Maximizing CMS Reimbursement in an EA World

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Maximizing CMS Reimbursement in an EA World

• September 2, 2009
• Marsha Morris, J,D.
• Commissioner
• Bureau for Medical Services
• West Virginia

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Overview

• My presentation is to share with you how the
  Medicaid agency can develop an aligned strategic
  direction that maximizes our opportunities,
  including CMS reimbursement
• Key objectives
• Convey the need for an integrated strategy that
  aligns stakeholders and resources in the state
• Provide an example of an integrated statewide
  strategy
• Provide insight to how you can develop such a
  strategy and engage the stakeholders

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Background on West Virginia
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The State Overview

• 1.8 Million citizens
• 70 Hospitals (52 acute care 18 critical access
  hospitals 6 rehabilitation 4 Veterans Affairs)
• 3,743 active and practicing physicians
• 80 of population lives in communities of less
  than 5,000
• West Virginia ranks in the bottom 10 in State
  Health Rankings (United Healthcare Kaiser)
• Health care costs estimated at approximately 19
  of gross state product

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Background on WV Medicaid

• Pay for more than 50 of all newborn deliveries
• Pay for more than 68 of NICU babies
• Pay for 73.51 of nursing home stays
• Pay for two waiver programs
• MR/DD has a dedicated budget line
• ADW has a dedicated funding source (Lottery)

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Medicaid (contd)

• The two current waivers now have waiting lists
• The agency was just court ordered to add a third
  waiver for persons with Traumatic Brain Injury
  (TBI)

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Environment
Provider Integrated Service Delivery Networks
WVHIN
TeleHealth Alliance
Payer Sponsored Initiatives
CMS Transformation Grants Health Improvement
Institute
Hospital Based Systems
Employer Based Initiatives
WVMI 8th CMS Scope of Work
Educational Institutions
eHealth West Virginia
Medical Foundation Educational Outreach
Open Source Solutions
New Office of GOHELP
Early Adopter Private Providers
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CMS Opportunities

• CMS Demonstration Programs
• CMS Transformation Grants
• MITA Funding
• ARRA Funding Opportunities working in
  Collaboration with the Office of the National
  Coordinator

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What Is CMS Seeking with State Partners?

• The state understands health information
  technology and is thinking through the strategic
  needs as outlined in the MITA Architecture
  Guidance
• The state is making efforts and achieving success
  in aligning stakeholders in a forward strategic
  direction
• This forward direction is evidenced by a HIT
  strategic plan with consensus of the stakeholders
• There is confidence that the state has an
  execution strategy for funding opportunities that
  minimizes potential execution failure

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State HIT Plan

• We determined the need for a statewide strategic
  planning process
• The foundation for planning was preceded by
  several months of group dialogue on HIT issues
• We used the Health Improvement Institute (HII)
  as the vehicle to facilitate accelerate the
  planning process. The HII was established
  through a MTG

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West Virginia Health Improvement Institute
Stakeholder Advisory Group Meet
Quarterly Virtual Engagement On-Going
Steering Committee
Provider Education
Self Management
Adoption of HIT
Measurement/ Reimbursement/ Reporting
Evaluation Innovation
Pilots
Pilots
Pilots
Innovation Community 300 Provides
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Work Group
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The Vision

• The vision for the health information system
  strategic plan is to establish a coordinated
  information technology infrastructure and
  delivery system that allows patients, families,
  communities and the health care practitioners to
  collaboratively partner in improving the health
  and well being of all West Virginians.

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Preliminary Goals

• 80 of physicians will be using Electronic
  Medical Record for clinical support in daily work
  by 2019 exceeding the federal guidance and intent
  associated with meaningful use
• 100 of our hospitals will be using Electronic
  Medical Record systems and related technology by
  2015 in a meaningful way and will be
  interconnected throughout the state to ensure
  critical health information is readily accessible
  and communicated

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West Virginia State Health Information Technology
Strategic Plan
.
The vision for the health information system
strategic plan is to ensure a coordinated
information technology infrastructure and
delivery system is established that allows
patients, families, communities and the health
care system to collaboratively partner to improve
the health and well being of all West Virginians.

