New technology solutions do not necessarily fix old problems. Conversely, not every technology platform keeps up with the operational needs of organizations when policies or programs change. As communities and participants in CalAIM begin to confront the realities of providing, managing, and coordinating Enhanced Case Management (ECM) and Community Supports services they are increasingly asking themselves (and their community partners) questions like:

• • Is there a more efficient process (for things like generating claims for non-medical services, or consolidating SDOH information for reporting purposes)?
  • Can we get data from other organizations on common clients (especially important for broad coordination services for complex patients by ECM providers)?
  • Do we need a new technology solution, do we need multiple solutions?
  • How do we pick the solution that is right for us?
  • How do we pick a scalable, sustainable solution that isn’t just going to take us to next year or solve a single problem?

Large organizations, such as health plans, hospitals, or community clinics, may have dedicated IT teams or project managers available to discover requirements and manage process change. However, many organizations that provide health and social services are resourced challenged and are burdened with frequent staff turnover and IT resources that may be more attuned to solving clinical workflow problems rather than considering broad community-wide strategic data sharing circumstances; making it difficult to identify organizational needs and manage change internally, let alone in the context of a community-wide CalAIM service delivery system.

Understanding this resource gap, the Department of Health Care Services (DHCS) launched the Providing Access and Transforming Health (PATH) Technical Assistance (TA) Marketplace. This hub serves a critical role in CalAIM, providing the ability to navigate and connect CBOs and other CalAIM stakeholders to subject matter experts that can supplement their team and identify sustainable technology solutions–whether a simple integration or the procurement of an ecosystem of solutions.

Intrepid Ascent’s Technology Strategy Group has engineered several solutions that can be delivered in a traditional consulting model or purchased as an ‘off the shelf’ solution, where the organization completes online assessments, and a series of products are customized for the organization to review and submit to vendors.

Our process leverages a vast data lake of user interviews, procurements, and client implementations. In our Technology Gap Assessment, users at every level of the organization can access our on-demand technology tools and answer questions suited for their level of technology familiarity. The conditional based tool allows users to answer questions which then are translated into technical needs. These needs are compared to other organizational respondents to identify likely gaps.

Once a report has been generated, an organization may choose to pursue some of the provided recommendations. These recommendations could be around existing workflow changes, but more likely an integration or procurement.

Intrepid’s Technology Strategy Group has developed follow on technology tools for integrations and procurements meant to be used as a subsequent process following a gap assessment or for organizations that have already identified a need for one of the two products:

Technology Integration Discovery and Specifications Development: Integrations can be particularly challenging because they are usually done between different vendors and require an ability to translate data needs into a common data format used between the two organizations. Furthermore, a very common scenario under CalAIM is the need for integration between a HIPAA covered entity and a non-HIPAA covered Community Based Organization (CBO), which could involve a very secure, complex EHR establishing an exchange with a nonclinical coordination platform or a community repository of information critical to providing core CalAIM services – like a local Housing Information Management System (HMIS). Intrepid has developed an online tool that enables users to identify their business cases and receive an output of technical specifications for vendor guidance.

Technology Procurement: Procurements for new technology solutions, especially when a given technology sector is still emerging, are always tricky; often relying on staff with limited experience in procurements to make decisions that ultimately lock the organization into a solution for years. Furthermore, the question is always asked, “What solutions are out there?” Even with the Internet at our fingertips, it can be hard to find technology solutions that are the right fit for your business operations. Intrepid Ascent has developed an online procurement tool intended to be used through a facilitated procurement management process allowing for everything to happen in our cloud-based portal solution. If an organization doesn’t already have a vendor in mind, Intrepid Ascent can help identify potential vendors and then send a link to these vendor candidates. Vendors will upload documents, answer, and ask questions all in the online portal. Upon vendor proposal submissions, evaluators receive summary reports where they can rank and score the different vendor candidates entirely online. The culmination of this guided procurement process is a decision meeting where evaluators can look at anonymized voting patterns of scoring categories by other members along with analytical breakdowns of vendor product maturity and desired feature availability.

