transforming health care delivery with hit: arizona
DESCRIPTION
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Tony RodgersTRANSCRIPT
Transforming Health Care Delivery with HIT: Arizona
Anthony Rodgers, Director
Arizona Health Care Cost Containment System
Critical Drivers for Health System Transformation
Current medical cost trends are unsustainable both public and private payers of health care coverage.
The current healthcare system produces significant variances in cost and quality.
Lack of health system integration leads to duplication, administrative inefficiency and lack of patient care coordination.
In the public sector medical cost escalation has or is becoming a “Budget Buster”.
Employer sponsored premium rate increases have made healthcare coverage increasingly unaffordable for many businesses and individuals which is increasing the numbers of uninsured workers.
Historic Barriers to System Transformation
Lack HIT Enabler Technologies
Lack of Public Private Synergy
Lack Financial Investment
Misaligned Incentives
Health System Transformation Goal
To improve healthcare system efficiency, patient care quality, rapid and continuous adoption of clinical best practices, public health protection and disaster response, through the implementation of interoperable health information systems and clinical decision support tools that enable the exchange of electronic health information between providers, payers, consumers and those that help to advance the boundaries of our health science knowledge and quality of life.
Arizona’s Sense of Urgency to Achieve Statewide Adoptions of HIT that Support Exchange of
Electronic Records
It is our belief that:1. The single greatest opportunity for gains in healthcare
system transformation will occur with the statewide adoption of electronic health records and health information exchange.
2. That creating an environment that encourages widespread deployment of enabling health information exchange technology will lead to a significantly improved health system efficiency, cost effectiveness, patient safety and quality of care.
3. That significant return on investment can be achieved within this decade by leveraging our Medicaid Programs to lead and support the acceleration of the adoption and deployment of electronic health records and standardize infrastructure for health information exchange.
Arizona’s Vision of a Transformed Healthcare System
A healthcare system that provides: Integrated healthcare delivery, Cost and quality transparency, The productive interchange between provider and patient, Informed activated consumers and patients, Healthcare provider’s able to provide cost effective care
management and use clinical decision support tools to reduce cost and quality variances.
Vision of an Integrated Health System
Primary Care Physicians
Hospitals andHealthcare Facilities
Specialists
Subspecialists
PublicHealth
Virtual Integrated networks
Medical Homes for Medicaid Enrollees
More Effective Clinical Collaboration
Improved Systems of Care
Impact of Health Information ExchangeImpact of Health Information Exchange
Key Building Blocks For Health System Transformation
Web-based health information and care management decision support tools that provide consumers, provider and payer healthcare value transparency as a common point of reference.
System-wide access to web-based electronic health records, health information exchange and patient relevant healthcare management tools integrated the system of care to maximize value and reduce variations in cost and quality.
New generation of consumer, provider and payer care management decision support and analytical tools integrated with EHR, EMR and PHR systems
Keys to Creating the Environment for Health System Transformation
Creating aligned incentives and legal framework rapid adoption and deployment of health information exchange infrastructure and standards that supports exchange electronic health information,
Assure everyone is at the table and no one is left behind in the adoption and deployment of electronic health records and health information exchange.
Medicaid Leadership in Health System Transformation
Requires:
A strong Federal and State partnership and financial support,
Agency leadership and participation Effective health information system planning and
development know-how, New skills and organizational competencies
within State Medicaid Program and Public Health,
New reimbursement strategies and health information exchange policies,
Public/Private partnerships as well as partnerships with other state Medicaid programs.
AHCCCS Health System Transformation Initiative
AHCCCS EHR Repository & Web Portal
EHRRepository
AHCCCS Web Portal
RLS
NPI
DHS ImagingHealth Plans AHCCCSLabs
Provider EMRs Hospitals Pharms/PBMsIHS HIEs/SAHIE
ePrescribing
Lab Order and Results Delivery
ReferralsPrior Authorization
Access Hospital Discharge Info
Claims and Eligibility Management
Clinical Info Management
AHCCCS HIE/EHR
Value Driven Decision Support System
Acute and Personal
Healthcare
Long TermCare
Disease Management
And Chronic Care
Beneficiary Health
Education
Population Health
Information
Health Information Exchange
Electronic Health Record
Web BasedE-Learning
Systems
AHCC
CS H
ealth
Info
rmat
ion
Tech
nolo
gy In
frast
ruct
ure
Healthcare System Transform
ation
Health Care Practice and Consumer Value
Rapid Learning And
Knowledge TransferSystem
Managed Care Organization Value Driven Decision Support System
Health System Transformation Enabler
Clinical Care Transformation Enabler
Patient Self Care Management Enabler
Health Care Practice Competency and Capacity Enabler
Value Driven Decision SupportValue Driven Decision Support
Population Survey
Encounter
Medical Data
Population
Prescription Drug
Premiums / Cap
Evidence-BasedMedicine
Public & SpecializedData Sets
Beneficiary Data
External Data / Profiles
Program SegmentationAnalysis
AHCCCS Methods/Analytics•Episodes of Care
•Performance Measures•Disease Staging
Data ManagementProcess
•Security Protection•Integration
•Standardization•Data Enhancement•QA/ImprovementProfile and Screens
DataWarehouse
Medical Management
Fraud Detection
Drug U/R & Cost
Performance Analysis
Eligibility Analysis
ChronicIllness
Sub-databasesRegistries
DecisionSupport ReportingApplications
Eligibility Data
ManagedManagedCareCare
ManagedManagedCareCare
1980’s-1990’s1980’s-1990’s
• Prepaid healthcarePrepaid healthcare– More comprehensive More comprehensive
benefitsbenefits– More choice and coverageMore choice and coverage
• Contracted NetworkContracted Network
• Focus on cost control Focus on cost control and preventive careand preventive care
– GatekeeperGatekeeper– Utilization managementUtilization management– Medical ManagementMedical Management
IntegratedHealth
2000+2000+
• Patient Care CenteredPatient Care Centered– Personalized Health CarePersonalized Health Care– Productive and informed Productive and informed
interactions between Patient and interactions between Patient and ProviderProvider
– Cost and Quality Transparency Cost and Quality Transparency – Accessible/Affordable ChoicesAccessible/Affordable Choices– Aligned Incentives for wellnessAligned Incentives for wellness
• Multiple integrated network and Multiple integrated network and community resourcescommunity resources
• Aligned cost management processesAligned cost management processes
• Rapid deployment of new knowledge Rapid deployment of new knowledge and best practices in quality care and best practices in quality care
• Patient and provider interactionPatient and provider interaction– Information focusInformation focus– Aligned care managementAligned care management– E-health capableE-health capable
• Fee For ServiceFee For Service– Inpatient focusInpatient focus– O/P clinic careO/P clinic care– Low ReimbursementLow Reimbursement– Poor Access and QualityPoor Access and Quality– Little oversight Little oversight
• No organized networksNo organized networks
• Focus on paying claimsFocus on paying claims
• Little Medical ManagementLittle Medical Management
Fee for Service
1960’s-1970’s1960’s-1970’s
Managing Health System Transformation in Arizona
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