The allocation of $7.5 billion in Medicaid funding signifies a vital link between healthcare and social care needs in New York State. SCNs, comprising nine networks across the state, are set to receive funds to establish services through their network of Community-Based Organizations (CBOs). These networks play a pivotal role in coordinating various types of information, including screenings, service tracking, outcomes, and Medicaid billing. And while New York is one of the trailblazers, it is certain other states will be following suit, which will place social care networks across the nation in increasingly greater need of higher performance.
Social Care Networks: Bridging Healthcare and Social Needs
Amid the pivotal components demanding precise and effective handling, the proficiency in Medicaid billing for services stands out. As delineated in the 1115 Waiver, a system is expected to showcase its prowess in establishing a unified platform that encompasses standardized screenings, assessments, service navigation, outcome tracking, case management, and billing. The imperative for such a seamlessly integrated system necessitates the adoption of a sophisticated yet user-friendly platform—arguably a realm best served by intelligent technology.
Key Requirements for Social Care Networks
The approval of the NYHER waiver marks a transformative phase for New York's Medicaid Program, introducing substantial funding to address health equity and social care needs. SCNs, supported by advanced technology, play a crucial role in efficiently utilizing these resources. As New York embarks on this new endeavor, staying informed about further clarifications from the Department of Health (DOH) and CMS becomes paramount. The infusion of funds not only signifies financial support but also underscores the commitment to revolutionizing the intersection of healthcare and social care in the state. This will require an all-encompassing technology support platform.
Technology Transformation is Here
IMPOWR emerges as the optimal system, seamlessly capturing every step while securely connecting with Electronic Medical Records (EMRs) and Health Information Exchanges (HIEs) through Fast Healthcare Interoperability Resources (FHIR). As a cloud-based platform, IMPOWR offers professional services, including dedicated project managers and implementation specialists, ensuring that SCNs are set up for success. Leveraging technical skills and experience from launching more than 1,500 programs over the past five years, IMPOWR has become an essential and relied-upon partner in optimizing the utilization of new resources for social care networks.
IMPOWR: The Comprehensive Solution
1115 Medicaid Waiver: Changing the Game for Social Care Networks
On January 9, 2024, CMS marked a significant milestone by approving the New York Health Equity Reform (NYHER) waiver, which injects $7.5 billion over 3.25 years into the state's Medicaid Program. NYHER, targeting health equity, aims to address disparities for 7.6 million Medicaid beneficiaries, emphasizing health-related social needs and impacting the transformation of safety net hospitals into value-based payment structures.
The implications of this momentous approval have significant impact on Social Care Networks (SCNs), who are realizing the crucial role of technology in ensuring efficient coordination and billing within this evolving landscape.
In the landscape of healthcare and social services, effective communication is undeniably crucial (see IMPOWR’s February 5, 2024 article, “1115 Medicaid Waiver: Changing the Game for Social Care Networks”). Expanding on this compelling theme, interoperability goes hand-in-hand, as the seamless flow of essential data is what truly revolutionizes the efficacy of service delivery.
New Technology: Providing Interoperability for Social Care Networks
It is well known that interoperability—which facilitates the exchange of vital information among various systems used by collaborating organizations within SCNs—is just as essential as effective communication.
However, for SCNs to operate optimally, data standardization alone isn't enough; it must also be easily accessible and actionable across platforms, which absolutely requires establishing connections between systems.
The Significance of Interoperability
The IMPOWR technology platform is playing an essential role in transforming care delivery by powering community networks. A prime example of this impact is found in the recent Axis of Care program implemented by the Community Action of Orleans and Genesee (CAOG). Remarkably, CAOG has been able to successfully connect existing services and healthcare providers, and consolidate robust information from five partners into one unified record.
This initiative has yielded significant outcomes, from facilitating insurance enrollment to providing telehealth services and substance use disorder treatment. Such success stories underscore the truly transformative potential of technology-powered interoperability. Read the full case study here
Technology: Facilitating Integration for Community Networks
Communication goes far beyond simply sharing data. And while it does require the exchange of robust and accurate facts, it also significantly impacts the whole care team, patients, and overall coordination. This is why SCNs need to plan now for broader communication to ensure the correct information about each patient is known at the right time by the right groups.
Communication: Beyond the Data
Without intuitive, comprehensive technology, achieving effortless interoperability can be challenging. Factors such as data format, update frequency, sharing methods, and ingestion processes all must be standardized, which makes sophisticated collaboration among organizations essential for maintaining data integrity and security.
On top of this, interoperability is not unilateral—SCNs must both receive and share critical information with connected systems. So, flexibility and deployability become significant in designing infrastructure, requiring technology systems that are built to adapt to various data types, update frequencies, and access permissions.
As SCNs continue to evolve, they will increasingly be looking for technology-based solutions that foster collaboration among the many stakeholders. This approach is the clear solution for unlocking groundbreaking new possibilities in coordinated care and social services delivery. Learn more about IMPOWR.