The process is remarkably simple, enabling busy executive teams and/or broad community coalitions to make informed decisions quickly, but it also streamlines the process for vendors – standardizing their responses and making for an easier side-by-side evaluation.

We are excited to be part of the CalAIM PATH TA Marketplace and looking forward to meeting your team and identifying the best solutions for you!

To learn more please visit our TA Marketplace Page on our website or browse our 27 off the shelf project offerings on the TA Marketplace.

The California Advancing Innovation in Medi-Cal (CalAIM) initiative represents one of the most ambitious efforts to overhaul a state’s Medicaid program in recent memory. Just over one year into the five-year rollout, stakeholders are gearing up for the next round of implementation milestones in 2023 and beyond. This summer, one of CalAIM’s core service delivery improvements, Enhanced Care Management (ECM), will go live for new, at-risk populations (e.g., children and youth). County jails and youth correctional facilities will begin building the health technology infrastructure to deliver first-of-its-kind health and social services to individuals reentering the community. And many counties participating in CalAIM’s behavioral health initiative, the Behavioral Health Quality Improvement Program (BHQIP), will implement new electronic health record (EHR) platforms or leverage new integrations with their regional health information exchanges (HIE).

The success of these CalAIM initiatives is dependent upon robust and secure data exchange among stakeholders. Early lessons from CalAIM implementation through California’s managed care plans (MCPs) consistently demonstrated that local providers and community-based organizations (CBOs) lacked the technical and operational support to facilitate meaningful connections to critical health and social service information for CalAIM.[1]^,[2] In addition, stakeholders face a complex web of new and oftentimes conflicting state and federal regulations governing the exchange of health information and other types of sensitive data (e.g., social needs, behavioral health).

New state laws like Assembly Bill 133 (AB 133) sought to provide a safe harbor from existing California regulations for CalAIM stakeholders[3] by permitting broad exchange of health and social service records. However, AB 133 does not preempt more stringent federal rules governing the exchange of substance use disorder (SUD)[4] or Homeless Management Information System (HMIS),[5] two types of data that are crucial to painting a picture of the “whole person” within Medi-Cal’s enormous delivery system.

 Given the scope and complexity of CalAIM’s data sharing objectives, stakeholders have a growing to-do list before data is ever exchanged. There are regulations to interpret. Policies and procedures to amend. Agreements to review and revise, then review again. Readiness assessments of existing data systems and organizational practices. The list goes on.

 We learned from our early CalAIM implementation work with MCPs and community stakeholders that the available guidance from the state isn’t enough, despite the best of intentions. Many organizations may opt to err on the side of caution when it comes to data exchange, undermining the foundational goal of CalAIM: leverage cross-sector data sharing to upend the status quo for vulnerable, at-risk Californians. It’s no surprise that stakeholders need certainty as they wade into a still-evolving landscape for cross-sector data sharing.

 In February 2023, the Department of Health Care Services (DHCS) launched the Providing Access and Transforming Health (PATH) technical assistance (TA) marketplace to connect CalAIM stakeholders – CBOs, providers, county agencies – with experts who can provide critical support with implementation of ECM and community supports. Intrepid Ascent’s Policy Innovation Group (PIG) has developed 9 unique products and services for the TA marketplace specifically designed to meet the needs of CalAIM stakeholders as they establish a new data governance framework for CalAIM.

Our team of policy consultants crafted these products and services based on industry-leading experience in information privacy and data governance from real-world clients, including our recent work with Whole Person Care (WPC) and CalAIM clients. Each product or service ensures that your organization has a plan for meeting statewide data sharing requirements, while aligning with the fundamental vision for a more data-driven, whole-person centered Medicaid delivery system in California.

To learn more, visit our website or find us on the PATH TA Marketplace.

