Health Information Technology Health Information Technology and its Role in Medicaidand its Role in Medicaid

State of Wisconsin PerspectiveState of Wisconsin Perspective

Presentation to the Second National Presentation to the Second National Medicaid CongressMedicaid Congress

Kevin R. Hayden, SecretaryKevin R. Hayden, SecretaryDepartment of Health and Family Department of Health and Family

ServicesServicesJune 15, 2007June 15, 2007

2

Agenda

Health Care Environment and Health Care Environment and Wisconsin’s eHealth AgendaWisconsin’s eHealth Agenda

Transforming Medicaid through Transforming Medicaid through eHealtheHealth

QuestionsQuestions

3

The Health Care Environment 1999 “To Err is Human”1999 “To Err is Human”

Human impact and health care costs of errorsHuman impact and health care costs of errors ““Crossing the Quality Chasm”Crossing the Quality Chasm”

Roadmap for health care redesignRoadmap for health care redesign Four Cornerstones of Value-Driven Health Four Cornerstones of Value-Driven Health

CareCare Wisconsin’s provider and payer responseWisconsin’s provider and payer response

Wisconsin Collaborative for Healthcare Wisconsin Collaborative for Healthcare Quality (WCHQ)Quality (WCHQ)

eHealth Care Quality and Patient Safety eHealth Care Quality and Patient Safety BoardBoard

Wisconsin Health Information Organization Wisconsin Health Information Organization (WHIO)(WHIO)

4

Wisconsin eHealth Initiative Public-private collaboration for Public-private collaboration for

widespread adoption of HIT/HIEwidespread adoption of HIT/HIE Wisconsin’s eHealth Action Plan includes:Wisconsin’s eHealth Action Plan includes:

Creation of a technical infrastructureCreation of a technical infrastructure Establishing a governance structure for Establishing a governance structure for

exchangeexchange Options for addressing privacy and security Options for addressing privacy and security

issuesissues Support for the acquisition of EHR systems Support for the acquisition of EHR systems

by small provider groups and safety-net by small provider groups and safety-net providersproviders

5

eHealth Action Plan December 1, 2006

1.1. Establish the eHealth technology Establish the eHealth technology platformplatform

2.2. Value-based purchasing policies Value-based purchasing policies and actionsand actions

3.3. Link HIT and HIE plans to Link HIT and HIE plans to prevention and disease prevention and disease management activitiesmanagement activities

4.4. Take an incremental approach – Take an incremental approach – growing thoughtfully over time with growing thoughtfully over time with frequent evaluation of progressfrequent evaluation of progress

6

eHealth Technology Platform HIT adoptionHIT adoption

Encourage adoption and investment in Encourage adoption and investment in electronic health record systemselectronic health record systems

Regularly monitor adoption progressRegularly monitor adoption progress Regional health information exchangeRegional health information exchange

Foster creation of regional health Foster creation of regional health information exchangesinformation exchanges

Simultaneously focus on statewide health Simultaneously focus on statewide health information exchangeinformation exchange

Focus early on providing patient Focus early on providing patient information timely and at point of careinformation timely and at point of care

7

Wisconsin Regional Health Information Organizations (RHIO’s)

eHealth Action Plan envisions the eHealth Action Plan envisions the development of a total of five WI development of a total of five WI RHIO’sRHIO’s

First RHIO formed in Southeast WI—First RHIO formed in Southeast WI—the Wisconsin Health Information the Wisconsin Health Information Exchange (WHIE) Exchange (WHIE) Member-governed, non-profit, Member-governed, non-profit,

collaborative effort involving health collaborative effort involving health agencies in nine counties to facilitate agencies in nine counties to facilitate information access for clinicians information access for clinicians

WHIE is just beginning development and WHIE is just beginning development and implementation of an operational HIEimplementation of an operational HIE

8

Value-based purchasing Develop standard requirements for Develop standard requirements for

reimbursementreimbursement Leverage purchasing power of state Leverage purchasing power of state

government to align incentives that government to align incentives that promote high quality, safe, and promote high quality, safe, and efficient careefficient care

