L.A. Care’s primary goal in Health Information Technology (HIT) is to improve the adoption and meaningful usage of HIT solutions, mainly Electronic Health Records, Health Information Exchanges (HIE), Interoperability, and other technologies used to securely and electronically capture, maintain, and facilitate the exchange of health information.
Health Information Exchange (HIE)
Electronic health information exchange (HIE) allows healthcare providers and members to access and securely share vital medical information electronically. This enhances the speed, quality, safety, and cost-effectiveness of member care.
HIE is the secure sharing of member health information among authorized providers, while Health Information Organizations (HIOs) facilitate this exchange between participating providers. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 laid the groundwork for adopting Electronic Health Records (EHR), crucial for building a successful HIE infrastructure.
Health Information Ecosystem (HIEc)
The Health Information Ecosystem (HIEc) encompasses multiple HIEs and HIOs. This allows L.A. Care Health Plan to broadly improve the information exchange ecosystem and connectivity.
It also bridges the data exchange gap between the plan and providers, including practices, provider groups, hospitals, and skilled nursing facilities, to share member information electronically and facilitate care delivery across the continuum.
- Build a network of Health Information Exchange (HIE) vendors to achieve a high degree of market penetration among hospitals, Federally Qualified Health Center (FQHC), Skilled Nursing Facility (SNF), Independent Physician Association (IPA), Managed Services Organization (MSO), and Health Plan.
- Ensure L.A. Care member information is accessible in near real-time across the care continuum.
- Adopt the latest interoperability standards such as FHIR and educate cross-functional teams on new standards and their impact on different models of care.
- Integrate near real-time L.A. Care member data into cloud-based applications.
- Meet the latest health plan interoperability regulatory requirements.
- Support cross-functional business units and pertinent programs that require integration and use of near real-time member data.
- Support quality initiatives with specific objectives.
- Provide a platform to measure and assess the quality of care and services delivered by the provider network.
- Improve optimization and usage of electronic health record systems.
- Real-Time Notifications: Access to Admit, Discharge, and Transfer (ADT) notifications.
- Timely Clinical Information: Obtain notes, labs, radiology reports, and more.
- Enhanced Member Care: Conduct timely follow-ups and deliver transition of care services.
- Reduce Duplicates: Minimize duplicate testing and prevent member harm.
- Improve HEDIS Scores: Boost Healthcare Effectiveness Data and Information Set (HEDIS) performance.
- Reduce ED Visits: Lower avoidable emergency department visits and readmissions.
Available Incentives
In an effort to improve HIE adoption and provide sustainable funding, L.A. Care introduced incentives designed to enhance connections among providers, members, and the community.
We are offering one-time incentives for adopting and using HIE, specifically tailored for providers not currently engaged with the Los Angeles Network of Enhanced Services (LANES) or PointClickCare (PCC). The One-Time HIE Incentives are currently available for FQHCs, Small and Solo Providers, Hospitals, and SNFs.
HIE participation is also a component of various incentive programs. These measures incentivize ongoing participation in the California Data Exchange Framework (DxF) and participation and exchange of Admit, Discharge, and Transfer (ADT) notifications and Continuity of Care Documents (CCDs) with LANES or PointClickCare.
- HIE Participation Measure for IPA: Value Initiative for IPA Performance (VIIP)
- HIE Participation Measure for FQHCs, Small and Solos: Physician Pay for Performance (P4P)
- HIE Participation Measure for Hospitals: Hospital Pay for Performance (P4P)
Please contact L.A. Care's Health Information Technology team for more information about HIE Incentives and Participation Measures.
Data Exchange Framework (DxF)
The California Health and Human Services Agency (CalHHS) DxF is the first-ever required statewide Data Sharing Agreement (DSA). DxF is key to improving connections between health and social services entities. Entities required under DxF need to sign the DSA by January 31, 2023.
By January 31, 2024, the majority of the large mandatory signatories are required to exchange health and social services information (HSSI) with other DxF participants upon request. Some small organizations are required to start exchanging HSSI by January 31, 2026.
L.A. Care has signed the DSA before the state deadline and is in the process of implementing the data exchange. We have chosen LANES as our Qualified Health Information Organization (QHIO). We encourage all our providers to sign the DSA, participate in DxF, and leverage all available incentives.
CMS Interoperability Mandate
The Centers for Medicare & Medicaid Services (CMS) recently introduced new interoperability mandates for health plans. This rule is designed to make health information more easily available to members by implementing new industry standards like HL7 FHIR APIs and deterring information blocking.
The effort is pursuant to the CMS Interoperability and Member Access Final Rule (CMS-9115-F).
L.A. Care believes in empowering member access to health information and has implemented Interoperability solutions as per the CMS mandate.
To learn more about Interoperability, visit Interoperability Information.