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Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
Transforming Health Care Delivery with HIT: Arizona
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Transforming Health Care Delivery with HIT: Arizona

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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Tony Rodgers

Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Tony Rodgers

Published in: Business, Health & Medicine
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  1. Transforming Health Care Delivery with HIT: Arizona Anthony Rodgers, Director Arizona Health Care Cost Containment System
  2. Critical Drivers for Health System Transformation <ul><li>Current medical cost trends are unsustainable both public and private payers of health care coverage. </li></ul><ul><li>The current healthcare system produces significant variances in cost and quality. </li></ul><ul><li>Lack of health system integration leads to duplication, administrative inefficiency and lack of patient care coordination. </li></ul><ul><li>In the public sector medical cost escalation has or is becoming a “Budget Buster”. </li></ul><ul><li>Employer sponsored premium rate increases have made healthcare coverage increasingly unaffordable for many businesses and individuals which is increasing the numbers of uninsured workers. </li></ul>
  3. Historic Barriers to System Transformation Lack HIT Enabler Technologies Lack of Public Private Synergy Lack Financial Investment Misaligned Incentives
  4. Health System Transformation Goal <ul><li>To improve healthcare system efficiency, patient care quality, rapid and continuous adoption of clinical best practices, public health protection and disaster response, through the implementation of interoperable health information systems and clinical decision support tools that enable the exchange of electronic health information between providers, payers, consumers and those that help to advance the boundaries of our health science knowledge and quality of life. </li></ul>
  5. Arizona’s Sense of Urgency to Achieve Statewide Adoptions of HIT that Support Exchange of Electronic Records <ul><li>It is our belief that: </li></ul><ul><li>The single greatest opportunity for gains in healthcare system transformation will occur with the statewide adoption of electronic health records and health information exchange. </li></ul><ul><li>That creating an environment that encourages widespread deployment of enabling health information exchange technology will lead to a significantly improved health system efficiency, cost effectiveness, patient safety and quality of care. </li></ul><ul><li>That significant return on investment can be achieved within this decade by leveraging our Medicaid Programs to lead and support the acceleration of the adoption and deployment of electronic health records and standardize infrastructure for health information exchange. </li></ul>
  6. Arizona’s Vision of a Transformed Healthcare System <ul><li>A healthcare system that provides: </li></ul><ul><li>Integrated healthcare delivery, </li></ul><ul><li>Cost and quality transparency, </li></ul><ul><li>The productive interchange between provider and patient, </li></ul><ul><li>Informed activated consumers and patients, </li></ul><ul><li>Healthcare provider’s able to provide cost effective care management and use clinical decision support tools to reduce cost and quality variances. </li></ul>
  7. Vision of an Integrated Health System Public Health Primary Care Physicians Hospitals and Healthcare Facilities Specialists Subspecialists
  8. Improved Systems of Care <ul><li>Virtual Integrated networks </li></ul><ul><li>Medical Homes for Medicaid Enrollees </li></ul><ul><li>More Effective Clinical Collaboration </li></ul>Impact of Health Information Exchange Integrated Health
  9. Key Building Blocks For Health System Transformation <ul><li>Web-based health information and care management decision support tools that provide consumers, provider and payer healthcare value transparency as a common point of reference. </li></ul><ul><li>System-wide access to web-based electronic health records, health information exchange and patient relevant healthcare management tools integrated the system of care to maximize value and reduce variations in cost and quality. </li></ul><ul><li>New generation of consumer, provider and payer care management decision support and analytical tools integrated with EHR, EMR and PHR systems </li></ul>
