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.
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