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Change is Occurring!
Linette T Scott, MD, MPHChief Medical Information Officer, DHCS
“Population Health”HIMSS NCal Educational Program, Sacramento, CA| February 4, 2014
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Population Data at DHCS
Adoption of Electronic Health Records
Driving Quality
Changes in Health Care
Population Data at DHCS
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As of December 2013, over 8,601,500 are enrolled in Medi-Cal
The Medi-Cal Population
Health Disparities in the Medi-Cal Population
Poor neighborhood safety has been associated with
poor health outcomes
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Diverse Information EnvironmentProgrammatic Data Eligibility Demographics
Utilization (Claims and Encounters)
Providers
Third Party Liability
Managed Care Plans
Certifications and Licensing
Reporting Descriptive Statistics
Quality and Performance Measurement
Monitoring
Financial
Oversight
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For Business Process Redesign
Key drivers:
◦ Efficiency within the organization
◦ Common language and requirements
◦ Comparability across states
◦ Integration with changes in health care
Specifies connection to intrastate health information exchange to advance maturity
Medicaid Information Technology Architecture (MITA) is a Framework
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MITA Comparability – Maturity Model
http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/mitamm.pdf
Modularity Standard
Align with and advance MITA
Use industry standards
Share and reuse technology
Deliver business results
Performance reporting
Interoperable across health & human services community
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MITA Seven Conditions & Standards
Adoption of Electronic Health
Records
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There was the Health Information Technology for Economic and Clinical Health (HITECH) Act
A staged approach to implementing electronic health records (EHRs)
Multiple grant and incentive programs establish rules of the road for electronic health data:
◦ (CMS) Medicare and Medicaid EHR Incentive Programs State programs end in 2021
◦ (ONC) Standards & Certification Criteria (S&CC)Grant programs end in 2014
Before the Affordable Care Act …
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Health Outcome Policy Priorities
1) Improving quality, safety, efficiency and reducing health disparities.
2) Engage patients and families in their healthcare.
3) Improve care coordination.
4) Improving population and public health.
5) Ensure adequate privacy and security protections for personal health information.
CMS EHR Incentive Program:Changing the Norm
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How is the Norm Changing?Re-engineering business processes
Paper-based Care
EHR-based Care
Effective, Quality Care
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National EHR Adoption
http://www.cdc.gov/nchs/data/databriefs/db143.htm
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As of December 2013 Medi-Cal EHR Incentive Program has paid
over $715 Million to:◦ 11,442 Medi-Cal eligible professionals ◦ 241 eligible hospitals
Medicare and Medicare Advantage EHR Incentive Programs have paid over $1 Billion to:◦ Over 28,000 California eligible professionals and
hospitals
Incentives Paid in California
Driving Quality
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Required as part of the Affordable Care Act
First released in 2011 – Annual Reporting
Three Aims:
◦ Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.
◦ Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care.
◦ Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.
http://www.ahrq.gov/workingforquality/index.html
National Quality Strategy
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Hospital Readmissions Reduction Program - Medicare
Provider-Preventable Conditions Including Health Care-Acquired Conditions
Adult Quality Measures – core quality measures used for voluntary reporting
Prevention - Medicaid Incentives for Prevention of Chronic Diseases Program
And Others
New Programs Focused on Quality
DHCS Strategic Vision
DHCS Transforming and Innovating to Achieve its Commitments
It begins with the DCHS Strategic Plan:
◦ To the Public …
◦ To the People We Serve …
◦ To our Employees …
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Built on the DHCS Quality Strategy
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DHCS’s Three Linked Goals
Improve the health of all Californians
Enhance quality, including the patient care experience, in all DHCS programs
Reduce the Department’s per capita health care program costs
EnhancingHealth Care Programs
Improving the Healthof All Californians
ReducingHealth Care Costs
DriveHealth Care Quality
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Driving Quality and Care Coordination
Affordable Care Act (ACA)The ACA Fosters…• Evidence-based medicine• Prevention• Coordinated care• Access
ACA Challenges…• Major system redesign• Reducing costs (while
expanding access)• Linking health care with
population health• Data limitations
An Example
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Common Goals Across Payment Environments
Thank you!
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