All Posts by Debjit Bhattacharyya

Are you ready for CalAIM?

Are you ready for CalAIM?

Photo by Monkey Business Images on Shutterstock

What is CalAIM?

CalAIM – California Advancing and Innovation Medi-cal, is a multi-year program by the Department of Health Care Services (DHCS) designed to enhance the quality of life and health impacts on the population. CalAIM was built on the successful results from prior pilots (such as Whole Person Care Pilots (WPC), Health Homes Program (HHP) and Coordinated Care Initiative) and was created to reform Medi-Cal by implementing broad delivery system, program and payment improvements across the program. [1]

CalAIM has three fundamental objectives:
  • Using whole person care approaches to identify and manage member risk and need, as well as addressing Social Determinants of Health
  • Reducing complexity and increasing flexibility by shifting Medi-cal to a more stable system
  • Enhancing quality outcomes, reduce health disparities, and modify the delivery system by using value-based initiatives, updating systems, and payment reform

For a more detailed explanation of what CalAIM entails, see 2021 CalAIM Proposal Review and CalAIM Executive Summary and Summary of Changes.

CalAIM Changes and Updates

CalAIM’s implementation was delayed due to the COVID-19 public health emergency, but is now set for execution on January 1, 2022. So, are you ready?

CalAIM is made of a variety of components, each to be released subject to their own timeline: [2]

  • 2022: New Enhanced Care Management (ECM) benefit and In Lieu of Services (ILOS)
  • 2022: Major Organ Transplant (MOT) benefit carved into Managed Care
  • 2022: Update medical necessity criteria for specialty mental health services (SMHS) to improve access
  • 2023: Long Term Care (LTC) benefits carved into Managed Care
  • 2023: Dual Special Need Program (DSNP) Aligned Managed Care enrollment in CCI Counties
    • 2025: Aligned Managed Care enrollment in non-CCI Counties
  • 2023: Population Health Management (PHM) strategy
  • 2026: NCQA accreditation for Medi-Cal MCPS and subcontractors
  • 2027: Statewide Managed Long Term Services & Supports (MLTSS)

Two foundational pillars of CalAIM are Enhanced Care Management (ECM) and In Lieu of Services (ILOS). Both of these reforms are set to be implemented at the beginning of January, 2022. ECM refers to a whole-person approach to comprehensive care management that addresses clinical and non-clinical needs. ILOS are medically appropriate and cost-effective alternatives to state plan services. ILOS are optional services to provide for Medical Managed Care Plans (MCPs) and optional for managed care members. [3] 

A significant terminology change through revised ECM implementation is ‘Target Population’ to ‘Populations of Focus’. This term is defined in the finalized ECM Key Design Implementation Decisions, “To promote health equity, adhering to the guiding principle of using person-centered language whenever possible, “Populations of Focus” instead or “Target populations” will be used to describe the Members who are eligible to receive ECM.” [4]
For more information regarding ECM and ILOS requirements, implementation, and more, see Enhanced Care Management and In Lieu of Services.

Case Management and Care at ARW

At ARW, we are eager and getting ready for the implementation of CalAIM. Our Case Management (CM) showcases how Cozeva works as a trusted channel of communication between your patients, providers and care team to proactively manage your patient population. CM focuses on the social needs of a person and questions how your organization is managing the patient individually – this relies on a whole-person, comprehensive approach to care.

Cozeva Care is Care Management and CM for whole person care, this speaks on how to manage a population geographically, such as population management assessments.

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SCAN Health Plan Announcement

SCAN Health Plan Announcement

Fremont, CA — September 8, 2021 — Applied Research Works, Inc. (cozeva.com) congratulates our top performing California Medical Groups based on SCAN health plan’s quality metrics!

Based on SCAN’s internal quality metrics, several of Cozeva’s medical group clients were among the top 15 performers for care and service. We are thrilled to partner with these medical groups as they continue to deliver high quality care to their patients, especially during this challenging year.

The following Cozeva clients were recognized by SCAN Health Plan:

  • MemorialCare Medical Foundation
  • Monarch Healthcare Optum
  • Optum
  • Scripps Health Plan Services, Inc.
  • St. Joseph Heritage Healthcare
  • Torrance Memorial IPA
  • Primary Care Associates Medical Group
  • Axminster Medical Group
  • PIH Health Physicians

SCAN’s internal quality metrics focus on preventive screenings, treatment of chronic conditions, and appropriate documentation to ensure patients get the care they need to remain healthy and independent. This past year has been extremely challenging for the healthcare industry and we want to recognize the hard work of all these medical groups. For the full article, please visit SCAN’s press room.

