1. Health Information Technology and DC Medicaid Transformation Grant John McCarthy Senior Policy Director DC Department of Health Care Finance Washington, D.C

2. Not a place you would want to be... Not a place where you would want to be...

4. DC Healthcare System Challenges High incidence of chronic disease High mortality rates for selected diseases Distribution of health care resources Variations in the utilization of services

5. Health Insurance Coverage DC has a very high coverage rate Medicaid covers 1 out of 4 residents Local Only Funding & XIX > 1 out of 3

6.  Interface currently separate patient data on IT systems across MAA, DOH, six local health centers and three local hospitals  The interface will be accomplished through the development and implementation of a Medicaid Patient Hub which will include: linkages to the providers’ EHR and EMR products a master client index a physical repository for population-based data a record locator component an analytical component for data analysis by MAA user access control and audit component Medicaid Transformation Grant Project Purpose

7.  Data Integration: Integrate patient data so DOH can expand its ability to perform analysis on Medicaid populations and individuals served by the Department and those who are served by other organizations participating in this effort (6 neighborhood health centers, 3 hospitals, and DOH programs).  Coordinate Health Services Delivery: Enable community health centers to coordinate health services delivery with other participating clinics and hospitals.  Medical Decision Making: Improve the quality of medical decision making through secure exchange of accurate and comprehensive patient health information and through patient- centered and outcome driven analytical capabilities. Medicaid Transformation Grant Project Goals

8.  DC-wide Clinical Informatics and Analysis Capabilities: Available at the point of care for providers with individual level access, and on the desktop for aggregate analyses by program level analysts and administrators in MAA and DOH.  Patient Care: Medicaid patient’s medical information (in linked systems) will be accessible at the point of care including clinics, hospitals, DOH facilities, Medicaid care managers, etc.  Cost Savings by Management of Care, Outcomes & Costs: Patient and provider data will be analyzed to identify cost savings through the reduction of duplicate services and better coordination of care among the provider participants.  Potential NHIN-type Linkages: Provide connecting link to larger, regional HIE and RHIO efforts in the NCA MTG Project Goals (cont.)

9. MTG Project Chronology CMS Approval Letter: February 2007 Project Award: First Year funds: $ 5,459,000 Second Year funds:$ 4,405,000 Executive Steering Committee formed: March 2007 Joined Medicaid Transformation Grant Collaborative (13 states) Retained GWU Contractor to Support: Use Case development, Outline Evaluation Framework, and Draft Scope of Work for RFP Finalized Draft RFP but procurement process has been slower than originally anticipated

10. MTG Steering Committee: (Chair: John McCarthy) Medicaid Representatives DC Dept. of Health Representatives Office of the Chief Technology Officer Representatives Program Manager TBD Patient Hub Contractor/ Systems Integrator Vendor - TBD Subject Matter Experts: Medicaid Administration Medicaid Operations HIT Standards & Interfaces Health Information Exchange Privacy/Security/Confidentiality Local/State Legislation Variation Policy and Procedure Development EHR and EMR Interfaces MITA Standards & Requirements Health Care Costs and Outcomes Business Processing Re-engineering GWU – MTG Facilitator Physical Repository Executive Sponsor Robert Maruca Sr. Deputy Director, Medical Assistance Administration MAA Senior Policy Director John McCarthy Master Client Index Links to EHRs and EMRs Data AnalysisRecord Locator User Access Control and Audit MTG Project Organization

11. MTG Events Time Line January 25, 2007Round 1 MTG awarded with 2/1 start date January 16, 2009No-Cost Extension Requests due for grants ending on March 30, 2009. March 30, 2010Active grants: End of budget & project period. October 31, 2010Final Grant Report Due for grants that ended on 3/31/10 Notes: After 3/31/09, if grant is extended 3, 6, or 9 months, final FSR is due 90 days after the end of the grant and the final evaluation report is due 180 days after the end of the grant. The calendar above reflects up to a 12-month no-cost extension.

