Health Information Technology Meeting April 28, 2009

1. Health Information Technology MeetingApril 28, 2009 MO HealthNet Division, Department of Social Services State of Missouri George L. Oestreich, Pharm.D., MPA Deputy Division Director, Clinical Services

2. CyberAccessTM, MO HealthNet Division Summary • Objectives and Desired Outcomes • Original project began in 2002 as an internal tool, provider portal added mid 2006 • To date we have seen exception growth and adoption • The tool is enhanced on a quarterly basis to incorporate user service requests • Expected Impact • Who will benefit and how will they benefit? • Coverage • What is the scope of the project? • What is out of scope?

3. CyberAccessTM, MO HealthNet Division Summary Expected Impact Providers Access to near real-time patient data Direct “window” into MO HealthNet clinical management tools Save time, access impact of specific edits, direct interface with call center Participants Access to health information to empower and increase health literacy Access to information on paid services Ability to maintain individual information such as blood sugar records, BMI, asthma treatment plan State Effective, economical way to allow system access and increase transparency Provide tools to work collaborative with providers and participants to improve health outcomes Ability to accumulate additional data to allow targeting of services and report outcomes

4. CyberAccessTM, MO HealthNet Division Summary Coverage The current scope of the services are all MO HealthNet participants (FFS and MCO MHD clients are being added (non-Medicaid) Other populations may be added public are private consistent with CMS guidelines Incorporation of functionality incompatible with MO HealthNet mission would be out-of-scope

5. CyberAccessTM, MO HealthNet Division Summary • Constituents • Currently state only constituencies are included. • Private sector participation except as providing overviews and descriptions have not yet been included • Governance Structure • MO HealthNet Division is the primary governing authority • Efforts for state-wide agency involved are in process through planning and collaboration • Given funding streams formally broadening current governance would be difficult, partnerships may be entertained pending CMS approval

6. CyberAccessTM, MO HealthNet Division Summary Data The project started with all paid claim data for all MO HealthNet participants No sub setting was undertaken, three years of claims (80million/per year) are included Other areas under consideration include clinical data from provider electronic records, additional discrete lab data, data from home monitoring, and long term data from imaging

7. CyberAccessTM, MO HealthNet Division Summary • Timeline • The project is ongoing • Targeted quarterly goals are established • Project Approach • Provider feedback and survey • Participant feedback and survey • Outcomes on services, wait times, acceptance, and financial impact are monitored

8. CyberAccessTM, MO HealthNet Division Summary Technical Approach and Reason CyberAccess system solution functions as a 3-tier, multi-payer, electronic health record solution and provider services solution with a Service-Oriented Architecture (SOA) How did the team determine this technology solution? Allow a federated approach to data use without data housing issues Concerns around broadening the approach include jurying data quality and, as in all tools, ongoing data security

9. CyberAccessTM, MO HealthNet Division Summary • Lessons Learned • Basic truth, nothing is every as easy as it seems • Plan for the future use opportunities at the beginning to avoid “redos” • User “computer literacy” is an ongoing challenge • Plan twice before implementing would be our advice, always look to sustainability issues

10. CyberAccessTM, MO HealthNet Division Summary Program/Tool Specific Overview and Issues

11. Current Tools for Clinical Use Clinical Tools Smart PA Decision Support Tools CyberFormance Paid Claim Tool CyberAccess Care Connection Patient/Participant Tools Direct Inform (A PHR [patient/personnel health record]) MORx Compare (web tool)

12. Today’s HIT, How it Fits Together

13. CyberAccess User Growth Total of 2,702 Sites Trained (Rural Health Clinics, Hospitals, DME Suppliers, Pharmacies, etc…) Total of 13,072 Active Users Rolling 36 months of records for approximately 1 million participants  

14. CyberAccessTM Current Features Patient demographics Electronic Health Record Record of all participant prescriptions All procedures codes All diagnosis codes E prescribing Preferred Drug List support Access to preferred medication list Precertification of medications via clinical algorithms Implementation of step therapy Prior authorization of medications) Medication possession ratio DirectCare Pro Direct medication management notices Allows documentation of interventions

15. CyberAccessTM(current,con’t) General Medical Uses Integrated call center support Availability of laboratory values (and references) Precertification of imaging Precertification of durable medical equipment (DME)

16. CyberAccessTM(con’t, future) Near Term Additions (SF 2009) Determination of level of care and precertification of home and community based services Electronic capture and storage of EPSDT forms Precertification of optical (as covered) Patient level editing Electronic medical record lite (EMR) Patient case management tools Risk assessment Stratification Gaps in therapy Episodes of care Concurrent case management Eligibility determination reporting Incorporation of diabetic patient care management information

17. CyberAccessTM(con’t, 2nd quarter 2009 and beyond ) Later term additions Interoperability with other services (EMRs, hospital records) Precertification of dental “Plug-ins” for EMR Scheduling Billing Integrated billing for service Integration of discharge summary and medication reconciliation Integration of home monitoring data/information Integration of immunization registry

18. Future AdditionAcross User Interfaces Direct notification to participants and providers of gaps of care Integration of drill down to best practice lapse and gaps of care Integration of patient empowerment information such as asthma action plans, diabetic management plans of care Wellness initiatives such as anti-obesity programs Smoking cessation programs and general wellness empowerment tools

19. Who Do We Serve? All state partners DSS DHSS DMH DESE Corrections Potential roles with private sector partners Collaborating on HIT strategic plan

20. What Are Our Challenges? We need access to other data Many partner users Other users have different platforms (hardware and software) Standards are emerging but in progress Integrating, translating and holding data has huge resource requirements Clinical data has a short useful life Interoperability is difficult Hardware is quickly evolving

21. Where Are Our “Opportunities”? We need access to “other’s” data Other users have different platforms (hardware and software) Standards are emerging but in progress Integrating, translating and holding data has huge resource requirements Data has a short useful life

22. Missouri – Statewide Health Information Exchange CyberAccesssm Info-Crossing ITSD Electronic Plan of Care Electronic Health Record MMIS DSS Programs CCIP Smart PA MMIS Data Eligibility Data Pharmacy Partner Contracts Participants Home Services Rules Engine Community Services Enterprise Bus Personal Health Data Direct Care Pro Web Services Direct Inform HL7 Messaging EPSDT X.12 Messaging Governance Body DMH & DHSS Identity Management Privacy & Security Exchange / Interface Team Business Associate Agreements Service Oriented Infrastructure Service Oriented Operations Service Bureau Immunizations & Behavioral Health Providers Partners Value-add Data Relationships Point of Care

23. Service Bureau Components Multi-partner governance Public-private partnership Quasi-public organization Administrative roles Support the bureau technology Develop and administer the contracts Secure and budget the funding Set privacy and data use policy

24. A Brief Overview of CyberAccess The current tool https://uatwww.cyberaccessonline.net/CyberAccess/Login.aspx

25. Discussion Questions Thank you George.L.Oestreich@dss.mo.gov 573.751.6961