Health Information Technology and its Role in Medicaid State of Wisconsin Perspective

1. Health Information Technology and its Role in MedicaidState of Wisconsin Perspective Presentation to the Second National Medicaid Congress Kevin R. Hayden, Secretary Department of Health and Family Services June 15, 2007

2. Agenda • Health Care Environment and Wisconsin’s eHealth Agenda • Transforming Medicaid through eHealth • Questions

3. The Health Care Environment • 1999 “To Err is Human” • Human impact and health care costs of errors • “Crossing the Quality Chasm” • Roadmap for health care redesign • Four Cornerstones of Value-Driven Health Care • Wisconsin’s provider and payer response • Wisconsin Collaborative for Healthcare Quality (WCHQ) • eHealth Care Quality and Patient Safety Board • Wisconsin Health Information Organization (WHIO)

4. Wisconsin eHealth Initiative • Public-private collaboration for widespread adoption of HIT/HIE • Wisconsin’s eHealth Action Plan includes: • Creation of a technical infrastructure • Establishing a governance structure for exchange • Options for addressing privacy and security issues • Support for the acquisition of EHR systems by small provider groups and safety-net providers

5. eHealth Action PlanDecember 1, 2006 • Establish the eHealth technology platform • Value-based purchasing policies and actions • Link HIT and HIE plans to prevention and disease management activities • Take an incremental approach – growing thoughtfully over time with frequent evaluation of progress

6. eHealth Technology Platform • HIT adoption • Encourage adoption and investment in electronic health record systems • Regularly monitor adoption progress • Regional health information exchange • Foster creation of regional health information exchanges • Simultaneously focus on statewide health information exchange • Focus early on providing patient information timely and at point of care

7. Wisconsin Regional Health Information Organizations (RHIO’s) • eHealth Action Plan envisions the development of a total of five WI RHIO’s • First RHIO formed in Southeast WI—the Wisconsin Health Information Exchange (WHIE) • Member-governed, non-profit, collaborative effort involving health agencies in nine counties to facilitate information access for clinicians • WHIE is just beginning development and implementation of an operational HIE

8. Value-based purchasing • Develop standard requirements for reimbursement • Leverage purchasing power of state government to align incentives that promote high quality, safe, and efficient care • Seek funding to develop these systems • Participate in development of the WHIO data repository to track quality and cost across episodes of care

9. Link HIT and HIE to prevention and disease management • Develop a routine health risk assessment and member agreement • Promote chronic disease management tools by safety-net providers • Improve coordination of care across health settings • Research ways to engage patients in the health decision-making process

10. Link HIT and HIE to prevention and disease management (cont.) • Establish biosurveillance capabilities for rapid detection, management, and recovery across health settings • Assure interoperability of HIT/HIE with public health systems

11. Take an incremental approach • Address HIT and HIE simultaneously • Establish benchmarks • Start with projects that build infrastructure • Use standards consistent with national developments • Create incentives for interoperable systems

12. Take an incremental approach (cont.) • Build on existing assets • Establish effective communications strategies • Monitor progress and adjust activities as necessary

13. Transforming Wisconsin Medicaid • Goal is to transform Medicaid from a passive health insurance, claims processing/payment operation to: • Care management • Use of EHR’s to educate our providers and recipients • Defining clinical standards of care • Identifying and resolving treatment gaps • Performance-based reimbursement rates

14. Medicaid Now Price driven Hidden price & quality information Knowledge disconnected Disease focused Paper based Process focused government Quality and price measured Medicaid of the Future Values driven Transparent price & quality information Knowledge intense Prevention/wellness focused Electronically based Outcomes focused government Quality of care and life measured Transforming Wisconsin Medicaid

15. Health Information Technology • Enables: • Improved quality • Reduced errors • Lowered costs • Consumer engagement • Population health • Essential and key to transforming Medicaid

16. Transforming Wisconsin Medicaid • Bring benefits of electronic health records (EHR’s) to our Medicaid population • Advance regional health information exchange for the Medicaid population • Reform Medicaid reimbursement system • Design programs to improve the health care delivery system and engage consumers in managing their own health care

