Foster Care Electronic Health RecordLarge-Scale Applicability

Kay GhahremaniMedicaid/CHIP Director for Policy Development

October 2011

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Overview

Texas Medicaid serves about 30,000 children in foster care through a managed care model called Star Health

Children in foster care are perhaps the most vulnerable population, with expenditures for behavioral health totaling about 40 times more than healthy Medicaid children and overall expenditures totaling about five times more.

The Texas Legislature adopted S.B.6 in 2005 to provide comprehensive reform in the state’s child protective services, including the requirement for a managed healthcare system with a “health passport” to help coordinate care.

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STAR Health

STAR Health became operational April 1, 2008.

Texas has administered services using managed care since the early 1990s, and already had experience with managing HMOs providing services to the aged and disabled populations.

Texas decided to contract with only one managed care organization (MCO) statewide in order to facilitate continuous healthcare for children in foster care as they moved placements.

Texas was able to avoid CMS requirements for at least two choices of health plans by making the model “voluntary”.

Superior Health Plan is the MCO that administers STAR Health.

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Features of STAR Health

•Medical home model (PCP)

•Immediate enrollment upon entering state custody

•Focus on preventive care

•Broad network of providers

•24/7 nursing and behavioral help-line

•Integrated services including physical, behavioral, dental and vision

•Service Management Teams across the state

•Medical advisory committees to monitor the provision of the healthcare

•Health Passport for continuity of care

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Service Management

Health risk screening: All clients are screened within 30 days upon entry to the STAR Health program. A general screening is completed on each child to evaluate their individual health care needs. The score identified on completion of this screen falls into one of three categories:

No case management healthcare needs identified at this time Client has no significant needs and requires no assistance at this time

Service Coordination Some physical and/or behavioral problems Client appears stable Monitored by LVN’s, social workers, degreed professionals

Service Management Medically Fragile, transplants, pregnant, major behavioral health needs Highest priority Monitored by RN’s and licensed clinicians Health care service plans are completed within 30 days of entry to program

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Service Management

Specialty Teams:Transplant Team – for clients in need of transplant services and/or are post transplant

OB/GYN Team – for pregnant and postpartum clients

Discharge Planning Teams –to ensure clients have all services in place upon discharge from the hospital

Complex Case Management Teams – to monitor clients with complex medical needs

Psychotropic Medication Utilization Review Team – to monitor adherence to Texas’ psychotropic medication guidelines

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Health Passport

•Secure, web-based electronic health record (EHR) system

•Accessed at www.fostercaretx.com (follow the link to “sign-up”)

•Provides access by authorized users according to their role

•Populated with two years of Medicaid and CHIP claims history and pharmacy data for children in those programs before entering conservatorship

•When the child leaves foster care, the Passport is available in electronic or printed formats to:

•• child’s legal guardian, managing conservator, or parent•• child if at least 18 years of age or an emancipated minor

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Health Passport

System Features:Demographics: Displays personal contact information of the child’s physicians and other individuals involved in the child’s care

•Visit History: Displays claim-based record of each visit to a health care provider with date of service, diagnosis, and procedure(s) performed

•Medications: Displays claims-based record on all prescriptions filled

•Immunizations: Displays a comprehensive list of a child’s immunizations

•Lab Results: Displays results of lab tests performed, if available

•Electronic Documentation: Providers can document Texas Health Steps, dental, and behavioral health assessments within the Passport

•Vital Signs: Providers can record vital signs at the point of care

•Allergies: Providers can record allergies at the point of care; Passport checks the allergy for medication interactions

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Health Passport

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Health Passport

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Health Passport

Examples of Uses: Case worker avoided duplication of dental services for a large

family because the claim records of previous services were in the Passport

In a pre-adoption review, case worker intervened when a pattern of non-compliance with behavioral health treatments was noticed

Child began exhibiting behavioral issues. With the historical data contained in the Passport, Child Protective Services was able to contact the previous provider to obtain detailed medical history and prevent a placement breakdown

In a kinship placement, relative of a diabetic child did not know about the medication needs of the child. The care coordinator used the Passport to identify the child’s previous physician to obtain medication dosage information

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Electronic Health Record Incentive Program

• ARRA made billions available to states to award federal dollars for electronic health records to providers of Medicaid services.

• Providers can qualify for both Medicare and Medicaid payments.

• Providers can be reimbursed for up to 85% of costs

• Medicare providers that do not demonstrate meaningful use of an electronic health record (EHR) by FY 2016 will be penalized 1% reimbursement.

• Providers must show over time an increasing sophistication with the “meaningful use” of EHRs to include clinical decision support and advancing better health outcomes.

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Medicaid ID Card andHealth Information System

New System Digital technology to streamline Medicaid eligibility verification. Enables providers to access Medicaid recipients’ health history.

New Card Replaces paper Medicaid ID. Most recipients received both the paper ID and new card for month of September. Beginning October 1, 2011 all recipients will have received their new card.

Eligibility Verification Personal Computer – www.yourtexasbenefitscard.com Standard Card Reader Point of Service Card Reader

Recipients’ Health History – Winter 2011 Basic claims-based health information system Diagnosis history Lab data E-prescribing Prescription history E-prescribing tool for Medicaid providers Immunization details

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Medicaid ID Card andHealth Information System

Single phone number for help.Statement that the card itself does not

guarantee eligibility.

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Website address for more information.Instructions to call the health plan for the primary

care provider’s information.

Back of card:

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Conclusions

The health passport is used more by MCO staff and state staff than by providers, who have been slow to adopt usage.

The new EHR ARRA money will make it more likely providers will adopt electronic medical records (EMRs).

Providers will increasingly use the web portals to access the health passport and the Medicaid health information system.

Ultimately, providers will be interested in the health passport and the Medicaid health information system if they can use them to pull data into their EMRs.

EMRs/EHRs will be important tools for providers and service coordinators/case managers in advancing strategies to better health outcomes.