A California Health Information Exchange Vision

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A California Health Information Exchange Vision

• Ann Boynton
• Undersecretary
• California Health Human Services Agency

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Governors Health Care Reform Initiative

• Prevention and wellness
• Coverage for all/shared responsibility
• Affordability

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84 of the Uninsured Work
Source California Health Interview Survey, 2005
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The Hidden Tax
Cost to Insured
17 of premium
Actual Cost of Medical Care
Uninsured
17 of premium
Medi-Cal Underfunding
Source Administration Analysis of Cost Shift
Hydraulic, Dobson
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Prevention and Wellness

• Offer consumers incentives and rewards
• Promote diabetes prevention and treatment
• Reduce medical errors
• Prevent obesity
• Continue leadership in tobacco control

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Shared Benefit
GOVERNMENT Healthy, productive economically
competitive state
EMPLOYERS Affordable coverage Healthy, productive
workforce
DOCTORS HOSPITALS Expanded insured
population Fair compensation
INDIVIDUALS Access to affordable coverage Health
care security Healthier CA

HEALTH PLANS Expanded market Fair compensation
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Shared Responsibility
GOVERNMENT Promote functional health care
market Provide access to affordable
coverage Fairly compensate Medi-Cal providers
EMPLOYERS Support employee access to affordable
coverage
DOCTORS HOSPITALS Provide affordable, quality
care Share cost savings
INDIVIDUALS Obtain health coverage
HEALTH PLANS Guarantee access to affordable
coverage Pass along savings

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Affordability Short term

• Reduce hidden tax
• Provide tax breaks for individuals businesses
  tied to purchase of health insurance
• Remove regulatory barriers
• Reduce regulatory red tape
• Enhance insurer hospital efficiency by
  requiring 85 of premiums hospital dollars be
  spent on patient care

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Affordability Long-Term

• Support health promotion, prevention wellness
• Tie future Medi-Cal rate increases to performance
  measures
• Enhance health care quality efficiency through
  transparency and performance measures
• Accelerate adoption of health information
  technology

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July 2006 Executive Order

• Making health information available quickly at
  the point of care and ensuring its
  confidentiality
• Improving safety, reducing medical errors, and
  avoiding unnecessary medical procedures
• Improving patient care coordination among health
  care professionals and hospitals, clinics,
  pharmacies, skilled nursing facilities, and other
  entities

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July 2006 Executive Order

• Providing consumers with their own health
  information to encourage them to participate
  fully in their health care decisions
• Ensuring access to specialists in rural and
  underserved areas through technologies such as
  telemedicine and tele-health and
• Reducing administrative costs due to greater
  efficiencies

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HIT Elements of Reform

• Provide state leadership and coordination to
  promote HIT adoption
• Improve patient safety through e-prescribing
• Drive adoption of HIT standards by leveraging
  state purchasing power

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HIT Elements of Reform

• Support consumer empowerment and decision making
  by advancing personal health records
• Incentive broader system adoption of HIT through
  innovative financing
• Expand broadband capabilities to facilitate use
  of telemedicine and tele-health
• Improve outcomes through use of interoperable
  electronic health records

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Possible State Roles

• Set/endorse standards for data exchange
• Develop and maintain the Master Patient
  Index/Record Locator System
• Develop and maintain common elements
• Architect our systems with HIE as focus

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National Security and Privacy RFP

• Federal HHS via AHRQ contracted with RTI
  International, and the National Governors
  Association (NGA) to identify privacy and
  security solutions
• RTI awarded contracts to 33 states, including
  California, and one territory
• RTI has national responsibility to
• Assess variations in business policies and state
  laws that may pose barriers to health information
  exchange
• Identify and propose practical solutions
• Develop detailed plans to implement solutions

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Project Approach

• OBJECTIVES
• Understand existing business practices and how
  they are institutionalized
• Identify similar and variable business practices
  across organizations
• Discuss relative interpretations of existing laws
  and/or regulations

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Stakeholder Representation

• 7 Regional Scenario Workgroups Mendocino, Long
  Beach, Orange County, Sacramento, San Francisco,
  Santa Cruz, San Diego
• 175 individuals invited
• 95 organizations participated

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Areas of Findings
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Potential Implementation Structure
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Proposed Mental Health Information Exchange
Architecture
County C
Allied Agencies
Providers
County B
County A
Reporting Data Repositories
MH Information Exchange Houses consumer
demographic information and locations of
previous services for continuity of care
purposes.
Hospital (ED)
Laboratory
My Health Folder
County D
Pharmacy
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A California Health Information Exchange Vision