Montana Enhancing EHR – Clinical Decision Making 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.
As the nation’s largest health insurance program, surpassing Medicare in 2005 both in the number of lives covered and total dollars spent, Medicaid is also the nation’s most efficient health care program. Medicaid spends approximately 4% on program administration and information systems compared to the 6 to 8% spent by commercial payors. The State of Montana continues to seek innovative and effective business and technology solutions for maximizing our program budget spent on Medicaid services to our state recipients. The Department sees the Medicaid Transformation Grant presented by CMS as an opportunity to further improve service delivery and outcomes through enhanced technology and business processes. The Department fully recognizes the benefits that appropriate technology can bring to the overall efficiency and effectiveness of the Medicaid program, and we have long been a leader in using advanced technology to support the business needs of our Medicaid program. We were among the first states to implement an interactive, web-based Medicaid portal for providers, pharmacists and recipients. This resulted in enhanced self-service for these stakeholders as well as streamlined business processes. Our portal serves as a single point of entry to the Montana Medicaid program and supports real-time claims submission, eligibility and status checks, enrollment activities, outreach and education. Through the portal, we offer the first CMS approved Electronic Health Record (EHR) to authorized treating providers. Through the provisions of the CMS grant, Montana will leverage this “touch-point” to the community, providing enhanced healthcare information to program stakeholders. We are proposing a clinical decision support system to link the observations of clinicians to the best available evidence, in the hopes of influencing their behavior and improving the quality of patient care. A well-designed computer system that has integrated data from various sources helps doctors reduce errors, avoid misdiagnoses and address unmet needs. Clinical decision support systems remind doctors that their patients are due for preventive screening and tests. They provide an automated system designed to help improve the safety and quality of medical practice. The clinical decision support system would be available through our existing MMIS web portal to enhance our current EHR. Combined, the system will provide health information technology and enhanced capability at the place where it matters most: at the point-of-care.
Program Goals and Outcomes: Through the grant project, Montana will address the two-fold goal of containing rising health care costs and improving health outcomes for program recipients. Our clinical decision support system will provide evidence-based health guidelines in support of our existing EHR. Combined with our existing EHR capability, clinical analysis will improve provider effectiveness, helping to identify patients at risk, ensure appropriate treatment and utilization. The key is to enforce nationally established guidelines of care, with a clinical rules engine that allows real-time monitoring of up to 40 different disease conditions. This information then becomes “actionable” knowledge for our practitioners and providers. The resulting outcomes are: lower patient risk, improved health outcomes, improved quality of life and ultimately lower costs for Montana Medicaid.
Budget: The requested budget for 2007 is $853,122 and $628,030 in 2008.
