Electronic Health Records in Medicaid Programs. ACAP CEO Summit July 24, 2007 Washington, DC
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1 Electronic Health Records in Medicaid Programs ACAP CEO Summit July 24, 2007 Washington, DC
2 UPMC for You, Inc. Pennsylvania non-profit Medicaid coverage program 14 counties in Western PA Approximately 100,000 covered lives 95% mandatory enrollment in 10 counties 5% voluntary in 4 counties 2
3 About UPMC Integrated delivery system built on an academic medical center platform 19 hospitals 2000 physicians Variety of complementary programs (home health, assisted living, rehab, SNF, etc.) Insurance Services Division 3
4 About UPMC Insurance Services Division Commercial insurance 310,000 lives Medicare programs Medicare Advantage 45,000 lives Medicare Dual SNP 15,000 lives Part D plan 2500 lives S-CHIP program 4000 lives Behavioral Health MCO 600,000 lives Medicaid 100,000 lives 4
5 About Medicaid in PA Full risk model Risk adjusted for acuity Behavioral health carve-out at state level Essentially all Medicaid recipients are included in the behavioral health carve-out Physical health (including Rx coverage) is managed separately 5
6 About PH Medicaid in PA Approximately 2/3 of Medicaid recipients are included in the mandatory HealthChoices program Primarily around relatively urban areas Balance are in a primary care case management model, with an overlay of Special Needs support and Disease Management 6
7 What is MyHealth Record? Personal Health Record (PHR) designed to empower members to take an active role in managing their health care Encourages members to conveniently view and manage their health-related information online Easily accessible through MyHealth OnLine Securely maintained online tool held to the same security standards as the banking and finance industries Only members have the ability to retrieve and edit their records 7
8 MyHealth Record Individual Member Claim Data (Medical, Pharmacy & Lab) Personalized Reminders Annual Screenings & Immunization Schedules Physician & Procedure Appointments MyHealth Record Personal & Family Medical History Educational Resources Drug Allergies 8
9 MyHealth Record Benefits Information available to members each time they open their MyHealth record: Automatically updated records of outpatient and inpatient health care services Continuously recorded results of tests and lab work Personalized reminders for managing chronic medical conditions Educational resources linked to results of diagnostic testing Comprehensive and educational way for members to manage health conditions and participate in wellness programs 9
10 MyHealth Record Benefits Members may track progress toward health-related goals by reviewing results of a health screening (BMI, blood sugar, and cholesterol levels) or an online health risk assessment Enables improved communication with providers to: Reduce or eliminate duplicate procedures or processes Close gaps in care Encourage open dialogue to maintain an accurate medical history Reinforces UPMC Health Plan s commitment to increased transparency of health care information 10
11 Particular Challenges in Medicaid Regulatory approval process Reading comprehension level Member access to IT Privacy concerns Appropriate content (level of detail) Communication with members reach rate 11
12 Assessment of Performance Utilization rates Comments from members Comments from providers 12
13 MyHealth OnLine 13
14 MyHealth Record 14
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18 Customizing Your erecord Section 1: Contact Information Your Information (edit) Kimberly M. Stuart 18 Apple Tree Lane, Concord, MA (H) (C) (W) IDEA Labs (Consultant) 1 Technology Drive, Boston, MA Languages Spoken: English (primary), Spanish Emergency Contacts (edit) Primary Contact Donna Jackson (Sister) 4 Ridge Road, Bellman, PA (H) (C) (W) djackson@yahoo.com Secondary Contact None Medical Contact None Legal Contacts (edit) Primary Contact None Insurance Providers (edit) UPMC Health Plan <address> Group Number: Anthem <address> Group Number: Healthcare Providers Primary Care Physician OB/Gyn Therapist Dentist Optometrist (edit) Steven Markoff, Internal Med Associates 27 Medical Center Drive, Oakbrook, MA Carol Altman, Generational Care 45 Brookstone Lane, Harvard, MA
19 Health Summary: Kimberly M. Stuart This summary includes information from your self-reported personal & family history, advanced directives, and UPMC Health Plan claims history. Age: Last Physical: Height: Weight: Body Mass Index: Tobacco Use: Alcohol Use: [calculated] None Occasional Vision: Blood Type: Allergies: Immunizations: Chronic Conditions: Medications: Advanced Directives: R: 20/20 L: 20/40 A positive 2 medicines, 3 other None recorded None recorded 2 prescriptions, 3 OTC None Recorded Last Updated: Edit Personal & Family History Edit Advanced Directives Recent Health Care: Kimberly M. Stuart This includes the most recent health care for which your providers submitted claims. A complete list is available in your Health Care History, and details on all UPMC Health Plan claims are available under My Claims. To view details on a claim below, click its Date. Date Provider Altman, Carol Parker, Isaac Domat, Imad N. Martin, Stephen Altman, Carol Specialty OB/Gyn Cardiology Internal Medicine Podiatry OB/GYN Care Type Office Visit Hospitalization Office Visit Outpatient Surgery Emergency Room Prescription Medications: Kimberly M. Stuart This shows your most recent prescriptions. A complete list is available in your Health Care History, and you can order new or refill prescriptions using your escript account. Date Filled Prescriber Altman, Carol Parker, Isaac Drug Name Lisinopril 10 MG tablet Prozac 20 MG tablet Drug Class class name class name Days Quantity MyHealth erecord Create a custom erecord where you can store health information and then create printed reports. View and Customize erecord Prepare Report for an Office Visit Reminders for Better Health Based on your health care history with UPMC Health Plan, there may be medications, tests, programs and/or procedures that could improve your health. These suggestions are not meant as diagnoses, but as an opening for further discussion with your physician. Reminder Based On Annual Mammogram Age/Sex Annual Physical Age Osteoporosis Prevention Age/Sex Pneumonia Vaccine Age/Condition Annual Flu Shot Age Diabetes Prevention Condition View Details Health & Wellness Tools UPMC Health Plan and our partner health care web sites offer many Educational Tools. Here we highlight the most commonly used tools. WebMD Health Risk Assessment Current Score: 140 View Report Card Take Assessment Annual Health Screening Scheduler Last Screening: View Past Results Schedule Next Screening 19
20 Does Information Change Behavior? 20
21 Contact Information John Lovelace President UPMC for You, Inc. Chatham Center II, 11 th Floor 112 Washington Place Pittsburgh, PA
22 Conclusion Q&A
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