transforming health care delivery with hit: arizona

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Transforming Health Care Delivery with HIT: Arizona Anthony Rodgers, Director Arizona Health Care Cost Containment System

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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Tony Rodgers

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Page 1: Transforming Health Care Delivery with HIT: Arizona

Transforming Health Care Delivery with HIT: Arizona

Anthony Rodgers, Director

Arizona Health Care Cost Containment System

Page 2: Transforming Health Care Delivery with HIT: Arizona

Critical Drivers for Health System Transformation

Current medical cost trends are unsustainable both public and private payers of health care coverage.

The current healthcare system produces significant variances in cost and quality.

Lack of health system integration leads to duplication, administrative inefficiency and lack of patient care coordination.

In the public sector medical cost escalation has or is becoming a “Budget Buster”.

Employer sponsored premium rate increases have made healthcare coverage increasingly unaffordable for many businesses and individuals which is increasing the numbers of uninsured workers.

Page 3: Transforming Health Care Delivery with HIT: Arizona

Historic Barriers to System Transformation

Lack HIT Enabler Technologies

Lack of Public Private Synergy

Lack Financial Investment

Misaligned Incentives

Page 4: Transforming Health Care Delivery with HIT: Arizona

Health System Transformation Goal

To improve healthcare system efficiency, patient care quality, rapid and continuous adoption of clinical best practices, public health protection and disaster response, through the implementation of interoperable health information systems and clinical decision support tools that enable the exchange of electronic health information between providers, payers, consumers and those that help to advance the boundaries of our health science knowledge and quality of life.

Page 5: Transforming Health Care Delivery with HIT: Arizona

Arizona’s Sense of Urgency to Achieve Statewide Adoptions of HIT that Support Exchange of

Electronic Records

It is our belief that:1. The single greatest opportunity for gains in healthcare

system transformation will occur with the statewide adoption of electronic health records and health information exchange.

2. That creating an environment that encourages widespread deployment of enabling health information exchange technology will lead to a significantly improved health system efficiency, cost effectiveness, patient safety and quality of care.

3. That significant return on investment can be achieved within this decade by leveraging our Medicaid Programs to lead and support the acceleration of the adoption and deployment of electronic health records and standardize infrastructure for health information exchange.

Page 6: Transforming Health Care Delivery with HIT: Arizona

Arizona’s Vision of a Transformed Healthcare System

A healthcare system that provides: Integrated healthcare delivery, Cost and quality transparency, The productive interchange between provider and patient, Informed activated consumers and patients, Healthcare provider’s able to provide cost effective care

management and use clinical decision support tools to reduce cost and quality variances.

Page 7: Transforming Health Care Delivery with HIT: Arizona

Vision of an Integrated Health System

Primary Care Physicians

Hospitals andHealthcare Facilities

Specialists

Subspecialists

PublicHealth

Page 8: Transforming Health Care Delivery with HIT: Arizona

Virtual Integrated networks

Medical Homes for Medicaid Enrollees

More Effective Clinical Collaboration

Improved Systems of Care

Impact of Health Information ExchangeImpact of Health Information Exchange

Page 9: Transforming Health Care Delivery with HIT: Arizona

Key Building Blocks For Health System Transformation

Web-based health information and care management decision support tools that provide consumers, provider and payer healthcare value transparency as a common point of reference.

System-wide access to web-based electronic health records, health information exchange and patient relevant healthcare management tools integrated the system of care to maximize value and reduce variations in cost and quality.

New generation of consumer, provider and payer care management decision support and analytical tools integrated with EHR, EMR and PHR systems

Page 10: Transforming Health Care Delivery with HIT: Arizona

Keys to Creating the Environment for Health System Transformation

Creating aligned incentives and legal framework rapid adoption and deployment of health information exchange infrastructure and standards that supports exchange electronic health information,

Assure everyone is at the table and no one is left behind in the adoption and deployment of electronic health records and health information exchange.

Page 11: Transforming Health Care Delivery with HIT: Arizona

Medicaid Leadership in Health System Transformation

Requires:

A strong Federal and State partnership and financial support,

Agency leadership and participation Effective health information system planning and

development know-how, New skills and organizational competencies

within State Medicaid Program and Public Health,

New reimbursement strategies and health information exchange policies,

Public/Private partnerships as well as partnerships with other state Medicaid programs.