17. Transforming WI Medicaid – EHR Adoption • Submitted a Medicaid Transformation Grant application to provide technical assistance to WI safety net clinics for EHR systems • Grant will support planning, implementation, use of EHR’s in 5 Milwaukee FQHC’s and 6 other FQHC’s across the state

18. Transforming WI Medicaid – HIE • WHIE, Wisconsin’s First RHIO—major partner in WI’s eHealth Initiative and Medicaid Transformation Grant • A model for statewide HIE implementation • Creating HIE between Milwaukee hospital emergency departments, FQHC’s, and public health for Medicaid and GAMP population

19. Transforming WI Medicaid – Purchase for Value • Report key quality and cost measures on Medicaid patient population by partnering with WCHQ and WHIO • Expand pay-for-performance (P4P) for state Medicaid providers

20. Transforming WI Medicaid – Purchase for Value (cont.) • Explore systems to support safety-net providers in exercise of measuring and reporting key quality data • Perform research to address: • Engaging consumers in use of health data • Assessing impact that public reporting of quality measures is having on improvements across the State of Wisconsin

21. Transforming WI Medicaid – The Consumer • Enhance use of Medicaid data collection infrastructure • Trend important chronic diseases within Medicaid population • Deliver disease management and prevention programs through managed care • Streamline the process for engaging vulnerable families in health and benefits decision-making through: • A non-binding, voluntary member agreement offered at the point of Medicaid enrollment • An online Health Risk Assessment (HRA) that will be automatically forwarded to the individual’s medical home (PPO, HMO, etc.)

22. Transforming WI Medicaid – Consumer Interests (cont.) • Conduct research to identify best approaches to engaging vulnerable patients with quality information and decision support tools for making health care decisions • Provide online educational materials (in multiple languages) on managing medical conditions, disease prevention, and other health-related topics

23. QUESTIONS?

24. Additional Informational Slides

25. Executive Order #129November 2005 • Governor Jim Doyle created the eHealth Care Quality and Patient Safety Board to: • Ensure health information is available at the point of care • Reduce medical errors and duplication • Improve coordination of care • Further health care research • Engage consumers in their health care

26. eHealth Care Quality and Patient Safety Board • Charged with: • Identifying existing and potential eHealth resources • Identifying technology options • Identifying options for serving consumer information needs • Ensuring privacy and security in the exchange • Facilitating statewide adoption • Creating an infrastructure for statewide adoption

27. eHealth Board Members Chair:Kevin Hayden, Secretary, Department of Health and Family Services Betsy Abramson, Elder Law Attorney and Consultant Christopher Alban, MD, Clinical Informaticist, Epic Systems Corporation Bevan Baker, Commissioner of Health, City of Milwaukee Health Department Edward Barthell, MD, Executive Vice President, CIO, Infinity Healthcare Gary Bezucha, Administrator, Boscobel Area Health Care  Patricia Flatley Brennan, Professor of Nursing and Industrial Engineering  Catherine Hansen, Director, Health Information Svcs, St. Croix Regional Medical Center Ravi Kalla, CEO and President, Symphony Corporation Don Layden, Executive Vice President, Corporate Development, Metavante Corporation Michael L. Morgan, Secretary, Department of Administration Lois Murphy, IT Specialist, Veterans Administration Candice Owley, RN, President, Wisconsin Federation of Nurses and Health Professionals Debra Rislow, CIO and Director of Information Systems, Gundersen Lutheran Peg Smelser, Chief Operating Officer, Wisconsin Education Association Trust Eric Stanchfield, Secretary, Employee Trust Funds Justin Starren, MD, PhD, Director, Biomedical Informatics Research Center, Marshfield Clinic Lon Sprecher, Senior Vice President and COO, Dean Health Insurance John Toussaint, MD, President and CEO, ThedaCare Hugh Zettel, Director, Government and Industry Relations, GE Healthcare Technologies

28. eHealth Care Quality and Patient Safety Board 2007

29. For more information on the WI eHealth Initiative and Medicaid Transformation • Go to: http://ehealthboard.dhfs.wisconsin.gov/ • DHFS Contacts: Kathy Farnsworth, eHealth Chief of Staff FarnsK@dhfs.state.wi.us (608) 267-2082 Denise Webb, Policy Initiatives Advisor, eHealth Initiative webbdb@dhfs.state.wi.us (608) 267-6767