Discussion with BEACON Council

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Discussion with BEACON Council
Medicaid Provider Incentive Program

• ODJFS/OHP
• 7.23.10

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Ohio Medicaid Health Care Reform

• Coverage for Ohioans High risk pool, Health
  Care Coverage Exchange, Eligibility Expansion
• High Quality Person Centered Care - Accountable
  Care Organizations
• Improved Efficiency - Reduced test duplication,
  Medication reconciliation, Care Coordination
  Streamline administrative processing
• Improved Effectiveness - Reduced errors,
  Evidence-based decision support, Preventive care
  reminders Reduce avoidable re-hospitalization
  ED, Chronic care management
• Improved Value P4P, Payment reform

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Where did this come from?

• ARRA (American Recovery and Reinvestment Act)
  provided incentive for eligible professionals
  and hospitals who become meaningful users of
  certified electronic health record technology
  (EHR, ePrescribing, eligibility, etc.)
• Purpose - to enhance quality and health care
  outcomes and reduce overall health care costs
• Theres a Medicare and a Medicaid program.
  Medicaids program is called the Medicaid
  Provider Incentive Pmt program MPIP

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What do we have to do to get the federal money?

• First, CMS had to approve our plan to work with
  Stakeholders to define
• Ohios As Is state of HIT and EHR
• Where Ohio will be in 5 years on HIT and EHR
• The Road Map for Getting to this Vision
• The basics of Ohios MPIP program
• Our SMHP
• Ohios I-APD

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Who is eligible for MPIP?Medicaid Provider
Incentive Payment

• Eligible Professionals (EPs)
• Physicians (Pediatricians have special
  eligibility payment rules)
• Nurse Practitioners (NPs)
• Certified Nurse-Midwives (CNMs)
• Dentists
• Physician Assistants (PAs) who lead a Federally
  Qualified Health Center (FQHC) or rural health
  clinic (RHC) that is directed by a PA
• Eligible Hospitals
• Acute Care Hospitals
• Childrens Hospitals

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CURRENT STATUS

• CMS approved Ohios approach to planning for HIT
  on June 30. Work is underway to define
• Develop Ohios As Is and To Be framework
  June-Sept
• Stakeholder Input on The Vision for Ohios HIT
  and EHR in 5 years June-Sept
• Develop Submit SMHP to CMS Sept-Nov
• Develop Submit I-APD to CMS upon approval of
  SMHP
• Negotiate with CMS Dec Jan 2011
• Develop and Implement MPIP Spring 2011

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BEACON and MPIP

• Quality Measurement gt Quality Improvement gt
  Payment Reform
• MPIP provides an incentive to high volume
  Medicaid providers to move to EHR
• EHR requires systematic clinical data collection
• BEACON is
• Quality Measurement Quality Improvement

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Goals of Meaningful Use

• Improving quality, safety efficiency of care,
  while reducing disparities
• Engaging patients and families in their care
• Promoting public and population health
• Improving care coordination
• Promoting the privacy and security of EHRs

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EHR Incentive Program Final CMS Regulations (2
years)
CHIPRA Quality Measures

• Harmonization with CHIPRA
• 4 Measures in Stage 1.
• BMI
• Pharyngitis
• Immunizations
• Chlamydia Screening

• Must meet 15 core measures in 2nd year
• Includes reporting quality measures to the state.
• May choose several among 10 in the Menu Set.
• States may require submission of data to
  state-wide registries.

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Consider aligning future BEACON projects with
meaningful use and quality measurement
requirements of EHR incentive program