Adoption of Electronic Health Records (EHRs) and Agency Health - - PowerPoint PPT Presentation

Indian Health Services (IHS)/638 Adoption of Electronic Health Records (EHRs) and Agency Health Information Technology (HIT)/Health Information Exchange (HIE) Strategy

Jakenna Lebsock, MPA Region 9 HITECH Meeting August 26-27, 2014

Overview

• Overview of Agency Strategic Plan
• Description of current EHR Program

Successes

• IHS and the EHR Incentive Program
• Payments to IHS and 638 providers
• Care Coordination Opportunity
• HIE Barriers
• Next Steps

2 Reaching across Arizona to provide comprehensive quality health care for those in need

AHCCCS Strategic Plan

3

Reaching across Arizona to provide comprehensive quality health care for those in need

Reaching Across Arizona to Provide Comprehensive, Quality Health Care for Those in Need

Reduce fragmentation in healthcare delivery to develop an integrated system

• f healthcare

Bend the cost curve while improving the member’s health

• utcomes

Pursue continuous quality improvement Maintain core

• rganizational

capacity, infrastructure and workforce.

EHR Adoption Growth and Meaningful Use (MU) Payments

4 Reaching across Arizona to provide comprehensive quality health care for those in need

Combined Medicare and Medicaid Payments to eligible providers (EPS) and eligible hospitals (EHS)

• From January 2011 to May 2014 the National Medicare

Incentive Payment for EPs and EHs was $15,872,232,709.00

• The combined National Medicaid Payment to EPs and

EHs was $8,135,713,421.00

• Arizona’s combined EP/EH Payment (Medicare and

Medicaid) from 2011 through May 2014 was $415,777,529.00

• HUGE OPPORTUNITY

5 Reaching across Arizona to provide comprehensive quality health care for those in need

Overall Growth in EHR Adoption

• In the 2007-2009 approximately 45% of

physicians used Electronic Medical Records (EMRs)

• In 2009-2011, approximately 52% of physicians

used EMRs

• In 2012-2013, approximately 81% of Arizona

physicians who responded to the survey used some form of electronic medical record storage

EHR Adoption is Increasing

• EHRS adoption is expected to be almost 100%

by 2018

• Older physicians leave practices
• Continued EHR incentives help drive care systems

adoption and use

• Some Rural communities have higher rates of adoption

compared to metro areas

• Especially important to look at areas where American Indian

Populations are based

Physician EMR Use by County, 2012-2013 (N = 9,351)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Apache Cochise Coconino Gila Graham Greenlee La Paz Mohave Navajo Pinal Santa Cruz Yavapai Yuma Maricopa Pima 79.0% 82.0% 84.0% 84.0% 86.0% 100.0% 58.0% 81.0% 76.0% 86.0% 94.0% 86.0% 83.0% 80.0% 81.0%

Source: AMB, ABOE Survey Data, 2012-2013. Note: Table does not include retired physicians. Additionally, 1,906 respondents did not identify a method of storing medical records and 607 were of unknown county. Pima and Maricopa Counties (red) represent the urban areas. All other counties in blue represent the rural areas.

Indian Health Services and RPMS

• All of the IHS clinical facilities use Resource and Patient

Management System (RPMS)

• All IHS facilities have attested for Stage 1 of MU
• Integrated solution for clinical, business practice and

administrative information management

• 2012 RPMS Product received Office of the National

Coordinator (ONC) Certification; three IHS Areas hired MU Coordinators

• Current IHS reports show that MU Stage 2 deployment is

underway; target late summer/fall for implementation

9 Reaching across Arizona to provide comprehensive quality health care for those in need

EHR Payments

• To date, 438 payments have been made to

EPs working at IHS or 638 facilities in the state

• 398 have been for Adopt, Implement, Upgrade

(AIU) (90.9%)

• 35 = Stage 1, Year 1 (two facilities)
• 5 = Stage 1, Year 2 (one facility)
• 12 payments have been made to IHS EHs
• Additional 6 are under review

