BACKGROUND
L.A. Care Health Plan is the largest health plan in Los Angeles County, serving more than one of every four Angelenos. It is also the largest publicly operated plan in the country. As a public entity, L.A. Care’s mission is to provide access to quality health care for L.A. County’s low-income communities, and to support the safety net required to achieve that purpose. Since 2018, L.A. Care has worked with its data-sharing partner, the qualified health information organization (QHIO) Los Angeles Network for Enhanced Services (LANES), to ensure member information is exchanged at the time of need, but is still protected and secure.
CHALLENGE
In May 2020, the Centers for Medicare & Medicaid Services (CMS) published the Interoperability and Patient Access Final Rule, which puts patients first by mandating that health plans make data available to patients and providers using Fast Healthcare Interoperability Resources (FHIR) standards. As the largest publicly operated health plan in the country, L.A. Care not only wanted to ensure compliance with the new CMS rule but also ensure seamless data exchange among providers and payers to improve patient health outcomes. This required a strategic shift toward adopting FHIR standards and integrating them into its existing systems.
THE SOLUTION
Upon recognizing the value of FHIR as an opportunity to address silos in health information sharing, L.A. Care embraced this standard for data exchange in its strategic long-term plan and as part of its work with LANES. As L.A. Care prioritizes quality, access, and inclusion, elevating health care for all of L.A. County, its goal through FHIR implementation was to make patient information available at the point of care for providers and improve downstream applications such as transitions of care, Enhanced Care Management (ECM) delivery, and population risk stratification.
To achieve these goals, L.A. Care is working with LANES to integrate FHIR standards into its systems, enabling real-time data exchange and improved workflows. Because the LANES platform already had a fully managed, enterprise-scale Google Cloud Healthcare API, including support for Health Level Seven International Version 2 (HL7v2), Fast Healthcare Interoperability Resource (FHIR), and analytics in BigQuery, it was a seamless implementation process for the L.A. Care team.
L.A. Care is using FHIR to feed data into downstream applications, such as the health plan’s risk stratification tool, which is helping categorize members based on their health risks. This is allowing L.A. Care’s care management team to target high-risk members for outreach and coordination of care, improving efficiency and outcomes. By partnering with LANES and collaborating on best practices, L.A. Care is able to seamlessly implement FHIR standards to enhance its operations and ultimately improve how providers access information.
LANES’ enhanced processing capacity, which turns data into actionable information, is critical to L.A. Care’s Medi-Cal population and Enhanced Care Management (ECM) providers. L.A. Care’s FHIR implementation will also support CalAIM, the long-term commitment to transform Medi-Cal, making the program more equitable, coordinated, and person-centered to help people maximize their health and life trajectory. The success of CalAIM will be a model for transformation of the entire health care sector – clinical, behavioral, and social service organizations will be processing a growing volume of patient documents through the LANES collaborative platform. LANES’ FHIR native data repository also allows its participants, including L.A. Care, to serve as a data resource for CalAIM-required use cases and develop applications more rapidly and at a lower cost.
THE RESULTS
By implementing FHIR standards, L.A. Care is making progress toward streamlining data exchange, helping reduce nurse hours spent on searching for patient information, and improving care coordination. Moving forward, the implementation of FHIR will allow L.A. Care to build interfaces with other entities more quickly and efficiently, particularly as FHIR increasingly becomes adopted as the standard for data exchange in the healthcare industry.
L.A. Care plans to continue to expand its use of FHIR to communicate with a broader range of entities. The organization sees FHIR as a key enabler for faster, more nimble data exchange, allowing different systems to communicate harmoniously. This approach will help L.A. Care stay ahead in the ever-evolving landscape of healthcare interoperability and continue to provide access to quality health care for L.A. County’s low-income communities.
“FHIR helps us achieve our goal of making relevant information available right at the point of care for our providers. It also helps contribute information to downstream applications that better support transitions of care, ECM, and risk stratification in a much more nimble way and real-time.”
– Tom Schwaninger
Senior Executive Advisor, Digital Interoperability for L.A. Care Health Plan
