Medicaid/SCHIP Technical Assistance for Health IT/HIE

1. Medicaid/SCHIP Technical Assistance for Health IT/HIE 2008 AHRQ Annual Conference Presented by: Linda Dimitropoulos, RTI International

2. Why Medicaid and SCHIP? • Medicaid and the State Children’s Health Insurance Program (SCHIP) serve the most medically and financially vulnerable populations • Largest payer and insurer in the nation • Can influence the adoption of Health IT and HIE by providers that serve vulnerable populations • Agencies face considerable challenges

3. Project Purpose and Focus • Purpose: To support Medicaid and SCHIP program efforts to identify and adopt effective health IT and to participate in electronic data exchange to improve the quality and safety of their programs for the people who rely on them. • Focus: To develop a program of technical assistance that helps agencies toidentify and prioritize goals, toovercome barriers to adoption and implementation, and to evaluate outcomes.

4. Overview of Project Activities • Conduct a Nationwide Needs Assessment • Develop a Program of Assistance • General Technical Assistance • Targeted Technical Assistance • Access to Repository of Resources specific to Medicaid and SCHIP • Communities of practice and opportunities for peer-to-peer learning

5. Current Status • Completed pilot needs assessment • Nationwide needs assessment is going on now through mid-November. • Results will inform program plans for 2009 • Ongoing program evaluation will inform program changes • Products, best practices and lessons learned will be disseminated following each event • Reassessment will be done in year 2—June/July 2009

6. Pilot Needs Assessment • 7 agencies participated • Selection based on • Demographics, Size of Medicaid/SCHIP program, Medicaid/SCHIP affiliation, Extent of Health IT/HIE Activity • Structured question guide provided in advance • State Profiles • In-person and web conference

7. Identification of Health IT Projects • Agencies plans change frequently and several agencies had modified/updated their state’s health IT project plans in the past 12 months • For most agencies, their MMIS/Medicaid Information Technology Architecture (MITA) was their main health IT project • Medicaid/SCHIP participation is largely limited to a role within a statewide health IT project or within a project implemented by another entity.

8. Pilot Needs Assessment • Summary Findings • Majority of Health IT projects are in early planning stages. • Plans for formal evaluation components specific to Medicaid/SCHIP are limited. • Sustainability was noted as the primary challenge to implementation. Also, • Provider participation • Privacy and Security Issues • Transitioning between MMIS systems

9. Goals and Outcomes • General • Improve care to Medicaid population. • Improve efficiency of business processes with providers. • Project-specific • Prevent drug-related adverse events, fraud, and abuse (e-Prescribing). • Make more clinically related data available electronically to providers (electronic health records [EHRs] built from Medicaid’s administrative data). • Share aggregate health information with provider at point of care (Health Record Bank). • Allow consumers access to their health information (Health Record Bank). • Afford providers better/more timely access to Medicaid administrative data. • Improve overall efficiency of administrative systems (MMIS projects).

10. Challenges to Implementing Initiatives • Sustainability/funding of project • Maintaining participation from providers in the project • Privacy and security issues • Implementing new MMIS systems (while continuing to perform and operate concurrently under the old, legacy systems) • Aligning the goals/interests of multiple partners/participants in project; and • Seeking and securing legislative approval for participation

11. TA Topic Areas • Overall health IT/HIE policy issues • Health IT/HIE privacy and security issues for Medicaid/SCHIP • Adoption and use of data and technical standards • Medicaid/SCHIP health IT project initiatives—general topics • Medicaid/SCHIP and EHRs • Medicaid/SCHIP and PHRs • Medicaid/SCHIP and medication management/e-Prescribing • Medicaid/SCHIP and HIEs • Role of health IT and HIE in quality improvement and business process improvement

12. Reported Priority Areas for TA • Role of health IT/HIE in quality improvement and business process improvement. • Adoption and use of data and technical standards. • Health IT/HIE privacy and security issues for Medicaid/SCHIP. • Overall health IT/HIE policy issues.

13. Priority Sub-Topics • Federal and state regulations/laws/guidance that impact Medicaid/SCHIP plans for health IT and HIE initiatives • Business process analysis for the implementation of health IT projects in Medicaid/SCHIP agencies • Cost/benefit analysis to support the implementation of health IT projects by Medicaid/SCHIP agencies (assessing resource requirements and cost/value to agency) • Integration of e-Prescribing and medication management with MMIS, MITA, and other internal Medicaid/SCHIP systems

14. General TA: Year 1 Webinars • Unraveling privacy and security in HIEs: An overview of requirements and options for Medicaid/SCHIP programs – March 20, 2008 • Identity Managementfor Interoperable Health Information Exchanges – March 26, 2008 • Overview of Technical and Data Standards for Health IT and HIE – April 3, 2008 • Evaluating Health IT Projects: A Primer for Medicaid and SCHIP – May 1, 2008

15. Year 1 Webinars (continued) • Understanding EHRs: Common features and strategic approaches for Medicaid/SCHIP – June 5, 2008 • HIEs for Medicaid and SCHIP Agencies: An Overview of Core Characteristics, Components and Approaches – June 19, 2008 • Evaluating Health IT Projects: A State Perspective – July 10, 2008 • Clinical Decision Support Systems – Critical Health IT Tools for Interoperable Health Information – August 14, 2008 • Electronic Standards for Consent Directives– August 27, 2008 Transcripts and Slides for all webinars can be found at: http://healthit.ahrq.gov/Medicaid-SCHIP

16. Targeted TA: Workshops • Strategic Planning work shop • Identify goals • Develop Roadmap • Follow-up tracking • Tool kit (development) or product or plan • Evaluation

17. Access to Resources • Develop and maintain Medicaid/SCHIP-specific section on AHRQ National Resource Center website including: • a repository of information and tools specifically related to Medicaid and SCHIP • a web-based learning community for Medicaid and SCHIP representatives to share experiences and lessons learned • Establish and support on-going learning community

18. AHRQ MEDICAID and SCHIP Website and Repository

19. Additional Technical Assistance and Support Activities • Other planned activities include: • Facilitated peer-to-peer learning sessions • In-person educational meetings • Tool kits • Issue Briefs • Highlighted lessons learned

20. How to Keep Informed • Visit the website often! http://healthit.ahrq.gov/Medicaid-SCHIP • Email ideas and comments to: Medicaid-SCHIP-HIT@ahrq.hhs.gov • Register for the listserv so you can keep informed about project events! • Send an E-mail message to: listserv@list.ahrq.gov. • In the subject line, type: Subscribe • In the body of the message type: sub Medicaid-SCHIP-HIT and your full name. • You will receive a message asking you to confirm your intent to sign up. You must respond to the message to complete your registration.

21. Thank you! lld@rti.org