Promoting HIT Adoption in HRSA Community Making Medicaid Work For You

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Promoting HIT Adoption in HRSA Community Making
Medicaid Work For You

• Anthony Rodgers, Director
• Arizona Health Care Cost Containment System
• November 5, 2007

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National Vision of Health Information Exchange
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HIE/EHR the System Transformation Enabler
Population Management
Delivery System Redesign
Self Management
Electronic Health Records and Information
Technology

• Personalized care plan
• Personal health record
• Online goal setting tools

• Care coordination
• Set goals for optimal health
• Primary care team

Decision Support

• Alert and reminders
• Guidelines
• Clinical knowledge
• Templates

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Historic Barriers to Statewide HIE and EHR
Adoption
Lack HIT Enabler Technologies Leadership
Lack of Public Private Synergy
Lack Financial Investment
Misaligned Reimbursement Incentives
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The Charter of the NGA State Alliance for e-Health

• To establish a consensus based, executive
  level body of state elected and appointed
  officials to collectively address state-level
  health information technology issues and
  challenges to interoperable electronic health
  information.
• Co-Chaired by
• The Honorable Phil Bredesen, Governor of
  Tennessee and
• The Honorable Jim Douglas, Governor of Vermont

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State Alliance for e-Health Specific Objectives

• Address barriers to health information exchange
  and adoption of health IT, while preserving
  privacy, security and consumer protections.
• Build consensus in seeking the harmonization of
  the variations in state policies, regulations,
  and laws, where appropriate, and develop
  standards and/or guidance for modifying such
  policies, regulations, or laws.
• Allow for dialogue among states that will fuel
  creativity and partnership among states and with
  the private sector in the area of HIT.
• Allow for the appropriate input of experts and
  others working on health IT endeavors, to inform
  state policymaking.

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State Alliance Working Taskforces

• Health Information Protection Taskforce will
  address issues related to privacy and security of
  health information exchange.
• Health Care Practice Taskforce will assess state
  legal barriers to practice of medicine as it
  relates to telemedicine, medical liability, and
  health information exchange.
• Health Information Communication and Data
  Exchange Taskforce will address governance of
  health information exchanges, financial
  sustainability, relationship between public
  payers and state level health exchanges, and
  integration with public health program
  information

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Health Information Communication and Data
Exchange Taskforce Charge

• Support the State Alliance on issues
  regarding the appropriate roles for publicly
  funded health program in interoperable,
  electronic health information exchange (eHIE).
• Develop and advance actionable policy
  statements, resolutions, and recommendations to
  State Alliance to inform their decision-making
  process in addressing ways in which states can
  enhance Medicaid, State Childrens Health
  Insurance Programs (SCHIP), employee health
  benefits, and public health through cooperative
  HIE activities with the private sector.

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State Alliance Taskforce on Health Information
Communication and Data Exchange

• Convened first meeting May 15th -16th 2007
• Taskforce is schedule to complete its work by
  January 2008
• Has met to develop recommendations on
• Medicaid/SCHIP role in HIE/EHR,
• CMS role in financing Medicaid/SCHIP HIE/EHR,
• Public Health and HIE,
• State Employees and HIE/EHR

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Taskforce Membership

• Co Chair Rhonda Medows, Georgia Commissioner
  Dept. of Community Health
• Patricia Anderson, Minnesota Commissioner of
  Employee Relations
• Ann Boynton, California Undersecretary For Health
  and Human Services
• Devore Culver, Exec. Director HealthInfoNet
• Christine Dutton, Pennsylvania Chief Counsel to
  Dept of Health
• Edward Ewen, MD Director of Clinical Informatics
  Christiana Care Health System
• Gregory Farnum, President Vermont Information
  Tech Leaders
• David Gifford, MD, Rhode Island Director Dept. of
  Health

• Co-Chair Anthony Rodgers, Director Arizona Health
  Care Cost Containment System
• Steven Hill, Administrator Washington Health Care
  Authority
• Steven Hinrichs, MD, Nebraska Director of Public
  Health Lab
• J. Michael Leahy, CEO Oregon Primary Care
  Association
• Ruth Turner Perot, Exec. Director Summit Health
  Institute for Research and Education
• Michele V. Romeo, CIO New Jersey Division of
  Medical Assistance
• Will Saunders, President ACS Heritage
• Teresa M. Takai, Michigan Director of IT
• Alan E. Zuckerman MD, Pediatrics Georgetown
  University Hospital

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Taskforce Work Products

• Conduct a survey and analysis of state coverage
  programs that cover large populations and
  identify opportunities within these programs that
  states can utilize to further eHIE. This analysis
  will include an assessment of the following state
  programs
• State Medicaid and SCHIP
• State employee health benefits
• State Public Health
• Provide an overview of the landscape of current
  state action to support the creation and
  operation of electronic health information
  exchange networks.
• Provide findings and recommendation to the State
  Alliance on e-Health

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Findings and Recommendations on Health Data
Exchange and Communication

• The taskforce will make findings and
  recommendations in the following areas
• Leadership/Governance
• Consumers Role
• Financial and Contributory Responsibility
• Interoperability
• Structure and Current Approach

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Findings on Success Factors for State
Medicaid/SCHIP HIT and HIE Initiatives

• Governor has provided visible leadership in
  regard to HIT/eHIE efforts in Medicaid and SCHIP
• State roadmaps have been viewed as a successful
  tool to set state-wide priorities involving
  publicly funded health programs
• Multi-stakeholder collaborations between payers
  (including Medicaid/SCHIP), providers and
  consumers are essential to success
• Foster trust among public and private
  stakeholders
• Flexible funding models as demonstrated by the
  DRA Medicaid Transformation Grants has been
  integral to expanding HIT/eHIE efforts in many
  Medicaid/SCHIP agencies
• Traditional mechanisms do not address the scope
  of HIT/eHIE projects

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Findings on Key Challenges for State
Medicaid/SCHIP Programs

• Current lack of communication and data sharing
  mechanisms between state agencies (silos)
• Lack of data systems interoperability between
  state agencies, other payers, and health
  providers
• Perceived and actual legal and regulatory issues
  in regard to data sharing and ownership
• Lack of provider adoption of HIT tools such as
  EHR
• Medicaid agencies are often understaffed for
  large scale HIT/eHIE projects
• Medicaid staff need education and training on the
  appropriate use of data created by these tools
  for quality measurement and improvement purposes

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Recommendation 1.0

• 1.0 The NGA should provide states guidance for
  the development of executive orders and provide
  guidance related to legislation. State level
  public HIE initiatives should, at a minimum,
  include
• A set of specific objectives for Medicaid/SCHIP
  participation in eHIE, particularly as it relates
  to quality, transparency, and cost containment
• Procedures for designing an eHIE roadmap
• Indemnity
• Requirement that all state agencies adopt and
  utilize interoperable HIT
• Consumer protections to ensure appropriate access
  to health data
• Commitment to inclusiveness and diversity in eHIE
  activities amongst health care providers, payers,
  and consumers and
• State procurement rules that enable fair and
  flexible innovations, require the adoption of
  interoperable HIT applications, and align with
  any state-wide eHIE/HIT policies.

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Recommendation 2.0

• 2.0 Each state should develop or adopt a vision
  for state eHIE that leverages existing and
  planned public and private eHIE efforts and
  outline an eHIE roadmap by the end of 2008 and
  implement by 2014. Components of the roadmap
  should, at the least, include how the state plans
  to
• organize the implementation of eHIE in the state
  
• engage diverse stakeholders, including consumers,
  providers and payors
• develop and test exchange architectures
  incorporating existing and approved standards
• build financial, political support, and
  legislative authority for eHIE development
• ensure consumer protections are in place
• train and sustain an eHIE-capable workforce and
• enable intrastate collaboration and data
  exchange.
• 2.1 In close coordination with Office of the
  National Coordinator (ONC) and other federal
  agencies (e.g. CMS), NGA should play a leadership
  role on behalf of all governors to facilitate the
  coordination of individual state roadmaps in the
  context of a national interstate eHIE strategy.

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Recommendation 3.0 and 4.0

• 3.0 Governors should designate a single
  authority for the state to coordinate state
  government based eHIE implementation activities
  and work, in collaboration, with public/private
  eHIE efforts.
• 4.0 Governors and state legislatures should
  align to establish flexible financial mechanisms
  to support and ensure sustainable eHIE.

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Recommendation 5.0

• 5.0 To successfully implement HIT and eHIE
  initiatives and to meet Medicaid MITA standards,
  states will require new technology, project
  management, policy, legal, consumer protection
  and programmatic competency development.
  Therefore, states should fund greater development
  of technical assistance resources for state
  Medicaid/SCHIP and information technology
  agencies to build workforce competency on eHIE.
• Such resources could be aligned with the Health
  Resources and Services Administration technical
  assistance toolbox modules
• Introduction to HIT     
• Getting Started       
• Opportunities for Collaboration        
• Project Management and Oversight 
• Planning for Technology Implementation      
• Organizational Change Management and Training
• System Implementation       
• Evaluating, Optimizing, and Sustaining          
• Advanced Topics   

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Recommendation 6.0 and 6.1

• 6.0 State Medicaid agencies implementing
  electronic health record systems in the Medicaid
  program, should implement a standards-based
  personal health record functionality that is
  portable and includes appropriate privacy and
  other consumer protections. When available, state
  Medicaid programs should require use of certified
  electronic health records (EHR) and networks with
  standards-based information exchange
  capabilities.
• 6.1 State Medicaid agencies should ensure
  portable, private and secure access to personal
  health information to their enrollees through HIT
  systems such as personal health records. The
  State Alliance should encourage states to provide
  human and financial resources to develop cultural
  and linguistic competency required to engage
  diverse Medicaid/SCHIP enrollees.

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Recommendation 7.0

• 7.0 State Medicaid agencies should implement
  incentive programs and, or reimbursement policies
  such as pay for participation, rate adjustment,
  case management, and quality pay for performance
  that will encourage provider adoption and use of
  HIT systems and participation in eHIE.

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State Medicaid Programs Collaboration on System
Transformation

• State Medicaid Transformation Grant
  recipients agreed to collaborate on
• Project coordination,
• Joint planning opportunities,
• Maximize the chances of success,
• Establish common vision for HIE among state
  Medicaid Programs
• Create a learning community to share lessons
  learned with other states Medicaid programs
• Leverage each states investment in EHR/HIE

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Collaboration with other state Medicaid Programs
on EHR/HIE

• State Medicaid Program that are participating
• Alabama
• Arizona
• Connecticut
• District of Columbia
• Hawaii
• Idaho
• Kentucky
• Michigan
• Mississippi
• Missouri
• Montana
• New Mexico
• New Jersey
• Texas
• West Virginia
• Wisconsin

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Medicaid Leadership in HIE/EHR Deployment

• Requires
• A strong Federal and State partnership and
  financial support,
• Agency leadership and participation
• Effective health information system planning and
  development know-how,
• New skills and organizational competencies within
  State Medicaid Program and Public Health,
• New reimbursement strategies and health
  information exchange policies,
• State Level Public/Private partnerships

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Role of Safety Net and Community Health Centers

• The safety net must be part of any state
  leadership group or public private partnership
• Community Health Centers need to work together
  and collaborate to assure no health center is
  left behind
• With the Medicaid Transformation Grants State of
  resources to collaborate with community health
  centers
• Other funding sources maybe available over the
  next several years to help state that have shown
  leadership achieve statewide health information
  exchange

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Making Medicaid Work For You Success through
Collaboration