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MY2021 AMP Measure Certification

MY2021 AMP Measure Certification

ARW-COZEVA has successfully completed MY 2021 AMP measure certification as well as beta testing for another consecutive year! We ensure that our clients’ AMP submissions are done with the most up-to-date measure logic. 

 

Congratulations to Team COZEVA for this accomplishment and getting it done so quickly!

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NCQA Launches New Program to Help Ensure Accuracy of Clinical Data for Quality Reporting

NCQA Launches New Program to Help Ensure Accuracy of Clinical Data for Quality Reporting

Data Aggregator Validation Program Evaluates How Organizations Ingest, Manage and Output Clinical Data

Press Release - August 5, 2021

WASHINGTON—NCQA has launched its new Data Aggregator Validation program, which helps ensure the validity of clinical data used for quality reporting and other initiatives.


The program enables more data and more data sources to be trusted, useful, and comparable, resulting in decreased burden, more streamlined processes between healthcare segments and improved care quality.


NCQA’s Data Aggregator Validation program evaluates the ingestion, transformation and output of clinical data to support data integrity. This gives health plans, government entities and care delivery organizations confidence in the validity of the clinical data they are using for quality reporting, value-based contracting, closing gaps in care and other initiatives.


“We invested heavily over the past two decades to digitize clinical data in this country, and we aren’t yet getting full value from that investment because the data are inconsistent, incomplete and unvalidated,” said Brad Ryan, MD, Chief Product Officer of NCQA. “NCQA’s Data Aggregator Validation program brings trust, comparability and utility to clinical data streams for use in HEDIS and beyond.”


The program also saves organizations time and money as part of the Healthcare Effectiveness Data and Information Set (HEDIS®) reporting process. Data from health information exchanges, care delivery organizations and other data aggregators are increasingly used as supplemental data for HEDIS reporting. Data streams validated by NCQA through the NCQA Data Aggregator Validation program can be used as standard supplemental data in HEDIS reporting, eliminating the need for primary source verification during the HEDIS audit process and saving time and money for provider organizations and health plans.


Four organizations had data streams validated as part of the pilot and early adopter programs: Hixny, HealtheConnections, HEALTHeLINK and Manifest MedEx.


Rob Hack, President and CEO, HealtheConnections, said, “The Data Aggregator Validation program is important to HealtheConnections and our participants, particularly clinical practices and health plans, because it provides real value in support of our ongoing work in quality measurement. Additionally, the program demonstrates HealtheConnections’ commitment to data quality, data governance and process that expands beyond the realm of quality measurement.”


NCQA is validating data streams through a series of cohorts. The first began in July and included data streams from the four organizations mentioned above, as well as new participants Azara Healthcare LLC, COZEVA® by Applied Research Works, Inc., CyncHealth, Diameter Health, Healthix, HealthShare Exchange, Kansas Health Information Network, Inc. d/b/a KONZA, KPI Ninja, Los Angeles Network for Enhanced Services (LANES), Stellar Health and the Wisconsin Statewide Health Information Network (WISHIN).


“We are proud to partner with NCQA in leading this important transformation effort to streamline data sharing and provide high-quality data for health plans and providers,” said Claudia Williams, CEO of Manifest MedEx. “Reducing the burden of HEDIS reporting enables plans and providers to focus on what matters most—caring for patients and their communities.”


This program is part of a broader initiative at NCQA to help make quality measurement easier, more trusted and more relevant. NCQA is partnering with QMetrics to validate data streams in two cohorts in 2021. More than 40 organizations have already requested to apply to the program. The first data streams will begin earning validation this fall. To learn more, contact NCQA to speak to a program expert


About NCQA


NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations. It also Recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make informed health care choices. NCQA can also be found at Twitter @ncqa, on Facebook at facebook.com/NCQA.org/ and on LinkedIn at linkedin.com/company/ncqa

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

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Internship

ARW USA Internships Applied Research Works' internships are intended to be an exercise in matchmaking and mutual learning.  Through hands-on projects, interns learn about the world of health economics, data…

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Clinic Relations Manager (CRM)

