Medicaid and HIT: EHR s s for Medicaid Providers

Transcription

1 Medicaid and HIT: EHR s s for Medicaid Providers National Medicaid Congress Christine H. Nye, Director Agency for Health Care Administration nyec@ahca.myflorida.com Better Health Care for All Floridians

2 Outline Background on Florida s Medicaid EHR initiative Elements of Florida s Medicaid EHR project Impact of ARRA HIT provisions on the EHR project Future considerations

3 Background: Florida Legislature directs the Agency for Health Care Administration (Agency) to develop a strategy for the adoption and use of electronic health records. (2004) The Florida Legislature requires the Agency to develop a Florida electronic health information network (FHIN) to exchange health records among health care providers and insurers. (2005) The Florida Legislature authorizes the Agency to integrate health care data from state agencies and make the health data available to health care practitioners through a state health information network. (2006) RHIO funding supports up to nine local health information exchange organizations ( )

4 Background: The Agency issues a Request for Information (RFI) to determine the capability of vendors to offer a statewide, multi-payer health information exchange which would include Florida Medicaid claims data. (2008) The Agency contracts with Availity, LLC to deliver Medicaid claims history along with claims from multiple payers to providers and consumers, using the HealthTrio solution for consumers. (2009)

5 Pre-ARRA Florida Agency for Health Care Administration

6 Medicaid-Claims Based EHR/PHR Provides web portals for both providers and consumers Allows providers to submit claims, verify eligibility, and view electronic health records for their patients derived from multiple payer sources. Provides access to a patient s medical and prescription claims history, eventually from multiple payers in an integrated view Has e-prescribing capability and access to lab results as such information may become available Provides consumer access to a personal health record (PHR) product Meets Agency privacy and security requirements and is a HIPAA covered entity for the clearinghouse requirements of this proposal

7 Multi-Payer Provider Web Portal Services Administrative Functionality Year One Submit claims to multiple payers; Check of patient eligibility and benefit information for multiple payers as applicable; E-Prescribing; Download claims to a provider s electronic medical record; Link to the Florida State Health Online Tracking System (SHOTS) Immunization website; Link to available prior authorization or service authorization information screens; Link to the Florida Medicaid provider portal; and, Direct non-medicaid providers to the Florida Medicaid provider application.

8 Multi-Payer Provider Web Portal Services Year One Payer-Based Health Records (claims) Provides information about patients when little information is available First time patients Patients with frequent emergency visits Post hospital discharge Other benefits include Improved coordination and continuity of care between commercial and public services The elimination of duplicates and reduction of unnecessary procedures Protection against fraud

9 Multi-Payer Provider Web Portal Services Year One Health-Related Functionality Office visits and hospitalizations Diagnoses and associated procedures Prescription history Lab event history Lab results Radiology event history Immunization history Treating provider and place of service

10 Multi-Payer Provider Web Portal Services Year Two Administrative Functionality Patient-centric view of patient eligibility and benefit information for multiple payers, when available Ability to download claims to a provider s electronic medical record, including the Agency s Point of Care grantee, or provide a data feed to a health information exchange Accept prior authorization data from the Continuity of Care Record (CCR) when available electronically

11 Multi-Payer Provider Web Portal Services Year Two Link for active Medicaid providers to electronic prior authorization or service authorization information through a single sign-on Link for health care providers to the Florida SHOTS immunization secure provider portal through a single sign-on; and Link to Florida Medicaid secure provider portal through a single sign-on

12 Multi-Payer Provider Web Portal Services Year Two Health-related functionality provides Patient-centric view of integrated medical and prescription claims history from multiple payers; Patient-centric integrated view of gaps, duplications and other clinical issues that may assist providers in care delivery Integrated laboratory, immunization and other clinical information, as allowed by State and Federal laws

13 Consumer Web Portal Services Year One Consumer care management information and tools Ability to self-enter health related information Download PHR content to their computers or other storage device Portability through interfaces with health data storage banks at no cost to the consumer, for either storage or transfer of information to another vendor

14 Consumer Web Portal Services Year Two The capability to add medical and pharmacy claims history, laboratory, immunization and other clinical information Provide care management tools that assist consumers in identifying gaps, duplications, and other clinical issues using integrated data from multiple payers as applicable The ability for consumers to grant providers access to their PHR content at no cost to the provider

