march 29, 2012 improving health outcomes for children in foster care: the role of electronic...

March 29, 2012

Improving Health Outcomes for Children in Foster Care:

the Role of Electronic Information Exchange

Overview

Need for improved information sharing in the provision of health care services to children in foster care

How electronic information exchange (EIE) can be used to improve health outcomes

Strategies for developing EIE for children in foster care

Ventura County Foster Health Link: an EIE demonstration project

About The Children’s Partnership (TCP) TCP is a national nonprofit, nonpartisan child

advocacy organization with offices in California and Washington, DC

Mission is to ensure that all children grow up to lead healthy and lead productive lives

Expertise in research, analysis and policy development to benefit all children, especially the underserved

Expertise includes

About TCP (cont’d)

Primary focus has been on securing health coverage for uninsured children and expanding access to technology to underserved children

TCP’s e-health work includes development of Express Lane eligibility and enrollment system, telehealth, electronic record systems, and now, foster care coordination

Health Care Challenges Facing Children in Foster Care

Large number of children in care

Poor health status and significant unmet health care needs

Greater utilization of services and disproportionately high health care expenditures

Fragmented care and poor health outcomes

Factors Contributing to Inadequate Health Care and Poor Outcomes

Placement instability and variability

Resource and staff limitations in child welfare services

Lack of coordination and information sharing between service providers

Electronic Information Exchange (EIE): The Means to a Solution

EIE can support information sharing and address coordination gaps

EIE can support provider practice changes, especially through the use of electronic health records

EIE can help assess the changing health status and needs of a population

Why Development of EIE for Children in Foster Care Should be a Priority

Gives providers access to more comprehensive information about a child

Facilitates communication between providers for purposes of coordinating care and delivery of services

Provides youth with a record of health conditions and services received as they prepare for permanency or emancipation

Basic Elements of EIE for Children in Foster Care

Data Included Basic health information including allergies,

immunizations, diagnoses, and provider contact information

Medical service claims, pharmacy claims, lab data

Access Medical providers, child welfare workers, foster

parents and foster youth

Basic Elements of EIE for Children in Foster Care (cont’d)

Additional FunctionsReminders about a child’s needs, warnings of

gaps in care or medication interactions

Potential for ExpansionEIE can be expanded to include other

responsible entities such as schools and courts, with appropriate safeguards

Early Evidence Supports Use of EIE for Children in Foster Care

Improved Health Outcomes Better preventive care Decreased hospital stays Improved clinical conditions

Cost Savings Decrease in expensive avoidable illness and

hospital stays Reduction in pharmacy costs

Strategies for Developing EIE for Children in Foster Care

Identify public and private funding Medicaid, including Early and Periodic

Screening, Diagnosis, and Treatment (EPSDT), Medicaid Management Information Systems, and standard Medicaid administrative match

HITECH, including Innovation Grants State and county sources Private funding, primarily foundation grants

Strategies for Developing EIE for Children in Foster Care (cont’d)

Identify and develop stakeholders and strong leadershipDevelopment process may be long and require

complex negotiations Involve stakeholders, including foster parents

and youth, early in the processProgrammatic champions from state and local

government help drive the process

Strategies for Developing EIE for Children in Foster Care (cont’d) Address privacy and confidentiality

concerns early and oftenLaws are complex and there are unique and

varied privacy concerns for children in foster care

Key considerations: Who controls information into and out from EIE? Who has access to information contained in the EIE? What role do foster parents and youth play in contributing to

and controlling information in the EIE?

Strategies for Developing EIE for Children in Foster Care (cont’d)

Scope EIE Project Appropriately Important to balance need for including

enough information to improve outcomes with need to avoid including so much information the system becomes unwieldy

Select an EIE architecture that allows a narrow approach at first and broadening of scope over time

Strategies for Developing EIE for Children in Foster Care (cont’d)

Discuss evaluation and sustainability early in EIE development Important to build key evidence base to

demonstrate improved outcomes and cost savings as soon as possible

Long-term sustainability depends on: Secure funding Engaged leadership and stakeholders Clear privacy and confidentiality protections Demonstrated improved outcomes and cost savings

Ventura County Foster Health Link (VCFHL): an EIE Demonstration Project Why Ventura County?

Manageable size—population of about 825,000 (2010) with about 800 children in foster care

County-operated system of hospitals and clinics—ease of implementation

Strong leadership in both county human services and health care agencies

VCFHL Project (cont’d)

Primary Goals:Connect health and child welfare information

for all children in foster care

Leverage existing technology

Provide appropriate access to real-time information

VCFHL Project (cont’d)

Key Components

Master Person Index

Record Locator Service

“Youth-facing” Portal

Interface with state CWS and health databases

VCFHL Project (cont’d)

Current Status and Next Steps:

Partnering with State for $1 million federal Medicaid HIE funding; submission of IAPD-U

Nonfederal $100,000 match in place—county funds and foundation grants

Governance structure for EIE developed; developing MOUs and contracts

Once federal funding received, 22-month project timeline

For more information

TCP Website:www.childrenspartnership.org

Contact me:Ginny Puddefoot, Director

HIT Initiatives for Vulnerable ChildrenThe Children’s Partnership916-572-7340gpuddefoot@childrenspartnership.org