Data Sharing Is the Missing Link in Addressing Non-Medical Drivers of Health in Texas

Alex Perkins, Texas State University

Madeleine Richter-Atkinson, Treaty Oak Strategies

Texas prioritized addressing non-medical drivers of health (NMDOH) by enhancing Medicaid services and case management. In 2024, The 88^th Texas Legislature passed House Bill 1575, which standardized Medicaid managed care organization (MCO) NMDOH screening questionnaires to improve effective collection and sharing of NMDOH data and improve health outcomes for mothers and their children. MCOs, providers, and community-based organizations (CBOs) share data to improve service coordination and health outcomes for Medicaid members. Treaty Oak Strategies and the Center for Health Care Strategies, with support from the Michael & Susan Dell Foundation and the Episcopal Health Foundation, conducted a landscape assessment to better understand what difficulties MCOs, providers, and CBOs still face when sharing NMDOH data since implementation of HB 1575.

Findings from the Assessment

Through interviews with Texas MCOs, providers, and CBOs, Treaty Oak Strategies found ample opportunity for improving data-sharing systems and practices throughout the state to advance the goals of HB 1575.

Closed-Loop Referrals Are the Goal

The majority of interviewees agreed on what a good data sharing system looked like. They identified closed loop referrals as the ideal outcome of good data sharing. In such a system, organizations can both see that a referral was made and whether medical or social services were delivered and needs were met. Providers mostly operate with partial information because of the lack of visibility into the services the patients received elsewhere. MCOs may not know when NMDOH needs have already been identified, and CBOs often receive referrals without context to act effectively.

Current Systems are Fragmented

One of the biggest difficulties in data sharing between MCOs, providers, and CBOs today is an overwhelming number and complexity of disparate systems. Providers and CBOs have to navigate a dozen or more data-sharing systems, each with different requirements and formats. For smaller organizations and non-profits, such a fractured system can be costly and difficult to manage. They often lack the staff, time, or technical capacity to develop data sharing agreements and manage all these systems. Data may arrive in formats that are technically “shared” but functionally unusable, such as massive PDFs that cannot be easily analyzed or acted upon.

Fragmented Services Leads to Over-Screening and Duplicative Services

Because existing systems are often not set up to receive data from each other, most patients are screened multiple times for the same NMDOH needs. This is not only an inefficient use of time and financial resources but also becomes an inconvenience to the individual who is getting screened. Fragmentation of data sharing systems also makes it hard to identify duplicated services. When patients change providers due to dissatisfaction or changing needs, new providers may have no visibility into what prior services the patient received.

Health Information Exchanges’ Full Potential Has Not Been Realized

While Health Information Exchanges (HIEs) were designed to be a bridge to bring data from disparate platforms into harmony, their full potential has not been realized yet. Participation is uneven, data contributions are incomplete, and many organizations report minimal data to HIEs due to administrative burden and lack of resources to onboard to an additional platform.

Trust Is as Important as Technology

Trust is a huge factor in addressing NMDOH. Families are wary of how sensitive information will be used, afraid of wrongful separation from their children and other repercussions for having unmet needs. Without clear safeguards and transparency, families may hesitate to share what they need the most.

A Path Forward

The assessment offers several recommendations, including:

• Plans, CBOs, and providers in partnership aligning on what NMDOH data should be collected and by whom.

• Agreeing on standardized formats and timelines for sharing data.

• Prioritizing flexibility and support from organizations with greater resources.

• Moving toward a universal screening and referral platform.

• Developing a living, uniform NMDOH screening tool across sectors.

None of these steps will be simple, but they point toward a future where NMDOH data can be used to ensure closed loop referrals.

HB 1575 has the potential to help meet patients’ non-medical health-related needs. Reaching the bill’s full potential will require collaboration, investment, and a willingness to reshape how data gets shared across the health care systems.