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Evolution of E-Health in Medicaid

Joe MillerAmeriHealth Mercy

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

Evolution of E-Health

PayerProvider

Practice Mgt Sys. No EHR

Portal (NaviNet)

Administrative Info(Eligibility, Claim Status, etc)

E-Business2006 - Present

PayerProvider

Practice Mgt Sys. Early Stage EHR

Portal + Health Info

(Care Gaps, Meds, Clinical Summaries )

E-Health 1.02009 - Present

PayerProvider

Practice Mgt Sys. Mature and Connected

EHR

Health Info ExchangeBiDirectional Exchange of

Health Info(CCD w/ Care Gaps, Meds, Clinical Summaries, Diagnoses/Problems )

E-Health 2.02012 -

TestSeven, MaryTestSeven, Mary

TestSeven, Mary

Initial Efforts

Care Gap Delivery via Portal• Effective• Scalable to All Providers• Not Integrated with Clinical Workflow• Low Utilization

Care Gap Delivery via Smart Phone E- Prescribing• Effective• Integrated with Clinical Workflow• High Utilization• Not Scalable

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

Example

Pushing Discharge Info to PCPs and Care Mgrs

Portal

EHR Provider (e.g. PCPs, specialists, home health)

Health Plan

Hospital HIE

IDs PCP/Care Team, Routes to Care Manager

Receives info via EHR and qualifies for MU or can receive via health plan portal

Intelligent Routing of Discharge Info To Care Team

Sends Inpatient and ED discharge info. Qualifies for MU

Direct Direct CCD