12. Other HIE Projects in DC DC Regional Health Information Organization (DC RHIO) DC Department of Health Medical Homes Project Medicare’s EMR grants

13. INTEGRATIONREPOSITORYLOCATORANALYSIS Providers can receive basic patient record summary data from MMIS Providers access patient data through patient hub User access control and audit enforces HIPAA compliance Master Client Index provides for accurate identification of patients across MAA, DOH, health centers and hospitals Reduces medical record errors and duplication Physical data repository for population- based data from public health programs Public Health data can be pushed to remote providers Informs clinical decision-making at the provider site Patient Record Locator for remote access and exchange of necessary medical record data Provides for future access to larger NHIN exchange efforts Patient Data Linkages Identity Reconciliation Population-based Data Secure Data Exchange Data Mining & Analysis Analytical component to determine true costs of care Ability to check for duplication of services across provider sites MASTER INDEX MTG Project Components

14. TG Patient Data Hub Enable Access Aggregator TG Patient Data Hub Enable Access Aggregator Transformation Grant: Project Period Analytics & Reporting Predictive Modeling Adm. Decision Support Tool Analytics & Reporting Predictive Modeling Adm. Decision Support Tool Safe Passage Portal (Limited Data Set) OPERATIONAL DATA REPOSITORY Safe Passage Portal (Limited Data Set) OPERATIONAL DATA REPOSITORY Metadata Repository IMA CFSA DYRS DMH DOH APRA MAA SHPA EPSDT MPCA WIC IR Lead Cancer HAA AIDS HEPRA Public Labs HCRLA Hospitals Record Locator 3 Hospitals Record Locator Other Hospitals Clinics Record Locator 6 Clinics Record Locator Other Clinics Labs Record Locator Private Labs Providers Record Locator Other Providers CMS Medicaid MMIS MDS OASIS Medicaid Data Never Rolls Off Real time: record locator Analytical: repository $ $ $ $$ $ $ - Scope $ - Fully Funded $ - Not funded- Vision Corrections DCPS Completed - Black In process - Grey Separately funded Master Patient Index Clearing House $ $ Data Flows Both Ways Through Record Locators

15. Post Transformation Grant Vision TG Patient Data Hub Enable Access Aggregator TG Patient Data Hub Enable Access Aggregator Analytics & Reporting Predictive Modeling Adm. Decision Support Tool Analytics & Reporting Predictive Modeling Adm. Decision Support Tool Metadata Repository IMA CFSA DYRS DMH DOH APRA MAA SHPA EPSDT MPCA WIC IR Lead Cancer HAA AIDS HEPRA Public Labs HCRLA Hospitals Record Locator All Hospitals Clinics Record Locator All Clinics Labs Record Locator Private Labs Providers Record Locator Other Providers CMS Medicaid MMIS MDS OASIS Medicaid Data Never Rolls Off Real time: record locator Analytical: repository Master Patient Index Safe Passage Portal (Limited Data Set) OPERATIONAL DATA REPOSITORY Safe Passage Portal (Limited Data Set) OPERATIONAL DATA REPOSITORY Corrections DCPS Data Flows Both Ways Through Record Locators

16. Possible DC-RHIO / Medicaid Transformation Integration

17. Relationship MTG to Medical Home-EMR PhaseHUBEMR InternalInterface I (MTG) Architecture & Design Build infrastructure Create Master Patient Index Architecture & Design Build API Establish EMR base in clinics II (MTG) Fix Defects Provide Reporting Enhance Capability Connect to 6 Clinics Connect to 3 Hospitals Connect to HUB III (Post MTG) Fix Defects Enhance Capability Connect to Labs Connect to Other Clinics Connect to Other Hospitals IV (Post MTG) Connect to All Providers

18. Where We Want to Be A full and active participant in developing statewide HIE efforts A key facilitator of providers ’ participation, especially for vulnerable populations, and An effective user of Health IT to improve the quality and health outcomes of Medicaid recipients

19. Thanks for Listening Contact Information: John McCarthy Senior Policy Director D.C. Dept. of Health Care Finance 825 N. Capitol St. NE Washington, DC 20002-4210 202-442-9074 John.McCarthy@dc.gov