Alabama Together for Quality - Health Information Systems Abstract
In 2007, 27 states received Medicaid Transformation Grants under Section 6081 of the Deficit Reduction Act of 2005. The grants were rewarded to states that proposed innovative methods which in the end of the two years are designed to produce better health outcomes at lower cost.
The Center for Health Transformation is highlighting states that have received these Medicaid Transformation Grants, and will be following their progress for the next two years. In order for key decisionmakers and industry leaders from around the country to learn from others’ successes, it is our intention to provide this resource in order to showcase innovative practices from across the nation. In the future, this site will be interactive, allowing program directors to submit updates and comments regarding their program.
Project Goals
The Alabama Medicaid Agency (ALMA) will create a statewide electronic health information system (HIS) that links Medicaid, state health agencies, providers, and private payers and establishes a comprehensive, quality improvement model for the Alabama Medicaid Program. As a core piece of the HIS, Medicaid will develop an interoperable patient data hub (PDH). The PDH will serve as the foundational architecture for data exchange between all stakeholders, public and private, responsible for all facets of the health care delivery system, providing secure real time access to individual health information, claims, immunization records, prescription data and laboratory results. This system will pave the way for outcome based evaluation of patient care and will provide the necessary data for Medicaid’s future pay for performance and disease management efforts. A healthier population is less expensive and more productive. To reflect these aims, the project will be entitled, Together for Quality.
Project Description
The current system of data exchange continues to thwart ALMA’s efforts to improve quality. Data sources are limited and are not immediately accessible to ALMA. Nor are data accessible to providers or other agencies without extensive, costly intervention by ALMA staff. Real time accessibility does not exist. Without data it is difficult to effectively case manage. Without data it is difficult to make appropriate point of care decisions. ALMA proposes to change this by creating a data system and warehouse that includes claims, immunization records, laboratory results and electronic health records (EHR) that will support a dynamic and responsive quality improvement system. This HIS will provide data necessary to establish baselines, set targets and monitor progress, transforming ALMA from a highly vulnerable, process oriented, provider-centric, bureaucratic model into a fully transparent, result-oriented system that consistently asks the most important question of all: are Medicaid beneficiaries getting healthier? ALMA will be able to collect and organize claims based health records for chronic disease management, design specific provider and beneficiary education and incentive programs and improve collaboration across Health and Human Services (HHS) agencies. Not only will ALMA address internal transformation with improved data access, it will lead a statewide data coordination effort by creating an enterprise architecture based Patient Data Hub (PDH). This step will resolve issues stemming from the interaction of multiple HHS systems while leveraging the investments made in existing system infrastructure. Improved communication between Medicaid, HHS agencies, providers, and other payers will result in the delivery of more efficient, cost effective health care. Additionally, the development of PDH will compliment ALMA’s modernization effort, making it more consistent with the enterprise architecture envisioned by the Medicaid Information Technology Architecture (MITA). The transformation accomplished by Together for Quality will improve ALMA’s fiscal health because it will improve out beneficiary’s physical health.
Project Budget
Together for Quality will result in true transformation of the Alabama Medicaid program. To do this, ALMA is requesting $7,587,000 over two years. This infusion of resources will support the purchase of the technical components, services, personnel and consultants.
Project Outcomes
This project will result in and automated, inclusive, interoperable, real time HIS and a data driven quality improvement program.