Technology that Meets Obstacles to Integration
Medicaid members in New York State (NYS) experience a high annual churn rate of approximately 20%, which highlights the dynamic nature of their membership within the program. Amidst this turnover, the emergence of new payments for Social Determinants of Health (SDOH) services speaks to the importance of ensuring comprehensive coverage and reimbursement for the entities involved.
SCNs (Social Care Networks) play a pivotal role in supporting Medicaid members as they receive services from Community-Based Organizations (CBOs). However, effective coordination hinges on verifying the eligibility of members across the entire ecosystem.
SCNs & Eligibility
Establishing mechanisms for eligibility verification at a regional level is imperative in the effort to reduce turnover among Medicaid-eligible members. Maintaining continuous coverage for these individuals is critical, and the collaborative efforts of the entire ecosystem, including SCNs, are instrumental in achieving this goal.
Whether it involves real-time access to monthly rolls or the seamless exchange of member files between entities, it is becoming increasingly necessary to lean on effective technology.
IMPOWR, an increasingly relied-upon technology platform, offers a singular solution for securely sharing data across entities. Whether through real-time APIs or periodic SFTPS, IMPOWR’s platform facilitates seamless communication, which directly improves the efficiency and effectiveness of Medicaid support initiatives.
By leveraging technology and fostering collaboration within the ecosystem, SCNs can confidently fulfill their pivotal role in optimizing Medicaid support and improving outcomes for vulnerable populations. Learn more about IMPOWR.
Emerging Technology Offers Seamless Coordination
Whether your network has a consistent platform like Unite Us or FindHelp, or if you are managing good old-fashioned phone call referrals, there are a myriad of ways people will be channeled to your front door. Ensuring that your network is able to funnel all referrals into to the main SCN tool is key to keeping all the data clean and readily usable.
IMPOWR offers many paths to help referrals reach your front door:
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Public website to submit referrals directly (e.g. self-referral or from colleagues)
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Referral platform connections via API
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Community Call Center tools
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Email, phone, text, walk-in documentation tools
Networks need to be flexible to meet the needs of the community members and CBOs alike. The CBOs all have varying levels of organizational maturity. By offering a single tool to meet all the referral needs, it keeps the entire network coordinated and reduces data siloes.
Navigating Referrals: Diverse Paths to Your Front Door with IMPOWR
With the formalization and funding of Social Care Networks (SCNs) through the recently announced New York State 1115 waiver, it is becoming increasingly important to examine the intricacies of the waiver’s structure and key elements crucial for its success. As SCNs aim to create a more integrated and efficient healthcare ecosystem, fostering collaboration among various entities is critical. There are a number of fundamental components that define these networks—chief among them is establishing seamless communication between the entities involved: Managed Care Organizations (MCOs), Health Information Exchanges (HIEs), Community-Based Organizations (CBOs), and the Social Care Networks.
Maximizing New York State 1115 Waiver: The Essential Role of SCN Communication
In New York State, there are thirteen SCNs to be structured with a central lead entity. These networks bring together the diverse array of stakeholders. This collaborative framework aims to enhance the coordination and delivery of social care services, fostering a more integrated and effective healthcare ecosystem to better serve Medicaid patients.
Current Structure in New York State
The SCN needs to communicate clearly and in a specific
sequence, including:
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SCNs to/from CBOs and HIEs
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SCNs to/from healthcare providers and MCOs
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SCNs to/from New York state
*See figure at bottom of page
The Need for Communication Exchange
Communication goes far beyond simply sharing data. And while it does require the exchange of robust and accurate facts, it also significantly impacts the whole care team, patients, and overall coordination. This is why SCNs need to plan now for broader communication to ensure the correct information about each patient is known at the right time by the right groups.
Communication: Beyond the Data
To facilitate seamless and comprehensive communication within the care ecosystem, technology is emerging as the key to success. The required information exchange encompasses a broad spectrum, ranging from demographic details about patients, consents and referrals, to active service provision and coordination, billing, and reporting. Even the ability to securely connect with members of care teams across different organizations during a single patient engagement can be difficult—and yet it is absolutely critical.
Often forgotten in the discussion of communication is how essential it is for patients to be able to communicate with their care team and access their information. And while healthcare has offered patient portals in the recent era, social care tends to lag far behind in expeditiously providing vital information back to a patient—this is largely due to the use of too many disparate systems.
This is where technology becomes pivotal. SCNs are in need of an effective system that consolidates essential information in one accessible place, provides across-the-board efficiency, and enables rapid deployment.
Technology has the power to provide a smooth flow of patient information, facilitating seamless connections between SCNs, healthcare providers, and MCOs. An advanced, intuitive technology platform such as IMPOWR can serve as the catalyst for optimizing the overall effectiveness of care delivery within the networks of evolving SCNs. Learn more about IMPOWR