News
D.C. Medicaid HIE flags at-risk patients
Government Health IT Magazine, September - October Issue
September 1, 2009
By John Moore
The District of Columbia’s Medicaid agency is ramping up a health information exchange that in addition to basic clinical information sharing will provide physicians analytics on disease trends among their patients.
The D.C. Department of Health Care Finance (DHCF) in June announced its choice of MedPlus to deploy the HIE, dubbed the Medicaid Patient Data Hub. The DC HIE specifically focuses on Medicaid beneficiaries. Funding for the Patient Data Hub’s pilot phase comes through a CMS Medicaid Transformation Grant.
In the HIE’s pilot phase, clinical data will flow from individual clinicians in participating institutions to the payor, DHCF, and to the D.C. Department of Health for reporting requirements, according to DHCF. There are also planned flows in which aggregated data from the public sector will track back through the Patient Data Hub to individual providers, DHCF noted in a prepared statement.
Beyond clinical information sharing, the HIE’s analytical features make it stand out, according to Richard Mahoney, president of MedPlus, a subsidiary of Quest Diagnostics.
“One thing that DC is doing that I think is a little different from other HIEs is they are using some very sophisticated predictive modeling capabilities that we have introduced to them,” he said.
MedPlus’s technology supports predictive modeling of claims and clinical data to identify high-risk populations. This puts providers’ disease management programs in a position to devise effective intervention plans, according to Mahoney.
The approach will help DHCF focus on particular segments of the city’s Medicaid population. The agency plans to examine how it can leverage data coming through the Patient Data Hub to better address chronic health conditions such as asthma, diabetes, and heart disease.
Lynne Dunbrack, program director for provider/health payor research at IDC Health Insights, said predictive modeling for population health management is not widely adopted among HIEs at this point. But she said exchanges are moving in that direction. She cited Shared Health, a Tennessee-based exchange, as having features that provide the ability to do population health management.
“Most HIEs are still trying to get off the ground and get basic transactions going,” Dunbrack said. “As HIEs become more established, having the capability of being able to manage the health of a population is certainly one of the key objectives.”
She said predictively modeling is particularly compelling since the technology can identify patients who are at risk for diseases—diabetes, for example—based on certain health indicators. Early identification lets public health agencies proactively manage at-risk patients, improve their quality of life and address escalating health costs.
The Patient Data Hub’s pilot phase will include three hospitals and six clinics, according to MedPlus. The hub will aggregate patient data from the nine clinical sources and four additional government sources, which MedPlus said will provide an improved data set for clinical decisions.
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