marrying your medicaid management information system … · 3 what is health information...
TRANSCRIPT
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Presentation to: CMS Region 4 & 6 Meeting
Presented by: Stacey Harris, Director of Health IT Innovation Division of Health IT
Date: September 16, 2014
Marrying Your Medicaid Management
Information System (MMIS) and Your
Health Information Exchange (HIE)
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Mission The Georgia Department of Community Health (DCH)
We will provide Georgians with access to
affordable, quality health care through
effective planning, purchasing and oversight.
We are dedicated to A Healthy Georgia.
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DCH Division of Health IT
• The Division facilitates various aspects of the Health IT infrastructure throughout Georgia, including:
– Strategic planning for health IT adoption by providers and patients
– Technology and policy development of the Georgia statewide health information exchange network and connection to the nationwide network
– Promotion of the overall statewide health IT infrastructure in Georgia
– Administration of the Medicaid EHR Incentive Program
• Our Mission is to advance healthcare quality while reducing costs – Improving access to information to support coordination of care and among hospitals,
labs, and healthcare organizations to better manage patient care
– Promoting the early detection, prevention, and management of chronic illness through use of health information technology
– Achieving improvements in care efficiency and population health
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What is Health Information Technology?
• Set of technologies that makes it possible for providers and
patients/consumers to better manage one’s care through secure
use and exchange of health information.
– Electronic Health Records (EHR)
– Health Information Exchanges
– Personal Health Records (PHR)
– Mobile health apps, “smart” tech
• What is the purpose of Health Information Exchange?
To close the patient information gap across care settings by electronically
connecting disparate systems and data sources to support improved quality of
care, better health outcomes, and reductions in cost.
– ePrescribing
– TeleHealth
– Digital health devices
– Health informatics, and more
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Georgia’s Health IT Continuum
Electronic Health Records
ePrescribing
Digital health tools
Patient Engagement Widespread provider
connectivity
Population Health
Management
Strengthen privacy and
data protections
Evaluate effectiveness of
health IT initiatives
Support public-private
health IT collaborations
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Georgia Health Information Exchange Network
• DCH has facilitated the development and implementation of
Georgia’s statewide health information exchange network.
• DCH collaborated with the Georgia Health Information Network, Inc.
(GaHIN), a non-profit organization, to establish the statewide HIE
– GaHIN is a Network of Networks Model. Health systems and regional HIEs connect
hospitals, physician practices and other providers to GaHIN
– Not a central repository of clinical data. Information remains with the treating provider and only
flows when there is authorization
– Established governance and policy framework to support Network
– DCH transitioned the HIE operations and technology to GaHIN June 2014.
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Current GaHIN Members/Connections
State Agencies: Georgia Medicaid
Department of Public Health
Department of Juvenile Justice
Department of Family and Children Services
Amerigroup (CMO)
Emory Healthcare (Cerner)
Grady Health System (Epic)
ArchHIE (Siemens) Q3 2014
Children’s Healthcare of Atlanta (Epic) Q32014
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Title or Chapter Slide
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Leveraging existing technologies and infrastructure
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GAMMIS Web Portal
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GAMMIS Web Portal
37 Public Pages Available
• Search for Providers with a Direct
Exchange Address
• Ability for members to self-register
for secure access
• Ability for providers to self-register
for secure access
41 Secure Pages Available
• Level of access determined by
user role/delegations
• Ability to register for a Direct
Exchange E-Mail Address
• Ability to access the Georgia
Health Information Network
(GaHIN) Patient Profile site
• Ability to submit/view applications
for the EHR Incentive Program
(MAPIR)
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Georgia Medicaid Management
Information System (GAMMIS)
• HP interChange system went live 11/2010
• Medicaid Provider Secured Web Portal
– Georgia Medicaid Provider Web Portal has been
operating since 4/2003
– Medicaid Provider use the web to Enroll in Medicaid,
submit/resubmit Claims, Prior Authorizations, and
Referrals, verify Member Eligibility, view Remittance
Advices
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Georgia Medicaid Management
Information System (GAMMIS)
• Both Medicaid Providers and Medicaid Members use the
Web Portal
• They are familiar with the technology
• We are able to do mass communications in the form of
banner messages, provider and member notices, and
messages to their secured web portal inbox
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Medicaid Providers
• Medicaid Providers are able to register for Georgia Direct
via the GAMMIS Web Portal. Secured Direct Messaging is
available to Georgia provider at no cost
• Medicaid Providers can access the GaHIN Clinical
Viewer/Patient Profile via GAMMIS Web Portal
– Gives Medicaid providers a longitudinal look a the
Medicaid member including lab results, pharmacy, and
encounters from all providers including non-Medicaid
providers.
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Direct Exchange Address –
Registration/View
• Registration and request status is available to all Georgia Medicaid
Providers and the delegates to whom they grant access to on the
secure GAMMIS.
• A weekly extract file submits new requests to the Direct Exchange
vendor and all Direct Exchange request status responses are loaded to
the Georgia MMIS.
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GaHIN Patient Profile Access - Providers
• All registered Georgia Medicaid Providers and the delegates to whom they
grant access to have access to the GaHIN Patient Profile link on the
secure GAMMIS by means of a single sign-on solution.
• Multiple extracts from the Georgia Medicaid MMIS are provided to the
GaHIN Patient Profile vendor, including claims, member data, provider
data and so on.
• Provider and user information is securely passed to the GaHIN Patient
Profile site when navigating from the GAMMIS.
• As of July 24, 2014, over 157,000 Georgia Medicaid Providers have
registered for secure access to the GAMMIS.
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Access to the GaHIN
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A view to more patient information
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A view to more patient information
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Georgia Medicaid Management
Information System (GAMMIS)
• Medicaid Member Secured Web Portal
– Member Web Portal has been operating since 4/2003
– Medicaid Members use the portal to view their Medicaid
eligibility, request replacement Medicaid card, view
claims and prior authorizations, search for Medicaid
Providers
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A view to more patient information
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Medicaid Member
• Member Engagement and Outreach
• Enhancements to Medicaid Member Portal to
include:
– More interactive and consumer focused view of their
information
– Aligning the Medicaid member web experience with that
of our State Health Benefit Plan-BeWell SHBP to
support health and wellness
– Personal Health Record
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GaHIN Patient Profile Access - Members
• As of July 24, 2014, over 51,000 Georgia
Medicaid Members have registered for secure
access to the GAMMIS.
• The Georgia Department of Community Health
and HP Enterprise Services are collaborating on
solutions for easy access and management of
personal health information by Georgia Medicaid
members.
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Title or Chapter Slide
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Future Innovations
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Future Innovations
• Enhancements to allow linking of claims and clinical
data for better analytical.
• Bi-directional sharing of information between the
data sources and the MMIS.
• XDR connection between MMIS and GeorgiaDirect
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Thank You.
Questions and Answers
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Stacey Harris, Director of Health IT Innovation
Georgia Department of Community Health