wv transformation slide show may conference2

Marsha Morris, CommissionerMarsha Morris, Commissioner

Designated Agents for today’s presentation:Designated Agents for today’s presentation:

Peter Groen, Director, SURCPeter Groen, Director, SURCJack Shaffer, CIO, CHNWVJack Shaffer, CIO, CHNWV

West Virginia Medicaid Transformation

Health IT Systems

Collaboration, Open Solutions, and Innovation

A 20/20 Vision of the Future for West VirginiaA 20/20 Vision of the Future for West Virginia

Imagine a future healthcare system that is customer-Imagine a future healthcare system that is customer-focused and focused and patient-centeredpatient-centered, one in which every , one in which every citizen has health insurance and a secure, private citizen has health insurance and a secure, private Electronic Health Record (EHR)Electronic Health Record (EHR) that is available that is available whenever and wherever needed, enabling the highest whenever and wherever needed, enabling the highest degree of coordinated medical care based on the latest degree of coordinated medical care based on the latest medical knowledge and evidence. medical knowledge and evidence.


Imagine a healthcare system in which digital and Imagine a healthcare system in which digital and mobile technologies, mobile technologies, medical knowledge medical knowledge at the point at the point of need, and of need, and collaborationcollaboration among providers deliver among providers deliver safe,safe, high-quality care high-quality care for everyone—a healthcare for everyone—a healthcare system that does not require the patient to complete system that does not require the patient to complete the same forms at every access point. the same forms at every access point.


Imagine a healthcare system where primary care Imagine a healthcare system where primary care physicians have access to your specialty medical physicians have access to your specialty medical information and specialists have access to your information and specialists have access to your primary care information via primary care information via inter-connectedinter-connected “smart” EHRs that are integrated with “smart” EHRs that are integrated with personalizedpersonalized eHealth service providers and delivered directly to a eHealth service providers and delivered directly to a multi-purpose, intelligent, multi-purpose, intelligent, mobile mobile digital device that digital device that can be carried in one’s pocket. can be carried in one’s pocket.

Electronic Medical Records (EMR)Electronic Medical Records (EMR) - The State intends to support - The State intends to support the acquisition and deployment of electronic medical record (EMR) the acquisition and deployment of electronic medical record (EMR) systems to better manage costs, improve quality of care, and enhance systems to better manage costs, improve quality of care, and enhance patient safety. Medicaid providers will be able to access and record patient safety. Medicaid providers will be able to access and record clinical and other data in these EMR systems for Medicaid members. clinical and other data in these EMR systems for Medicaid members.

e-Health Network e-Health Network - - The proposed West Virginia Health Information The proposed West Virginia Health Information Network (WVHIN) will provide an electronic network to share Network (WVHIN) will provide an electronic network to share electronic medical records (EMR), personal health records (PHR), electronic medical records (EMR), personal health records (PHR), and other clinical data between health care providers and payers.and other clinical data between health care providers and payers.

West Virginia Medicaid Transformation GrantWest Virginia Medicaid Transformation Grant

- Health IT Goals -- Health IT Goals -

West Virginia HIT Strategies

Collaboration, Open Solutions, and Innovation (COSI)

* Collaboration – The State is collaborating with other HIT organizations and state on multiple eHealth initiatives within West Virginia and beyond, e.g. Veterans Affairs, State of Hawaii, Indian Health Service, WorldVistA. Etc.

* Open Solutions – EMR Solutions for the state must be - CCHIT certified; standards based; public domain or open source; and interoperable

* Innovation – Collaboration + Open Solutions = Innovation

Collaborating with the large, open source HIT community on EMR, PHR, HIE, TeleHealth, ePrescribing, Standards and other HIT solutions has led us to a range of low cost, innovative alternatives

Developed by Douglas Goldstein and Peter GroenDeveloped by Douglas Goldstein and Peter GroenSource: Medical Informatics 20/20, Quality and EHR through Collaboration, Open Solutions and Innovation, Source: Medical Informatics 20/20, Quality and EHR through Collaboration, Open Solutions and Innovation, Jones & Bartlett, 2007Jones & Bartlett, 2007

COSI StrategiesCOSI Strategies

The COSI strategies of The COSI strategies of Collaboration, Open Solutions, Collaboration, Open Solutions, and Innovationand Innovation are the key to are the key to transformingtransforming the health the health and medical culture, the processes, the leadership and and medical culture, the processes, the leadership and the technology necessary to support better, safer and the technology necessary to support better, safer and higher quality care in our healthcare system and higher quality care in our healthcare system and other healthcare systems across the globe. The other healthcare systems across the globe. The application of these strategies is already evident application of these strategies is already evident throughout other major industries. throughout other major industries.

