Mastering Data Management

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Health Information Exchange is atop many states' wish lists

States have been working in silos for years. Health and Human Services departments, like Aid to Families with Dependent Children (AFDC) and Food Stamps, work independently from Medicaid agencies, which work separately from public health departments – all of which work apart from private medical facilities and institutions.

Legacy systems running unique applications do not easily connect – and why try? Trying to connect them needed a lot of cash and prodding various stakeholders to agree on a new, single data store. We all know the challenge there.

There was also very little drive for public and private healthcare data to coexist.

These long-standing silos at the top of mind as states develop priorities for stimulus monies, serving as the foundation for states’ holiday wish lists this year, including:

• Prescription registries to help detect fraud and substance abuse. This will reduce prescription costs and pinpoint abuse that adds many secondary costs to all state services.
• The sharing of immunization records across state boundaries. This will decrease unnecessary repeat immunizations, which reduces the associated costs and risks.
• The ability to coordinate benefits for Medicaid, AFDC and other social programs.  This could save millions of dollars as states would be able to reduce fraud and better coordinate service delivery. Population health could also benefit.

Topping the list for many states is an integrated, state-run health information exchange (HIE).

As luck may have it, a combination of directive, necessity, and cash may be coming together to help make state wishes come true.

Directives and Necessity

Across the country, state governors have issued Executive Orders directing states to reduce medical – specifically Medicaid – costs. The federal government has also increased emphasis on reducing medical costs and increasing operational efficiencies.

As these pressures mount, states are seeing a fast-increasing need to connect public and private patient information, and the value in having this connection forged and run by the state.

States understand that they need more than the communities to drive this connection; the communities understand that for programs to be sustainable, they need state and federal funding.

Health and Human Services departments, public health organizations, and Medicaid/Medicare agencies understand that they must work together and implement a common strategy to ensure the success of a state-run, commonly shared HIE.

While so many constituents understand what must be done, the primary challenge to date has been finding the funding to make the state-led exchange happen.

Enter ARRA

The American Recovery and Reinvestment Act, also known as the stimulus bill, provides $19 billion (net) for healthcare IT. Specifically, ARRA sets aside $17 billion for Medicaid and Medicare providers to adopt HIT initiatives within the next five years. The additional $2 billion will help fund the nation’s HIT infrastructure.

That’s a lot of money.

States are now in the process of drafting project blueprints in hopes of qualifying for federal grants and loans to get the money necessary to make their #1 priority a reality.

An Even Bigger Wish

While the creation of a public-private healthcare exchange is currently at the top of states’ wish lists, and the ARRA may provide needed funding, it may soon be eclipsed by an even larger-scale wish.

For leading-edge states, this combined public-private healthcare exchange is simply the first step toward creating an even broader Master Citizen Index. The creation of a Master Citizen Index will provide a single citizen view across all silos that can be leveraged by any state agency. This will lead to new levels of efficiency and cost savings for the state.

Ultimately, the focus will shift from patient-centric views of data to a more comprehensive citizen-centric view.