Seek funding to develop these Seek funding to develop these systemssystems

Participate in development of the Participate in development of the WHIO data repository to track WHIO data repository to track quality and cost across episodes of quality and cost across episodes of carecare

9

Link HIT and HIE to prevention and disease management

Develop a routine health risk Develop a routine health risk assessment and member agreementassessment and member agreement

Promote chronic disease management Promote chronic disease management tools by safety-net providerstools by safety-net providers

Improve coordination of care across Improve coordination of care across health settingshealth settings

Research ways to engage patients in Research ways to engage patients in the health decision-making processthe health decision-making process

10

Link HIT and HIE to prevention and disease management (cont.)

Establish biosurveillance Establish biosurveillance capabilities for rapid detection, capabilities for rapid detection, management, and recovery across management, and recovery across health settingshealth settings

Assure interoperability of HIT/HIE Assure interoperability of HIT/HIE with public health systemswith public health systems

11

Take an incremental approach

Address HIT and HIE simultaneouslyAddress HIT and HIE simultaneously Establish benchmarksEstablish benchmarks Start with projects that build Start with projects that build

infrastructureinfrastructure Use standards consistent with Use standards consistent with

national developmentsnational developments Create incentives for interoperable Create incentives for interoperable

systemssystems

12

Take an incremental approach (cont.)

Build on existing assetsBuild on existing assets Establish effective communications Establish effective communications

strategies strategies Monitor progress and adjust Monitor progress and adjust

activities as necessaryactivities as necessary

13

Transforming Wisconsin Medicaid

Goal is to transform Medicaid from a Goal is to transform Medicaid from a passive health insurance, claims passive health insurance, claims processing/payment operation to:processing/payment operation to: Care managementCare management Use of EHR’s to educate our providers Use of EHR’s to educate our providers

and recipientsand recipients Defining clinical standards of careDefining clinical standards of care Identifying and resolving treatment gapsIdentifying and resolving treatment gaps Performance-based reimbursement ratesPerformance-based reimbursement rates

14

Transforming Wisconsin Medicaid

Medicaid NowMedicaid Now Price drivenPrice driven Hidden price & Hidden price &

quality quality informationinformation

Knowledge Knowledge disconnecteddisconnected

Disease focusedDisease focused Paper basedPaper based Process focused Process focused

governmentgovernment Quality and price Quality and price

measuredmeasured

Medicaid of the FutureMedicaid of the Future Values drivenValues driven Transparent price & Transparent price &

quality informationquality information Knowledge Knowledge

intenseintense Prevention/wellness Prevention/wellness

focusedfocused Electronically basedElectronically based Outcomes focused Outcomes focused

governmentgovernment Quality of care and life Quality of care and life

measuredmeasured

15

Health Information Technology

Enables:Enables: Improved qualityImproved quality Reduced errorsReduced errors Lowered costsLowered costs Consumer engagementConsumer engagement Population healthPopulation health

Essential and key to transforming Essential and key to transforming MedicaidMedicaid

16

Transforming Wisconsin Medicaid Bring benefits of electronic health Bring benefits of electronic health

records (EHR’s) to our Medicaid records (EHR’s) to our Medicaid populationpopulation

Advance regional health information Advance regional health information exchange for the Medicaid populationexchange for the Medicaid population

Reform Medicaid reimbursement Reform Medicaid reimbursement system system

Design programs to improve the Design programs to improve the health care delivery system and health care delivery system and engage consumers in managing their engage consumers in managing their own health careown health care

17

Transforming WI Medicaid – EHR Adoption

Submitted a Medicaid Transformation Submitted a Medicaid Transformation Grant application to provide technical Grant application to provide technical assistance to WI safety net clinics for assistance to WI safety net clinics for EHR systemsEHR systems