CollaborationCollaboration

““We start with the premise that we should partner We start with the premise that we should partner with everyone.” - with everyone.” - Tim Armstrong, Vice President, GoogleTim Armstrong, Vice President, Google

““It is a great thing to make scientific discoveries of rare It is a great thing to make scientific discoveries of rare value, but it is even greater to be willing to share those value, but it is even greater to be willing to share those discoveries and to encourage other workers in the same discoveries and to encourage other workers in the same field of scientific research.” - field of scientific research.” - W.J. Mayo, January, 1928W.J. Mayo, January, 1928

Open SolutionsOpen Solutions

““Open Source Everywhere—Software is just the Open Source Everywhere—Software is just the beginning . . . open source is doing for mass beginning . . . open source is doing for mass innovation what the assembly line did for mass innovation what the assembly line did for mass production.” production.” - Thomas Goetz,- Thomas Goetz, Editor, Wired MagazineEditor, Wired Magazine

But, we’re not just talking about Open Source, But, we’re not just talking about Open Source, we’re talking about we’re talking about Open SolutionsOpen Solutions

Growth in Open Source SoftwareGrowth in Open Source Software

In the last few years, the growth in OSS In the last few years, the growth in OSS has accelerated significantly. Key has accelerated significantly. Key contributing factors for this growth contributing factors for this growth are: are:

growing awareness of open source growing awareness of open source increased software functionality increased software functionality increasing adoption of OSS by many increasing adoption of OSS by many organizationsorganizations

many high quality OSS applications many high quality OSS applications now operating at the enterprise level -now operating at the enterprise level -

LinuxLinux ApacheApache OpenOfficeOpenOffice Mozilla/FireFoxMozilla/FireFox MySQLMySQL VistA / RPMS VistA / RPMS

Health IT Software in the ‘Public Health IT Software in the ‘Public Domain’Domain’

Electronic Health Record (EHR) Systems – VistA, RPMS, FreeMed, AMPATH, OpenEMR, OSCAR, etc.

Personal Health Record (PHR) Systems – My HealtheVet, iHealth Record, myPHR, etc.

Health Information Exchange (HIE) Systems – FHIE/BHIE, OpenHRE, HCUP, caBIG, etc.

Disease Surveillanc Software – HealthMap, RODS, NEDSS, SatSCAN, etc.

Public Health Software – PHIN, Epi Info, SETS, etc. Genomic Systems – HUGN, BLAST, GeMCRIS, LocusLink, etc. Clinical Imaging Software – myPACS, BLOX, ImageJ, etc. Specialty Software – PHLIS, VAERS, etc.

* Over 1000 ‘open source’ or ‘public domain’ health IT software projects and/or products to choose from and the list is growing.

InnovationInnovation

“ “Always and everywhere, free resources have Always and everywhere, free resources have been crucial to innovation and creativity.” been crucial to innovation and creativity.”

Lawrence Lessig, Lawrence Lessig, The Future of IdeasThe Future of Ideas: :

The Fate of the Commons in a Connected WorldThe Fate of the Commons in a Connected World

Innovative Solutions to be Innovative Solutions to be Implemented by 2020Implemented by 2020

Electronic Health Record (EHR) with CPOE – widespread deployment and use by 2015 (>80%)

Health Information Exchange (HIE) Networks - widespread deployment and use by 2020

Personal Health Record (PHR) Systems – widespread deployment and use by 2020

Clinical Imaging & EHR Systems – widespread deployment and use by 2015

‘Open Source’ HIT Software – widespread deployment and use by 2015 Wearable Health IT Systems – widespread deployment and use by 2020 Genomic Information Systems & EHRs – widespread deployment and use

beyond 2020 Robotics & EHRs – widespread deployment and use of robotic devices

interfaced to EHRs by 2020 Nanomedicine & EHRs – widespread use of nano-technologies and

implantable devices interfaced to EHRs beyond 2020

Other technologies – VOIP, RFID, Encryption, …

Imagine the Future …Create the Future – Health@Anywhere

Deficit Reduction Act of Deficit Reduction Act of 20052005

The DRA changes the face of Medicaid. Rx LTC Transfer of Assets Fraud and Abuse Benefits and Cost Sharing Financing Grants

West Virginia is poised to move Medicaid to a model that emphasizes preventive care, partnership, personal empowerment and responsibility.

