Written by Malik Chambers, Civitas Networks for Health
Located in Newark, California, Health Roads is a boutique Information technology (IT) consulting firm dedicated to serving the health and human services industry. With a commitment to public sector entities, including local and state government agencies, community-based social care organizations, and non-profit health information organizations, Health Roads is a catalyst for technological advancements.
The firm excels in collaboration with Electronic Health Record (EHR) and social care technology companies, implementing cutting-edge IT systems. It extends its impact through strategic advisory services at the Chief Information Officer (CIO) level, guiding clients through the complexities of technology strategy planning, data governance development, and data analytics.
Affiliated with DirectTrust, Gravity Project®, and the Civitas Network for Health, Health Roads actively engages in state and federal-level dialogues on data interoperability standards, multi-sector data exchanges, data privacy, information security standards, identity management, and more. This wealth of knowledge seamlessly integrates into client engagements, ensuring they benefit from the latest insights and innovations in the field.
Navigating the Changing Landscape: A Dual Focus on Medicaid and Community
As Health Roads navigates the evolving health care landscape, it maintains a dedicated focus on both the Medicaid population – which is over 85 million people (about twice the population of California) nationwide. The expanding scope of Medicaid prompts a national contemplation of integrating social care, health care, and behavioral health on a grand scale. Recent developments, such as the move towards Qualified Health Information Networks (QHIN), FHIR-based interoperability, and increased adoption of closed-loop referral systems, have moved holistic health into the spotlight, forcing organizations to rethink their ways of incorporating technology so it best meets the needs of the population they serve.
Challenges persist, especially with underfunding, even with the pandemic bringing about financial support and accelerated standardization efforts. Health Roads collaborates closely with clients to implement cost-effective, sustainable, and future-proof solutions. Recognizing the tension in balancing objectives, the firm invests in fortifying the capacity, maturity, and resilience of human and process infrastructure within client organizations. Acknowledging funding constraints, Health Roads promotes a strategic focus on sustainable changes.
Regional barriers, influenced by diverse regulations, add complexity to the equation. In California, where Health Roads is headquartered, state laws historically impeded cross-sectorial data sharing, addressed with the revision and waiver provisions of CalAIM. However, regional nuances demand a nuanced approach, preventing the adoption of a uniform, nationwide strategy for all clients.
The Wake-Up Call: COVID-19 Exposes Disconnections in Health Care
“The COVID-19 pandemic exposed the lack of connective tissue within our nation’s health care system.” – Rajib Ghosh, Health Roads CEO
The COVID-19 pandemic starkly revealed the existing disconnections within the health care system, impacting all levels of governance – local, state, and federal. The wake-up call came when daily death tolls reached alarming numbers, emphasizing the need for a more connected and resilient system that can tap into necessary resources when faced with a crisis.
An illustrative example is California’s response with the Home Key system, aimed at housing the growing unhoused population. While effective in the short term, it failed to address the fundamental causes leading to homelessness, highlighting systemic disconnections within the health care system. Despite evident shortcomings highlighted by the crisis, public and federal health care systems grapple with severe underfunding, underscoring the urgent need for improved financial support.
To address the disjointed nature of the health care system, Health Roads actively works towards healing the ruptured connective tissue between local, state, and federal health care entities. This involves fostering collaboration and coordination among these levels of governance, ensuring a more integrated and cohesive approach to health care delivery.
Health Roads’ Human Support Structure Approach
The consultancy recognizes the intricate challenges in serving the Medicaid population and navigates these complexities through a multifaceted strategy that includes:
Engagement with Local Systems
Health Roads takes a proactive approach, advocating for the establishment of a robust local support structure. This involves active engagement and attentive listening to local systems addressing social determinants, ensuring a nuanced and effective response tailored to each community’s unique needs.