Grant will support planning, Grant will support planning, implementation, use of EHR’s in 5 implementation, use of EHR’s in 5 Milwaukee FQHC’s and 6 other FQHC’s Milwaukee FQHC’s and 6 other FQHC’s across the stateacross the state

18

Transforming WI Medicaid – HIE

WHIE, Wisconsin’s First RHIO—WHIE, Wisconsin’s First RHIO—major partner in WI’s eHealth major partner in WI’s eHealth Initiative and Medicaid Initiative and Medicaid Transformation GrantTransformation Grant A model for statewide HIE A model for statewide HIE

implementationimplementation Creating HIE between Milwaukee Creating HIE between Milwaukee

hospital emergency departments, hospital emergency departments, FQHC’s, and public health for FQHC’s, and public health for Medicaid and GAMP populationMedicaid and GAMP population

19

Transforming WI Medicaid – Purchase for Value

Report key quality and cost measures Report key quality and cost measures on Medicaid patient population by on Medicaid patient population by partnering with WCHQ and WHIOpartnering with WCHQ and WHIO

Expand pay-for-performance (P4P) for Expand pay-for-performance (P4P) for state Medicaid providersstate Medicaid providers

20

Transforming WI Medicaid – Purchase for Value (cont.)

Explore systems to support safety-Explore systems to support safety-net providers in exercise of net providers in exercise of measuring and reporting key quality measuring and reporting key quality datadata

Perform research to address: Perform research to address: Engaging consumers in use of health Engaging consumers in use of health

data data Assessing impact that public reporting of Assessing impact that public reporting of

quality measures is having on quality measures is having on improvements across the State of improvements across the State of WisconsinWisconsin

21

Transforming WI Medicaid – The Consumer

Enhance use of Medicaid data collection Enhance use of Medicaid data collection infrastructureinfrastructure Trend important chronic diseases within Trend important chronic diseases within

Medicaid populationMedicaid population Deliver disease management and prevention Deliver disease management and prevention

programs through managed careprograms through managed care Streamline the process for engaging Streamline the process for engaging

vulnerable families in health and benefits vulnerable families in health and benefits decision-making through:decision-making through: A non-binding, voluntary member agreement A non-binding, voluntary member agreement

offered at the point of Medicaid enrollmentoffered at the point of Medicaid enrollment An online Health Risk Assessment (HRA) that An online Health Risk Assessment (HRA) that

will be automatically forwarded to the will be automatically forwarded to the individual’s medical home (PPO, HMO, etc.) individual’s medical home (PPO, HMO, etc.)

22

Transforming WI Medicaid – Consumer Interests (cont.)

Conduct research to identify best Conduct research to identify best approaches to engaging vulnerable approaches to engaging vulnerable patients with quality information patients with quality information and decision support tools for and decision support tools for making health care decisionsmaking health care decisions

Provide online educational Provide online educational materials (in multiple languages) materials (in multiple languages) on managing medical conditions, on managing medical conditions, disease prevention, and other disease prevention, and other health-related topics health-related topics

23

QUESTIONS?QUESTIONS?

24

Additional Informational SlidesAdditional Informational Slides

25

Executive Order #129November 2005

Governor Jim Doyle created the Governor Jim Doyle created the eHealth Care Quality and Patient eHealth Care Quality and Patient Safety Board to:Safety Board to:

Ensure health information is Ensure health information is available at the point of careavailable at the point of care Reduce medical errors and duplicationReduce medical errors and duplication Improve coordination of careImprove coordination of care Further health care researchFurther health care research Engage consumers in their health careEngage consumers in their health care

