This document discusses the evolution of e-health in Medicaid managed care. It describes how e-health has progressed from mainly administrative information exchange between payers and providers through portals, to including more health information like care gaps, medications and clinical summaries. The next phase involves bi-directional health information exchange between payers and electronic health records. The document provides an example of how discharge information from hospitals could be intelligently routed from the HIE to primary care providers and care managers' EHRs or portals.

1. Evolution of E-Health in
Medicaid
Joe Miller
AmeriHealth Mercy
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2. AmeriHealth Mercy
• Nation’s leader in health care solutions for the
underserved
• Among the largest organizations of Medicaid
managed care plans and related businesses in
the United States
• Touch the lives of more than 4 million individuals
covered by Medicaid, Medicare, SCHIP and other
insurance
• Mission-driven company with nearly 30 years of
experience serving low-income, chronically ill
populations

3. Evolution of E-Health
Portal Provider
E-Business Payer Practice Mgt Sys.
2006 - Present (NaviNet)
No EHR
Administrative Info
(Eligibility, Claim Status, etc)
Portal Provider
E-Health 1.0 Payer Practice Mgt Sys.
2009 - Present + Health Info Early Stage EHR
(Care Gaps, Meds, Clinical
Summaries )
Provider
E-Health 2.0 Practice Mgt Sys.
2012 - Payer Health Info Exchange Mature and Connected
BiDirectional Exchange of EHR
Health Info
(CCD w/ Care Gaps, Meds, Clinical
Summaries, Diagnoses/Problems )

4. Initial Efforts
Care Gap Delivery via Portal
• Effective
• Scalable to All Providers
• Not Integrated with Clinical Workflow
TestSeven, Mary
TestSeven, Mary TestSeven, Mary • Low Utilization
Care Gap Delivery via Smart Phone E- Prescribing
• Effective
• Integrated with Clinical Workflow
• High Utilization
• Not Scalable

5. Future
• Provider – Plan Collaboration
– HIEs
• Standards Based Data Sharing AND Portal
– CCD
• Leverage Plan Assets
– Care Team
• Consumer AND Supplier of Information
– Claim data too slow and limited, access to EHR
data essential

6. Example
Pushing Discharge Info to PCPs and
Care Mgrs Health
IDs PCP/Care Team,
Routes to Care
Manager
Plan
Direct Direct CCD
EHR
Provider (e.g.
PCPs, specialists,
Hospital home health)
HIE
Sends Inpatient and Intelligent
Routing of Receives info via
ED discharge info. EHR and qualifies for
Qualifies for MU Discharge Info Portal
To Care Team MU or can receive
via health plan
portal