1 Medicaid Transformation Grants & HIE Initiatives Jessica P. Kahn, MPH Centers for Medicare & Medicaid Services

2 The Medicaid Transformation Grants The 2005 Deficit Reduction Act amended the SS Act: for the adoption of innovative methods to improve the effectiveness and efficiency in providing medical assistance under this title $150 million appropriated for Medicaid Transformation Grants Two competitive solicitations in FY07 35 States and 1 Territory were awarded 49 grants for months

3 CMS Expectations for MTG Serve as Models for nationwide replication Sustainable Evaluated: Results  Quality Improvements  Clinical Outcomes  Estimated Cost Savings

4 Purposeful Ambiguity `(A) Methods for reducing patient error rates through the implementation and use of electronic health records, electronic clinical decision support tools, or e-prescribing programs. `(B) Methods for improving rates of collection from estates of amounts owed under this title. `(C) Methods for reducing waste, fraud, and abuse under the program under this title, such as reducing improper payment rates as measured by annual payment error rate measurement (PERM) project rates. `(D) Implementation of a medication risk management program as part of a drug use review program under section 1927(g). `(E) Methods in reducing, in clinically appropriate ways, expenditures under this title for covered outpatient drugs, particularly in the categories of greatest drug utilization, by increasing the utilization of generic drugs through the use of education programs and other incentives to promote greater use of generic drugs. `(F) Methods for improving access to primary and specialty physician care for the uninsured using integrated university-based hospital and clinic systems.

5 Defining Terminology HIT term# Organizations found to have meaningful data # Unique definitions found Electronic Health Record (EHR) 9963 Electronic Medical Record (EMR) 3526 Personal Health Record (PHR) 5236 Health Information Exchange (HIE) 2520

MTG Grantees with an HIE/EHR focus AlabamaMinnesotaW. Virginia ArizonaMississippiWisconsin ConnecticutMontanaIndiana District of ColumbiaNew JerseyOregon HawaiiNew MexicoRhode Island KentuckyTexas

7 What is the Value of HIE/EHRs to Medicaid Programs & Recipients? To the Program: Recipient profiles (high-cost/high-risk) in order to better target care Cost Savings Monitoring provider performance (Value- Based Purchasing)

8 Value to the Recipient Improved care through clinical decision support tools Opportunity to verify claims (also a program benefit as it can reduce fraud/abuse) More individualized care, less repeat testing, repeat forms completion

9 Health Information Exchange & Electronic Health Record Initiatives A variety of approaches A variety of starting points:  Electronic health records systems May include e-prescribing and/or clinical decision support tools  Patient Data Hubs/Data Warehouses/Health Record Banks  Health Information Exchanges By geographical areas By types of providers (nursing homes, foster care caseworkers, special needs shelters, etc) By type of beneficiary (just those with disabilities, children, etc) In partnership with other payers (Health Plans)

10 Technical Assistance to Grantees AHRQ has awarded a 3-year task order contract to provide technical assistance to state Medicaid and SCHIP programs for Health Information Technology  The first task order was awarded to RTI  While open to all states, is heavily focused in Year 1 on the MTG as the “early adopters”

11 Synergies with DEHPG Grants, etc Areas of common focus:  Emphasis on Quality  In some cases, shared target population of Medicaid beneficiaries: Persons with disabilities and/or the elderly, their providers and caregivers  Focus on improving care coordination  Guided by the CMS Compendium of Quality Measures

12 Example 1: Kansas MTG Objective is to improve the effectiveness of case manger intervention through their use of predictive modeling software for case identification and opportunities for intervention and improvement. Will provide case mangers with a computerized, claims- based querying system. Focuses on persons with disabilities who are generally less likely to receive gender and age appropriate services and fair poorly when it come to management of chronic conditions.

13 Example 2: Missouri Will create an integrated web-based instrument for requesting and tracking HCBS for aged and disabled Medicaid beneficiaries System will be portable for real-time, "in-the- field" access to obtain authorization for HCBS services Will also contain Medicaid beneficiary claims data to ease assessment for appropriateness of HCBS and automate Medicaid claims billing

14 Example 3: Georgia Georgia will develop a beneficiary-focused website on healthcare cost and quality of all Medicaid services. Similar to the CMS websites: “Hospital Compare and “Nursing Home Compare.” GA site will include:  Nursing home data  HCBS  Clinical providers data

15 Coordination with You Where you see some overlapping objectives with the ADRC grants, please encourage them to identify the Medicaid Transformation Grant staff in their state for internal collaboration

16 MTG Contact Information CMS Project Officer Jessica Kahn: or MTG on the NASMD Website: tion.asp MTG on the CMS Website: