www.chcs.org
Leveraging Medicaid to Encourage
HIT Adoption and Strengthen
Primary Care
Dianne Hasselman
2010 Medicaid Managed Care Congress
September 28, 2010
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CHCS Mission
To improve health care quality for low-income children and
adults, people with chronic illnesses and disabilities, frail
elders, and racially and ethnically diverse populations
experiencing disparities in care.
CHCS Priorities
Improving Quality and Reducing Racial and Ethnic
Disparities
Integrating Care for People with Complex and Special
Needs
Building Medicaid Leadership and Capacity
National Reach• 47 states
• 160+ health plans
The challenges facing Medicaid are
unprecedented….
• Fiscal environment demanding cuts to budget
• 15-20 million new beneficiaries by 2019
► Primary care network must be primed to absorb
tremendous influx
• State agencies are under-staffed and under-funded
► Early retirements, hiring freezes, leadership changes
following gubernatorial races
• Affordable Care Act (ACA) mandates are
overwhelming and a priority over voluntary programs
► Limited guidance from Centers for Medicare and
Medicaid Services (CMS) on ACA to date
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…but so are the opportunities.
• States continue to explore ways to support
quality improvement at the point of care;
• Federal and state funds are available for
adoption, implementation, upgrade and
meaningful use (MU) of electronic health
records (EHRs), and electronic exchange of
information; and
• Federal funding is available to states for
innovative primary care initiatives.
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Why focus on primary care transformation?
• Private physicians play a significant role in supporting the
health care safety net:1
► They account for 78% of primary care visits for patients with either
Medicaid or no insurance; and
► 63% of primary care visits for minority patients occur in private
physician offices.
• Need to address the ongoing plight of primary care:
► Continuing and dramatic decrease in medical students choosing
internal medicine; and
► Ongoing struggle of “hamster wheel” for primary care practices.
• Systems with strong primary care systems yield lower
costs and higher quality.2
1 Forrest, C & Whelan, E (2000). Primary Care Safety-Net Delivery System in the United States – A Comparison of
Community Health Centers, Hospital Outpatient Departments and Physicians’ Offices. Journal of the American Medical
Association 284 (16). 2077-2083.
2 Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83:457-502.
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Five Ways Health Plans Can Support Primary
Care Transformation
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1. Proactively support adoption of EHRs and
achievement of meaningful use
2. Encourage practices to use patient registries
3. Provide supports to small Medicaid practices
for practice redesign and transformation
4. Pursue (time-limited) funding opportunities
available through Affordable Care Act (ACA)
5. Collaborate with state or regional partners to
more effectively engage provider community
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Inland Empire Health Plan
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• Non-profit Medi-Cal health plan in Riverside and
San Bernadino, California
• History of commitment to quality improvement
• Selected to contract with regional extension center
(REC) as local recruiter of practices
► Partnering with medical societies
► Engaging Medi-Cal practices in meaningful use
(outreach, education, sign contract for MU, etc.)
► Facing similar challenges as other RECs, particularly
around engaging small Medicaid practices
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Neighborhood Health Plan of Rhode Island
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• Invested significantly in community health
centers in 2007 to position them to “go
electronic”
► Today, six have fully operating EHRs; three have
signed contracts with REC
• Implemented Primary Care Infrastructure
Support program with health centers
► Today, moving towards (1) more “hands on”
assistance to help providers achieve MU, and (2)
greater alignment across HEDIS measures, PCMH
elements, and MU definitions
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Pennsylvania Medicaid and Health Plans
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• Medicaid agency and three health plans are
aligning efforts by:
► Engaging 10 small, high-volume Medicaid practices in
Philadelphia
► Providing, populating and implementing Reach My
Doctor registry
► Pedagogical tool and important step to EHR
► Providing shared Nurse Care Manager to work with
practices on redesign, care management
► Providing practice management consultant
► Convening collaboratives for participating practices
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Why focus on small practices?
• 60% of all physicians work in practices with four or fewer providers1
• Up to half of Medicaid beneficiaries are served in (under-resourced) practices of four or fewer providers
• Quality improvement efforts are often hindered by poor reimbursement and inadequate staff support2
• Few programs focus on quality in small practices, despite the practices’ large role in providing primary care in the U.S.
• It is a struggle to specifically engage small practices in transformation, including EHRs
1 American Medical Association2 Audet, AJ, Doty, MM, Shamasdin, J, and Schoenbaum, SC (May/June, 2005). Measure, learn and improve:
physicians’ involvement in quality improvement. Health Affairs; 24(3); 843-853.
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State of Michigan and Medicaid MCOs
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• Michigan Medicaid and six health plans are
aligning efforts by:
► Engaging six small, high-volume Medicaid practices
► Helping practices select and implement a registry to
measure and improve patient care
► Providing financial incentives for specific milestones
achieved
► Deploying a QI coach – representing all 6 plans – to
provide one-on-one support to each practice
► Providing NCQA’s PCC-PCMH training and tools to
participating practices
Pursue Opportunities Available through
Affordable Care Act (ACA)
• Health care reform authorizes and/ or
appropriates federal funding for several
Medicaid or state primary care-related
initiatives:
► Health Homes for Enrollees with Chronic Conditions
► Primary Care Physician Rate Increases
► Primary Care Extension Programs
► Community Health Teams to Support PCMH
• Creates opportunities to advance and enhance
HIT
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Section 2703 Health Homes for Enrollees with
Chronic Conditions
• Patients with:
► At least two chronic conditions, or
► One chronic condition and at risk of a second, or
► One serious and persistent mental health condition.
• Health home services must include:
► Comprehensive care management;
► Care coordination and health promotion;
► Comprehensive transitional care;
► Referral to community and social supports;
► HIT; and
► Patient and family support.13
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Section 2703 (continued)
• Increased FMAP funding for two years for
health home services
• Up to $25 million in planning grants to support
development
• Reimbursement may be tiered according to:
► Severity and/or co-morbidities, or
► The performance of the provider.
• CMS to provide further guidance on how health
homes will work in a managed care delivery
system
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Advancing Primary Care through Regional
Alliances
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• Multi-payer, multi-stakeholder regional alliances
► Aligning Forces for Quality (AF4Q)
► Minnesota, Cleveland, Maine, Puget Sound
• Assessing the characteristics (including HIT
adoption and use) of “high-value” practices to:
► Better understand the strengths and opportunities for
improving these practices;
► Assess what type of education, training and support
these practices might need; and
► Design interventions in partnership with the alliances
and Medicaid.
Visit www.chcs.org to….
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• Learn about cutting-edge efforts to strengthen primary
care and reduce disparities within Medicaid.
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