Improving information sharing in Medicaid home and community-based services with learning health systems: Implications for older adults and individuals living with disabilities and dementia.

Introduction: Medicaid home and community-based services (HCBS) support community living for older adults and individuals living with disabilities. Information sharing and effective communication among home care team members are critical to HCBS care coordination but are often fragmented, resulting in potentially avoidable consequences, particularly for persons living with complex health conditions, like dementia. Medicaid HCBS programs collect a range of data that could be leveraged in a learning health system (LHS) model to strengthen coordination between home care team members to improve outcomes and equity in HCBS care delivery. Methods: We leverage Friedman's Socio-technical Infrastructure for LHS to consider information sharing capabilities and needs within Medicaid HCBS in Maryland. Results: Given longitudinal care complexities, significant costs, and data collection protocols, Medicaid HCBS is promising for LHS efforts. Recommendations for implementing an LHS in Medicaid HCBS highlight a socio-technical infrastructure (i.e., people, technology, policies, processes), information cycles (e.g., existing research relationships and opportunities for expansion), and governance (e.g., ensuring ethical LHS implementation). Additional considerations for persons living with dementia should be made, such as the integration of dementia-related policies into care delivery. Conclusions: Integrating LHS strategies into Medicaid HCBS holds promise for strengthening efficiency and equity in information sharing across state agencies, care teams (e.g., direct care workers, nurses), and families.