26

eHealth Care Quality and Patient Safety Board

Charged with:Charged with: Identifying existing and potential Identifying existing and potential

eHealth resourceseHealth resources Identifying technology options Identifying technology options Identifying options for serving Identifying options for serving

consumer information needsconsumer information needs Ensuring privacy and security in the Ensuring privacy and security in the

exchangeexchange Facilitating statewide adoptionFacilitating statewide adoption Creating an infrastructure for Creating an infrastructure for

statewide adoptionstatewide adoption

27

eHealth Board MembersChair:Chair:    Kevin HaydenKevin Hayden, Secretary, Department of Health and Family Services, Secretary, Department of Health and Family ServicesBetsy AbramsonBetsy Abramson, Elder Law Attorney and Consultant , Elder Law Attorney and Consultant Christopher Alban, MDChristopher Alban, MD, Clinical Informaticist, Epic Systems Corporation, Clinical Informaticist, Epic Systems CorporationBevan BakerBevan Baker, Commissioner of Health, City of Milwaukee Health Department, Commissioner of Health, City of Milwaukee Health DepartmentEdward Barthell, MDEdward Barthell, MD, Executive Vice President, CIO, Infinity Healthcare, Executive Vice President, CIO, Infinity HealthcareGary BezuchaGary Bezucha, Administrator, Boscobel Area Health Care  , Administrator, Boscobel Area Health Care  Patricia Flatley BrennanPatricia Flatley Brennan, Professor of Nursing and Industrial Engineering  , Professor of Nursing and Industrial Engineering  Catherine HansenCatherine Hansen, Director, Health Information Svcs, St. Croix Regional , Director, Health Information Svcs, St. Croix Regional

Medical CenterMedical CenterRavi KallaRavi Kalla, CEO and President, Symphony Corporation, CEO and President, Symphony CorporationDon LaydenDon Layden, Executive Vice President, Corporate Development, Metavante , Executive Vice President, Corporate Development, Metavante

Corporation Corporation Michael L. MorganMichael L. Morgan, Secretary, Department of Administration, Secretary, Department of AdministrationLois MurphyLois Murphy, IT Specialist, Veterans Administration, IT Specialist, Veterans AdministrationCandice OwleyCandice Owley, RN, President, Wisconsin Federation of Nurses and Health , RN, President, Wisconsin Federation of Nurses and Health

ProfessionalsProfessionalsDebra RislowDebra Rislow, CIO and Director of Information Systems, Gundersen Lutheran, CIO and Director of Information Systems, Gundersen LutheranPeg SmelserPeg Smelser, Chief Operating Officer, Wisconsin Education Association Trust, Chief Operating Officer, Wisconsin Education Association TrustEric StanchfieldEric Stanchfield, Secretary, Employee Trust Funds, Secretary, Employee Trust FundsJustin Starren, MD, PhD,Justin Starren, MD, PhD, Director, Biomedical Informatics Research Center, Director, Biomedical Informatics Research Center,

Marshfield Clinic Marshfield Clinic Lon Sprecher, Lon Sprecher, Senior Vice President and COO, Dean Health InsuranceSenior Vice President and COO, Dean Health InsuranceJohn Toussaint, MDJohn Toussaint, MD, President and CEO, ThedaCare, President and CEO, ThedaCareHugh ZettelHugh Zettel, Director, Government and Industry Relations, GE Healthcare, Director, Government and Industry Relations, GE Healthcare

Technologies Technologies

28

eHealth Care Quality and Patient Safety Board 2007

Steering Committee for Security and Privacy Project

eHealth Board Workgroup

Security and Privacy Project Ad-hoc Workgroup

29

For more information on the WI eHealth Initiative and Medicaid Transformation

Go to:Go to:

http://ehealthboard.dhfs.wisconsin.gov/http://ehealthboard.dhfs.wisconsin.gov/

DHFS Contacts:DHFS Contacts:

Kathy Farnsworth, eHealth Chief of StaffKathy Farnsworth, eHealth Chief of StaffFarnsK@dhfs.state.wi.usFarnsK@dhfs.state.wi.us(608) 267-2082(608) 267-2082

Denise Webb, Policy Initiatives Advisor,Denise Webb, Policy Initiatives Advisor,eHealth InitiativeeHealth Initiativewebbdb@dhfs.state.wi.uswebbdb@dhfs.state.wi.us(608) 267-6767(608) 267-6767