California’s CalAIM program is all about making healthcare more effective, and Enhanced Care Management (ECM) plays a key role in that. ECM services are designed to help individuals with complex health needs by delivering and coordinating comprehensive care. These services help improve overall health while also reducing unnecessary hospitalizations and emergency department visits, ultimately helping Medi-Cal better serve its patient base. While ECM is already a powerful service, the integration and adoption of data sharing into existing workflows will further enable it to reach its full potential.
The Role of Data in ECM Success
To understand why data sharing is so critical to ECM providers, it is essential to first understand its role in ECM services. ECM provides a range of services that extend beyond traditional healthcare to ensure that patients receive the right care at the right time. This includes following up with patients post-hospitalization on their care needs, coordinating visits with care providers including patient transportation, helping patients get housing, or ensuring their existing homes are equipped with necessary modifications, like ramps or handrails, to prevent accidents.
Many of these non-medical services require medical data to justify their need and approval by payors. For example, a service provider offering transportation might need physician notes indicating the patient’s mobility issues, or an organization providing home modifications might require documentation showing the patient’s risk of falls. This is where data exchanged by Qualified Health Information Organizations (QHIOs) comes into play.
Data sharing across these platforms ensures that both medical and non-medical providers can access the information they need to provide the right services at the right time. Without the appropriate data in the hands of those who can assist the patient, these essential support services might be delayed or even denied while providers try to connect and share information through email, fax, or other methods, ultimately impacting patient care delivery and satisfaction.
How Providers Leverage LANES to Support ECM
In the greater Los Angeles area and beyond, LANES plays a significant role in facilitating ECM by ensuring that healthcare providers and community-based organizations (CBOs) have access to the medical data required for their services. LANES supports Medi-Cal patients both within and outside of L.A. County, with a focus on those in the county’s Department of Health Services (DHS) and Department of Mental Health (DMH) systems, and community hospital systems like Alta/Prospect, which care for a significant portion of the county’s vulnerable population. LANES maintains access to a vast amount of data, including physician notes and historical demographics, which are vital for ECM providers. Physician notes are essential for determining and supporting a patient’s specific needs, and historical demographics help providers understand a patient’s background, improving their ability to reach and serve them effectively. The strength of LANES lies in its ability to connect this clinical data with non-clinical community support services, allowing for a more holistic approach to patient care.
LANES also helps primary care ECM providers track eligible and enrolled ECM patients, streamlining the eligibility process to help close or eliminate gaps in care. On-location indicators and ADT notifications help providers identify and connect with patients either live or immediately after hospitalizations and ED visits. LANES’ service utilization reports additionally support a data-driven approach to help organizations close care gaps.
For example, LANES assists hospitals and integrated health systems in transitions of care for difficult-to-manage and costly patient outliers. One example that highlights this collaborative work is a use case between Alta/Prospect Coordinated Regional Care (CRC) Group and Partners in Care Foundation (PICF), a large CBO, to improve care coordination of patients who are high ED utilizers through the use of LANES data and community support services provided by PICF. With patient rosters created on LANES, the Alta hospital team achieved 17% improvement (reduction) in the unique number of patient visits to ED and a 30% improvement (reduction) in the unique number of patient visits to inpatient settings across all of Alta/Prospect hospital’s rosters using LANES and in coordination with PICF from June to September 2024.
Why Data Sharing is Crucial for ECM Providers and Services
For ECM providers, LANES is not just a repository of medical information; it acts as a connector and a collaborative platform between healthcare providers, CBOs, and other support organizations. This collaboration enables ECM providers to offer enhanced services more efficiently, saving time and money while improving patient health outcomes.
Without proper data sharing, the coordination between medical and non-medical providers would be fragmented and time-consuming. A patient might receive medical treatment but lack access to the social and community supports that are necessary to maintain their health. Without access to a patient’s medical history, a community-based organization might not be able to justify providing services like transportation or home modifications, even though those services could prevent a costly emergency room visit or hospital stay.
Moreover, sharing data helps ensure that services are appropriately targeted and justified. It allows providers to offer the right kind of support based on the patient’s actual needs, reducing the risk of unnecessary or duplicate services.
Continuing to Advance Better Health Outcomes
The success of ECM depends on effective data sharing between healthcare providers and community support organizations. ECM strives to deliver holistic care for individuals with complex needs, but this is only possible when everyone involved has access to the right information.
LANES offers the infrastructure needed to facilitate this data sharing, ensuring that ECM providers have access to the clinical data required to provide essential services. By connecting medical and non-medical data, these platforms help create a seamless ecosystem where patients can receive the comprehensive care they need to stay healthy, avoid unnecessary hospital visits, and ultimately improve their quality of life.
And, this work continues to expand. LANES is currently developing and supporting a closed-loop referral system that reflects and includes county jail health records, substance use data, and social determinants of health data. In short, data sharing is not just a technical necessity—it’s a foundational element of how ECM can deliver on its promise to create better health outcomes for vulnerable populations. Without it, the whole system would be less efficient, less targeted, and less effective.
Learn more about LANES ECM support.
