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Change is Occurring!

Change is Occurring!. Linette T Scott, MD, MPH Chief Medical Information Officer, DHCS “Population Health” HIMSS NCal Educational Program, Sacramento, CA| February 4, 2014. Changes in Health Care. Population Data at DHCS Adoption of Electronic Health Records Driving Quality.

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Change is Occurring!

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  1. Change is Occurring! Linette T Scott, MD, MPH Chief Medical Information Officer, DHCS “Population Health” HIMSS NCal Educational Program, Sacramento, CA| February 4, 2014

  2. Changes in Health Care Population Data at DHCS Adoption of Electronic Health Records Driving Quality

  3. Population Data at DHCS

  4. The Medi-Cal Population Health Disparities in the Medi-Cal Population Poor neighborhood safety has been associated with poor health outcomes As of December 2013, over 8,601,500 are enrolled in Medi-Cal

  5. Diverse Information Environment Programmatic Data Eligibility Demographics Utilization (Claims and Encounters) Providers Third Party Liability Managed Care Plans Certifications and Licensing Reporting Descriptive Statistics Quality and Performance Measurement Monitoring Financial Oversight

  6. Medicaid Information Technology Architecture (MITA) is a Framework • For Business Process Redesign • Key drivers: • Efficiency within the organization • Common language and requirements • Comparability across states • Integration with changes in health care • Specifies connection to intrastate health information exchange to advance maturity

  7. MITA Comparability – Maturity Model http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/mitamm.pdf

  8. MITA Seven Conditions & Standards Modularity Standard Align with and advance MITA Use industry standards Share and reuse technology Deliver business results Performance reporting Interoperable across health & human services community

  9. Adoption of Electronic Health Records

  10. Before the Affordable Care Act … • There was the Health Information Technology for Economic and Clinical Health (HITECH) Act • A staged approach to implementing electronic health records (EHRs) • Multiple grant and incentive programs establish rules of the road for electronic health data: • (CMS) Medicare and Medicaid EHR Incentive Programs State programs end in 2021 • (ONC) Standards & Certification Criteria (S&CC)Grant programs end in 2014

  11. CMS EHR Incentive Program:Changing the Norm Health Outcome Policy Priorities Improving quality, safety, efficiency and reducing health disparities. Engage patients and families in their healthcare. Improve care coordination. Improving population and public health. Ensure adequate privacy and security protections for personal health information.

  12. How is the Norm Changing?Re-engineering business processes

  13. National EHR Adoption http://www.cdc.gov/nchs/data/databriefs/db143.htm

  14. Incentives Paid in California As of December 2013 • Medi-Cal EHR Incentive Program has paid over $715 Million to: • 11,442 Medi-Cal eligible professionals • 241 eligible hospitals • Medicare and Medicare Advantage EHR Incentive Programs have paid over $1 Billion to: • Over 28,000 California eligible professionals and hospitals

  15. Driving Quality

  16. National Quality Strategy • Required as part of the Affordable Care Act • First released in 2011 – Annual Reporting • Three Aims: • Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe. • Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care. • Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government. http://www.ahrq.gov/workingforquality/index.html

  17. New Programs Focused on Quality Hospital Readmissions Reduction Program - Medicare Provider-Preventable Conditions Including Health Care-Acquired Conditions Adult Quality Measures – core quality measures used for voluntary reporting Prevention - Medicaid Incentives for Prevention of Chronic Diseases Program And Others

  18. DHCS Strategic Vision

  19. DHCS Transforming and Innovating to Achieve its Commitments • It begins with the DCHS Strategic Plan: • To the Public … • To the People We Serve … • To our Employees …

  20. Built on the DHCS Quality Strategy

  21. Driving Quality andCare CoordinationAffordable Care Act (ACA) • The ACA Fosters… • Evidence-based medicine • Prevention • Coordinated care • Access • ACA Challenges… • Major system redesign • Reducing costs (while expanding access) • Linking health care with population health • Data limitations An Example

  22. Common Goals Across Payment Environments

  23. Thank you!

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