Health IT Underpins Medicaid Medical Homes

State Medicaid agencies are busy planning patient-centered medical home initiatives with an initial focus on the chronically ill or high-cost beneficiaries. Part of the states’ planning efforts involves figuring out the data-sharing infrastructure that will be required to support medical-home networks.

Section 2703 of the Affordable Care Act will provide enhanced federal funding for states that provide health homes for enrollees with chronic conditions. But those health homes must coordinate care and report quality and cost data to states, which in turn must report to the Centers for Medicare & Medicaid Services (CMS). Three states, Oregon, Rhode Island and Missouri, have submitted plans. Six others have submitted draft proposals, and 13 have received initial funding to help with health home planning.

A Sept. 29 webinar sponsored by the U.S. Agency for Healthcare Research and Quality (AHRQ) focused on the role of health information technology in developing and supporting a Medicaid health home program. Attendees heard Denise Levis Hewson, RN BSN, MSPH, director of clinical programs and quality improvement for Community Care of North Carolina (CCNC), describe the increasing role her agency’s Informatics Center has played in engaging physicians, nurses, pharmacists and care coordinators.

CCNC provides 14 networks of community-based, physician-led medical homes with resources to better manage Medicaid populations.

The Informatics Center features a data warehouse fed by Medicaid claims data. Labcorps provides laboratory results for the statewide Medicaid population; CCNC also gets real-time hospital admission/discharge/transfer data from 48 North Carolina hospitals.

“We have found that timely data is so important to care managers to manage our populations,” Levis Hewson said. “Practices want help in de-fragmenting care,” she said. Problems arise if patients are admitted and discharged from hospitals without communication to the medical home.

Accessing data from the Informatics Center allows care managers to determine which patients should be contacted for appointment reminders. Its reports identify opportunities to target the highest-risk individuals. The center also feeds quality data back to the practices to help benchmark against other practices. “It couples performance measurement with actionable information,” Levis Hewson said.

Talking about results, she said that CCNC is in the top 10 percent in the U.S. in Healthcare Effectiveness Data and Information Set (HEDIS) measures for diabetes, asthma and heart disease compared to commercial managed care. The state has seen more than $700 million in state Medicaid savings since 2006, she added. Goals for the future include continuing to build out the Informatics Center and a provider portal and facilitating accountable care organizations.

For states looking to replicate CCNC’s success, it is important to remember that its development was gradual over a 25-year period. Neither the relationships nor the health IT infrastructure can be built from scratch in a year or two.