• Accelerate the Adoption of HIT
• Accelerate adoption EHRs
• Serve as a Regional Extension Center for HIT
• Encourage Reimbursement System to Promote Use
• Encourage Adoption Tele-health Technology
• Telemedicine
• Encourage e-
• Prescribing
• Encourage Patient Health Records
• Standards

• Foster Health Information Exchange
• Clinical messaging
• Coordinated care
• Improve Quality and Value

• Ensure
• BroadBand
• Infrastructure
• Complete a Broadband Inventory to Identify Gaps
  and Needs
• Establish a Budget for Tele-Health Alliance
• Align Reimbursement to Create Local Business Case
• Work with the Vendor Community to Encourage Local
  Investments

• Create Usable and Accessible State-Wide Data
• Leverage MITA to Establish State Data
  Infrastructure
• Ensure adoption of national standards
• Establish Security Protocols
• Encourage Voluntary Reporting by Payers
• Encourage Voluntary Reporting by Providers
• Provide Transparency
• Drive Improvement in Key Areas Using Data

• Ensure Financial Viability Sustainability
• Leverage federal partnerships (MITA/CMS/ONCHIT/AR
  RA)
• User Fees and Aligned Reimbursement to support
  use of technology
• State Role in Driving Technology

• Develop the Work Force
• Establish a Regional Extension Center
• Establish a Centralized Technical Help Desk for
  Provider Support
• Recruit and Retain Health IT Professionals

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The Execution Phase

• We drafted the straw man strategic plan between
  May 1st and August 31st, 2009
• We presented this to a wide audience, including
  CMS Microsoft, on June 30th and solicited
  comments.
• We continued to refine the plan and monitor
  federal initiatives
• We are reconvening the stakeholders for a final
  review in early September and asking for formal
  sign off
• The Legislature established a new office for
  Health Reform, GOHELP, and charged this office
  with oversight and execution of the plan
• We are applying for CMS and ONC funding
  opportunities as outlined in the ARRA legislation
  and recent federal guidance

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Critical Success Factors to Date

• We prepared the local environment
• We engaged stakeholders early
• We created a neutral playing field for dialogue
• We used an external facilitator to drive the
  process and ensure time sensitivity
• We communicated routinely
• We created an infrastructure for execution

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• State HIT Plan

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1 Accelerate Adoption of HIT

• Priority 1 Accelerate Adoption of Electronic
  Health records
• Encourage Use of Interoperable Electronic Medical
  Record Solutions
• Require Minimal Level of Functional Requirements
  and CCHIT Certifications
• Require Interconnectivity
• Health Information Exchange as a Catalyst for
  Adoption
• Centralized Help Desk Support

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• Priority 2 West Virginia is integral in
  developing a Regional Information Technology
  Center
• Make available purchasing decision support
• Develop waves of structured deployment
• Provide training in the use of technology
• Engage those who have already purchased systems

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• Priority 3 Encourage the Reimbursement System
  to Promote Use of Technology
• Priority 4 Encourage the Adoption of
  Telemedicine Technology
• Priority 5 Encourage e-Prescribing
• Priority 6 Encourage the use of Personal Health
  Records

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2 Health Information Exchange

• Priority 1 Encourage Clinical Messaging
• Priority 2 Coordinated Care
• Priority 3 Improve Quality and Value
• Physician Analysis
• Public Health
• Personal Health Records
• Research

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3 Ensure Availability of a Broadband
Infrastructure to Support Technology Use

• Priority 1 Complete a statewide Broadband
  Inventory
• Priority 2 Establish a budget for the
  Tele-Health Alliance to Continue to Support Its
  Role
• Priority 3 Align Reimbursement Model that
  Support a Local Business Case for Investments in
  Infrastructure
• Priority 4 Work with the vendor community to
  encourage local investments

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4 Create Usable and Accessible State-Wide Data

• Priority 1 Leverage MITA to Establish State
  Data Infrastructure
• Priority 2 Ensure Adoption of Standards to
  Guide HIT in the State
• Priority 3 Establish Security Protocols for the
  Protection and Use of Data
• Priority 4 Encourage Payers to Voluntarily
  Report Claims Data to a Centralized Warehouse
  Quarterly
• Priority 5 Encourage Providers to Voluntarily
  Report Clinical Data Centrally on a Monthly
  basis
• Priority 6 Provide Transparency in Line with the
  Patient Health Charter
• Priority 7 Information will be used to drive
  improvement in key areas of need throughout the
  state

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5 Develop the Work Force

• Priority 1 Become a Regional Extension Center
• Priority 2 Establish Centralized Help Desk
  Support
• Priority 3 Recruit and retain Professionals
  with skills in HIT
• Priority 4 Build a Pipeline of HIT
  Professionals
• Collaborate with the professional Societies
• Coordinate with State University System, and
  Community Colleges
• Ensure Use of technology in medical education
• Leverage State based Infrastructure to provide
  on-demand education and training
• Encourage Hospitals and Health System s to
  Continue training opportunities

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6 Ensure Financial Viability and
Sustainability

• Leverage federal Partnerships
• Partner with CMS on MITA
• Partner with CMS on ARRA
• Partner with ONC
• Partner with HSRA
• User Fees and Viable Marketplace Supported by
  Reimbursement Reform
• State Role in Driving technology

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