To transform the future of health care, we must understand current care. This is especially true when it comes to addressing the multiple socioeconomic and other factors that drive health disparities, which the COVID-19 pandemic has amplified. Right now, our ability to reduce these inequities and increase quality of care for those most in need is limited because we do not have accurate and complete information about how our most vulnerable patients access health care. We also lack full insight into the types of conditions that impact vulnerable patients.
A new Health Net initiative is designed to help address this limitation. Envisioned by the California Department of Managed Health Care (DMHC) as part of its approval of managed care company Centene Corp’s acquisition of Health Net, this $50 million program will help identify and overcome barriers to the timely submission of complete and accurate patient health data.
This critical information—called encounter data—is reported from each patient visit or interaction with the health care system. It is a record of the services provided to patients and of the health conditions they are experiencing. This information is not only used at the individual patient level; it can also help identify common conditions and population health trends statewide and help track health care costs across the medical system. These insights are key to understanding how the most at-risk patients access and navigate care. Yet, today, there is a lack of standardization in how encounter data is reported, and the data is often incomplete, inaccurate and challenging for many providers to collect and submit—especially for those serving Medi-Cal patients.
To better address health equity, we need to better understand and address why certain patient populations are suffering from higher rates of illness, injury, disability and mortality, and to uncover and help close gaps and barriers in access to care.
Better data will help to address these realities, which disproportionately impact California’s communities of color and residents in rural areas. In 2017, we launched the Encounter Data Improvement Program to strengthen the collection and reporting of this data. As a result, the program is improving the health outcomes of our most vulnerable patients.
The Encounter Data Improvement Program is grounded in evidence-based research to inform solutions that can remedy our fragmented data infrastructure. Health Net has worked with providers on the ground to understand the barriers they face in data collection, which range from outdated technology to insufficient staff capacity, and has piloted strategies to overcome them. We’ve also convened high-level representatives from hospitals, health plans, local government, data clearinghouses and other parties to review research, discuss new strategies and provide recommendations for improvement.
Across this multi-year collaborative process, one solution became clear: the need for a more unified effort to clarify, standardize and monitor the collection and reporting of encounter data statewide.
In March, this effort shifted into action. Health Net contracted with the Integrated Healthcare Association (IHA) to act as a governance entity to monitor, implement and standardize encounter data improvement efforts statewide. This first-of-its-kind investment will ensure we stay focused on improving the collection of accurate patient health data, and that we have a singular entity that providers, plans and stakeholders can rely on to implement improvement efforts, oversee systemwide changes and troubleshoot a highly fragmented system.
There is no magic solution that will fix this overnight—but the creation of this new role and this significant investment represent another step forward to bridge the divide in access and quality of care for our most traditionally underserved patients. We also know that changes to encounter data collection should not stop with Medi-Cal. To drive more equitable and affordable care, we must apply these solutions industrywide to continue innovating and advancing our health care delivery system to better serve all Californians. Data is, and will continue to be, one key piece of the puzzle.
Brian Ternan is president and CEO of California Health & Wellness and Health Net of California, one of the state’s longest-serving and most experienced managed care plans.
Mary Watanabe is director of the California Department of Managed Health Care, the state’s largest regulator of health plans.
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