[1] HealthNet. https://www.healthnet.com/content/dam/centene/healthnet/pdfs/general/ca/hn-calaim-lessons-learned-recommendations.pdf

[2] CHCF. https://www.chcf.org/wp-content/uploads/2022/05/LaunchingCalAIM10ObservationsECMCommunitySupports.pdf

[3] See Civ. Code § 56 et seq (Confidentiality of Medical Information Act), WIC § 5000 et seq (Lanterman–Petris–Short Act), WIC § 10850.7

[4] 42 CFR Part 2. https://www.ecfr.gov/current/title-42/chapter-I/subchapter-A/part-2

[5] 24 CFR § 578.57. https://www.law.cornell.edu/cfr/text/24/578.57

Technology is only as good as how it is used.

This statement is simple, yet the process behind the use of these systems is complicated. How many of us have had a negative experience adopting new technology? How many of us have tried, and failed, to roll out a new platform within our organization? Yet technology continues to be at the center of cross-sector collaboration initiatives – such as California Advancing and Innovating Medi-Cal (CalAIM) and its predecessor Whole Person Care – and the California Data Exchange Framework (DxF) will only expand on that.

We have spent the past five years guiding more than 2,000 users through onboarding to various technology platforms, and through this, we have learned what works and what doesn’t when it comes to supporting the people-side of technology implementation and adoption. During this time, we have defined and refined Best Practices for Technology Onboarding. These concepts are baked into our onboarding approach and help to shape and define what we do.

Here are our top 3 best practices:

1. Manage Change. It’s a fact that change is a daily occurrence in our lives. We believe how we prepare and react to change strongly influences the overall outcome of a project. Our approach to change management highlights two critical points: change causes a variety of positive and negative emotional reactions, and how people respond to change matters. Our understanding of how people respond to change is what drives our approach to onboarding. We purposely segment onboarding into distinct phases to allow people to react to and understand change as the process flows

2. Identify and involve key parties in stakeholder engagement. Mapping stakeholders at all levels of the project aims to ensure all voices are represented appropriately, including quieter voices or those that historically have not been invited to the table. To do this we utilize the networks of stakeholders that already exist and ask them a series of questions, including:

– Who else is missing from the project?
– Who are the champions or key leaders that will be advocating for this project or helping to remove barriers along the way?
– Who are the people that will help implement this project, the “doers and drivers”?
– Who are the people who will be using the product, the “customers”?

We use these guiding questions to help think outside of the box to try and capture all parties that have a hand in the process. From there, we encourage visually mapping the stakeholders to understand what the connections are and how they can support each other and the implementation of the technology solution.

3. Define success for your project and monitor over time. When thinking about technology onboarding, defining success allows you to identify whether your onboarding approach is working the way you intended. For instance, your end goal might be for someone to use your system for referral purposes, but instead, you observe that users are logging in to look up demographic information. You can target additional support towards getting people to understand how to send referrals, rather than spending time supporting people logging in. It’s important to define success early so you know what you and your team should be working towards, and so you can celebrate wins as they come!

Through our work, we have refined an approach that leverages best practices for technology adoption and created a Technology Adoption Toolkit to support users at any step in the onboarding process.  The Toolkit is accompanied by a corresponding workbook for learners to practice skills, apply knowledge to personal scenarios, and help prepare for real-world application. This model follows a learn-as-you-go approach to support various learners and the individual experiences they bring to their learning journey. Our content guides those designing technology onboarding plans through the entire technology onboarding process.

Our innovative Toolkit presents tips and techniques for understanding organizational readiness for technology adoption, analyzing and revising workflows to support implementation of the new solution, and suggesting opportunities to implement continuous feedback loops and small tests of change (or PDSA cycles) throughout the process.  The Toolkit also explores different training approaches, strategies for developing engaging training content, and tips to support adoption after training.

We know implementing a technology solution is only part of the picture – getting people to use it is the hard part. Let us help you along your journey!

To view our toolkit, or more about our TA Marketplace offerings, please visit our website.

If you have seen the news that DHCS’ CalAIM PATH Technical Assistance (TA) Marketplace is live but thought you missed an opportunity, you’re in luck – it’s not too late to register and receive support with your CalAIM needs. 

PATH, which stands for Providing Access and Transforming Health, is a five-year, $1.85 billion initiative to build up the capacity and infrastructure of on-the-ground partners to successfully participate in the Medi-Cal delivery system as the state widely implements Enhanced Care Management (ECM) and Community Supports and Justice Involved services under CalAIM. The TA Marketplace is a critical component of PATH, providing funding for providers, community-based organizations, counties, and other entities to obtain technical assistance resources needed to implement ECM and Community Supports. It is a virtual marketplace for services that include both hands-on, custom support, and off-the-shelf products ready for implementation.  

How do you know if you are eligible to receive services? First, you must be an eligible recipient type, such as: 

• City, county, and other government agencies 
• Public hospitals 
• Provider organizations (health and/or behavioral health) 
• Community-Based Organizations (CBOs) 
• Justice Agencies 
• Medi-Cal Tribal Designees and Indian Health Programs 
• Others, as approved by DHCS 

Second, TA recipients must be actively contracted with Managed Care Plans (MCPs) for ECM / Community Supports. If your organization is one of the approved eligible recipient types but is not yet contracted with an MCP for ECM/Community Support, you can still apply as a TA recipient if you provide a signed attestation that you intend to contract to provide ECM / Community Supports. Alternatively, entities that are not contracted or actively engaged with a MCP may seek DHCS approval to register as a TA Recipient by sending an email to ta-marketplace@ca-path.com to request such approval.   

To shop services on the Marketplace, eligible entities must submit a TA Recipient Registration Form on the DHCS TA Marketplace website. Applicants must provide evidence of a contract(s) with managed care plans (MCPs) that provide Enhanced Care Management and/or Community Supports, intent to contract with MCPs to provide Enhanced Care Management and/or Community Supports, or approval from DHCS to register as a TA recipient. 

Once accepted, TA recipients will be able to shop for off-the-shelf TA projects or request hands-on, custom support. “Off-the-shelf” TA projects have clear, pre-established goals and defined timeframes for easy consideration. Intrepid Ascent has 27 approved off-the-shelf projects across the following Domains: 

• Domain 1: Building Data Capacity: Data Collection, Management, Sharing, and Use 
• Domain 3: Engaging in CalAIM Through Medi-Cal Managed Care 
• Domain 4: Enhanced Care Management (ECM): Strengthening Care for ECM ‘Population of Focus’ 

Eligible entities may also request hands-on, custom TA services to design and implement systems, training, and recruitment processes uniquely suited to their priorities and needs. TA goals, deliverables, and timeframes are all developed “from scratch” and are specific to the individual entity and project. 

Intrepid Ascent is an approved vendor for the PATH TA Marketplace to deliver DHCS-approved services and resources to eligible organizations at no cost to them, with DHCS directly funding our work.  You can find additional information on our expertise and the services we provide by visiting our website. To learn more, please contact calaim-ta@intrepidascent.com to set up a meeting with our team to walk you through our offerings on the Marketplace and learn how we might be able to support the needs of your organization through DHCS-funded TA.  

The seeds were planted over the past several years, some into well-plowed rows, others more optimistically tossed on seemingly fertile ground, all across the state. And now (after all this rain!) the green shoots of CalAIM have flowered like California poppies in the spring. This is not a pilot project, this is an entire landscape changing at scale. With innovations unfolding all around us, we are witnessing and we are participating in the rapid evolution of the Medi-Cal delivery ecosystem.  

The advances are many, as we move toward locally integrated service environments to support whole person care for Medi-Cal beneficiaries. With Enhanced Care Management (ECM), the personalized coordination of services across organizations and sectors represents the greatest single effort, ever, to link health care services with Community Supports (CS) addressing Social Determinants of Health. Population Health Management, launched in January, builds upon these new approaches to encompass the entire Medi-Cal beneficiary population, roughly one out of three Californians. The impact, on both individual lives and persistent social inequities, promises to be profound and is significant grounds for optimism. 

