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Data prep, analysis helps county keep probationers healthy and sheltered

Through its Whole Person Care (WPC) program, Riverside County, Calif., is using data analytics to help keep probationers off the streets and out of the emergency room.

When prisoners are released from incarceration, they visit with a probation officer and a nurse, who screen them for substance abuse, physical and behavioral health as well as social services and housing needs. The nurse then makes referrals based on those needs, and the county tracks how well those interventions work at keeping probationers healthy and sheltered. The program, led by the Riverside University Health System (RUHS), has screened almost 12,000 people since it started in October 2017.

To deliver those results, the county had to overcome several technological challenges, such as standardizing electronic health records (EHRs), exchanging health information and measuring the program’s efficacy with data analytics.

Each partner -- the county’s Detention Health Services, RUHS Department of Behavioral Health system, RUHS Medical Center and 13 community health clinics -- had its own EHR system in place, said Judi Nightingale, the county’s director of population health. The county addressed interoperability issues with a health information exchange that uses a Manifest Medex platform. It also contracted with SAS to help  identify people who were screened at the clinics, which use a system called Epic, and refer them for services. Initially, that work was done manually, but SAS digitized it, enabling entity resolution, or verifying a person’s identity across the partners’ systems.

“Between [the] detention house and the medical center and the clinics and behavioral health, we were able to get to a point where we could identify that Judi Nightingale in this system is the same Judi Nightingale there, and then we were able to actually pull out reports that were electronic, rather than comparing Excel spreadsheets from all of our partners,” Nightingale said.

SAS is also assisting the county with data integration -- bringing together information from all those sources to help Riverside analyze how well the program works. WPC is part of the 2020 Medicaid Waiver. Known as Medi-Cal 2020, it is an 1115(a) waiver with four components, one of which is the WPC program. Under the five-year agreement, WPC must meet certain metrics for the county to be reimbursed for the services it provides.

Metrics include decreasing avoidable admission to psychiatric and primary care hospitals by 5% each of the program’s four years, increasing by 5% each of three years the percentage of program participants who acquired and successfully maintained housing for at least six months and increasing by 5% each of three years the number of probationers who keep appointments to which they are referred.

The integrated data platform with entity resolution sped up the process. Plus, there was no longer “any more back-and-forth with the state on ‘are these numbers right,’” said Josh Morgan, national director of behavioral health and WPC at SAS. Time savings and increased data accuracy let the county get the reimbursement it needed to effectively provide these services.

To bring the data together into what it calls a “landing area,” SAS uses a variety of interfaces. Once the data has been collected, the technology performs the extract, transform and load process, resolves the identities and puts everything together in a data warehouse.

SAS collects data around whether probationers access the appointments they were referred to, whether they were reincarcerated and what their ER use was. Two doctoral students at Claremont Graduate University where Nightingale is an adjunct professor used data in the SAS system to study 6,000 probationers. They found that if someone went to one behavioral health appointment, the reduction in reincarceration was 64%. If the individual went for one substance use appointment, the reduction was 50%.

“We would never have been able to get that data analyzed if it hadn’t been in that SAS format because there were so many Excel spreadsheets going back and forth. We have 17 partners on this effort,” Nightingale said.

WPC was set to expire with the end of the waiver period in December 2020, but COVID-19 postponed its end date to January 2022. At that time, the California Department of Health Services will implement California Advancing and Innovating Medi-Cal, a multiyear initiative that will incorporate WPC.

This article was changed March 5 to correct Judi Nightingale's title and clarify the identity of the partners. 

About the Author

Stephanie Kanowitz is a freelance writer based in northern Virginia.

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