15 Challenges Medicaid and HIPAA privacy requirements Lack of funding Systems issues Provider and consumer outreach Changing environment resulting from ARRA

16 Present: ARRA & HIT Provisions American Recovery and Reinvestment Act of 2009 (ARRA) passes with $20 billion for HIT development nationally. Governor directs the Agency, with the advice of the Health Information Exchange Coordinating Committee, to plan for the use of newly authorized federal funding and implement a plan for Health Information Exchange in Florida. A newly envisioned, but undefined, national infrastructure, terminology, requirements, and funding become available Challenge of meshing multiple year planning and implementation efforts with new federal opportunity and

17 New and Expanded Responsibilities State Planning and Coordination Broadband for Health IT Regional Extension Center Program Medicaid EHR Incentive Program EHR Adoption Loan Program

18 State Planning and Coordination Health Information Exchange Coordinating Committee nominated by Governor Charlie Crist to take the lead developing a proposal for a state level Health Information Exchange. Working with health care stakeholders statewide to define the optimal approach to Florida s HIE as it applies to ARRA provisions. Developing a strategic plan with health care stakeholders for Health Information Technology in Florida, as required by the Office of the National Coordinator for Health IT.

19 Broadband for Health IT AHCA membership on the Florida Office of Economic Recovery Broadband Workgroup to develop broadband infrastructure in Florida. Administering $11.3 million Rural Health Care Pilot Project to connect nine rural hospitals with broadband in the Florida Panhandle. Conducting health care broadband connectivity needs assessment with hospitals and health care facilities across Florida. Developing Geographical Information System mapping of access to broadband for health care facilities.

20 Regional Extension Centers Responding to the Request for Comments from the Office of the National Coordinator for Health IT concerning Regional Extension Centers. Working with not-for-profit organizations across the state to collaborate in developing proposals to the National Coordinator for Health IT to become regional extension training centers. Encouraging proposals that include education for providers and consumers, sophisticated technical support and collaboration with libraries, public health agencies and community outreach programs.

21 EHR Adoption Loan Program Three years of experience administering the Florida Health Information Network Grants Program to leverage the development of HIE across Florida. Currently administering the Point of Care Grant Program to install electronic health records systems in two free clinics in Miami, Florida. SB 162 passed during 2009 Legislative Session, provides statutory authority to the Agency to create an EHR loan program for providers.

22 Medicaid EHR Incentive Program Determining which hospitals and other providers (FQHCs, RHCs), physicians, nurses, etc. will actually be eligible based on ARRA language. 30% for physicians and dentists, nurse mid-wives and practitioners and certain physician assistants; 20% for pediatricians; 10% for hospitals and all children s hospitals; RHCs and FQHCs with 30% needy population Beginning outreach activities to hospitals and other provider associations and working with them on outreach activities. Calculating payments to hospitals based on federal formula Meeting with vendors to learn their thoughts and ideas about how they think the program will work

23 State-Level HIE Overview of HIE Plan Components and Infrastructure The Agency proposes to partner with a not-for-profit organization, institution, or other eligible entity that can establish a State-Level HIE. This State-Level HIE will be responsible for providing connectivity to health care providers and other sources of health care information and will offer secure exchange of health care information among all of the providers in its network

24 Overview of HIE Plan Goals and Objectives Promote, facilitate, and support, as funding is available, the development of health information exchange systems which provide inter-operability among health care providers Promote provider adoption of Certification Commission for Health Information Technology (CCHIT) certified EHR software, including fully informed electronic prescribing functionality. Provide available financial support for the construction of a broadband network connecting rural health care providers with urban health care centers Ensure that the Medicaid Management Information System (MMIS) meets national standards for secure HIE of Florida Medicaid data

25 Overview of HIE Plan Goals and Objectives Assure that HIE in Florida is unassailable with respect to HIPAA and FL privacy statutes Coordinate the development of payer and provider-based personal health records that meet national standards Educate Floridians in the use of HIT Require the use of national standards and certification-based technology as a condition for receiving monetary support Support the use of telemedicine technologies Collaborate with states in the Gulf Coast area to promote HIE for normal course of business and disaster situations

26 ARRA Florida Agency for Health Care Administration

27 Questions