The Wave that Never Breaks:
Health IT Implementation and
Adoption Initiatives
Margo Edmunds, Cheryl Austein-Casnoff,
Rachel Block, Shirley Girouard, and
Patricia MacTaggart
AcademyHealth Annual Research Meeting
Chicago, IL, June 29, 2009
Welcome
Meet the panelists
– Margo Edmunds, Booz Allen and Johns
Hopkins University
– Cheryl Austein-Casnoff, HRSA Office of
Health IT
– Rachel Block, New York eHealth
Collaborative (NYeC)
– Shirley Girouard, San Francisco State
University
– Patricia MacTaggart, The George
Washington University
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What Our Panel is About
Technology adoption and innovation in the
public sector
– Using IT to promote administrative
simplification and reduce errors
– Based on experiences implementing the
State Children’s Health Insurance
Program (SCHIP, S-CHIP, CHIP, schip)
– Apply lessons learned to current
challenges in technology adoption and
health reform
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Highlights of the State Children’s
Health Insurance Program
Congress passed SCHIP as part of Balanced
Budget Act of 1997
Largest expansion of healthcare coverage since
Medicare and Medicaid in 1965
New opportunities for innovation
– Consumer-friendly, e.g., PeachCare
– Streamlined administrative processes, e.g.,
faxed or Web-based applications instead of
face to face
– More accurate information; improved tracking
and electronic reporting of enrollment
numbers
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Who Helped to Launch the State Children’s Health Insurance Program?
EXECUTIVE BRANCH
WHITE HOUSE
FEDERAL
•
•
•
•
•
•
Federal Interagency Task Force
Dept. of Health & Human Services
– Office of the Secretary
– Asst. Secretary for Planning & Evaluation
– Agency for Healthcare Research &
Quality
– Center for Medicare & Medicaid Services
– Health Resources & Services
Administration
– National Center for Health Statistics
(CDC)
Dept. of Commerce, Bureau of Census:
Current Population Survey
Dept. of Education: School-Based Outreach
Dept of Agriculture: Food Stamps
Dept of the Interior: Park-Based Outreach
STATES
Governors
• Medicaid Directors/Human Services Agencies
• “Separate State Agencies”
• Insurance Departments
• Health Departments
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•
•
Office of the First Lady
Office of Management & Budget
PUBLIC/PRIVATE PARTNERSHIPS
National Organizations of Public Officials
• American Public Human Services
Association
• Association of State & Territorial Health
Officials
• National Conference of State
Legislatures
• National Governors Association
• National Association of Insurance
Commissioners
STATES
State Organizations
•
•
Robert Wood Johnson Foundation
(RWJF) Covering Kids
American Academy of Pediatrics
Chapters
PRIVATE SECTOR
Business & Industry
• Bell Atlantic
• Kaiser Permanente
• Blue Cross-Blue Shield; Caring Programs
Foundations
• RWJF: Covering Kids
• Packard Foundation (AHRQ grants)
• Milbank Memorial Fund
• W. T. Kellogg Foundation
National Organizations – Private
• American Academy of Pediatrics
• Children’s Defense Fund
• Families USA
• Family Voices
• March of Dimes
• National Assn. of Children’s Hospitals
Research & Policy Organizations
• Center on Budget & Policy Priorities
• Institute of Medicine
• Mathematica
• National Academy of State Health Policy
• Urban Institute
Universities & Public Service Organizations
Institute of Medicine, 1998:
Recommendations at Program Launch
All children should have health insurance
Develop national and state performance
monitoring systems using technology (IT)
– Develop systems that produce meaningful
information on SCHIP’s effects at federal and
state levels
– Develop core set of basic indicators for all
types of programs (Medicaid expansions,
separate state program, private program)
– Make information available to the public via
Web
Source: Edmunds and Coye, America’s Children:
Health Insurance and Access to Care and
Systems of Accountability (IOM, 1998) (RWJF)
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Children’s Defense Fund:
Progress Report, 2000
States that used technology got more kids
enrolled faster
– Toll-free numbers and call centers
– TV and radio ads (social marketing)
– Web-based enrollment
Reduced enrollment barriers/access through
streamlined application procedures, application
assistance, and community-based outreach
Positive disruptor in Medicaid: software
upgrades, program coordination, interoperability
 Source: Edmunds et al. All Over the Map: A Progress
Report on SCHIP (CDF, 2000) (RWJF, Packard, Kellogg)
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That was Then, This is Now, or
Déjà Vu All Over Again
IT as a means to an end: goal was getting kids
enrolled so they can access health care
Medicaid reforms with SCHIP were precursors
to IT-focused Medicaid transformation grants
Public sector innovation continues through
shared services and system integration
Focus on “consumers”: child- and familycentered programs and policies
Provider leadership, engagement and advocacy
Model for small group market coverage
expansions in public sector
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