With Round Two the of State Innovation Model (SIM) program grants, $660 million has been made available for states to continue changing how they deliver and evaluate healthcare. While each state is taking a different set of tactics, there is a lot that they have in common. Most importantly, they all need to demonstrate how IT can affect outcomes, panel participants told the audience at the State Healthcare IT Connect Summit in Baltimore.
Hunt Blair, a subject matter expert contractor for the Office of the National Coordinator, said “$660 million sounds like a lot, but it’s really just seed money. It’s a catalyst for change—to bring together and accelerate conversations about pay for performance and healthcare innovations.”
Kate Kiefert, State HIT Coordinator for Colorado, reviewed how the state created a foundation for long-term healthcare IT ecosystems. Colorado has two successful exchanges, and has connected 71 acute care hospitals with 10 in development. About 1.2 million Coloradans are now covered under Medicaid. The state has an all-payor claims database, and an active comprehensive primary care initiative with payors. “This was a lot of IT investment,” she said. Still, the state is working on coordinating governance and introducing meaningful use into health care. “We haven’t come up with a comprehensive cost, and quality measurement strategy.” Under SIM, a $65 million to provide access to integrated primary care and mental health services could help in this direction.
Camille Harding, Quality and Health Improvement Manager for LPC, said that Colorado was looking at lots of different data sources. “We started looking at the clinical measures available, what’s collected in public health and environment agencies, and human services offices,” she said. The Brookings Institution model for moving people out of poverty and into the middle class, she said, has been helpful for also looking at outcomes indicators that can make these social shifts. For example, screening new mothers for depression could be compared to data on depression at a state or local level, and connected to other indicators such as graduation rates, higher education attainment, crime, or unintended pregnancies.
William Golden, Medical Director for Arkansas Medicaid, noted that while Arkansas in its in fifth year of payment reform, a lot of IT work predated the SIM program. “We had a vision of working toward effectiveness and improved outcomes across all health care services.” For acute care, the state entered all episodes of care (patient treatments, admissions, etc.) into a spectrum. They could then look at risk-adjusted care per provider, for a year (since the state is entirely fee-for-service, this was valuable to showing providers how they fared with others). The state now has an extensive patient centered medical home program, with substantial savings incentives for keeping costs in control. Providers can now see if patients spend more on pharmacy, ER use, or pathology labs, for example. They’re now up to 150 practices with 700 doctors, a significant scale up in a short period of time.
In New Jersey, the state Department of Health studied and discovered six hospital conditions that could have been prevented at the public health of primary care level, with a savings of $6.1 billion, said CIO Cathleen Bennett. “These were not catastrophic or severe chronic conditions,” she added. For its SIM program, the state focused on birth outcomes. Medicaid births total a third of all state births, and the health department focused on low birth weights because of their health and family risks (as well as costs). “The biggest struggle was to figure out who is involved, or should be involved, in each care episode.” It turned out that 14 different groups or individuals are involved with just birth outcomes. They’re now using a SIM planning grant to improve coordination and ultimately outcomes, with a go al of an eight percent reduction in pre-term births. “For prevention, quality and integrating public and clinical health, we’re working to get disparate systems to talk to each other.”
Ohio also had made a lot of investments in technology infrastructure, but needs to look more at healthcare outcomes, said Rex Plouk, Enterprise Health IT Officer for the state. Ohio is largely managed care, and the state rolled out five models and tried to find ways to leverage data the state already has. “We have silos within silos of data,” he said. “There’s a lot of value here, and people have told us they could do more with it.” The state is creating “use cases,” essentially expanded healthcare/patient profiles, to “tie real life examples to technology,” Plouk said. “We use these to identify cases where gaps are, and we can apply technology.” SO far, the state has developed 50 such cases.
Overall, under the SIM program, “whether in planning, design, or testing, you’re making fundamental changes in payment, delivery systems; you’re looking at patients differently, and it’s multi-payor,” said Yvonne Powell, Senior Vice President for States and Payors, for the Lewin Group. “You’re fundamentally changing healthcare systems. It’s surprising how well it’s worked. But it’s a very heavy lift,” indicating the need to better match HIT with users, quality and outcomes.
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