Getting Medicaid to Talk—Managing Data in the New Healthcare System

Date: April 10, 2014||  0  Comments

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States and their partners will have many more opportunities to innovate the use of Medicaid clinical, financial and administrative data than the federal government, so they should share systems development with other states and stakeholders as much as possible, said Jessica Kahn, head of state systems data for the US Centers for Medicare and Medicaid Services.

Kahn, a keynote speaker at the State HealthCare IT Connect Summit in Baltimore on April 1st (View archive Video and PPT Here>>), underscored requirements under the Affordable Care Act for states to deliver data on patient and provider behavior, expenses and health outcomes back to the federal government for the Medicaid program, which currently serves more than 65 million Americans.

Sharing systems between states will be an important component of this new data stream, Kahn said. It also will ultimately make data delivery easier and make healthcare delivery more efficient.

“We won’t know anything if we don’t have the systems in place. We should know how many are newly enrolled, how long it takes to see a provider, do disease and case management especially for people who are newly covered,” she said.

Such connections could be made between healthcare marketplaces, managed care organizations and Medicaid. Other human services and health information exchanges could also be connected. Currently, Kahn said, about 18 states have a multi-benefit application beyond Medicaid, “and that number should grow. We should take an opportunity to gain efficiency for what’s the same population.”

Sharing and creating connections will help reduce the impact of challenges states are facing in creating (or improving) IT systems that handle Medicaid’s reporting requirements. Such challenges will include handling code, underestimating the work involved in integration of systems, and wrestling with very old information systems. “There are a lot of opportunities for vendors,” Kahn said.

But Medicaid information should not stop at enrollment figures, she warned. “It’s about getting people healthier and having better outcomes. It’s not working if they’re not going to the doctor, if they’re not getting healthier. We need to know what the cost curve is doing, to gain better population health, better individual health at a lower cost.”

CMS does have funding opportunities, including funds for EHR adoption and meaningful use demonstration under HITECH, funds for MMIS and eligibility and enrollment, and Section 1115 waivers for experimental and pilot projects. “You can pilot things—be a laboratory—it’s not something we can do because of what’s appropriated to us,” Kahn said.

Keynote: What Medicaid Program, Administrative, Financial and Clinical Data Tell Us About the New Healthcare Paradigm

Jessica Kahn, Division of State Systems, Data and Systems Group Centers for Medicare & Medicaid Services, CMS

Register>> to view this session and others in archive at the State HIT Connect Media Portal

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