Agency on Aging Area 4 Partners with GroundGame.Health to Close Gaps in Care During Transitions from Nursing Homes to Home

GroundGame.Health's technology and model will power secure data exchange and steady funding for addressing Social Determinants of Health for vulnerable populations

SACRAMENTO, Calif. and TAMPA, Fla., Jan. 31, 2024 /PRNewswire/ -- Agency on Aging Area 4 (AAA4), the fifth-largest AAA providing home and community-based services to older adults and people with disabilities in California, and GroundGame.Health, the leading solution that fulfills unmet social and healthcare needs on the ground, announced a partnership this month to close healthcare gaps for people transitioning from skilled nursing facilities to home environments.

Home care is increasingly popular among healthcare providers, though according to a 2022 survey by IHCS and Sage Growth Partners, 72 percent of health plan executives reported that lack of coordination across services causes a fragmented home care experience.

The partnership will expand AAA4's ability to meet health-related social needs, from delivering healthy meals to securing transportation to appointments, as 45% of healthcare consumers have at least one unmet basic social need that affects their health and cost of care.

"Closing gaps in care requires the right blend of people on the ground and technology," said Susan Rawlings Molina, CEO of GroundGame.Health. "Through this partnership, AAA4 and GroundGame.Health can set a high standard in California for meeting vulnerable Americans' social and healthcare needs."

AAA4 will leverage GroundGame.Health's Implify™platform, which enables secure data exchange between health plans, providers, and other local Community-Based Organizations (CBOs). With this data, Community Care Workers will be able to identify Californians who are able to return to the community with the proper supports—and then actually provide them with those supports. Implify™ is HITRUST-certified and built for interoperability with health plans and smaller CBOs alike, eliminating one of the key barriers to those very different types of organizations from working together.

In 2021, California's Department of Health Care Services (DHCS) launched California Advancing and Innovating Medi-Cal (CalAIM) to increase collaboration and integration between the state's Medicaid program and CBOs. AAA4 is part of the California Association of Area Agencies on Aging (C4A), whose mission is to allow as many individuals to live in their communities for as long as they are able.

"For people who need care at home, there are a wide range of social and environmental factors that affect their experience," said Michael Costa, Executive Director of C4A. "The more we can deliver coordinated services that address these factors, the more we can improve quality of life for vulnerable people, their caregivers, and their families."

DHCS has also implemented a DxF grants program specifically to expand secure, high-impact health data exchange in service of the CalAIM goals. Through their partnership with GroundGame.Health, AAA4 will lead the field in achieving state-wide goals for health equity and becoming a Community Care Hub. Implify™ will enable AAA4 (and any other CBO that leverages the platform) to meet CalAIM reporting requirements and unlock critical resources.

"Our agency has a track record of fulfilling people's needs on the ground, and it's more critical than ever that we maintain steady funding for our work to grow our momentum," said Will Tift, Assistant Director of AAA4. "Implify not only makes doing the work easier, but also allows us to access funding from health plans and state programs who all share the same health equity goals as us."

After an initial focus on the transition of care from the nursing home to home, AAA4 will be able to leverage the same model and technology for other target cohorts, such as door-to-door transportation and home modifications.

For More Information
John Gonda
616-309-4888
[email protected]

SOURCE GroundGame.Health