The California Health & Human Services (CHHS) oversees 16 departments and offices that provide a wide range of services in the areas of health care, mental health, public health, alcohol and drug treatment, income assistance, social services and assistance to people with disabilities. At MarkLogic World last year, I had the pleasure of hearing CHHS Secretary, Mike Wilkening; CHHS’s CA Department of Managed Health Care (DMHC) Chief Deputy Director, Marta Green; and CHHS’s Office of Statewide Health Planning and Development (OSHPD) Chief Information Officer, Scott Christman, discuss how technology is helping their agencies improve service to millions of Californians.
Secretary Wilkening provides operational and policy leadership for CHHS. He explained that, by necessity, government agencies have numerous data silos because the organizations and budgets are so large that managing them is very complex. For example, about 14 million Californians are on Medicaid with an annual budget across those various programs of roughly $150 billion. That budget is distributed among 12 departments, and one department has over 200 programs.
“But the people we serve—their lives aren’t siloed,” said Secretary Wilkening. He elaborated by expressing the need for his agency to understand overlaps amongst and between different divisions and the services they provide. He wants, for example, to understand how cuts to one program in one organization impact a family that is accepting benefits from another organization and how any overlaps may make their lives more difficult.
This lack of insight led Secretary Wilkening to conduct research and make changes. Among them is taking a customer-centric approach to information delivery. “Usually government agencies produce what we know how to produce, and users consume the information. But instead, we should be involving the end-user … we should start thinking about what the end-user really needs and involving them in that process,” he said. He added that he doesn’t want a single mom sitting on the phone at work spending two hours with CHHS to determine whether or not a benefit is applicable.
Another change that Secretary Wilkening is implementing is making information transparent through the CHHS Open Data Portal. This initiative was created in order to increase public access to one of the state’s most valuable assets: non-confidential health and human services data. The portal’s goals are to spark innovation, promote research and economic opportunities, engage public participation in government, increase transparency and inform decision-making. “Open Data” describes data that is freely available, machine-readable and formatted according to national technical standards to facilitate visibility and reuse of published data.
To date, the portal contains over 300 datasets such as chemicals in cosmetics, West Nile Virus cases and hospital annual financial data. Secretary Wilkening says the portal receives tens of thousands of hits internally and externally.
As part of CHHS, the DMHC protects California consumers’ health care rights and ensures a stable health care delivery system by regulating health plans to ensure compliance. Health plans are delivered to DMHC in various formats that include structured, unstructured and semi-structured data, which makes finding specific details such as claims information difficult and time-consuming. “We’re a very mission-driven organization. We want to be working on our foundational work of protecting consumers’ health care and ensuring a stable health care delivery system. We don’t want to be spending all our time looking for records that are impossible to find,” Green said.
To address these challenges, DMHC created an Office of Financial Review (OFR) dashboard with MarkLogic®. The OFR is powered by an Operational Data Hub (ODH) that automatically gathers a 360-degree view of relevant information so that DMHC can more cost-effectively and efficiently monitor financial indicators of licensed health plans and medical groups in order to manage risk. “One of the things we can do is figure out when plans file incorrect information and find bad data. Without the OFR, we couldn’t grab the data and compare it into a single screen, so we wouldn’t know this single field or value was incorrect. But when we pull it all together, we can see it,” said Green. She added that the holistic view mitigates risk because if one organization “goes under, then the whole system can fall apart.” With a 360-degree view, DMHC has a clear picture of the entire process, so it can identify one potential failure and head it off early to prevent total system failure.
DMHC plans to add more sources and analytics to the system, as well as adding unstructured health plan information accessibility. Green said the new data can answer a question such as, “For any given health plan in CA, which organizations have licensed which products, in which counties and zip codes, and how many people are enrolled in those products within those parameters.” The new system should reduce the time it takes to discover this information from many days to real time.
The first project ingested over 2M JSON documents from six SQL databases, 10,500 PDFs, 800 Excel spreadsheets and 500 Word documents with terrific success. Green said DMHC experiences and expects:
Also part of CHHS, OSHPD’s mission is to advance access to safe, quality health care environments through innovative and responsive services and information. OSHPD achieves this by ensuring safe facilities, financing emerging needs, cultivating a dynamic workforce and supporting informed decisions, specifically with the construction and financing of hospital and health care facilities and supporting the health care workforce. OSHPD writes building codes, issues permits, monitors compliance of construction, provides loan insurance to finance construction and offers programs such as scholarships for professionals in the health care field.
Like DMHC, OSHPD receives countless types of data from hospitals and health care facilities throughout the state. And it’s a ton of information: OSHPD holds 40 years of data such as 19 million patient records from 460 hospitals that arrive in the system every year. Also, like many state agencies, OSHPD data is found in numerous silos and multiple transactional systems, all with unique query systems to search things like utilization or financials. In the previous system, answers were discoverable, but missing the broader context, or the 360-degree view.
Like Secretary Wilkening, OSHPD CIO Christman is leading his agency down a digital-transformation path that aims for transparency and 360-degree views of data. OSHPD has always had the gold standard for data quality, and now it is pursuing the gold standard for data delivery for various audiences. OSHPD internal users need accurate, comprehensive and high-quality data to determine benefits and compliance. External policymakers, legislature, trade groups, associations and advocates looking to improve health care need information on policy and decisions.
OSHPD began its digital transformation by undergoing a web transformation, beginning with hospital chargemasters (how much each hospital pays for each service). Christman explained that hospitals provide data in many formats, so there aren’t any standards. He said, “It’s helpful to use MarkLogic as a data hub by ingesting the data and then indexing and organizing the data so now it’s searchable … from the user standpoint, the information is much more accessible.”
Now that the web project is complete, OSHPD is creating an integrated digital content repository. Now that the organization has ingested chargemasters, OSHPD will add community benefit plans and more to create 360-degree views of health care facilities like hospitals and home care facilities. OSHPD and its users will then mine the data for effective planning and decision-making.
Since I’m lucky enough to live near these organizations, I get to hear their updates at various meetups throughout the year. If you’d like to hear more but can’t attend the events in person, check out the resources below. It’s inspiring to hear government agencies combining vision and technology to help people in need.
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