Change is Occurring!

Linette T Scott, MD, MPHChief Medical Information Officer, DHCS

“Population Health”HIMSS NCal Educational Program, Sacramento, CA| February 4, 2014

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Population Data at DHCS

Adoption of Electronic Health Records

Driving Quality

Changes in Health Care

Population Data at DHCS

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As of December 2013, over 8,601,500 are enrolled in Medi-Cal

The Medi-Cal Population

Health Disparities in the Medi-Cal Population

Poor neighborhood safety has been associated with

poor health outcomes

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Diverse Information EnvironmentProgrammatic Data Eligibility Demographics

Utilization (Claims and Encounters)

Providers

Third Party Liability

Managed Care Plans

Certifications and Licensing

Reporting Descriptive Statistics

Quality and Performance Measurement

Monitoring

Financial

Oversight

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For Business Process Redesign

Key drivers:

◦ Efficiency within the organization

◦ Common language and requirements

◦ Comparability across states

◦ Integration with changes in health care

Specifies connection to intrastate health information exchange to advance maturity

Medicaid Information Technology Architecture (MITA) is a Framework

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MITA Comparability – Maturity Model

http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/mitamm.pdf

Modularity Standard

Align with and advance MITA

Use industry standards

Share and reuse technology

Deliver business results

Performance reporting

Interoperable across health & human services community

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MITA Seven Conditions & Standards

Adoption of Electronic Health

Records

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There was the Health Information Technology for Economic and Clinical Health (HITECH) Act

A staged approach to implementing electronic health records (EHRs)

Multiple grant and incentive programs establish rules of the road for electronic health data:

◦ (CMS) Medicare and Medicaid EHR Incentive Programs State programs end in 2021

◦ (ONC) Standards & Certification Criteria (S&CC)Grant programs end in 2014

Before the Affordable Care Act …

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Health Outcome Policy Priorities

1) Improving quality, safety, efficiency and reducing health disparities.

2) Engage patients and families in their healthcare.

3) Improve care coordination.

4) Improving population and public health.

5) Ensure adequate privacy and security protections for personal health information.

CMS EHR Incentive Program:Changing the Norm

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How is the Norm Changing?Re-engineering business processes

Paper-based Care

EHR-based Care

Effective, Quality Care

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National EHR Adoption

http://www.cdc.gov/nchs/data/databriefs/db143.htm

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As of December 2013 Medi-Cal EHR Incentive Program has paid

over $715 Million to:◦ 11,442 Medi-Cal eligible professionals ◦ 241 eligible hospitals

Medicare and Medicare Advantage EHR Incentive Programs have paid over $1 Billion to:◦ Over 28,000 California eligible professionals and

hospitals

Incentives Paid in California

Driving Quality

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Required as part of the Affordable Care Act

First released in 2011 – Annual Reporting

Three Aims:

◦ Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.

◦ Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care.

◦ Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

http://www.ahrq.gov/workingforquality/index.html

National Quality Strategy

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Hospital Readmissions Reduction Program - Medicare

Provider-Preventable Conditions Including Health Care-Acquired Conditions

Adult Quality Measures – core quality measures used for voluntary reporting

Prevention - Medicaid Incentives for Prevention of Chronic Diseases Program

And Others

New Programs Focused on Quality

DHCS Strategic Vision

DHCS Transforming and Innovating to Achieve its Commitments

It begins with the DCHS Strategic Plan:

◦ To the Public …

◦ To the People We Serve …

◦ To our Employees …

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Built on the DHCS Quality Strategy

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DHCS’s Three Linked Goals

Improve the health of all Californians

Enhance quality, including the patient care experience, in all DHCS programs

Reduce the Department’s per capita health care program costs

EnhancingHealth Care Programs

Improving the Healthof All Californians

ReducingHealth Care Costs

DriveHealth Care Quality

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Driving Quality and Care Coordination

Affordable Care Act (ACA)The ACA Fosters…• Evidence-based medicine• Prevention• Coordinated care• Access

ACA Challenges…• Major system redesign• Reducing costs (while

expanding access)• Linking health care with

population health• Data limitations

An Example

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Common Goals Across Payment Environments

Thank you!