Health Net Invests $26 Million to Oversee, Monitor and Implement Encounter Data Improvement Efforts Across California
First-of-its-Kind Investment Will Standardize and Enhance Collection of Patient Data, Provide Insights on Population Health Trends and Increase Quality of Care
Sacramento, Calif. — Health Net, one of California's most experienced managed care plans, announced today a $26 million investment to improve the collection and reporting of patient encounter data — furthering its commitment and partnership with the state to reduce disparities and improve quality of care for vulnerable populations in California. With more than 13 million, or nearly one in three Californians, currently enrolled in Medi-Cal, this initiative is a key to understanding how underserved communities are navigating and accessing care statewide.
Health Net has committed a total of $50 million to fund a multi-year, multi-phased Encounter Data Improvement Program (EDIP). Envisioned and developed in collaboration with the Department of Managed Health Care (DMHC), the program is designed to identify and overcome barriers to the timely submission of complete and accurate patient health data across business lines — with an initial focus on the state's Medi-Cal providers.
"To continue to improve the state's Medi-Cal delivery system and bridge the divide in access and quality of health care, we need accurate population health data and the insights that come with it," said Brian Ternan, President and CEO of Health Net. "Through our improvement program, Health Net has collaborated with numerous stakeholders — including regulators, providers and plans — to identify challenges to encounter data collection and inform real solutions. Establishing a new, statewide entity to oversee how this crucial data is accumulated, reported and utilized arose as a clear recommendation we are proud to make a reality."
Today, Health Net announced it has selected the Integrated Healthcare Association (IHA), a non-profit with over 25 years of experience in health care and proven expertise in aligning the industry to create solutions for better care, to oversee, monitor and implement encounter data improvement efforts across California. IHA was selected after the issuance of a statewide RFP, securing a $26 million grant out of Health Net's total $50 million budget for this initiative — an unprecedented investment to tackle this systemwide challenge that has impacted providers, patients and plans.
Providers collect encounter data during each patient visit or interaction within the health care system, which serves as a record of patient conditions and services and is then submitted to managed care organizations for reimbursement. This information helps track health care quality and costs, monitors population health trends and identifies deficiencies or gaps in care. However, encounter data has been historically fragmented and inconsistent due to the complexity, administrative burden and a lack of standardization in reporting requirements. This lack of accurate, timely data can influence quality metrics and misrepresent how Medi-Cal patients are accessing care.
IHA will work alongside a Board of Directors comprised of industry leaders from public agencies, health plans, hospitals, community clinics and health providers with clear priorities to:
- Establish a statewide governance body to develop and organize policies, standards and processes;
- Develop standardized systems and coding for data submissions and reporting; and
- Develop encounter data trainings, technology support and technical assistance programs for providers and staff.
"This investment in California's health care delivery system will lead to improvements in the overall quality of care and affordability of health care," said Mary Watanabe, Director of the Department of Managed Health Care. "Complete, timely and accurate encounter data is critical to assessing population health, ensuring health equity and ultimately to understanding health care costs. I am looking forward to seeing the real-world solutions brought on by this industry-led collaboration."
Prior to today's announcement, Health Net's EDIP has made key investments to strengthen California's encounter data infrastructure, including:
- Market Assessment: An initial market assessment to identify what blend of investments would maximize improvement of encounter data submissions in California.
- Provider-Level Grants: A two phased provider-level grant program – phase 1 awarded grants to 19 Medi-Cal managed care providers to assess their encounter data submission processes and phase 2 provided funding to implement and evaluate subsequent improvement plans.
- Multi-Stakeholder Engagement Process: Convened and hosted two Encounter Data Summits with over 120 high-level, health care stakeholders to determine the best course of action for improving data collection through industrywide collaboration.
"Reliable and accurate encounter data will provide us important insights into patient care and emerging population health trends," said Will Lightbourne, Director of the Department of Health Care Services. "Health Net's investment is designed to remedy a fragmented system and directly supports the Department's priorities outlined in CalAIM – to implement innovations that drive higher-quality outcomes for Medi-Cal patients."
Throughout Health Net's provider and stakeholder engagement process, one uniform, actionable solution became clear: establishing a non-profit organization to be charged with implementing, overseeing, coordinating and monitoring encounter data improvement initiatives across California to standardize the approach.
"We are excited to collaborate with leaders from Health Net and other industry partners to improve the collection and utilization of encounter data across all lines of business, with a specific emphasis on Medi-Cal," said Jeff Rideout, M.D., President and CEO of IHA. "IHA's mission is exclusively about finding industry wide solutions to complex data problems that can't easily be solved by even the largest individual organizations. There is no question that solving the statewide encounter data challenges is a necessary condition to ensuring greater health equity and affordability in California."
About Health Net:
At Health Net, we believe every person deserves a safety net for their health, regardless of age, income, employment status or current state of health. Founded 40 years ago, we remain dedicated to transforming the health of our community, one person at a time. Today, Health Net's 3,000 employees and 85,000 network providers serve more than 3 million members. That's nearly 1 in 12 Californians. We provide health plans for individuals, families, businesses of every size, people with Medicare and people with Medi-Cal — Coverage for Every Stage of Life™. Health Net also offer access to substance abuse programs, behavioral health services, employee assistance programs and managed health care products related to prescription drugs. We offer these health plans and services through Health Net, LLC and its subsidiaries: Health Net of California, Inc., Health Net Life Insurance Company and Health Net Community Solutions, Inc. These entities are wholly owned subsidiaries of Centene Corporation (NYSE: CNC), a Fortune 100 company providing health coverage to more than 20 million Americans. For more information, visit Health Net.
About Integrated Healthcare Association:
At Integrated Healthcare Association (IHA), we bring the health care community together to overcome barriers to high-value care. For over 25 years, we've championed a more integrated care system that improves quality and affordability for patients in California and beyond. As a non-profit business league, we're funded by the health care industry to make the system work better for everyone. We do this work because we envision a future where providers can focus on delivering care. Health plans can focus on serving their customers. Purchasers can feel confident they're getting the most value for their money. And where patients can ultimately get the best possible care at an affordable price. For more information, visit Iha.