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Health Information Technologies and Health Care Transformation
James Golden, PhDDirector, Division of Health PolicyMinnesota Department of Health
February 7, 2008February 7, 2008
Overview
Opportunities in HIT
Clinical HIT
Administrative HIT
Actions
Mandates
Support
Community Effort
Opportunities for Savings
Electronic Health Records
EHRs
Better connect providers
Assist providers - Have the right information at the right time
Improve patient safety
Minnesota’s private sector has invested hundreds of millions of dollars in EHRs and other HIT
EHR Actions
Minnesota e-Health Initiative – Formed 2004
Statutory Mandate - that all health care providers must implement an interoperable electronic health record by January 1, 2015
State Appropriated Grants and Interest-Free Loans - $14.6 M to support the purchase, implementation, and connectivity of EHRs in safety net providers
EHR Actions
Revised & Recodified MN Health Records Act – to eliminate or reduce privacy barriers to electronically exchanging health information, while maintaining or strengthening patient privacy protections.
MN HIE - statewide health information exchange that will initially exchange medication history and formulary information between providers and payers
EHR Implementation Success
Adult Primary Care Clinics – June 2007
68% - have implemented or in the process
46% in 2005 ----- 68% in 2007
22% considering implementing - 12-24 months.
Acute Care Hospitals – Fall 2006
67% - have fully or partially implemented
Cost Saving Opportunities
Key Assumptions EHRs used to full potential
Standardized electronic communication among all payers and providers
Effective clinical decision support
Savings Available
4.3% of projected health care expenditures
$2.5 billion per year by 2015
Administrative Transaction Simplification Minnesota Health Care
Administrative Simplification Act
Purpose - Savings by implementing electronic data interchange using a single set of administrative standards and simplified procedures
Administrative Costs
Administrative Transactions Costs - % of total spending:
Health Plans 2%
Hospitals 1%
Clinics 3%
Projected System-Wide Costs
SFY 2008 - $742 million
SFY 2012 - $970 million
2007 Changes to ASA
Uniform Electronic Transaction and Implementation Guide Standards
Requires - Three administrative transactions must be exchanged electronically using a single standard for content and format starting in 2009
Eligibility verification
Health care claims
Payment and remittance advice
Applicability of 62J.536
All Health Care Providers
Provide health care services in MN for a fee
Eligible for reimbursement under Medical Assistance
All Health Care Payers
Health Plans/Insurers
Third Party Administrators
Workers Compensation
Developing the Standards
Commissioner of Health uses rulemaking to develop companion guides:
Based on Medicare standards
Developed in consultation with Minnesota Administrative Uniformity Committee
Modifications from Medicare as appropriate
Rules developed in 2008, effective in 2009
Opportunities for Savings
Single Standard - Content and Format
Easier to maintain billing software – fewer staff
Less effort to stay current about payer requirements
Easier coordination of benefits across payers
Electronic Transactions
Electronic claims are less expensive than paper
Reduced data entry across trading partners
Eliminates mailing and telephone costs
Implementation Costs
Single Standard - Content and Format
Programming changes to existing systems
Increase in suspended claims during the transition
Increased customer service costs in transition
Electronic Transactions
Computer equipment/software or clearinghouse
Training of staff on new procedures
Development of provider portals
Opportunities for Savings
Key Assumptions
7% reduction in costs
Adoption by all providers and payers
Savings Available – w/o implementation costs
SFY 2008 - $7.4 million
SFY 2009 - $23.8 million
SFY 2012 - $67.9 million
SFY 2008-12 - $215 million
Thank You! - Questions
Minnesota Department of HealthJames I. Golden, PhDDirector, Division of Health Policy
