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 Reaching across Arizona to provide comprehensive 2 quality health care for those in need
AHCCCS Strategic Plan Reaching Across Arizona to Provide Comprehensive, Quality Health Care for Those in Need Reduce Bend the cost Maintain core fragmentation in curve while Pursue organizational healthcare delivery improving the continuous quality capacity, to develop an member’s health improvement infrastructure and integrated system outcomes workforce. of healthcare Reaching across Arizona to provide comprehensive 3 quality health care for those in need
EHR Adoption Growth and Meaningful Use (MU) Payments Reaching across Arizona to provide comprehensive 4 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 Reaching across Arizona to provide comprehensive 5 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 o Older physicians leave practices o Continued EHR incentives help drive care systems adoption and use o 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) 81.0% Pima 80.0% Maricopa 83.0% Yuma 86.0% Yavapai 94.0% Santa Cruz 86.0% Pinal 76.0% Navajo 81.0% Mohave 58.0% La Paz 100.0% Greenlee 86.0% Graham 84.0% Gila 84.0% Coconino 82.0% Cochise 79.0% Apache 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 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) o All IHS facilities have attested for Stage 1 of MU o 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 Reaching across Arizona to provide comprehensive 9 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 o 398 have been for Adopt, Implement, Upgrade (AIU) (90.9%) o 35 = Stage 1, Year 1 (two facilities) o 5 = Stage 1, Year 2 (one facility) • 12 payments have been made to IHS EHs o Additional 6 are under review Reaching across Arizona to provide comprehensive 10 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 Reaching across Arizona to provide comprehensive 11 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 Reaching across Arizona to provide comprehensive 12 quality health care for those in need
Opportunity for Care Coordination and Improved Health Outcomes Reaching across Arizona to provide comprehensive 13 quality health care for those in need
Current AHCCCS Strategic Goals (2014- 2018) • Bend Cost Curve • Pursue Continuous Quality Improvement Promoting and evaluating access o Improving outcomes for integrated Populations o Measure improvements on contractor Performance Improvement Projects o (PIPs) and performance measures Leverage American Indian (AI) Care Management Program to improve o care outcomes • Reduce fragmentation in healthcare delivery to develop an integrated system of healthcare Seriously Mentally Ill , Children’s Rehabilitative Services, and dual eligible o alignment/integration Leverage HIT investments to create more data flow in healthcare o 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 o 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 Reaching across Arizona to provide comprehensive 15 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. Reaching across Arizona to provide comprehensive 16 quality health care for those in need
American Indian Health Plan (AIHP) Staffing & Data Resources AIHP Care Coordination Care Coordination Relationships Model 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 o through HIEs that cannot sign Data Use and Reciprocal Support Agreement (DURSA) HIE must pass legal and technical standards to succeed o • 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 o • HealtheWay Certification is planned for sometime in 2015-2016 Reaching across Arizona to provide comprehensive 18 quality health care for those in need
Next Steps to Accelerate Provider HIT/HIE Adoption Reaching across Arizona to provide comprehensive 19 quality health care for those in need
2014 State Medicaid HIT Plan (SMHP) Agency HIT – HIE Goals • 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 Reaching across Arizona to provide comprehensive 20 quality health care for those in need
HITECH Act and Meaningful Use 2009 – 2021 CMS/ AHCCCS Payoff
Questions? Jakenna Lebsock, MPA Quality Improvement Manager 602-417-4229 Jakenna.Lebsock@azahcccs.gov Reaching across Arizona to provide comprehensive 22 quality health care for those in need
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