A Look at the State Health IT Landscape for 2013 and beyond

Date: January 9, 2013||   2  Comments

healthcare IT in 20132013 should see large scale IT projects continue as states implement Health Insurance Exchanges (in various forms) and modernize Medicaid Management Information Systems including upgraded Eligibility and Enrollment Systems that can be shared across agencies ahead of envisaged Medicaid expansion in 2014 as a result of the Affordable Care Act. Medicaid data analytics will also be a driving theme as states look to manage the data from provider networks to reduce costs, State HIEs will also looking beyond connectivity and interoperability towards analytics and care coordination as they evolve their sustainability models.

  • Healthcare IT adoption will likely continue at its current brisk pace. The month of December 2012 saw $1.2 billion in Electronic Health Records incentive payments issued from CMS, for organizations and private practices demonstrating Meaningful Use.
  • Medicaid Enterprise Systems will continue to integrate across state agencies ahead of the 2014 Medicaid expansion. Look for older, legacy systems to upgrade their Medicaid Management Information Systems (MMIS) to MITA 3.0.
  • States’ Medicaid eligibility and enrollment efforts will continue to streamline their systems to provide for cross-agency interoperability. The 2014 Medicaid Eligibility Transition Toolkit was designed to assist states in systematically identifying issues and decisions they will face as they convert ahead of 2014.
  • While the ICD-10 migration has been pushed to October 1st, 2014, states will likely waste no time implementing the new coding system.  Look for EHR incentive payment recipients to be among the first to make the jump over to ICD-10.
  • Health Insurance Exchanges (HIX) will continue to roll out for the states who elected to manage efforts on their own. While preliminary approvals for a few states have already been issued by HHS, delays are likely to occur as many states are participating on uneven footing. For the 24 states who have elected to allow the federal government to run their HIX, it will be interesting to see how efforts toward large scale IT implementation shape up, without local assistance.
  •  In 2013, CMS will make available a web-based system that States can use to submit section 1115 demonstration applications electronically. 23 states have pending 1115 waiver demonstration project applications pending review by CMS.
  • New Medicaid populations mean renewed opportunities for Medicaid data analytics and quality improvement strategies. Look for enterprise management, quality assessment, and performance improvement to be the best opportunities for analytics applications in 2013.
  • The CMS State Innovation Models initiative should begin funding parts of its $275 million budget to states with the best plans for new care delivery models like ACOs and Patient Centered Medical Homes (PCHM).
  • 2013 began with a warning shot for organizations handling electronic health records. The Office of Civil Rights (OCR) reached a settlement with Hospice of North Idaho in the amount of $50k over the exposure of fewer than 500 private patient records. Look for state organizations to beef up encryption of protected health information on mobile devices, health benefits exchanges, and health information exchanges as required under HIPAA and the HITECH Act.
  • 88 advanced health information exchanges (HIEs) were identified in 2012. In 2013, look for HIEs to continue to innovate both within states and across state lines.
  • CMS estimated that improper payments under Medicare and Medicaid totaled more than $70 billion in 2010.  In order to combat fraud, waste, and abuse, look for some states to engage in stricter provider and supplier screening and oversight activities than those required by HHS for their Medicare and Medicaid programs.

The majority of these topics and more will be covered during the 2013 State Healthcare IT Connect Summit in Maryland May 21-22.


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