Making the Journey Toward an Electronic Social Health Record
Life is a journey and you never know where it will take you. In 2012, I was a corporate health care attorney and imagined that I would be in that position and with the same company for the rest of my career. A series of leadership changes forced me to reexamine my future, take a look at what truly energized me and ultimately resulted in my leaving law and jumping into Medicaid administration. Eight years later, I am in another place I would have never thought possible as a health care lawyer – advising an IT start-up company. Here’s how I got here and why I am so passionate about the latest chapter in my life.
As anyone in the Medicaid managed care space can attest, it is full of challenges. The most compelling for me was how to improve the health and wellbeing of Medicaid members. I have always seen Medicaid managed care as one spoke in a large wheel of organizations all focused on that goal. Physicians, hospitals, not for profit community organizations, and managed care plans are all tackling challenges in the Medicaid population from different angles. Unfortunately, all too often they are working in silos and rarely share successes, failures or critical information about the people they are serving.
I started to address this lack of coordination seven years ago by creating advisory panels where leaders from managed care organization, not for profits and providers would come together to discuss and strategize around how to better serve the various Medicaid populations. These meetings were impactful not only from what we learned from sharing information and insights but from the collaborations and relationships we created between organizations. I recall one meeting where we focused on women’s health and the challenges in providing prenatal care. It was then that I learned about the issue of periodontal disease in pregnant women which led to prematurity and other complications. Generally, treatment for periodontal disease is not covered by Medicaid even though such treatment could lead to improved maternal health and birth outcomes. This information led me to expand Medicaid benefits to add a periodontal benefit for pregnant women.
A couple of years ago as Medicaid managed care organizations increased their focus on social determinants of health (SDoHs), I realized that while we were assessing and trying to address SDoHs, we did not have the data to fully understand the SDoH challenges of our members. Which SDoHs were being identified, which were being successfully addressed and where were the gaps? My goal was to identify the gaps and then use the company’s charitable giving arm to attempt to address those gaps. I left the company before that work was finished.
Fast forward to the beginning of 2020, pre-pandemic. I am retired and looking forward to several months of exciting trips abroad. In January, my husband gets a call from an old friend who had developed a software platform for research administration. That friend, Mike Kamish, had sold his very successful software business and had created a new startup software company to help human service organizations. Knowing my interest in SDoHs and better serving the low income, disabled, and long term care populations, my husband refers Mike to me. Shortly thereafter I talk to Mike and his wife and business partner, Jan, and see my first demo of imPowr, the integrated software solution created by Mike for human service organizations. I am floored by the software’s depth, breadth, ease of use and overall capabilities. And while watching Mike’s demo I have an epiphany of sorts. What if health plans had a way of connecting with human service organizations in real time where they could instantly know the services a member is receiving and had received in the past? What if they had a way of better understanding the member’s challenges and needs, what services were working, and where there were gaps?
I also then realized that the way health plans were assessing and addressing social determinants of health left huge gaps. Today, here’s the way that social determinants of health are typically managed by managed care organizations. Health plans include questions relating to social determinants of health in their member assessments. When they identify a need, they work to put services in place through social connector software solutions such as Unite Us, Aunt Bertha, or Now Pow.
This approach misses the simple but critical fact that many members have already been served or are being served by social service organizations before or at the same time they join a health plan. The social service organizations serving members are performing assessments, putting services in place and making referrals, many of which are inside the organization (since the organization may provide an array of different services). Without having a way to connect with the social service organizations already serving a member, much of that information is lost to the health plan. The result is redundant services being put in place, an inability to see the whole picture and know which services worked or didn’t work and where are the real gaps that need to be addressed. This inability to see the whole picture also applies to social service organizations who generally do not know the services being provided (or that have been provided) by other organizations.
Since I had entered into my “retirement journey” I had started to wonder what’s next. Could I be content not working? I had spent the last 30 years or more with a crazy schedule, traveling weekly for the past 3 years, juggling meetings, family, and friends. While I loved the pace, energy and sense of purpose most of the time, I sometimes longed for a simpler, easier life. Now that I had time, I was craving a purpose, something that would light me up, allowing me to enjoy more leisure time but fulfilling my need to help others, improve the health and wellbeing of patients, and enhance how health plans provided value to their members. Talking to Mike and Jan, I saw an opportunity to fulfill these needs.
So, I shared my vision with Mike and Jan. Several conversations later they asked me to join the Continual Care Solutions team. This was in late January, 2020. In March we were embarking on a month-long trip to New Zealand and had three other trips planned, running through the end of June. I told Mike and Jan that timing was not good, but we could connect later in the summer. Of course, COVID hit, and all of our trips were eventually cancelled. I reconnected with Mike and Jan in April and here I am working with Continual Care Solutions to create a social health record using the incredible capabilities of imPowr.
In working with Mike, Jan and the rest of the Continual Care Solutions team, I am inspired by their passion and commitment to transform how human service organizations manage their business and use data to demonstrate their value. This new journey has its own set of challenges. As a start-up, new even to human service organizations, creating an effective social health record will require a critical mass of human service organizations in a community to adopt imPowr. Getting a managed care organization to commit the resources to move this forward will take vision and persistence. However, as I continue to learn more about the capabilities of imPowr, which are constantly growing, I am excited about the potential to transform the social determinant of health space and how managed care organizations and human service organizations work together to improve people’s lives.
To find out more about the capabilities of imPowr, visit here.