In the CalAIM ECM program, DHCS has provided standards for MCPs and ECM Providers to exchange information about members in the following types of exchanges:
- MCP Member Information File;
- ECM Provider Return Transmission File;
- ECM Provider Outreach Tracker File
MCP MIF (Member Information File): MIF is a file containing information about the MCP’s members. The MIF may include demographic information, conditions, enrollment information, and ECM benefit status. MIF file is used by MCPs to exchange member information with community providers.
ECM Provider RTF (Return Transmission File): File sent from ECM Provider to health plan containing updates to member ECM benefit status
ECM Provider OTF (Outreach Tracker File): OTF Refers to a file that tracks outreach activities, such as phone calls, emails, or other forms of communication, between the ECM/CS provider and members. The OTF includes information about the purpose of the outreach, the date and time of the communication, and any follow-up actions.
Streamlining the process for sharing data with multiple health plans can be challenging for community providers who work with different plans that have specific file formats for RTF and OTF. Here are some strategies that providers can use to help support the data-sharing needs of each plan:
Use MCP-provided portals: Some health plans are providing portals for ECM workflow. The main issue for providers is that these portals offer very basic functionality to do the actual work required for ECM, and are designed mainly for information collection. Further, providers have to log into each system separately to add data, a very cumbersome process.
Implement data exchange processes: ECM Providers can use IT staff to use electronic data interchange (EDI) or application programming interfaces (APIs), to streamline data exchange with health plans. However, most providers lack in-house technology skills and budgets to implement this complex functionality. Further health plans keep changing their formats, which makes it more difficult.
Partner with ECM technology provider: Providers can work with ECM technology providers, such as Sprite Health, to help streamline data sharing with multiple health plans. Sprite can help standardize data formats, automate data exchange processes, and provide technical support to help providers comply with plan-specific requirements.
By adopting these strategies, community providers can help support the data-sharing needs of multiple health plans more effectively. This can help improve the quality of care provided to patients while also reducing administrative burden and improving overall efficiency.