Academic journal article Health Care Financing Review

Clinical Health Information Technologies and the Role of Medicaid

Academic journal article Health Care Financing Review

Clinical Health Information Technologies and the Role of Medicaid

Article excerpt

BACKGROUND

Clinical HIT including electronic health records (EHR), computerized provider order entry, e-prescribing, and personal health records, are fast becoming the focus of quality improvement and health care efficiency initiatives across the country. (1) The Institute of Medicine (2001) has identified the need for an information infrastructure in order to achieve evidence-based decisionmaking and improve health care quality. Moreover, analyses have suggested that the use of HIT and the sharing of clinical health data amongst the multiple stakeholders in the health care arena (providers, payers, and consumers) through health information exchange (HIE) efforts could save the U.S. health care system billions of dollars annually (Walker et al., 2005; Hillestad et al., 2005).

The Federal Government has made a commitment to these technologies by creating the Office of the National Coordinator for HIT. Limited funding has been devoted to establishing Federal HIT standards and supporting the development of a national health information network. A recent Executive order directs Federal agencies to promote HIT as a means for improving the quality, efficiency, and transparency in the health care system. In addition, bipartisan legislation aimed at furthering the use of HIT and the exchange of digitized health information has recently been passed in Congress.

Despite the public policy attention being paid to the use of technology in health care settings, implementing a national HIT and HIE infrastructure will be a complex and difficult task. The significant number and diversity of stakeholders, the legal, privacy, and security issues, the lack of agreed on standards for data exchange and storage, the source of funding for these technologies, the uncertain return on investment, and the uneven distribution of the return present persistent issues that must be addressed if these technologies are going to achieve wide-scale improvements in our health care system.

There are a number of public and private efforts under way to address these issues, but to date there has been little focus on the Medicaid Program. This article provides a review of the potential impact of HIT and HIE on key stakeholders of the Medicaid Program, including beneficiaries, providers, and Federal and State governments. By way of a literature review, Web-based research, and interviews with experts, we present an overview of the complexities and unique characteristics that should be considered as policymakers address Medicaid's role and involvement in HIT and HIE efforts.

MEDICAID MANAGEMENT INFORMATION SYSTEMS

Administered by States, in partnership with CMS, Medicaid is the health care program for the sickest and poorest Americans. Originally enacted in 1965 (Title XIX of the Social Security Act), Medicaid was designed to provide States with the opportunity and flexibility to provide health care for dependent children, the blind, disabled, and elderly under broad Federal guidelines and joint Federal and State funding. Since its enactment, Medicaid has grown to serve more than 55 million Americans and spent more than $326.4 billion in fiscal year 2005--making it one of the largest health care payers in the U.S., second only to Medicare (Centers for Medicare & Medicaid Services, 2005).

Although there is overlap with other insurers, Medicaid disproportionately covers health care for a significant percentage of low income families, pregnant women, persons with severe disabilities, chronic medical and psychiatric conditions, and the elderly in need of long-term care (LTC) including those who are dually-eligible for both Medicaid and Medicare services. Medicaid Programs offer relatively comprehensive coverage for many health care services not covered or limited by commercial insurers. In addition to traditional hospital and physician care, Medicaid covers behavioral health and LTC services. In 2001, Medicaid accounted for 27 percent of national mental health and substance abuse expenditures (Mark et al. …

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