Medicaid TransformationMedicaid TransformationDeficit Reduction Act of 2005Deficit Reduction Act of 2005

Electronic Health Systems need to: support enhanced access to preventive

and disease management services, defined personal health management goals and responsibilities and rewards for healthy behavior;

meet needs of “Advanced Medical Home”; provide integration with telehealth

applications; and facilitate advanced planned care with

strong self-management components.

HIT and HIE to support HIT and HIE to support West Virginia Medicaid RedesignWest Virginia Medicaid Redesign

HIT and HIE to support HIT and HIE to support West Virginia Medicaid RedesignWest Virginia Medicaid Redesign

52 acute care community hospitals, 18 critical access hospitals, 6 rehab, 4 VA, with a total of 70 hospitals;

Seven state-operated facilities, 2 behavioral health facilities, four long-term care, one community hospital (all implementing a version of the VA’s Vista EHR);

14 behavioral health centers, and 65 certified intermediate care facilities;

34 nonprofit primary care centers, with 139 primary care service sites (including 41 school-based health centers), providing services in or to 47 counties;

54 local health departments, 73 home health agencies and 20 hospice organizations;

3,743 MDs and 507 DOs active and practicing in West Virginia according to the respective licensing boards. Approximately one-third of West Virginia’s physicians are self-employed in a solo practice. More than one-third of West Virginia’s physicians provide primary care.

Coordinating health care Coordinating health care delivery– the opportunity for delivery– the opportunity for health information exchangehealth information exchange

Coordinating health care Coordinating health care delivery– the opportunity for delivery– the opportunity for health information exchangehealth information exchange

Studies indicate that 20% to 40% of diagnostic tests are duplicated due to lack of results being readily available and the potential benefit of full HIT integration as producing a “reduction in laboratory and radiology test ordering by 9 to 14%, lowering ancillary test charges by up to 8%, reducing hospital admissions, costing an average of $17,000 each, by 2% to 3%, and reducing excess medication usage by 11%.”

Studies predict a gain of as much as 30% in efficiency from EHR use and HIE, mostly through reducing unnecessary tests and prescriptions, paperwork and medical mistakes. In West Virginia, this amounts to a potential $3 billion savings of total health spending of $10 billion (the total state general revenue budget for 2007 was $3.629 billion) and nearly $1 billion for West Virginia Medicaid.

Harnessing the Power of HIT Harnessing the Power of HIT for Health Improvementfor Health Improvement

Harnessing the Power of HIT Harnessing the Power of HIT for Health Improvementfor Health Improvement

Community health centers can be leaders in health improvement and EHR adoption;

Leverage health improvement, EHR alone is not a “silver bullet” to improve outcomes and contain cost without system improvements;

Data warehouse and HIE require ability to capture and report information electronically at the point of care (paper to bytes)

Exploring ways to coordinate with MITA to build and finance infrastructure (90% match);

Focus EHR acceleration and financing support at the primary care and community health level for greatest ROI.

Lessons Learned - Early Lessons Learned - Early StagesStages

Lessons Learned - Early Lessons Learned - Early StagesStages

Advanced Medical HomeAdvanced Medical HomeMedicaid Transformation GrantsMedicaid Transformation Grants

Personal ResponsibilityPersonal ResponsibilityHealth System ImprovementHealth System ImprovementApplied TechnologyApplied TechnologyStronger Medicaid ProgramStronger Medicaid ProgramEnhanced Medication Enhanced Medication ManagementManagement

Advanced Medical HomeAdvanced Medical HomeMedicaid Transformation GrantsMedicaid Transformation Grants

Combined into (3) for Combined into (3) for implementationimplementation

PharmacyPharmacyImproved MedicaidImproved MedicaidE-HealthE-Health

Advanced Medical HomeAdvanced Medical HomeMTG – Improved MedicaidMTG – Improved Medicaid

