Linette T Scott, MD, MPH Chief Medical Information Officer, DHCS “Population Health” HIMSS NCal Educational Program, Sacramento, CA| February 4, 2014

 Population Data at DHCS  Adoption of Electronic Health Records  Driving Quality 2

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As of December 2013, over 8,601,500 are enrolled in Medi-Cal 4 Health Disparities in the Medi-Cal Population Poor neighborhood safety has been associated with poor health outcomes

5 Programmatic Data  Eligibility Demographics  Utilization (Claims and Encounters)  Providers  Third Party Liability  Managed Care Plans  Certifications and Licensing Reporting  Descriptive Statistics  Quality and Performance Measurement  Monitoring  Financial  Oversight

 For Business Process Redesign  Key drivers: ◦ Efficiency within the organization ◦ Common language and requirements ◦ Comparability across states ◦ Integration with changes in health care  Specifies connection to intrastate health information exchange to advance maturity 6

7 Topics/Data-and-Systems/Downloads/mitamm.pdf

 Modularity Standard  Align with and advance MITA  Use industry standards  Share and reuse technology  Deliver business results  Performance reporting  Interoperable across health & human services community 8

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 There was the Health Information Technology for Economic and Clinical Health (HITECH) Act  A staged approach to implementing electronic health records (EHRs)  Multiple grant and incentive programs establish rules of the road for electronic health data: State programs end in 2021 ◦ (CMS) Medicare and Medicaid EHR Incentive Programs State programs end in 2021 Grant programs end in 2014 ◦ (ONC) Standards & Certification Criteria (S&CC) Grant programs end in

Health Outcome Policy Priorities 1) Improving quality, safety, efficiency and reducing health disparities. 2) Engage patients and families in their healthcare. 3) Improve care coordination. 4) Improving population and public health. 5) Ensure adequate privacy and security protections for personal health information. 11

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As of December 2013  Medi-Cal EHR Incentive Program has paid over $715 Million to: ◦ 11,442 Medi-Cal eligible professionals ◦ 241 eligible hospitals  Medicare and Medicare Advantage EHR Incentive Programs have paid over $1 Billion to: ◦ Over 28,000 California eligible professionals and hospitals 15

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 Required as part of the Affordable Care Act  First released in 2011 – Annual Reporting  Three Aims: ◦ Better Care: ◦ Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe. ◦ Healthy People/Healthy Communities: ◦ Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care. ◦ Affordable Care: ◦ Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government. 17

 Hospital Readmissions Reduction Program - Medicare  Provider-Preventable Conditions Including Health Care-Acquired Conditions  Adult Quality Measures – core quality measures used for voluntary reporting  Prevention - Medicaid Incentives for Prevention of Chronic Diseases Program  And Others 18

 It begins with the DCHS Strategic Plan: ◦ To the Public … ◦ To the People We Serve … ◦ To our Employees … 20

21 DHCS’s Three Linked Goals Improve the health of all Californians Enhance quality, including the patient care experience, in all DHCS programs Reduce the Department’s per capita health care program costs

22 The ACA Fosters… Evidence-based medicine Prevention Coordinated care Access ACA Challenges… Major system redesign Reducing costs (while expanding access) Linking health care with population health Data limitations An Example

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