1) Terminology and Common Language – In order to ensure clarity and effective communication, this program establishes the use of common language and terminology between Health Net and the ECM provider. Both parties shall make reasonable efforts to use consistent terminology and eliminate any ambiguity while referring to shared data and related concepts.

2) Types of data include, but are not limited to:

Data to be shared will vary depending on the criteria set by the Department of Health Care Services (DHCS) policy for each of the ECM Populations of Focus:

Parties de-identify data when applicable. Health Net prioritizes the data based on the criteria in the Enhanced Care Management Policy Guide and DHCS CalAIM Data Guidance on Member-Level Information Sharing Between MCPs and ECM Providers. Admit, Discharge and Transfer (ADT) data will be shared with the ECM provider for the purpose of identifying best contact information and better servicing members per their need. Certain data, including diagnosis, will be shared only after member consent.

3) Specific circumstances when Health Net grants the ECM provider access to the shared data is granted include, but are not limited to:

Based on the DHCS CalAIM Data Guidance: Member-Level Information Sharing Between MCPs and ECM Providers for ECM member information sharing, Health Net is required to grant access and share member level data with ECM providers through a Member Information File (MIF), which will list members who have been assigned to that provider for service delivery.

4) Specific circumstances when the ECM provider grants Health Net access to the shared data is granted include, but are not limited to:

The ECM provider is required to share timely updates about service delivery to Health Net through the Return Transmission File (RTF) and Outreach Transition File (OTF).

5) The individuals or staff roles within Health Net and the ECM provider who will have authorized access to the shared data.

a) Health Net individuals or staff roles who will have authorized access to the ECM provider’s shared data include, but are not limited to:

b) ECM provider individuals or staff roles who will have authorized access to Health Net’s shared data include, but are not limited to:

6) Tracking Referral Status - The methods and/or tools to be used for tracking referral status (i.e., shared database or software system, etc.), the responsibilities of each party in updating and maintaining the referral status information, and the frequency of sharing updates with each party.

a) Methods and/or tools used to track the status of referrals by Health Net include, but are not limited to:

The status for members who were referred for the ECM program can be found in the Health Net secure provider portal ECM tab. Once in the portal, select the Eligibility tab, then select Enhanced Care Management on the left navigation. This includes the members status and assigned ECM provider, if applicable (see data dictionary statuses below for member status definitions).

b) Methods and/or tools used to track the status of referrals by the ECM provider include, but are not limited to:

The status for members who were referred for the ECM program can be found in the Health Net secure provider portal ECM tab. Once in the portal, select the Eligibility tab, then select Enhanced Care Management on the left navigation. This includes the member’s status and assigned ECM provider, if applicable (see data dictionary statuses below for member status definitions).

c) Health Net’s updating and maintaining referral status information include:

Based on information received from ECM providers, Health Net updates the member status to maintain up to date information and share this with providers. This information is shared with providers through the provider portal, mini-MIF (referral file), and monthly MIF file as noted above. See data dictionary definitions below for additional details.

d) ECM provider’s updating and maintaining referral status information include:

Through the Return Transmission File (RTF) submitted monthly to Health Net, ECM providers are required to update the status of the member which will notify Health Net of the status change.

e) The frequency at which Health Net will update and share referral status updates:

On a monthly basis, Health Net shares the Member Information File (MIF) with the ECM provider as an update on the status of all members. Additionally, as members are enrolled in ECM, the Health Net provider portal is updated to reflect member enrollment status.

f) The frequency at which the ECM provider will update and share referral status updates:

ECM providers are required to submit their monthly RTF file which should be updated to reflect the current status of the member. For potential ECM members who were identified in the community for referral to the plan, ECM providers are encouraged to report the member’s interest in the program via the provider portal or fax.

7) Collaborative Evaluation

Both Health Net and the ECM provider will engage in a yearly bidirectional evaluation process aimed at supporting joint quality improvement objectives. The partnership evaluation process will provide an opportunity for both organizations to assess and improve the effectiveness of the partnership for both staff and the individuals who Health Net and the ECM provider serve. Collaborative improvement will involve both Health Net and ECM provider organizations in the evaluation process.

a) Health Net and the ECM provider will collaborate to evaluate the effectiveness of its partnership:

There are several ways Health Net partners with ECM providers to evaluate necessary improvements to the program.

b) Upon completion of the collaborative evaluation on the effectiveness of the partnership, Health Net and the ECM provider may use findings to inform any necessary improvements of the partnership to drive continuous quality improvement.