Discussion with BEACON Council ODJFS/OHP Medicaid Provider Incentive Program

2 Ohio Medicaid Health Care Reform Coverage for Ohioans – High risk pool, Health Care Coverage Exchange, Eligibility Expansion High Quality Person Centered Care - Accountable Care Organizations Improved Efficiency - Reduced test duplication, Medication reconciliation, Care Coordination & Streamline administrative processing Improved Effectiveness - Reduced errors, Evidence-based decision support, Preventive care reminders Reduce avoidable re-hospitalization & ED, & Chronic care management Improved Value – P4P, Payment reform

Where did this come from? ARRA (American Recovery and Reinvestment Act) provided incentive $ for eligible professionals and hospitals who become meaningful users of certified electronic health record technology (EHR, ePrescribing, eligibility, etc.) Purpose - to enhance quality and health care outcomes and reduce overall health care costs There’s a Medicare and a Medicaid program. Medicaid’s program is called the Medicaid Provider Incentive Pmt program: MPIP

What do we have to do to get the federal money? First, CMS had to approve our plan to work with Stakeholders to define: –Ohio’s ‘As Is’ state of HIT and EHR –Where Ohio will be in 5 years on HIT and EHR –The Road Map for Getting to this Vision –The basics of Ohio’s MPIP program *Our SMHP *Ohio’s I-APD

Who is eligible for MPIP? Medicaid Provider Incentive Payment Eligible Professionals (EPs) –Physicians (Pediatricians have special eligibility & payment rules) –Nurse Practitioners (NPs) –Certified Nurse-Midwives (CNMs) –Dentists –Physician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is directed by a PA Eligible Hospitals –Acute Care Hospitals –Children’s Hospitals

CURRENT STATUS CMS approved Ohio’s approach to planning for HIT on June 30. Work is underway to define: –Develop Ohio’s “As Is” and “To Be” framework June- Sept –Stakeholder Input on The Vision for Ohio’s HIT and EHR in 5 years – June-Sept –Develop & Submit SMHP to CMS –Sept-Nov –Develop & Submit I-APD to CMS upon approval of SMHP –Negotiate with CMS – Dec – Jan 2011 –Develop and Implement MPIP – Spring 2011

BEACON and MPIP Quality Measurement > Quality Improvement > Payment Reform MPIP provides an incentive to high volume Medicaid providers to move to EHR EHR requires systematic clinical data collection BEACON is … Quality Measurement + Quality Improvement

Goals of Meaningful Use: Improving quality, safety & efficiency of care, while reducing disparities Engaging patients and families in their care Promoting public and population health Improving care coordination Promoting the privacy and security of EHR’s

EHR Incentive Program Final CMS Regulations (2 years) CHIPRA Quality Measures Harmonization with CHIPRA 4 Measures in Stage 1. BMI Pharyngitis Immunizations Chlamydia Screening Must meet 15 core measures in 2 nd year Includes reporting quality measures to the state. May choose several among 10 in the Menu Set. States may require submission of data to state- wide registries. Meaningful Use Core Measures Menu Set Measures

Consider aligning future BEACON projects with ‘meaningful use’ and quality measurement requirements of EHR incentive program