Jeff Geier, Cyber Security Leader at Pivotalogic
California’s bold new CalAIM Medicaid transformation program is restructuring what partnership for health looks like across the state. With a goal of better-integrating healthcare and social services for our most vulnerable residents, many eyes are turning toward local community-based organizations (CBOs) as a critical component of that evolution and investment in health equity. However, traditional health privacy, security infrastructure, and regulatory requirements, like HIPAA and HITRUST, require capacity building for most of these new but crucial community partnerships.
As healthcare leaders, let’s talk about how best to support our local CBOs in participating in this opportunity without totally derailing their existing operations.
What kinds of CBOs are being talked about?
The California Department of Health Care Services provides examples of CBOs such as “housing agencies, medically tailored meal providers, and sobering centers” that are already providing care central to Medi-Cal’s (Medicaid’s) goals but aren’t used to working with health plans on reimbursement or sharing data with medical providers.
Organizations such as those that address the behavioral health needs of older adults and their families are strong candidates for participation. This includes dementia care and mental health support as well as early childhood development programs. These organizations are powerfully rooted in their communities, with authentic connections to language and culture as well as the local healthcare landscape.
Why Healthcare Leaders Should Help Advocate for CBOs
Supporting CBOs plays a vital role in strengthening the overall healthcare system and enhancing community well-being. Essential partners in delivering a wide range of services and addressing social drivers of health, these organizations play a crucial role in meeting the basic needs of vulnerable populations, ensuring that individuals have access to safe living conditions and adequate nutrition. This support not only improves overall health outcomes but also contributes to the stability and well-being of the community. Strengthening CBOs ensures they have the necessary resources and infrastructure to accommodate increased referrals from healthcare providers; a well-supported organization can respond effectively, reducing wait times and improving the quality of care for patients.
Furthermore, supporting CBOs fosters stronger partnerships between healthcare providers and community organizations. By integrating medical and social care, the full spectrum of a patient’s needs can be better addressed, leading to a more effective healthcare ecosystem. Investing in the privacy and security infrastructure of CBOs to help them safeguard sensitive information such as patient (client) data from cyber threats is also important, not only to protect the CBOs but also to reduce the risk of breaches that could extend to your own healthcare systems.
Building Momentum
Where do we go from here? To truly build momentum, we need to consider these foundational activities for successful community transformation and Medi-Cal redesign: build awareness, actively listen, and provide help. Time and time again, we see a welcoming of social services partnerships into the healthcare delivery fold without true collaboration and reengineering of service delivery on both sides of the house. Instead of folding social services into existing healthcare delivery, we need to consider how to achieve success by breaking the mold and forging new partnerships. A few ways we can get there include:
Building Awareness — Many CBOs don’t yet know about these new CalAIM programs that could potentially help them grow their capacity. Many don’t consider themselves to be a part of the healthcare landscape at all. State and county leaders are reaching out, hosting webinars, and posting information to encourage enrollment. Hearing from peers in their communities will also be key. Local health plans, public health agencies, hospitals, and clinics can help spread the word and ensure that valuable programs they work with have a chance to participate. Listening — Large healthcare organizations such as Anthem Blue Cross of California have been conducting “listening tours” of CBOs in the state to learn more about what they want and need from participating in CalAIM programs. These listening sessions are powerful examples of “user-centered design” in action, both in helping to build increased awareness and to shape outreach program details to be as effective as possible. Concerns from CBOs about the difficulty of enrolling, qualifying, earning HITECH certification, and managing the reimbursement process have directly led to new support efforts designed to help make it work. Providing Help — Part of CalAIM’s design is the “Providing Access and Transforming Health” (PATH) program, a $1.8 billion five-year initiative to help CBOs and others in the health and social care landscape participate. Resources such as security assessments, expert consultants, additional staff, billing systems, and data exchange capabilities are all available to CBOs interested in participating in CalAIM.This initiative presents a great opportunity for CBOs, which often lack the resources and expertise to undertake such comprehensive initiatives on their own. To ensure compliance with HITECH and HITRUST standards, CBOs can follow a structured process that includes obtaining HITRUST certification. This process, which is fully funded under the PATH program, involves several phases: an initial third-party assessment, remediation of identified issues, and final certification. Depending on the CBO’s current state, this process can take several months to a few years. Healthcare leaders can further support this transformation by encouraging CBOs to begin planning early for these infrastructure changes and serve as mentors and advocates for CBOs during their journey.
Looking to the Future
By supporting CBOs in expanding their roles within their communities, imagine a future healthcare landscape where these organizations are deeply connected with the latest technologies and well-funded in their work serving traditionally marginalized, underserved, and underrepresented populations. This would result in healthier communities, with clinicians and social workers better equipped to connect vulnerable patients to vital resources. The collaboration between healthcare and social services could lead to a brighter future for our state. Realizing this vision is a significant undertaking that requires substantial changes in funding, technology, and policy, but it is undoubtedly a worthwhile endeavor.
About Jeff Geier
Jeff Geier is a cybersecurity leader at Pivotalogic, a security consulting firm dedicated to helping health and social care organizations enhance their security infrastructure. As a trusted partner of Intrepid Ascent, Pivotalogic plays a key role in Medicaid transformation projects, bringing expert cybersecurity guidance to the forefront of healthcare innovation.
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