By Anne Montgomery and Katy Weber
This blog entry was written for n4a’s Aging and Disability Business Institute and is reposted here with permission.
Despite a surging population of adults age 60 and older in the United States and increasing pressure for more integrated health and social services systems, the Aging Network faces significant challenges in accessing the necessary information technology (IT) infrastructure to achieve this integration.
In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed to promote the adoption of electronic health records (EHRs) that meet “Meaningful Use” requirements by exchanging patient health information using Health Information Exchange (HIE) approaches. Significant federal funding has been invested in this effort and much advancement has been made by the health care sector thanks to this federal leadership. However, not all entities serving patients were allowed to participate—notably, Area Agencies on Aging and other home and community-based services organizations(HCBS), as well as facility-based long-term care providers, were left out and thus left behind. With the recent push for better integration of the medical and social services sectors, this imbalance and disconnect on EHRs has been even more keenly felt.
Another IT challenge is that historically, community-based organizations (CBOs) have not been required to report person-level outcomes data. As a result, many AAAs and other CBOs have limited capacity to engage in data analytics due to the lack of sophistication of their IT systems. But as health care systems have adopted EHRs and more advanced IT systems, CBOs are facing calls to acquire more sophisticated IT capabilities. Doing so would expand the ability of CBOs to coordinate multiple service providers and manage large populations of older adults who have complex chronic conditions and/or functional limitations.
Fortunately for CBOs, times are changing.
In February 2016, the Centers for Medicare & Medicaid Services (CMS) issued policy guidance in the form of State Medicaid Director Letter 16-003 (SMD #16-003) indicating its support for allowing qualified CBOs to use HITECH funds to modernize their IT systems. Specifically, the guidance expands the definition of providers and entities that can apply for 90/10 federal matching funds to aid IT design and development. The expanded definition includes “other Medicaid providers, including behavioral health providers, substance abuse providers…public health providers, and other Medicaid providers, including community-based Medicaid providers.” Available through 2021, HITECH funds may be used to support “multistate collaboratives partnering on shared solutions for…interoperability.”
In the time since this guidance was issued, some states have used HITECH funding to improve information sharing with public health agencies. While many of these states have successfully used a detailed planning and approval process known as the Advanced Planning Document (APD) process to receive HITECH funds, only a few have used this process to receive expanded funding that would enable them to develop partnerships with the Aging Network. Aging advocates need to change that status!
FINANCING TO SUPPORT HEALTH INFORMATION EXCHANGE
Based on SMD #16-003, HITECH funds can be used to facilitate integration and coordination with providers of home and community-based services when the state can show that this support directly enables eligible providers to meet their Meaningful Use requirements. The guidance emphasizes that HITECH funding may be used for onboarding activities that are related to connecting a community provider to an HIE.
Other sources of IT funding available to State Medicaid Agencies (SMAs) come from the Medicaid Management Information Systems (MMIS) and Eligibility and Enrollment (E&E) programs (SMD Letter #10-016). These funds allow states to use 90/10 matching funding to develop various IT capabilities, including provider directories, care coordination and client access to data. The guidance also allows states to use MMIS funding at a 75/25 matching rate for the ongoing operation and maintenance of state health IT infrastructure that can support CBOs.
The APD process requires that all involved parties collaborate. For example, SMAs work with CMS to secure final approval for federal funding while CBOs and AAAs work with their State Units on Aging and SMAs to ensure that their perspectives and needs are a part of the discussion. This means it is critically important for AAAs and CBOs to advocate for access to their state’s health IT funding opportunities, which are currently available only to the SMA. Tapping into this process and other opportunities could make a tremendous difference in integrating CBOs.
As the U.S. health care system shifts over the next decade to focus more on population health and value, AAAs and CBOs must expand their technical capacities to position themselves as equal partners in data sharing and care coordination for individuals who have complex medical needs.
Unfortunately, the ability of the Aging Network to collect data on client health outcomes and satisfaction, cost, workforce adequacy and efficiency, return on investment and multiple other measures is currently limited. Consequently, only a minority of AAAs and CBOs are equipped to collect, retain, report, exchange and analyze data on the range of services and supports they deliver to clients. In addition, few providers have a way to estimate unmet need across their community, even for their core services.
This lack of capacity was underscored in the National Association of Area Agencies on Aging’s (n4a) Information Technology in Area Agencies on Aging, which found that AAAs lacked financial resources to acquire and/or build sophisticated IT systems; did not have the ability to retain and analyze client and services data; were frequently unable to share data across social services and health care electronic systems about common clients; and had not developed IT plans for the future.
Fortunately, AAAs and other CBOs now have a remarkable opportunity to engage with ongoing state efforts to improve Medicaid IT systems in order to accommodate the growing number of individuals living in the community who are seeking HCBS. HITECH funds can be used for design and development of IT that bridges current “interoperability” gaps between medical care providers and the array of CBOs that provide vital social services and supports necessary to keep this population healthy. HITECH, MMIS and E&E funds provide opportunities for CBOs to coordinate services with Medicaid or other medical providers to effectively manage services, potentially reduce overall cost and improve the quality of care for a population of older adults who have medical needs that are growing in complexity.
For more resources on HIE, please visit: https://www.healthit.gov/topic/health-it-basics/health-information-exchange
Anne Montgomery, MS, is Deputy Director of Altarum’s Program to Improve Eldercare. Katy Weber, MPH, is a health and social services consultant specializing in population health for the aging population through the integration of medical and social services.