone Foundation believes strongly in technology’s power to connect health and social services. This month’s webinar was the latest piece of our campaign to understand the health information exchange landscape – how effectively patient data is shared, or why it’s not being shared, among all those caring for each Californian. Our exploration has included numerous interviews, a series of workshops, and even a trip to the Consumer Electronic Show; a report we commissioned from Manatt Health Strategies documents our learnings. While releasing that report to accompany the webinar was an important step, we want to learn more. (I am writing this, for example, from the Healthcare Information and Management Systems Society’s annual conference in Chicago.)
And then we want to act. The bright promise of better health information exchange – integrated teams working seamlessly, relying on a comprehensive set of shared facts, from routine primary care visits through the most complex end-of-life decisions – is central to improving care. But achieving this will require coordination among governments, community-based organizations, and philanthropies. So, let’s consider all three.
Governments Remain the Primary Driver of Health Policy
Federal and state agencies often represent the best sources of scalability, funding, and convening power. Their decisions are often dispositive for the success or failure of systemic changes.
While comprehensive and equitable reform of the health information exchange system will need Washington’s support – including the Office of National Coordinator for Health Information Technology at the Department of Health & Human Services, the Centers for Medicare & Medicaid Services, and the Federal Electronic Health Record Modernization Office – what’s happening in Sacramento points to steps required at all levels of government.
The state is in the second year of a five-year experiment to expand its Medicaid program, Medi-Cal, beyond medical care and into social services. Known as CalAIM, the initiative’s premise is that such a whole-person approach to care will improve outcomes, reduce disparities, and ultimately make Medi-Cal more efficient. But that efficiency will be achievable only if the health information exchange system adequately supports authorization and billing. And stakeholders have made several challenges clear: lack of standardization among the 58 counties, high administrative burdens on community-based organizations, and hardware and software unable to capture and transmit information or comply with policies such as HIPAA.
The Department of Health Care Services has responded. It has altered its data-sharing guidelines and explained the changes using documents, webinars, and workshops. And this winter it awarded $207 million to help providers, local governments, community-based organizations, and others build capacity and infrastructure to support CalAIM, the first of several rounds of grants from what’s dubbed the PATH CITED initiative. (The acronym stands for Providing Access and Transforming Health Capacity and Infrastructure, Transition, Expansion, and Development. Archstone Foundation will host a webinar on Thursday, April 27, 2023 about this funding opportunity.)
The department’s actions underscore the kind of steps governments at all levels must take for bold health system reforms to succeed. They must listen to all stakeholders, especially community-based providers. They must be quick to respond to emerging challenges. And then they must provide multiple opportunities to secure adequate funding, lasting long enough to allow the changes to prove worthy and cost-effective.
Community-Based Organizations are Often the Backbone of Successful Social Services Delivery
Community-based organizations act as a critical safety net for marginalized populations. And their commitment to their neighborhoods positions them best to respond to their communities’ unique needs with thoughtful and trust-based service.
And yet these organizations face many challenges. They often lack sustainable funding and so rely on grants and other temporary sources. The absence of sustained funding produces personnel challenges. One consequence is a shortage of workers who can navigate health exchange technologies, leading to poor coordination with other providers. Even when they can coordinate services, community-based organizations face bureaucratic burdens that take time and resources away from providing services. Finally, government support for health information exchange improvement has not flowed sufficiently to smaller organizations.
Despite these problems, community-based organizations have an unrivaled ability to provide tailored, accessible, and holistic social services – if backed with sustained funding and an adequate health information exchange infrastructure. To that end, these groups should secure sustainable funding whenever possible and in the meantime seek capacity-building support from PATH CITED and elsewhere. They should share their learnings and networks with other community groups and organizations with similar missions. And they should share their stories and challenges with the government agencies and organizations with similar missions.
Philanthropies are Critical in Supporting Systems Change
Archstone Foundation and other funders play a critical role in supporting systems change and putting together the forces who can make it happen. They bear the privilege and responsibility of holding this financial and convening power. And their spending has the capacity to catalyze projects so they can obtain sustainable sources of funding. Several of our grant awards, for example, have resulted in grantees securing multi-year contracts with the State of California. By leveraging philanthropies’ ability to provide short-term funding quickly, grantees can concentrate on developing long-term visions that align with the goals of the worlds where they operate (a statewide plan such as CalAIM, for example.) Also, private funders can bring like-minded organizations together and elevate the voices of those groups with the ability to make the biggest impact.
While each funder is different, most can take several steps to better integrate healthcare and social services through improved health information exchange. They should take time to listen to the needs of all in their funding ecosystem, aware the loudest voices can obscure the needs of smaller organizations. Their funding should be flexible and strategic to capitalize on new opportunities that might require some unconventional creativity. And they should collaborate to identify where support from several of them might fuel more impactful change.
In this spirit, Archstone Foundation is committed to funding the following:
- Partnerships among philanthropies, state agencies, and others that leverage funding and expertise – to identify promising programs and opportunities and evaluate outcomes for their populations of focus.
- Research and evaluation that quantifies, better identifies, and explains gaps in data exchange and technology-enabled services and resources – to facilitate cross-sector team-based care for older adults.
- Programs testing technology-enabled services and data exchange interventions – to improve team-based care and better integrate and coordinate care among health and human services providers.
If these ideas resonate at non-profit organizations serving older Californians and their caregivers, please visit our Technology Page so we can discuss how Archstone Foundation can support your work in health information technology.
