• Description

As health care transitions from an episodic to a population health model (PHM) of care, the management of data is becoming more critical. This report examines the data infrastructure to support the move toward PHM in California's safety net. It looks at the tools, processes, and approaches currently in place and planned for the near future. The research, which included qualitative interviews, an online survey, and a literature search, produced five primary findings:

  1. Many safety-net provider organizations in California have begun to conduct PHM with their existing data assets.
  2. The early-stage PHM efforts are driven by specific programs and reporting requirements, and focus on specific subsets of patients. Typically, they use IT systems that are either siloed or integrated in an ad hoc manner with other IT systems within the provider organization.
  3. Value-based and risk-sharing payment models are driving the transition from the episodic model of care to PHM.
  4. Organizational realignment around data strategy and governance is required for data-driven performance and population health outcomes improvement.
  5. Intermediary organizations serving multiple provider stakeholders are beginning to deliver essential data services for PHM, especially in the ambulatory setting.