Update: Improving Care for Washington D.C. Medicaid Beneficiaries with a Population Health Management Platform

Update: Improving Care for Washington D.C. Medicaid Beneficiaries with a Population Health Management Platform

Ahead of the 2018 Medicaid Enterprise Systems Conference next month in Portland, Oregon, we’re circling back to Washington D.C.

Specifically, the District’s state Medicaid agency, the Department of Health Care Finance (DHCF), and the District of Columbia Primary Care Association (DCPCA), a non-profit organization serving 200,000 residents through nine Federally Qualified Health Centers (FQHCs) and community health centers at more than 50 care delivery sites.

DHCF partnered with HealthEC in 2017 to create an enterprise data warehouse (EDW). Within 12 weeks, HealthEC migrated, scrubbed, crosswalked and normalized the previous 10 years of Washington D.C.’s clinical and financial Medicaid data. DHCF is now using HealthEC’s solution suite to analyze Medicaid Management Information Systems (MMIS) data to track distribution of 44,000 qualifying beneficiaries across Washington D.C.’s 12FQHCs and hospitals and identify beneficiaries that are eligible for certain care coordination programs – including My Health GPS, a benefit for Medicaid beneficiaries with multiple chronic conditions enrolled in either fee-for-service or managed care.

In addition to identifying beneficiaries eligible for My Health GPS, DHCF can now categorize patients by acuity, and document the agency’s communications/interventions with beneficiaries.

HealthEC’s data analytics solutions were also introduced to the provider community participating in My Health GPS, including DCPCA (which also contracted with HealthEC in 2017). The organization could now derive meaningful value out of the claims data from DHCF, and data from the state health information exchange to effectively stratify and manage their assigned patient population. DCPCA was also given access to non-emergent ER utilization, preventable admissions, and medication utilization details, regardless of where services were provided or who provided them.

As part of My Health GPS, interdisciplinary teams were embedded in DCPCA’s care settings, serving as the central point for integrating and coordinating the full array of eligible beneficiaries’ primary, acute, behavioral health, and long-term services and supports to improve health outcomes and reduce avoidable/preventable hospital admissions and ER visits.

The result?

A complete timeline of clinical events is now available for every one of DCPCA’s My Health GPS patients, enabling physicians to provide quality, effective and informed care – based on seamless access to information within HealthEC’s robust data warehouse.

Based on the initial feedback from DHCF and DCPCA, My Health GPS and early-stage implementation of the HealthEC platform, is making a big difference.

We look forward to sharing full-year patient outcomes with the Medicaid community, once the preliminary 12-month period of the program ends in November 2018.