We are deeply involved in this transformation at Intrepid Ascent. Years of work with multiple Whole Person Care pilots opened our eyes to the challenges and opportunities of broad, technology-assisted coordination among care teams from health care, housing, and allied sectors. With the pivot to CalAIM’s ECM and CS, we’ve supported communities in the adoption of new technologies, policies, and workflows, and we are facilitating collaborative planning in Contra Costa and San Diego Counties for DHCS. Now, broadening to the scale of Medi-Cal, we were recently selected to offer services through the PATH TA Marketplace across the state. With 27 pre-designed Off-the-Shelf offerings in the Building Data Capacity domain (and two others), and with the flexibility to create Hands-On TA services, we’re ready to support organizations and their stakeholders as they cultivate new solutions at this moment. Please visit the TA Marketplace page on our website for additional information on Intrepid Ascent’s expertise and how we might be able to support your organization through the TA marketplace.

Dear Colleagues,

As 2022 draws to a close, both the season and the sequence of events in our field make this a time of deep reflection, anticipation, and hope. The waves of the COVID-19 pandemic have diminished in force and regularity. Hospitals, clinics, and public health departments have begun to emerge from crisis mode to survey the wreckage, to appreciate institutions that held the line, and to consider opportunities to rebuild in new ways. The disparities spotlighted by the pandemic are adding policy-making momentum to integrate health care with allied fields, such as social services and housing, to address the social determinants of health and structural racism. Billions of dollars will flow into the Medicaid delivery system alone linked to related models and initiatives.

Just as importantly, we’ve begun to come together in person again to advance this work. Last week I attended the annual conference of the California Association of Public Hospitals / Safety Net Institute (CAPH/SNI) with several hundred companions. The positive in-person vibes and feedback loops flowed from the podium to the dance floor, which was hopping. And the commitment in the room to a robust public health care infrastructure was infectious and inspiring: check out these videos on award-winning health systems for advancing high quality equitable care in 2022. Several of these efforts incorporate technology tools in new and promising ways, such as linking clinic patients with healthy food delivery (Santa Clara County) and proactively engaging populations to improve health outcomes (Contra Costa County). At Intrepid, we are delighted to be supporting the overall award-winner – Alameda Health System’s BElovedBIRTH Black Centering – to onboard to a public health case management system.

Intrepid took several steps in 2022 that broadened our horizons and positioned us to journey further with our clients in 2023:

• Early this year we created three consulting groups – Technology Strategy, Policy Innovation, and Community Change – and have continued to hire talented, passionate people to our team  
• We published a series of “Data Exchange Explainers” with the California Health Care Foundation to inform policy-making for the state’s Data Exchange Framework, honing our abilities to translate complex topics to broader audiences
• We supported multiple communities in the adoption of technology for collaboration across sectors, from planning to implementation to training and workflow redesign, increasingly in the context of CalAIM goals to transform the Medi-Cal delivery system
• We expanded our work with public health as it emerges from the pandemic, beginning with the case management system in Alameda County mentioned above, but also with other public health departments building data integrations with health care delivery partners; and we facilitated a multi-region initiative on approaches to addressing congenital syphilis
• We also broadened our work in the behavioral health arena, assisting multiple behavioral health entities to advance their technology and policy infrastructure for data sharing
• We actively monitored New York’s proposed 1115 Medicaid Waiver program, engaging in conversations with colleagues throughout the state, as we adapt our services for California’s 1115 Whole Person Care Program and CalAIM initiative to the emerging New York environment; and
• We prepared new ways for clients to access our expertise, with significant investment in developing toolkits, off-the-shelf resources, and technology-assisted services that will become available in 2023.

We are grateful for the opportunity to participate with you in this transformative moment and look forward to joining forces next year. In the meantime, I hope that all of you are able to slow down, to settle into the changing season, to reflect, and to gather in warmth with family and friends.

See you next year,

-Mark