Page 12: Transforming Health Care Delivery with HIT: Arizona

AHCCCS Health System Transformation Initiative

Page 13: Transforming Health Care Delivery with HIT: Arizona

AHCCCS EHR Repository & Web Portal

EHRRepository

AHCCCS Web Portal

RLS

NPI

DHS ImagingHealth Plans AHCCCSLabs

Provider EMRs Hospitals Pharms/PBMsIHS HIEs/SAHIE

ePrescribing

Lab Order and Results Delivery

ReferralsPrior Authorization

Access Hospital Discharge Info

Claims and Eligibility Management

Clinical Info Management

Page 14: Transforming Health Care Delivery with HIT: Arizona

AHCCCS HIE/EHR

Value Driven Decision Support System

Acute and Personal

Healthcare

Long TermCare

Disease Management

And Chronic Care

Beneficiary Health

Education

Population Health

Information

Health Information Exchange

Electronic Health Record

Web BasedE-Learning

Systems

AHCC

CS H

ealth

Info

rmat

ion

Tech

nolo

gy In

frast

ruct

ure

Healthcare System Transform

ation

Health Care Practice and Consumer Value

Rapid Learning And

Knowledge TransferSystem

Managed Care Organization Value Driven Decision Support System

Health System Transformation Enabler

Clinical Care Transformation Enabler

Patient Self Care Management Enabler

Health Care Practice Competency and Capacity Enabler

Page 15: Transforming Health Care Delivery with HIT: Arizona

Value Driven Decision SupportValue Driven Decision Support

Population Survey

Encounter

Medical Data

Population

Prescription Drug

Premiums / Cap

Evidence-BasedMedicine

Public & SpecializedData Sets

Beneficiary Data

External Data / Profiles

Program SegmentationAnalysis

AHCCCS Methods/Analytics•Episodes of Care

•Performance Measures•Disease Staging

Data ManagementProcess

•Security Protection•Integration

•Standardization•Data Enhancement•QA/ImprovementProfile and Screens

DataWarehouse

Medical Management

Fraud Detection

Drug U/R & Cost

Performance Analysis

Eligibility Analysis

ChronicIllness

Sub-databasesRegistries

DecisionSupport ReportingApplications

Eligibility Data

Page 16: Transforming Health Care Delivery with HIT: Arizona

ManagedManagedCareCare

ManagedManagedCareCare

1980’s-1990’s1980’s-1990’s

• Prepaid healthcarePrepaid healthcare– More comprehensive More comprehensive

benefitsbenefits– More choice and coverageMore choice and coverage

• Contracted NetworkContracted Network

• Focus on cost control Focus on cost control and preventive careand preventive care

– GatekeeperGatekeeper– Utilization managementUtilization management– Medical ManagementMedical Management

IntegratedHealth

2000+2000+

• Patient Care CenteredPatient Care Centered– Personalized Health CarePersonalized Health Care– Productive and informed Productive and informed

interactions between Patient and interactions between Patient and ProviderProvider

– Cost and Quality Transparency Cost and Quality Transparency – Accessible/Affordable ChoicesAccessible/Affordable Choices– Aligned Incentives for wellnessAligned Incentives for wellness

• Multiple integrated network and Multiple integrated network and community resourcescommunity resources

• Aligned cost management processesAligned cost management processes

• Rapid deployment of new knowledge Rapid deployment of new knowledge and best practices in quality care and best practices in quality care

• Patient and provider interactionPatient and provider interaction– Information focusInformation focus– Aligned care managementAligned care management– E-health capableE-health capable

• Fee For ServiceFee For Service– Inpatient focusInpatient focus– O/P clinic careO/P clinic care– Low ReimbursementLow Reimbursement– Poor Access and QualityPoor Access and Quality– Little oversight Little oversight

• No organized networksNo organized networks

• Focus on paying claimsFocus on paying claims

• Little Medical ManagementLittle Medical Management

Fee for Service

1960’s-1970’s1960’s-1970’s

Managing Health System Transformation in Arizona

Page 17: Transforming Health Care Delivery with HIT: Arizona

Our first care is your healthcare