As state-level health information exchanges shift gears from grant-funded to self-sustaining, many are finding that the needs of their state Medicaid agencies are driving their agendas. States that had built very lightweight state-level HIE services are reconsidering the value of creating clinical data repositories. And because there is still federal grant funding available for HIE development tied directly to Medicaid’s mission, some states are even considering moving the HIE organization into the Medicaid agency.
In Washington state, for instance, “changes to Medicaid are now driving the need for greater functionality from the HIE, and it was never that way before,” said Nathan Johnson, state HIT coordinator and director of policy, planning and performance for the Washington Health Care Authority.
Speaking at the State Healthcare IT Connect Summit in Baltimore on April 2, Johnson said the HIE, which is overseen by the state but run by a for-profit contractor, was built to exchange data between providers, with no data repository or master patient index. But the shift to accountable care and patient-centered medical homes is requiring Medicaid and other payers to seek more real-time data and 360-degree views of their patients. Washington is planning to build a clinical data repository and an all-payer claims database to allow for the kind of population health analytics that could improve care and drive costs down. “The idea of a clinical data repository is much more sustainable than it ever was,” he said. The state also has a goal of breaking down barriers between behavioral and physical health, including on the data front, Johnson said. The state is exploring the CMS grant-funding options that would support Medicaid’s role in the HIE.
In Tennessee, the health IT needs of Medicaid managed care organizations are reviving the idea of statewide HIE services, said George Beckett, the state’s HIT coordinator.
Tennessee originally planned to link five regional HIEs in the state, but most of those did not survive financially, so the state shifted gears to focus strongly on Direct secure messaging to make sure providers could meet meaningful use requirements about sharing data.
But as the state’s Medicaid managed care organizations began working on new contracts for 2015, they realized they needed certain features such as Admit/Discharge/Transfer (ADT) messages and care coordination platforms, and rather than having each company develop its own solution, they decided perhaps they could agree on one solution, which would make things easier for providers. “They got together and started drawing things up and what they came up with looked an awful lot like an HIE,” Beckett said. So now they are looking at one ADT feed through a central hub, and looking at choosing one provider of care coordination software for all three. This type of cooperation would not have been possible even six months ago, he added. But payment reform and the State Innovation Model grant that the state got from the Centers for Medicare & Medicaid Innovation has turned competitors into collaborators, he said. “It is a breath of fresh air.”
The state will look at the options of extending the one flourishing public/private HIE statewide or using some CMS funding to make HIE services an extension of the Medicaid Management Information System.