Medicaid Eligibility and Health Information Services (MEHIS) Overview

Presentation to the e-Health Advisory Committee

March 24, 2017

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Agenda

• MEHIS Background

• Strategic and Legislative Drivers

• Goals and Objectives

• MEHIS Overview

• Services Overview

• Client and Provider Portal Overview

• Challenges in Sharing the Clients Health Information

• The Value of MEHIS

• MEHIS Future Initiative

• Portal Integration with Managed Care Organizations (MCOs) and Dental Maintenance Organizations (DMOs) Pilot

• Questions2

Strategic Drivers

• Service Improvements:

• Improve quality, availability and timeliness of care received by Medicaid clients. Reduce duplicative services. Enhance record keeping and data sharing.

• Improved Health Care Outcomes:

• Enhanced preventive care through notification and documentation of Texas Health Steps (THSteps).

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Strategic Drivers (con’t)

• Cost Efficiency:

• Through improved coordination of care, reduction of duplicative services and drug prescriptions.

• Future Expansion:

• The system has the potential to provide additional future EHR and health information exchange functionality currently not available to Medicaid providers.

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• Stage 1: Browser-based electronic health record for Medicaid beneficiaries.

• Stage 2: Expand electronic health record to CHIP; add lab test results, clinical data, client profiles, and alerts.

• Stage 3: Evidence-based benchmarking tools; add state agencies, laboratories, diagnostic facilities, hospitals and medical offices.

* House Bill 1218, 81st Legislature, Regular Session, 2009

Legislative Drivers

HB1218* authorizes HHS to develop:

Medicaid Health Information Exchange (HIE) System - to improve the quality, safety, and efficiency of healthcare services provided under the Medicaid program - in three Stages:

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Real-time member eligibility information including:

• Medicaid Benefits

• Primary Care Provider

• THSteps

• Managed Care Organization

• Other Insurance Benefits

Medicaid providers and their

staff are able to access the system using a Web Browser

System must have thepotential to be expandable

to support future capabilities such as Health Information Exchange (HIE), Data Analysis, Quality Monitoring, and Performance Benchmarking

Medicaid claims-based including:• Fee-for-Service Claims• Managed Care Encounters• Prescription Drugs• Lab DataOther Data:• Vaccinations – from the

State’s Immunization Registry

Electronic Health

Records

Access to Information at the Point of Care

Expandable Solution

Web Based Access

Goals and Objectives

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MEHIS Services

Card Services

Issuance, replacements.

Provider Services

Portal, IVR, Help Desk, and

Outreach.

Client Services

Portal, IVR, Help Desk, and

Outreach.

Host Processing Services

Scalable, application and

business rules, system hosting,

security, disaster recovery. 7

MEHIS Services (con’t)

Help Desk Services

Application support, program information.

Electronic Health Records

Extensible, standard and legacy messaging including: HL-7, CDA, ICD, NCPDP, X12, interactive and batch.

System Interfaces

Integration services, Enterprise Service Bus, data interfaces, trading partners services.

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Client and Provider Portal Overview

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MEHIS Status:

• HHS consolidated information originating from disparate data sources into single view of patients’ available Medicaid health information.

• Provides central system to access information for Fee-for-Service (FFS) and Managed Care clients.

Client and Provider Portal Overview (con’t)

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MEHIS Potential Value:

• Provides centralized tool to manage sharing patient consent.

• Can reduce duplicative services and improve quality of care.

• Complements provider’s clinical information (prescription compliance for example).

Your Texas Benefits (YTB) Client Portal

(English and Spanish)

Your Texas Benefits Card (YTBC) Provider Portal (English Only)

Seamlessly accessed (via SAML Token) from the State’s Self Service Portal where clients apply for benefits

Where Medicaid providers get timely information on a patient's Medicaid eligibility, services and treatments provided by Medicaid

• View, print and order Medicaid ID cards• Providers’ Front Desk staff can view and

print images of the clients’ Medicaid ID Cards

• View and set up Texas Health Steps Alerts and email notifications

• View case Texas Health Steps Alerts

• View available adult health information • Capture and view patient visits

• Choose whether to allow others to view their health information

• View available patient health information

• Blue Button • Blue Button

• View benefit and program information • Verify patient eligibility

Client and Provider Portal Functions

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Blue Button

• Blue Button was first implemented by the Veterans Affairs to enable service members to download their health records.

• Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) have been pushing for wider adoption of Blue Button.

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Blue Button (con’t)

Implemented Blue Button in Client and Provider Portals:

• Conforms with the Veterans Affairs, ONC, and CMS guidelines.

• Enables Medicaid clients and providers to download available health information in various formats:

• Text File

• Adobe Portable Document Format (PDF)

• Clinical Document Architecture (CDA)

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• Accessible from web browsers on PCs, smart phones, and tablets.

• CDA can be imported into providers’ EHRs and patients’ Personal Health Record (PHR) Systems.

Challenges Action Resolution

Sensitive Data: Sexual Assault, Genetics, Family Planning, Mental Health, Communicable Disease, Psychotherapy notes, Domestic Violence, Substance Use Disorder (SUD), HIV/AIDS, Treatment of Minors, Intellectual Disability

• Legal, Policy, Medical Review

• SUD requires consent

• Terms of Use (TOU)• Online Consent

Attestation• Display SUD

disclosure

American Medical Association (AMA) CPT code descriptor licensing

• HHS / AMA Negotiation

• Use ConsumerFriendly CPT descriptors

Texas Medical Association (TMA)concurrence with TOU

• HHS / TMA Negotiation

• Modified TOU to establish agreement with TMA

Health Information Limitations• HHS reviewed

available data• Health Information

Data Limitations Disclaimer

Challenges in Sharing the Clients’ Health Information

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The Value of MEHIS as a Scalable Integration Platform

• The MEHIS system is a Service Oriented Architecture (SOA) that connects users with valuable information needed to provide services to Medicaid clients.

• Supports integration and interoperability by:

• Accepting data in standard and legacy formats and translates it into industry standards such as HL-7 and Integrating the Healthcare Enterprise (IHE).

• Being scalable to cost effectively support new data interfaces, integrations, and health information exchange.

• Based on robust open integration patterns and eHealth framework.

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Portal Integration with MCOs/ DMOs Pilot

• Integrate the YTBC health information portal screens with the MCOs/DMOs through Single Sign On.

• Consistent way for access to information regardless which plan the client is enrolled.

• Access to Blue Button functionality and ability to import into their electronic health record (EHR).

• New information will be automatically available to users.

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Portal Integration with MCOs/ DMOs Pilot (con’t)

Benefits:

• One centralized location for providers to access the health record and manage consent.

• Streamlines overhead associated with maintaining the data in multiple systems.

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Portal Integration with MCOs/ DMOs Pilot – Project Milestones

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Questions and Next Steps

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Thank you