10 Reaching across Arizona to provide comprehensive quality health care for those in need

Provider Challenges for EHR Adoption

• Very similar to other providers
• Pre-Payment Documentation
• Aggregate Set-Up Process
• Payment Reassignments

11 Reaching across Arizona to provide comprehensive quality health care for those in need

EH Challenges

• Federal Updates (2)
• Timing
• Some have been expected to attest, but

such hasn’t occurred yet

12 Reaching across Arizona to provide comprehensive quality health care for those in need

Opportunity for Care Coordination and Improved Health Outcomes

13 Reaching across Arizona to provide comprehensive quality health care for those in need

Current AHCCCS Strategic Goals (2014- 2018)

• Bend Cost Curve
• Pursue Continuous Quality Improvement
• Promoting and evaluating access
• Improving outcomes for integrated Populations
• Measure improvements on contractor Performance Improvement Projects

(PIPs) and performance measures

• Leverage American Indian (AI) Care Management Program to improve

care outcomes

• Reduce fragmentation in healthcare delivery to develop an

integrated system of healthcare

• Seriously Mentally Ill , Children’s Rehabilitative Services, and dual eligible

alignment/integration

• Leverage HIT investments to create more data flow in healthcare

delivery system

• Maintain core organizational capacity, infrastructure and workforce

American Indian Health Plan (AIHP)

• American Indians Health Care Delivery System is

among the most fragmented

• Members are eligible for services through Indian

Health Services and 638 facilities

• More than 40% of Arizona’s 350,000 AI

population is enrolled in Medicaid

• Member can choose to receive care through

AHCCCS Health Plans or

• AIHP/Fee for Service (FFS) program

administered by Agency

15 Reaching across Arizona to provide comprehensive quality health care for those in need

Example of an AIHP “Super Utilizer”

• 57 Year old male AI member has visited and

Emergency Department of a non-IHS/638 hospital 28 times

• Had 8 in-patient stays at an IHS/638 facility in the

last 12 months

• 3 inpatient stays were readmissions within 30

days

• He has diabetes, heart disease, and mental

health/substance abuse issues.

16 Reaching across Arizona to provide comprehensive quality health care for those in need

American Indian Health Plan (AIHP)

Staffing & Resources Data Care Coordination Model Relationships

AIHP Care Coordination

17

Barriers to Data Sharing for AIHP

• Overall, most providers would say that the planning and

implementation of the HIT/HIE technology and strategy has taken longer and was more complex than expected

• State level HIE (The Network) current vendor cannot go through

HealtheWay Certification

• Federal Agencies IHS, VA, Social Security Administration cannot send data

through HIEs that cannot sign Data Use and Reciprocal Support Agreement (DURSA)

• HIE must pass legal and technical standards to succeed
• The Network out to bid for new HIE platform 2.0 to pursue greater

technical capabilities including meeting HealtheWay Certification

• The Networks goal is to start transition to new HIE vendor by December, 2014
• HealtheWay Certification is planned for sometime in 2015-2016

18 Reaching across Arizona to provide comprehensive quality health care for those in need

Next Steps to Accelerate Provider HIT/HIE Adoption

19 Reaching across Arizona to provide comprehensive quality health care for those in need

2014 State Medicaid HIT Plan (SMHP) Agency HIT – HIE Goals

20 Reaching across Arizona to provide comprehensive quality health care for those in need

• Ensure eligible Providers continue to move

through the EHR Program Continuum

• Accelerate Statewide HIE Participation for

all Medicaid Providers and Plans

• Increase agency uses and support for

HIT/HIE to increase organizational efficiency

HITECH Act and Meaningful Use 2009 – 2021

CMS/ AHCCCS Payoff

Questions?

Jakenna Lebsock, MPA Quality Improvement Manager 602-417-4229 Jakenna.Lebsock@azahcccs.gov

22 Reaching across Arizona to provide comprehensive quality health care for those in need