Best Practices in Indiana Medicaid

The Center for Health Transformation is inviting leaders from all 50 states to share their transforming solutions for the Medicaid program. In order that key decision-makers and industry leaders from around the country may learn from others’ successes, it is our intention to provide this interactive resource for showcasing the most innovative practices in the country. Please note that the following contributions have not been edited by CHT staff and will remain open indefinitely to future updates.

View Indiana's Official Medicaid website >>

Consumer-directed care demonstrations (include number of beneficiaries served now and in any expansion plans)

Indiana provides self direction for attendant care under its Aged and Disabled waiver. This waiver was developed through a CMS systems-change grant entitled “Community Personal Assistance Services and Support” (CPASS). The program is intended to provide attendant care within the Medicaid Aged and Disabled Waiver for at least 250 individuals during the first year of operation. Consumer Directed (attendant) Care already exists as a service within the Community and Home Options to Institutional Care for the Elderly and Persons with Disabilities (CHOICE) program.  It is funded with state-only dollars for those who are ineligible for the waiver. During fiscal year 2005, the average number of those receiving Consumer Directed Care under CHOICE was approximately 171 individuals.

Delivering high quality, coordinated, long term care for the disabled and/or the infirm

The Indiana Family and Social Services Administration (FSSA) has recently announced Care Select, a program which allows approximately 70,000 Medicaid recipients with serious mental illness, developmental disabilities and chronic diseases to receive assistance in coordinating personalized health care. Two care management organizations (CMOs) have been selected for the program:  ADVANTAGE Health Solutions, Inc.^SM and MDwise, Inc.

Through care coordination and disease management, Care Select clients will receive individualized attention to help them manage their health care challenges.  Members will undergo a health needs assessment, work with a care team to develop a plan of action, and then receive continual support from health members to accomplish their health care goals.  The plans will also be integrating utilization management services to more effectively tailor benefits based on their needs.  It is anticipated that in addition to improved quality of life of the membership, the program will lead to reductions in avoidable hospital admissions, nursing home admissions, and improved medication management. 

Use of health information technology (electronic health records, e-prescribing, electronic billing, etc.)

Health Information Technology

Medicaid currently has partnered with the Indiana Health Information Exchange (www.ihie.com) to advance health information exchange and the adoption of electronic health records (EHRs) through a number of initiatives.  Indiana was recently awarded a Medicaid transformation grant to enable major healthcare providers to share clinical information at the point of care in Evansville, Indiana, a mid-sized market within the state.  These providers will become part of a larger regional health information exchange growing statewide.

Additionally, in response to storms and flooding that took place in June 2008, FSSA created the Indiana Flood Victims eHealth Support Center.  This center provides doctors with medical information to assist flood victims and help ensure that necessary medical treatment was available.  IHIE handled the calls and worked with Electronic Data Systems (EDS) to provide the most accurate information available. 

Indiana is also planning to pilot a personal health record for its Medicaid population in 2009 to improve the availability of health information for its members and in the hopes of encouraging further provider EHR adoption. 

Expanding coverage through private sector initiatives

The Healthy Indiana Plan (HIP) is a pro-active preventive health insurance product for working Hoosiers aged 19 to 64. Parents or caretaker relatives of children in the Hoosier Healthwise program are likely candidates for HIP. The plan is similar to a commercial health savings account model and provides a POWER Account valued at $1,100 per adult to pay for medical costs and a basic commercial benefit package for expenses above $1,100.  Contributions to the account are made by the State and each participant (based on ability to pay). No participant will pay more than 5% of his/her gross family income on the plan. Services include: physician services, prescriptions, diagnostic exams, home health services, outpatient hospital, inpatient hospital, hospice, preventative services, family planning, case management, and disease management.  Preventive services are covered at 100%, with no deductible/co-pay up to $500.00 annually.  HIP took effect January 1, 2008, and since that time over 20,000 Hoosiers have become enrolled.  More information is available at: http://www.hip.in.gov

Transparent and publicly-accessible measurements of patient outcomes and/or quality improvements

Indiana Medicaid requires that the managed care organizations participating in the Hoosier Healthwise program comply with an annual, audited HEDIS survey. The HEDIS survey is a compendium of measures that assess components essential to high quality medical care, such as access to preventive care, receipt of disease-specific services, and outcomes of care delivered. Findings are published annually in the Hoosier Healthwise quality strategy. In addition, OMPP tracks several HEDIS and other measures on a quarterly basis in order to ensure that trends for high quality care are maintained over the course of the year.

Indiana Medicaid is working collaboratively in a cross-payer value based reimbursement initiative termed Quality Health First and is expecting to actively participating by January of 2009.    This program rewards physicians who obtain evidence-based, clinical outcomes to improve the quality, safety, and efficiency of health care services in Indiana. QHF uses medical and drug claims, patient drug information, and laboratory and radiology test results to form a database.  This information is combined with Regenstrief’s Indiana Network for Patient Care (INPC) clinical data to form a high-level clinical database.  This information is shared with health providers and health insurers to significantly improve the overall health of their patient population.

Another way Indiana is providing transparent measurements is through a medical error reporting system.  As one of the first states to provide this system, it requires hospitals, ambulatory surgical centers, abortion clinics, and birthing centers to report if any of the National Quality Forum’s 27 serious reportable events occur.  This reporting system is designed to obtain data that is used to reduce the frequency of medical errors, reveal the causes of medical errors, and empower health care professionals to design methods to prevent or discover errors before patients are harmed.  The requirement to report events encourages the movement towards increased awareness of patient safety issues and encourages work towards evidence-based initiatives that improve patient safety.