Project ManagementAdvanced Medical HomesHealth Improvement InstituteHealthy Rewards AccountsEducation and OutreachClinical Data Warehouse

Goals of West Virginia Goals of West Virginia Medicaid RedesignMedicaid Redesign

Goals of MHCGoals of MHCEstablishment of a Medical HomeTailor benefits to needs of a specific population Coordinate care, especially for members with chronic conditionsProvide members with the opportunity and incentives to maintain and improve their health

Hallmarks for Hallmarks for MembersMembers

Prevention

Personal Responsibility

Establishment of a Medical Home

Care Management

Mountain Health ChoicesMountain Health ChoicesAn OverviewAn Overview

Advanced Medical HomeAdvanced Medical HomeWV Health Improvement InstituteWV Health Improvement Institute

ADOPTION OFELECTRONIC

HEALTH RECORDS

Develop proposed mechanisms to

accelerate adoption of electronic health

records in West Virginia

MEASUREMENT

Create a forum of alignment of

measures across

stakeholders to facilitate reporting

SELF MANAGEMENT

SUPPORT

To align and improve access to resources

and best practices to improve the self-

activation capacity of all patients

EDUCATION OF THE PROVIDER

COMMUNITY

To develop a system of provider engagement to

accelerate Medicaid Transformation and

assist physician practices with migration

to AMH

PAY FORPERFORMANCE

To provide guidance on the deployment of a P4P program as a

model for the State

QUALITYCOLLABORATIONS

To support a focused collaboration of key

stakeholders on improving quality, building on past

initiatives

Member EducationHealthy Rewards

Advanced Medical Homes

Advanced Medical HomesPay 4 Performance

Evidenced Based MedicineHealth Information Systems

Electronic Health InformationProvider Technology Incentives

OTHER RELEVANT INITIATIVESWV HIN – WVMI - OTHERS

Advanced Medical HomeAdvanced Medical HomeMTG - PharmacyMTG - Pharmacy

Automated Prior-Authorization SystemPOS Enhanced Coordination of Care SystemClinical Web Portal

Advanced Medical HomeAdvanced Medical HomeMTG - PharmacyMTG - Pharmacy

Automated Prior-Authorization SystemRFP bids received – in technical reviewReview completion by April 28th.

POS Enhanced Coordination of Care System Withdrawn at this time

Clinical Web PortalBids Opened April 2nd

Start technical review – Completed May 2nd.

Advanced Medical HomeAdvanced Medical HomeMTG - E-HealthMTG - E-Health

Electronic Medical RecordsPersonal Health Records Coordinate with healthy rewardsCoordinate with healthy rewards

e-PrescribingProvider PortalsBenefit ManagementCare CoordinationAccess to Specialty Care - Telehealth


Participating in NASMD Multi-State Collaboration MeetingsShare information on EMR’s, PHR’s Share information on EMR’s, PHR’s and HIE’sand HIE’s

Researching Methods to Foster EMR AdoptionCoordination with Major HIT InitiativesWVHIN, WVTA, e-PrescribingCMS EHR demonstration project


Conduct an environmental scan of health information technology deployed within the State.Develop an “as-is” profile by June 2008Coordinate survey with WVHIN and WVTA

Evaluate and determine each system's functional capabilities based on the CCHIT Certification Standards regarding record content and interoperability. Also evaluate based on functionality required to perform quality improvement in conjunction with the advanced medical home concepts. Focus on the possibility of VistA and RPMS as a solution.


Collaborate with federal agencies and other states on CMS transformation initiatives - e.g. EMR, HIE, PHR, ePrescribing, etc.Hawaii – Heavily invested in VistA – moving toward RPMSOhio, Kentucky – regional HIE’s

Initiate Pilot Implementations of “open” EMR systems at selected facilities – e.g. government hospitals, FQHC’s and rural clinics. Pilot test and evaluate a Personal Health Record (PHR) solution.Develop and pilot test data extraction tools and a public health clinical data warehouse solution.

ContactContact

Marsha Morris, Marsha Morris, CommissionerCommissioner

West Virginia West Virginia Department of Health and Human Department of Health and Human

ResourcesResourcesBureau for Medical ServicesBureau for Medical Services

(304) 558-1700(304) 558-1700