HIT evaluation process 'must start with the Medicaid director'
HIT evaluation process 'must start with the Medicaid director'
According to Anthony Rodgers, director of the state of Arizona Medicaid/SCHIP programs, "the unprecedented amount of money that the federal government has put out for investing in electronic health records and health information exchange infrastructure is a significant opportunity for states and providers to become 21st century health care delivery systems, with the ability to exchange data. It's a huge opportunity."
Mr. Rodgers is chairman of the National Association of State Medicaid Directors (NASMD) Multi-State Collaboration for Medicaid Transformation, which will be discussing strategies and approaches as the Centers for Medicare & Medicaid Services puts out additional guidance on the funds for health information technology (HIT).
"That will solidify the direction that state Medicaid programs need to go," says Mr. Rodgers. "But states would be wise to begin strategic planning on their own, to see where their Medicaid providers and programs are as it relates to readiness for moving forward with electronic health records."
Evaluating HIT for Medicaid programs "must start with the Medicaid director," says Alabama Medicaid Commissioner Carol H. Steckel. Ms. Steckel is chair of NASMD.
"The Medicaid director must be involved in this process to make it work by setting the vision and establishing program goals," she says. "This also means knowing where he or she wants to take this initiative, and how it will improve not only Medicaid but the state's health care system as a whole."
With HIT, "people see the possibilities. It's a matter of trying to figure out how you can bring those possibilities into reality," says Neva Kaye, senior program director for the National Academy for State Health Policy.
"You can see the potential, but it's going to take a lot of work and coordination to make that happen," she says. "And if it doesn't happen, it has the potential to be a big investment that simply doesn't pay off, which would be a tragedy."
Here are some steps to take now to prepare:
Learn from what other state Medicaid programs have done. "There have been some very interesting things going on with HIT, particularly in Alabama and Arizona, coming out of the previously funded Medicaid transformation grants," says Ms. Kaye. "States will need to continue to look to each other for lessons learned. Somebody is always ahead in one area."
Some state Medicaid programs "are holding back because they are not sure what their approach is going to be," says Mr. Rodgers. "I think states can utilize information from other sources to model out potential benefits."
Arizona's Medicaid program has been contacted by other states who are interested in its purchasing collaboration for EHRs. "States want to know how we organized that, and how we are moving forward," reports Mr. Rodgers. "We have also had a lot of interest in our decision support capabilities."
Mr. Rodgers says "there has been pretty good documentation of where savings and quality improvement can be expected. So, states can use that as a proxy instead of doing their own analysis. That said, it is always good to try to validate any ROI that you expect."
However, in some cases states may need to move forward with HIT even without data demonstrating clear-cut savings. "Data always helps, but it's always hard to make those definitive statements, because there are so many factors to consider," says Ms. Kaye. "States may not be able to say, 'We saved X million in three years.' They may be able to show an impact, but it may not be so solidly quantified."
Be realistic about what is required to get results. Although HIT can promote more efficient systems and better outcomes, it does require change on many levels to do so effectively.
"For a physician's practice, it requires them to change how they do their business every day," says Ms. Kaye. "Since you are now doing things electronically, you have to incorporate the possibilities that it gives you, so it really does support that high-quality, patient-centered care."
If physicians adopt an EMR and uses it the same way they used a paper system, for example, they won't see the full benefit from it.
There also are things that need to be done at the state level to support the true exchange of information. "In some states, what they've been working toward is how to even go a step beyond the medical records of a physician and connect with the hospital, to see if there is some way of making that information available," says Ms. Kaye.
Assess where your provider community is currently. Do an assessment, which Mr. Rodgers calls "an environmental scan," of your provider community, to see how many of them currently qualify because they have certified EHRs, or are getting themselves ready, and how many are going to need significant help.
Ms. Steckel says Alabama is taking a "two-pronged approach" in looking at the usage and integration of EHR into a physician's practice as evidenced by a change in prescribed measures. At the same time, the actual physician's perception of how well the EHR is improving the business processes of the physician's practice and the impact that the information and knowledge has on patient health outcomes must be evaluated as well.
From there, you'll need to develop a strategic IT plan to establish the phase-in and strategic actions to drive widespread adoption of EHRs. "Don't try to do this alone," says Mr. Rodgers. "This has to be a collaborative effort with other stakeholders in your communityconsumer advocates, providers, and hospitals. It's one of those leadership activities that requires that you get a lot of stakeholder input so you can assure success."
According to South Carolina Medicaid director Emma Forkner, "There's a tremendous amount of interest in HIT opportunities in South Carolina. Right now, many of the players realize the first goal is to form collaborations with other entities so we avoid duplication of efforts and target grant opportunities," she says.
This is important, because unlike some other states, in South Carolina there is no single agency or entity responsible for these efforts. "Our agency has been mostly involved with the further development of the South Carolina Health Information Exchange [SCHIEX], which we hope can serve as the statewide infrastructure for future HIT projects," she says.
Establish what you want to achieve. Your biggest challenge, according to Ms. Steckel, is how to define success. This is because you have to go beyond the process of simply setting up an EHR system to look at whether the system is being adopted and used to meet quality and other goals.
It's a mistake to wait until the program is in place before designing the evaluation plan, however. "It is important that the state is clear on what they want the program to achieve," she says. "Then ensure that those pieces are in place as the program is being designed and implemented."
In addition, the evaluation model must allow for confounding factors to be considered in determining overall success and what exactly contributed to that success. "The other thing you must do to avoid problems is to involve all of your stakeholders in clearly defining what it is you want to accomplish and also what you are not trying to accomplish," says Ms. Steckel. "Clear communications to and from this group can help you stay focused."
Establish "business goals," says Mr. Rodgers, in terms of the quality improvements you want to see through HIT. "You have to have a clear understanding of your rationale; I call it the 'value proposition' associated with any HIT initiative."
Mr. Rodgers says in Arizona, data were analyzed in an effort to identify areas in which HIT would improve efficiencies, reduce patient errors, and reduce duplicate medication and lab orders because physicians didn't have the information they needed at the time of care. "It's not about the technology. It's about the improved efficiency, improved quality, and reduced costs," he says. "So, you need to establish those goals. Then, design the technology that will help you meet those goals."
Mr. Rodgers says states that are successful in achieving widespread adoption of EHRs and the ability to exchange information are going to be able to control their costs more effectively, because they will reduce inefficiency and have better transparency.
"The physician will be able to make better decisions with a full view of the patient's health information," he says. If a patient changes physicians, for example, the next physician won't have to bill for a new physical examination if the information is in an EHR.
"States that are prepared will not only see benefits related to their Medicaid program, but to the commercial health plans members, to Medicare, and even to state employee benefit programs," Mr. Rodgers says. "I think any physician that has an EHR will be able to practice at a more efficient, high-performing level."
Contact Ms. Kaye at (207) 874-6524 or [email protected], Mr. Rodgers at (602) 417-4111 or [email protected], and Ms. Steckel at (334) 242-5600 or [email protected].
According to Anthony Rodgers, director of the state of Arizona Medicaid/SCHIP programs, "the unprecedented amount of money that the federal government has put out for investing in electronic health records and health information exchange infrastructure is a significant opportunity for states and providers to become 21st century health care delivery systems, with the ability to exchange data. It's a huge opportunity."Subscribe Now for Access
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