A clinical repository of Medicaid patients' medical histories… "gives us a full 360-degree view of a patient's medical care, their medications, immunizations, tests, and procedures," says the University of Mississippi Medical Center's chief health information officer.
Provider organizations across the country are continuously searching for strategies to improve quality and outcomes while also lowering the cost of care.
For hospitals and health systems located in states that have not expanded Medicaid coverage, there is a particular need to focus on reining in costs and enhancing services for low-income populations.
Improving Access to Timely Data
That’s one of the major incentives behind the University of Mississippi Medical Center’s decision to work with the Mississippi Division of Medicaid on creating access to real-time data for Medicaid beneficiaries, says John Showalter, MD, UMMC’s chief health information officer.
Finding ways to treat the Medicaid population more effectively has been “at the forefront of our minds,” Showalter says. “We really wanted to work together since UMMC is DOM’s largest biller in the state. We’ve really been working together on population health strategies.”
Through a partnership with MedeAnalytics and Epic, UMMC and DOM have become the first health system and state Medicaid agency in the country to share real-time clinical data.
DOM began working on this initiative years ago and, in 2014, rolled out an enterprise master patient index and a single patient identifier. After analyzing and removing duplications from more than a decade of medical records, DOM and its vendor partners developed a unique longitudinal patient record for over 750,000 Medicaid and Children’s Health Insurance Program beneficiaries.
“After years of working with our technology partners to build a foundation consisting of an EMPI and clinical data repository, we can now instantly share patient summaries with external stakeholders, such as UMMC. This real-time access to beneficiary data will improve insight into beneficiary health trends, empower better care decisions and much more,” Rita Rutland, DOM deputy administrator of information technology management, said in a prepared statement.
Providing a More Complete Patient History
By having data that gives physicians a complete view of the patient’s medical history, Showalter says, UMMC will be in a better position to achieve its population health goals.
“The clinical repository… gives us a full 360-degree view of a patient’s medical care, their medications, immunizations, tests, and procedures,” he says.
“We believe that physicians who are armed with this data can make better decisions about care delivery and can help drive the triple aim” of creating a better patient experience, improving quality, and reducing the per capita cost of healthcare.
Prior to the launch of the real-time data system, UMMC physicians had access to a portal that housed patient information, but it was not user-friendly and, therefore, was not accessed very often, Showalter says. With the new system, the data is housed within UMMC’s electronic health record and all a physician needs to do is click on a tab that indicates more information is available on the patient.
“We wanted to go beyond our original version of the portal to create a much more intuitive tool,” Showalter says. “We have a list of tabs in the EHR, and a tab appears when Medicaid data is available.”
The physician can click on the tab to review the data and use it to make appropriate clinical decisions. Making the system easier to use has encouraged physicians to use the Medicaid information more frequently, Showalter says.
“The portal was not being accessed by providers as much as we would like,” he says. “The new tool drops directly into the physician’s workflow so they can see medication prescription fills right there, for example, and it has greatly increased their ability to use data to make better decisions.”
Physician Use of Data Skyrockets
It’s too soon to analyze the impact on care and costs, but Showalter says physicians are beginning to use the data in significant numbers even though UMMC is still in the training stage for the new system.
While the portal was accessed a few dozen times per month, physicians are already tapping into the new data repository about 3,500 times per week.
“Physicians are just deciding it’s a useful tool and using it on their own… We’re accessing data much, much more often,” Showalter says. “We are hearing very positive things from physicians, and the anecdotal reports are that they are using it. Someone is going in and looking at the data 3,500 times per week. That speaks volumes.”
UMMC’s immediate population health goals for the data include targeting areas such as ER visit rates, prescription fill rates, and the total cost of care, Showalter says. By being able to track patient’s real-time medical records across care sites, physicians and case managers will be in a much better position to identify patients with potential health risks and then intervene on their behalf.
“Generally speaking, after patients were discharged from the hospital or the specialist sent the patient back to the PCP, we had very little insight into whether the patient filled their prescriptions, saw their PCP for a follow-up visit, or followed immunization advice,” he says.
“For example, people with diabetes are supposed to have a pneumonia vaccine because there is a high risk of them getting pneumonia, so we want there to be 100% compliance. Now we have the ability to have case managers see who hasn’t gotten the vaccine and reach out to them to get them in to have the vaccine.”
Only the Beginning
Now that the hard work of launching the data repository has been done, DOM should be able to provide access to it for healthcare provider organizations across the state, thus improving care and lowing costs for this population on a broader scale, Showalter says.
“One of the most exciting things is how scalable this is for Medicaid. They can connect this to any EHR. Medicaid can now roll this out to almost any hospital in the state, and it won’t take nine months. It should only take weeks. We don’t want to just improve the health of the UMMC patient population, but the health of patients throughout the whole state,” he says.
“I think this level of multi-party involvement with health systems, vendors, and payers working together on common platforms is the kind of effort that it is going to take to make major leaps forward in population health.”
Rene Letourneau is a contributing writer at HealthLeaders Media.