An example of this approach is when Health Roads’ CEO collaborated with health care and housing services leadership in Alameda, facilitating the participation of numerous small and medium-sized housing sector Community-Based Organizations (CBOs) in CalAIM, California’s Medicaid Transformation program. Through this initiative, these organizations were empowered to bill managed care health plans from the outset, utilizing their standard Homeless Management Information System and following established medical billing protocols. This addressed a crucial need in the community, particularly as Alameda County faced significant housing shortages, enabling CBOs to secure sustained funding for expanding their services to a larger client base.
Recognizing the value of local insights, Health Roads goes beyond a one-size-fits-all approach. By actively listening and learning from local systems, the consultancy tailors its strategies to address specific social determinants impacting each community, fostering a more comprehensive and targeted approach.
Public Awareness and Advocacy
Understanding the crucial role of public perception, Health Roads places a strong emphasis on storytelling to create awareness about the significance of federal funding in contributing to meaningful health and health care improvement efforts. This initiative was demonstrated when Health Roads’ CEO, together with Alameda’s Health Care Services Agency’s Medical Director, showcased the success of the Social Health Information Exchange (SHIE) at HIMSS 2023, receiving standing applause from a diverse audience including federal agencies like ONC and CMS.
The outcomes achieved by the health care services agency using SHIE data garnered significant recognition. Health Roads persists in sharing this impactful story across various platforms. This includes active participation in Direct Trust meetings, where discussions on social care are paramount. Furthermore, the consultancy extends its reach through webinars and conferences, consistently emphasizing the importance of collaborative efforts and federal support in advancing health care outcomes. This story-sharing approach not only amplifies public awareness but also fosters a broader understanding of the role that federal funding plays in driving positive changes in health care systems.
Healing the Ruptured Connective Tissue through Sustainable Changes and Strategic Focus
Addressing Challenges in Transition: Whole Person Care to CalAIM
Health Roads faced a significant challenge during the transition from the Whole Person Care (WPC) pilot program to the CalAIM program in California. The state aimed for a seamless transition, assuming WPC programs had built sufficient capacity and technology infrastructure in Community-Based Organizations (CBOs) to participate in CalAIM’s managed care framework.
Health Roads adopted a strategic approach grounded in three fundamental design principles to alleviate barriers hindering CBOs’ entry into CalAIM:
Seamless Transition for CBO End Users:
• The first design principle ensured that end users at the CBO end would not need to make any changes to their existing processes, minimizing disruptions and facilitating a smooth transition for CBOs.
Effortless Expansion for Managed Care Health Plans:
• The second design principle focused on end users at managed care health plans, streamlining collaboration and partnership between CBOs and managed care health plans more accessible and efficient.
Transparent Data Flow for Reconciliation:
• The third design principle ensured the seamless flow of data as claims, encounters, and remittance advice, enabling appropriate reconciliation for transparency and robust reporting mechanisms.
Strengthening Impact Through Collaboration with Civitas Networks for Health
Health Roads’ commitment to crafting impactful and strategic solutions establishes them as an ideal collaborator for Civitas Networks for Health. Specifically tailored to serve the Health and Human Services sector, with a primary focus on the Medicaid population, Health Roads draws upon decades of invaluable experience in this domain.
As Health Roads aims to be a scalable solution provider, offering cutting-edge technology solutions and delivering CIO-level IT strategic guidance, its dedication aligns seamlessly with the mission of Civitas Networks for Health. Serving as a national convener for health care data solutions providers across the nation, Civitas Networks for Health creates a platform where like-minded organizations, including Health Roads, come together with a shared commitment to improving health care outcomes.
Health Roads’ vision of being a pioneering force and fostering collaboration finds resonance within Civitas Networks for Health, an organization that facilitates synergy among entities dedicated to the well-being of the Medicaid population. By becoming part of an organization with members sharing a similar mission, Health Roads enhances its ability to contribute meaningfully to the national conversation on health care data solutions and further advance its transformative initiatives.
For more information, please make sure to visit the Health Roads website.
