State health official meet online to discuss IT, spending

States planning to replace their Medicaid claims systems should consider
adding health information technology to the applications they fund in
order to take advantage of federal programs that reward investment in
health care infrastructure.

That was one of several suggestions speakers offered on how to tap
public funding streams for health IT in a Webcast June 1 on health IT
and Medicaid. It was sponsored by the National Conference of State
Legislators and the National Governors Association Center for Best
Practices.

Anthony Rodgers, director of Arizona's Health Care Cost Containment
System, said states should also take advantage of "transformation
grants" offered by the Health and Human Services Department to spur
state adoption of health IT. HHS has already awarded $103 million in the
first round of transformation grants; a second round, announced in
April, is currently under way.

"You have the opportunity to get not only transformation grants but
federal matching funds if you configure your system in conjunction with
your claims system," Rodgers said during the audio conference. The
session was produced by the State Alliance for e-Health, a federally
funded organization devoted to helping states focus on national health
care issues.

Rogers advised state legislators, Medicaid administrators and
policy-makers to take advantage of a mix of sources for financing
Medicaid and health care IT. He said they should:
  • Make sure state health IT projects meet standards in the Medicaid Information Technology Architecture (MITA), an initiative led by HHS' Centers for Medicare and Medicaid Services. "If a state is building its product to meet the MITA standards, there is greater opportunity for federal participation," Rodgers said.
  • Pursue a combination of funding sources, including Medicaid,
    public health grants and even user fees. "States should consider
    combining some of these other funding sources to finance these exchanges
    and electronic health records," he said.
  • Consider requiring state Medicaid managed-care organizations to
    participate in electronic health exchanges and to provide EHRs.
  • Maximize employee health benefit programs. Some states have
    combined Medicaid with managed-care organizations for their employee
    health programs, creating opportunities to fund EHR systems. "There are
    opportunities to leverage employee health programs" for EHRs, Rodgers
    said.
  • Agree to a common set of standards for state Medicaid programs.
    "We already have the federal guidelines...it's just a matter of pulling
    together and agreeing to a set of standards on how we will exchange data
    between states," Rodgers said. Doing so will "significantly improve the
    Medicaid program's ability to take a leadership role in interstate
    exchange of information."

Rodgers said 12 states that have received HHS transformation grants -
Alabama, Arizona, Connecticut, Hawaii, Kentucky, Michigan, Mississippi,
Montana, New Mexico, Texas, West Virginia and Wisconsin - and
Washington, D.C., have banded together to collaborate on health IT
project coordination, standards harmonization and joint planning.

"We want to establish a common vision for Medicaid agencies as it
relates to health information," he said. "It's new technology, new
requirements and new functions that many states are now taking on.... We
wanted to make sure we have the greatest opportunity to assure success
of the investment the federal government is making."

Shaun Alfreds, an analyst at the University of Southern Maine's
Institute for Health Policy, said Medicaid beneficiaries are distinct
from commercial insurance clients because they often have chronic
diseases and behavioral health issues, and they drop in and out of the
health care system.

These characteristics present states with significant challenges,
Alfreds said, for which health IT and health information exchanges
deliver a disproportionate benefit compared to commercial populations.

"The widespread adoption of health IT may contribute to improvements in
health care quality and health outcomes for Medicaid populations,"
Alfreds said. Benefits include more efficient tracking of claimants as
they move in and out of eligibility and between providers.

Fraud and abuse controls are another big pay-off health IT can deliver
in the Medicaid arena, Alfreds said.

But significant challenges remain for states in the adoption of health
IT for Medicaid programs, including a mixed rate of adoption of CMS'
MITA project.

"It was a very large project, and multiple stakeholders were involved,"
Alfreds said. But to date, "there haven't been any regulations for
Medicaid agencies ... so there's an issue of how do we modernize Medicaid
Management Information Systems so that they can communicate with the
external IT systems and with provider sites."
State health officials meet to discuss IT, spending

Paul McCloskey is the editor for Government Health IT, an 1105 Government Information Group publication.

About the Author

Paul McCloskey is senior editor of GCN. A former editor-in-chief of both GCN and FCW, McCloskey was part of Federal Computer Week's founding editorial staff.

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