Alliance for Health Reform Briefing: Medicaid and Health IT

1. Community Health Centers and HIT Driving Innovation in the Patient-Centered Medical Home Alliance for Health Reform Briefing: Medicaid and Health IT Presented by: Judith Featherstone MD, FAAFP Medical Director HealthPoint August 1, 2011

2. Health Centers Today Today, Health Centers serve as the health care home for more than 20 million patients nationally, including: • 1 in 7 Medicaid beneficiaries • 1 in 7 uninsured persons • 1 in 3 individuals in poverty • 1 in 7 ruralAmericans *Includes patients of federally-funded health centers, non-federally funded health centers or “Look-Alikes”

3. HealthPoint is the largest CHC in the 14th largest county in the US. 12 Clinics: 7 medical, 4 dental, 1 school-based Patients = 62,542, Visits = 210,865 Medicaid, Medicare and Public Insurance- 55% Uninsured – 37% In addition to primary medical and dental care, services include: Prenatal care and delivery Complementary and alternative medicine including naturopathic medicine, acupuncture and nutrition counseling Behavioral health Pharmacies in all clinics HealthPoint: Your Community Health Center

4. HealthPoint Patients Patient race/ethnicity Patient income by Federal Poverty Level Patient by insurance

5. Health Centers and HIT: National Perspective Nationally, three quarters of all health centers are now on the road to adopting integrated health information technology systems.

6. HealthPoint Perspective • 2005 Electronic Health Record/ Practice Management Adoption • 2007 Quality of Care Outcomes Reports • 2007 Immunization Data Interface with the State Registry • 2008 Population Recall Reports • 2008-11 Templates for Behavioral Health, MSS, Homeless care • 2008 Electronic Prescribing • 2010 Internal Pharmacy System Integrates with EHR, • 2010 Electronic Dental Record Integrates with EHR, • 2011 Billing from EHR • 2011 Future: Patient Portal, HIE, Enhanced Reporting and Decision Support

7. Challenges to Adopting Health IT Equipment Staff training Provider use Reassignment of Medicaid HIT Incentive Payments

8. Opportunities for Health IT Support • Medicaid HIT Incentive Payments • Health Center Controlled Networks • Primary Care Associations • Regional Extension Centers

9. Health Centers and HIT: National Perspective Health centers use Health IT in varied ways to meet the needs of their patients, for example… Telehealth: patients, including those in rural or remote areas, can “see” a provider for screenings, behavioral health encounters, remote eye exams, and chronic disease management. Referral Tracking: the record, patient history, medication and Rx plan follows the patient across health center sites and other health care providers. Personal Chronic Care Management: electronic records notify providers and patients when it’s time for a check up or check in.

10. Innovations at HealthPoint Other Video interpretation Mobile phones for health reminders Website with links to mobile applications for healthy living. Telepharmacies EHR • Specialist guidelines for referrals built into EHR. • Coordination of EDR and EHR • Tracking referral completion • Managing for quality of care outcomes • Reports on health disparities to target community approaches.

11. Health IT: Improving the PCMH Population Care Outreach to patients due for health maintenance services Outreach to patients with chronic diseases which are uncontrolled or due for monitoring. Reports can guide us in setting up appropriate systems such as community health workers for new immigrant populations. Develop interventions targeting obesity based on our reports including language and ethnicity. Patient Experience Time of visit activities Invite in for individual visit or group with cohort. Coordinate with specialists, ER and hospital, decrease redundant work. Decision support built in for referral appropriateness, referral preparation, evidence based testing.

12. Health IT: Improving the PCMH Patient-Centered Medical Home Six standards align with the core components of primary care 1)Enhance Access and Continuity 2)Identify and Manage Patient Populations 3)Plan and Manage Care 4)Provide Self-Carte Support and Community Resources 5)Track and Coordinate Care 6)Measure and Improve Performance Health IT is vital to meet these standards.