California Program to Help Fund HIE Connections for Medicaid Providers

April 15, 2019
Incentive payments for HIOs, providers that meet onboarding and HIE connection milestones

A recent survey of providers in California’s Medicaid program found low participation rates in regional health information organizations (HIOs). Only 26 percent of all Medi-Cal providers and only 17 percent of ambulatory practices currently connect to an HIO. To address the situation, the state Department of Health Care Services (DHCS) will provide incentive payments for HIOs and Medi-Cal providers to meet specific onboarding and HIE connection milestones.

Up to $50 million is available from a federal matching program. DHCS is awaiting final approval from the Centers for Medicare & Medicaid Services for the California Medi-Cal HIE Onboarding Program and expects to officially launch it in June 2019. To meet federal requirements, all Cal-HOP activities must be completed on or before September 30, 2021.

DHCS will oversee the program and distribute funds. Regional HIOs will apply to be “qualified” to participate in the program and will receive payments for meeting milestones with “qualified” provider organizations.

In a recent webinar, Raul Ramirez, chief of the Office of Health Information Technology at DHCS, said the vision for Cal-HOP is to expand Medi-Cal providers’ access and use of HIE services. “We intend to help Medi-Cal providers meet Meaningful Use measures, improve provider access to information across a medical community, improve care coordination in the quality of care for patients, improve efficiency by reducing unnecessary utilization and waste, and supporting specific Medi-Cal initiatives, including waiver programs such as the Whole Person Care Program.”

The approach DHCS is taking is to establish an incremental progression of “Milestones” that incentivize the use of HIE services. One of the milestones is accessing the CURES prescription drug monitoring database. (California law requires providers to consult CURES when prescribing controlled substances.) The prevailing method of accessing CURES today is via web portal that requires extra workflow steps for providers, Ramirez said. “Integrating CURES directly into the providers’ EHRs will greatly facilitate compliance with the law and help to reduce overprescribing of controlled substances, thus addressing the opioid epidemic.”

A second Milestone consists of provider organizations submitting encounter notifications and event notifications to the HIO and being able to access similar notifications submitted by other provider organizations.

A third set of Milestones consist of interfaces through the HIO between provider organizations and certain public health registries, such as the CAIR immunization registry, the CalREDIE reportable registry and POLST registries as well. Another category consists of interfaces to deliver clinical data from HIOs to providers’ EHRs, specifically through web services APIs, for example FHIR APIs.

The nonprofit HIE Manifest MedEx is offering a special limited-time bonus program of $60,000 to qualifying hospitals that choose Manifest MedEx as their HIE partner for the Cal-HOP program before May 31, 2019.

“We hope that providing additional resources will make it easy for hospitals across our state to sign up and get value quickly,” said Claudia Williams, Manifest MedEx’s CEO, in a statement. “Accelerating health information sharing in California is key to improving patient care, reducing healthcare costs, and collaboratively doing the hard work of transforming our medical systems.”

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