HIEs are opportunity for better value

Brian Osberg, Minnesota's state Medicaid director, says that the agency was "a bit surprised and pleased by how much emphasis the Office of the National Coordinator for Health Information Technology placed on HIE [Health Information Exchange]," as a result of the Health Information Technology for Economic and Clinical Health Act [HITECH] legislation.

"We think that there is certainly an opportunity to improve the value of the health services we are providing," says Mr. Osberg.

Minnesota plans to use its grant planning funds to develop its Health Information Technology plan and to develop the infrastructure to administer the incentive payments to Medicaid providers for the "meaningful use" of electronic health records (EHR), reports Mr. Osberg.

Mr. Osberg says that Minnesota Medicaid is currently waiting for the Office of the National Coordinator to approve its plans. "We have been quite involved in HIT development for some time," he says. "We are expecting they will be supportive of the approach we are taking."

The Minnesota Department of Human Services is a cosponsor of the Minnesota HIE. "We committed resources to form this organization about three years ago, because we thought it was a good business decision. This was all long before the HITECH legislation," notes Mr. Osberg. "We had already made a commitment to be involved."

Mr. Osberg says that he believes the Minnesota Department of Health has put together a strong grant application, which emphasized the role of the Minnesota HIE as a "key player in what we call a Health Information Organization. This will be the entity that is going to facilitate the exchange of clinical information. We quickly realized that this was going to be our best business model."

Incentives are key

Mr. Osberg says that another key piece of HITECH is the role of state Medicaid agencies in federal electronic health records incentive payments. "We're not going to be ready for the first cycle, early in 2011. It will be later in 2011 before we have all this ready to go," says Mr. Osberg. "We're going to do it as soon as we can, but we also want to do it right."

There needs to be a formal infrastructure in place in order to make the incentive payments, explains Mr. Osberg. "Providers will not be penalized, because if they meet the 'meaningful use' provision, they will get paid for the entire period of time. We have made that known to our providers."

The department is now waiting for further guidance on how to correctly identify providers who meet the criteria for incentives. "We are already bringing on staff to do this. It is a major priority for us," reports Mr. Osberg. "Our providers would be eligible for a lot of money, and on the Medicare side, of course, they will be subject to penalties. So, we want to do everything we can to make sure they are successful."

Mr. Osberg says, "In our minds, what the electronic health record really does is facilitate health care reform. This will allow providers to be more effective, in terms of managing health care costs and improving quality."

The incentive payments will result in providers being more accountable for the financial and quality sides of health care, says Mr. Osberg.

"This is not going to be sufficient, though, because our clients also interact with long-term care services, social services, and behavioral health services," he says. "We need to go beyond the acute care system, and get this connected with other health care providers and sectors."

For Minnesota Medicaid's HIE approach to be truly successful, Mr. Osberg explains, it has to go beyond providers exchanging clinical information. "It also has to be available to the client through personal health records," he says. "The HIE would be a conduit to keep the client in the loop. That is something that we want to do well."