Clinic Relations Manager (CRM) Positions Available: Clinic Relations Managers Location: Kolkata, India Salary: Competitive and based on Qualification & Experience The Clinic Relations Manager (CRM) will be responsible for initiating…

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Addressing LGBTQ Barriers to Healthcare​

Addressing LGBTQ Barriers to Healthcare

Barriers to care for LGBTQ communities have a great impact on an individual’s overall wellbeing. The American Psychological Association has defined the term ‘minority stress’ to describe a person experiencing a weight against their own self worth and in their social environment. Data shows that LGBTQ youth are 2-3 times more likely to attempt suicide and are more likely to be homeless. Data also shows that lesbians are less likely to seek preventative services for cancer, gay men are at a higher risk of HIV and other STDs and, elderly LGBTQ individuals face many barriers to health due to isolation and a lack of social services.[1]
The barrier we want to learn more about and have an engaging conversation around is EHR and SOGI data collection. Gina Sequeira et al’s study demonstrates that using gender-affirming language, including name and pronouns in EHRs, is associated with improved mental health outcomes in transgender youth.[2] The binary fields for “sex” are unsatisfactory as they lack the routine mechanism to address “gender”, which then results in data gaps like the insufficient ability to account for non binary individuals.[3]

In the image: ‘Notes from the Attic: Gender Identity, Mental Health and the Indian Nation State’ Cover

At ARW, we are dedicated to learning about ways in which we could support the LGBTQ community to help reduce these barriers to healthcare and create a safe space for honest, educational conversations. ARW proudly supports ‘Notes from the Attic – Gender Identity, Mental Health and the Indian Nation State,’ the result of a collaboration between two life changing organizations based in India, which is an explorative study prioritizing the mental health needs and interventions of transgender and gender non-conforming persons.

In the image: COZEVA, Anjali and Pratyay Gender Trust

Anjali is a mental health rights organization focused on establishing mental health within the mainstream health discourse in India and also, achieving systemic change in the mental health field by using frameworks of intersectionality and inclusivity.

 

Pratyay Gender Trust is a community led initiative that was created as a support space for and members of Calcutta’s transgender identified and other gender non-conforming persons who are facing stigma and violence due to their gender identity and gendered expressions.

1 Healthy Equity Summit. Mini Session, Part 1: Barriers to care for LGBTQ communities: inaccessibility of culturally competent care (American Health Law Association Webinar)
3 Healthy Equity Summit. Mini Session, Part 2: Barriers to care for LGBTQ communities: overcoming low quality and inequitable care (American Health Law Association Webinar)

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ARW’s Contribution to COVID-19 Relief in India

ARW’s Contribution to COVID-19 Relief in India

India’s COVID-19 cases are reaching new devastating heights everyday with over 3 million active cases. We are facing the largest humanitarian crisis we have seen in our lifetimes. As a global community, it’s time we join hands to contribute and stop this crisis.

 

ARW is participating in a volunteer effort power by Pathcheck Foundation – whose mission is devoted to containing COVID-19 and providing relief to India. A team of dedicated volunteers from all around the world are coming together to address poor resource allocation and gaps in data that can be fatal if neglected when fighting a pandemic.

Image credits: Manoej Paateel / Shutterstock.com

Pathcheck Foundation and Karuna web app

The team is launching a decentralized web app, Karuna, for crowdsourcing information and providing real time updates of beds, oxygen and hospital supplies in India. Currently, the pilot version of Karuna is live.

 

The efforts from this project include

  • Crowdsourcing patient recovery and treatment plan in a privacy preserving manner for COVID-19 recovered patients.
  • Have access to hospitals’ integrated oxygen and inventory mapping
  • Early detection and risk stratification
  • Variant tracker and super spreader tracking of the new variant
  • Ending misinformation about COVID-19
  • Modeling, prediction and analysis of COVID-19 cases

To know more about this project and how you can contribute, visit https://www.pathcheck.org/india.

Let’s do our part and fight this global crisis as one.

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MY2020 AMP Measure Certification

MY2020 AMP Measure Certification

COZEVA has completed MY2020 AMP Measure Certification ahead of schedule as one of two beta testers selected by NCQA. We are happy to support our clients’ AMP submissions with the most up-to-date measure logic available. Congratulations to the COZEVA team for completing AMP measure certification in record time!

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