The Value of a National Enrollment Database Eric A. Flowers, MBA July 8, 2013 v1.0

The Value of a National Enrollment Database

Eric A. Flowers, MBA

July 8, 2013v1.0

A Familiar ConceptBenefits of National DatabaseHistorical Concerns and ProblemsWhat is Different Today?ACA has created opportunitiesADAP – the Logical Starting PointUltimate BenefitsConclusions

Agenda

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A Familiar Concept•States sharing a common enrollment platform•As part of actual Client Enrollment Process•As a periodic data transfer•Check for other third party coverage•Check for enrollment in any other ADAP program•Aggregation of demographic information that is searchable utilizing real time data•Capacity to incorporate drug utilization and cost data•Creates a rich data warehouse available to all states

that participate

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A Familiar Concept

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A Familiar Concept

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Benefits of a National Database • Preservation of Payer of Last Resort status• Eliminate interstate ADAP enrollment• Data warehousing enables benchmarking

– Cost per client (Direct vs. Rebate or Hybrid)– Client outcomes (tracking CD4 and Viral load)– Enhanced cost modeling

• Utilizes current data vs. Prior Year• Business Continuity and Disaster Recovery• Expandable Platform• Multiple means of submitting data• Defrayed Cost

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Historical Concerns and Problems

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• Privacy and Security• Cost• Varied technical capacities amongst States• Varied quality of data amongst States• Lack of consistent support from stakeholders• Numerous competitive efforts at State and

Federal levels• Leadership?

What’s Different Today?

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• The Affordable Care Act• Accountable Care Organizations (ACO’s)• Concept of Medical Home• More healthcare dollars available• Increased need for Case Management• Improved Technology

– Data Analytics (Big Data)– Cloud Computing

ACA Opportunities – ACO’s

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• Accountable Care Organizations– Organizations working together to lower cost and

improve outcomes– Begins to change the economics of healthcare– CMS has begun ACO payment reform– Platform for Evidence Based care– Chronic conditions require coordination and

success measured over time– Ideal ACO organizations

ACA Opportunities – Medical Homes

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• Concept of Medical Home– Term originally coined in 1967 by American

Academy of Pediatrics– Shares some characteristics of ACO’s– More loosely defined than ACO’s– Patient-centric care– Can work hand in hand with ACO’s

ACA Opportunities – Medical Homes

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The Seven Tenants of Medical Homes1. Personal Physician2. Physician Directed Medical Practice3. Whole Person Orientation4. Coordinated and Integrated Care5. Quality and Safety6. Enhanced Access7. Payment Reform

ACA Opportunities – Continued

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• Greater Healthcare Dollars Available– Mostly through Medicaid– Dramatic increase in number of FQHCs

• Coordination will require case management• Health Information Technology

– Can help meet growing case management needs– Interoperability of EMR required for coordinated

care– Data Analytics aka “Big Data”

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• Potential Short Term Cost Savings• Source of valuable utilization and payer data• Utilize national data to promote learning, efficiencies

and better care• Can Start Lo-Tech/low cost while positioning for the

future• ADAP’s are the largest cost driver in RWHATMA• Opportunity to start aligning the RWHATMA with

ACO’s and Medical Homes beyond Part B

ADAP – The Logical Starting Point

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• ADAPs have the opportunity for a leadership role in how ACA will impact RWHATMA

• ADAPs have access to the data that can demonstrate efficacy of ACO’s and Medical Homes from both cost and quality of care perspectives

• The extensive national network of HIV/AIDS service providers is an asset that has serviced state governments and communities

Ultimate Benefits

The Future

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Common Portal

Social Services

Pharmacy Benefits

Primary Care

ADAPs

Case Worker

Individual Care Plan

Mental Health

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• ADAPs should look to future of Healthcare in the US• Start with and move beyond a national data base

– Integrate utilization data (de-indentified)– Integrate EMR data (de-identified)– Implement comprehensive needs assessment– Develop comprehensive case management tools– Develop benchmarks and metrics for best practices– Let the data and lives saved make the case

Conclusions

Questions

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