  10. Keys to Creating the Environment for Health System Transformation <ul><li>Creating aligned incentives and legal framework rapid adoption and deployment of health information exchange infrastructure and standards that supports exchange electronic health information, </li></ul><ul><li>Assure everyone is at the table and no one is left behind in the adoption and deployment of electronic health records and health information exchange. </li></ul>
  11. Medicaid Leadership in Health System Transformation <ul><li>Requires: </li></ul><ul><li>A strong Federal and State partnership and financial support, </li></ul><ul><li>Agency leadership and participation </li></ul><ul><li>Effective health information system planning and development know-how, </li></ul><ul><li>New skills and organizational competencies within State Medicaid Program and Public Health, </li></ul><ul><li>New reimbursement strategies and health information exchange policies, </li></ul><ul><li>Public/Private partnerships as well as partnerships with other state Medicaid programs. </li></ul>
  12. AHCCCS Health System Transformation Initiative
  13. AHCCCS EHR Repository & Web Portal EHR Repository AHCCCS Web Portal ePrescribing Lab Order and Results Delivery Referrals Prior Authorization Access Hospital Discharge Info Claims and Eligibility Management Clinical Info Management RLS NPI DHS Imaging Health Plans AHCCCS Labs Provider EMRs Hospitals Pharms/PBMs IHS HIEs/SAHIE
  14.  
  15. Value Driven Decision Support Population Survey Encounter Medical Data Population Prescription Drug Premiums / Cap Evidence-Based Medicine Public & Specialized Data Sets Beneficiary Data External Data / Profiles Program Segmentation Analysis <ul><li>AHCCCS Methods/Analytics </li></ul><ul><li>Episodes of Care </li></ul><ul><li>Performance Measures </li></ul><ul><li>Disease Staging </li></ul><ul><li>Data Management </li></ul><ul><li>Process </li></ul><ul><li>Security Protection </li></ul><ul><li>Integration </li></ul><ul><li>Standardization </li></ul><ul><li>Data Enhancement </li></ul><ul><li>QA/Improvement </li></ul><ul><li>Profile and Screens </li></ul>Data Warehouse Medical Management Fraud Detection Drug U/R & Cost Performance Analysis Eligibility Analysis Chronic Illness Sub-databases Registries Decision Support Reporting Applications Eligibility Data
  16. Managing Health System Transformation in Arizona Managed Care 1980’s-1990’s <ul><li>Prepaid healthcare </li></ul><ul><ul><li>More comprehensive benefits </li></ul></ul><ul><ul><li>More choice and coverage </li></ul></ul><ul><li>Contracted Network </li></ul><ul><li>Focus on cost control </li></ul><ul><li>and preventive care </li></ul><ul><ul><li>Gatekeeper </li></ul></ul><ul><ul><li>Utilization management </li></ul></ul><ul><ul><li>Medical Management </li></ul></ul><ul><li>Fee For Service </li></ul><ul><ul><li>Inpatient focus </li></ul></ul><ul><ul><li>O/P clinic care </li></ul></ul><ul><ul><li>Low Reimbursement </li></ul></ul><ul><ul><li>Poor Access and Quality </li></ul></ul><ul><ul><li>Little oversight </li></ul></ul><ul><li>No organized networks </li></ul><ul><li>Focus on paying claims </li></ul><ul><li>Little Medical Management </li></ul>1960’s-1970’s Integrated Health 2000+ <ul><li>Patient Care Centered </li></ul><ul><ul><li>Personalized Health Care </li></ul></ul><ul><ul><li>Productive and informed interactions between Patient and Provider </li></ul></ul><ul><ul><li>Cost and Quality Transparency </li></ul></ul><ul><ul><li>Accessible/Affordable Choices </li></ul></ul><ul><ul><li>Aligned Incentives for wellness </li></ul></ul><ul><li>Multiple integrated network and community resources </li></ul><ul><li>Aligned cost management processes </li></ul><ul><li>Rapid deployment of new knowledge and best practices in quality care </li></ul><ul><li>Patient and provider interaction </li></ul><ul><ul><li>Information focus </li></ul></ul><ul><ul><li>Aligned care management </li></ul></ul><ul><ul><li>E-health capable </li></ul></ul>Fee for Service
  17. Our first care is your healthcare

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