2022 SAG Award Winners

California Department of Health Care Services (DHCS)

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Project Goal

The California Department of Health Care Services (DHCS) oversees Medi-Cal, California’s Medicaid program, and has established network adequacy standards to meet and exceed federal standards. The Network Adequacy GIS project goal is to take multiple, disparate processes that are connected to the same effort and create a centralized process and reporting tool with visualizations that can support the differing network adequacy requirements for each DHCS delivery system.

DHCS intends to standardize data utilized by the process and remove any confidential data from the process. By doing so, the data sets used in the process, the logic, and the process itself are more easily shared both internally and publicly. DHCS created an ArcGIS Hub site for the data reports and visualizations related to the network adequacy process, with the goals of providing full transparency with providers and plans, and that these entities could use the same data to replicate the process to confirm results.
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Business Problem Solved

DHCS has multiple delivery systems that provide health care for Californians. Each delivery system has its own conditions and requirements for providing adequate coverage through its provider networks and manages its network adequacy process uniquely using different logic and different tool sets. In addition to siloed and disparate processes, much of the work was manually completed, resulting in the entire network adequacy process requiring months to complete. Staff would need to start the annual network certification process 12 months before the reporting deadline. Due to the time intensive nature of the work, there is only capacity to conduct the review annually. Opportunities to streamline the process would allow more frequent assessments.

Technology Implemented

DHCS worked closely with the Advantage Program Advisor and received robust support from technical resources across Esri, including staff from the Esri Health and Human Services Team. DHCS and Esri worked together to create a custom ArcGIS Pro toolbox and data input “templates” for the provider and population data. In doing so, the setup and execution of the program in ArcGIS Pro is streamlined and simple to set up for repetitive runs for network adequacy. Once the network adequacy process has run in ArcGIS Pro, DHCS is then using ArcGIS Online and ArcGIS Hub sites to publish and share the layer files and create the resulting reports and visualizations.

Development Team Biography

The network adequacy work has been supported by the efforts of several areas within DHCS. Gary Kean and Ryan Swift of the Geographic Data Team in the Health Information Management Division worked with support from Esri to develop the tools and implement the approach and direction for the DHCS network adequacy solution. Gabriel Jauregui of the Data Analytics Branch, Managed Care Quality and Monitoring Division, worked on compiling the volumes of provider data and generating the Structured Query Language (SQL) queries that provide the necessary data for the solution. Cortney Maslyn, Natalia Nash, and Emil Lumbang of the Network Adequacy Team in the Managed Care Quality and Monitoring Division provided the business requirements and feedback in working through the process to develop something new. Critical to the work was the technical support of Isabel Thong from DHCS’ Business Operations Technology Services Division in keeping the database running and helping to move very large volumes o