Crossing the Aisle: Creating Unlikely Data Partnerships to Better Serve Medically Complex Patients

Medically complex patients consume a disproportionate share of healthcare resources, yet often experience substandard outcomes. Patient care can be further impacted by the complex relationships between health plans and healthcare delivery systems. Partnership HealthPlan of California dispelled the common mythology of plan-health center relationships to form deep and lasting partnerships with health centers, with the goal of improving care for medically complex patients, while also improving patient experience and reducing costs. Leveraging a state-wide care coordination initiative out of the Pacific Business Group on Health, called the Intensive Outpatient Care Program, the health plan and health centers jointly built a regional care coordination program, developing a technological infrastructure, and sharing analytics on program and patient data across healthcare settings._x000D_
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This session addresses the shared experience between Partnership HealthPlan and Santa Rosa Community Health Centers, focusing on the program evolution, impact of funding changes, and critical technology and data elements pivotal to program success. Presenters will also address the lack of consistent payment models for care coordination services, despite demonstrated utilization reduction and improve outcomes for participating patients.

• Identify critical data elements and systems for engaging and tracking medically complex patients.
• Identify strategies to engage health plan and other community partners in improving outcomes for the medically complex population.
• Define current payment mechanisms for care coordination of medically complex patients.