July 15, 2009

Q4UQxQtoolClinicalARRA

◦The Money FlowPlanning for The Future

To create a statewide electronic health information system (HIS) that links Medicaid, state health agencies, providers and private payers and establishes a comprehensive, quality improvement model for the Alabama Medicaid Program.

Data Linkages

Q4U – Care management for individuals with chronic illnesses

Qx – Information exchange between state health and human service agenciesQTool – Electronic health record and clinical support tool

Start DateAsthma

# to Change

AsthmaMedicaid

Enrollment Goal

Current Enrollment

Tuscaloosa 5/05/2008 97 121 105

Lamar 5/05/2008 6 50 20

Pickens 5/05/2008 11 50 33

Calhoun 4/01/2008 69 86 57

Talladega 4/01/2008 47 59 37

Bullock 2/08/2008 20 50 45

Montgomery 4/01/2008 165 206 168

Pike 2/08/2008 77 96 114

Total 579

Start Date # to Change Medicaid Enrollment Goal

Current Enrollment

Tuscaloosa 5/05/2008 49 61 101

Lamar 5/05/2008 6 50 15

Pickens 5/05/2008 16 50 38

Calhoun 4/01/2008 38 50 52

Talladega 4/01/2008 43 54 50

Bullock 3/06/2008 7 50 27

Montgomery 4/01/2008 66 83 63

Pike 3/10/2008 20 50 51

Total 397

Medication Compliance

◦ Proper Technique◦ Rescue vs. Controller Medication◦ Understanding and Utilizing Asthma Action Plan

Eliminates ED visits and improves quality of life

Diet

Exercise

Medication Compliance

Resulting in better health outcomes and decreases chance of long term complications.

o 1,709 e-prescriptions (implemented March 16, 2009)o 4,400 Provider Hitso 2,594 EMR Pullso Interface with EHS (EMR)o Children’s Using Qtool through Interfaceo July Release

◦ Eligibility Information◦ Patient 1st Information◦ RMEDE Reporting◦ Opt Out Ability◦ Short Printable Version

Broadband

Comparative Research

ONC Grant Programs

Provider Incentives

HIT Extension Centers

90/10 Planning

Broadband Funds◦ Running of Cable◦ Projects◦ August 14th Due Date

Comparative Research◦ AHRQ◦ Evidenced Based Medicine◦ Use for Implementing Quality Measures◦ Varied Release Dates

ONC Grant Program◦ Create Infrastrutuce◦ Specific Projects◦ July 16th – preliminary outline of grants

Provider Incentive Payments◦ Defined Provider Groups◦ Based on Meaningful Use of “Certified” Systems◦ State Leeway in Deciding Final Measures◦ Maximum of $63,750 over a 6 year period based

on historical costs

o Assistance with the implementation, effective use, upgrading, and ongoing maintenance

o Broad participation of individuals from industry, universities, and State governments;

o Active dissemination of best practices and research on and for HIT, including EHRs

o Participation in health information exchanges; and o Integration of HIT, including EHRs, into the initial

and ongoing training in the healthcare industry

Priority for any direct assistance to:o Public or not-for-profit hospitals or critical

access o Federally qualified health centers o Entities that are located in rural and other

areas that serve uninsured, underinsured, and medically underserved individuals

o Individual or small group practices (or a consortium thereof) that are primarily focused on primary care.

o Just providing funds is not enough.o Many physicians don’t have the time for a thorough

selection process, or have bought systems and don’t use them or don’t use them to their fullest potential.

o No or limited use hinders the integration of up to date medical findings and preventive care.

o A primary reason for the lack of or inadequate use is the dramatic impact that EMR’s can have on work flow issues.

o REC’s can help with selection, workflow, and utilization issues so that higher quality care can be provided based a customized solution.

◦ Planning and Outreach◦ Environmental Scan◦ Stakeholders◦ Fully Develop the Next Level

◦ Implement Incentive Program for Meaningful Use◦ Decide Measures and Payment Mechanisms◦ Ongoing Oversight◦ Identify Qualified Providers

◦ Promote Adoption of HIT◦ Contract with Regional Extension Center

◦ Possible 10/2009

o What is a certified EHR?

o What does “meaningful use” actually mean?

o How will providers “eligibility” for incentive payments be determined? Confirmed?

o What information will States be required to submit to CMS for the 90% HIT Admin match, and for the provider incentive payments?

QUESTION: Where do we want to be. What do we want for our patients, our providers, our states.

ANSWER: UP.

QualityEfficiency

Value

=Better Health Outcomes

To create a statewide electronic health information system (HIS) that links Medicaid, state health agencies, providers and private payers and establishes a comprehensive, quality improvement model for the Alabama Medicaid Program.

SIMPLY STATED: A patient should have one record, regardless of who provided or paid for services in the past, that is available real-time regardless of who is now providing or paying for a service.

Robert (Bob) AshurstSenior Consultant

AUM Center for Government

System change can work, it just takes time, strong deliberate planning and long term vision. Don’t be afraid, just be prepared.