Longitudinal Member Records

Medi-Cal Connect Longitudinal Member Records (LMRs) are detailed records for each member, including their care team contact information, filled prescriptions, risk tier, quality metrics, and eligibility for programs and services. This rich source of information supports care coordination between Medi-Cal health plans.

Medi-Cal Connect uses claims data, which have a three- to six-month lag. The LMR is intended to give care managers helpful historical member information and provide a picture of the whole person that goes beyond medical care, including public health and social services information. The LMR supplements, not replaces, health records and health information exchange alerts.

Flags

The LMR includes more than 50 flags to help health plans identify, monitor, and address needs within their member populations. Flags indicate current enrollment, potential eligibility, and how many members are accessing services, such as specialty mental health services, Community Supports, Enhanced Care Management, and the Special Supplemental Nutrition Program for Women, Infants, and Children. 

Risk Tier

The LMR shows each member’s potential risk of experiencing adverse health outcomes or underusing essential health care over the coming year, based on the Risk Stratification, Segmentation, and Tiering (RSST) approach. Medi-Cal Connect’s RSST assigns each member a risk tier of low, medium-rising, or high to help plans understand critical population health needs, identify gaps in service, and monitor outcomes, disparities, and quality of care.