Eight states are in the early stages of a collaboration with the National Governors Association that could enhance their ability to use and share health-care data enterprise-wide, ultimately improving operations and services to residents.
On June 13, NGA, which works with governors on public policy and governance issues, announced a health policy partnership around data best practices with the states of Arkansas, Colorado, Delaware, Indiana, Iowa, Minnesota, Vermont and Washington. The 16-month initiative, which is called "Harnessing the Power of Data to Achieve State Policy Goals: The Foundation for State Success in Improving Quality and Reducing Costs," is still formative; and while state officials have connected via telephone, their first of two convenings won’t take place until October.
Already, however, health-care officials around the nation are looking in earnest at areas in their governments where existing laws and procedures could do more to enable a fuller and better use of the countless health-care data streams they collect and maintain. The initiative may last less than two years, but state and NGA officials said they expect it to have a lasting impact that could even extend beyond health care.
Hemi Tewarson, health division director for NGA's Center for Best Practices, said it has contemplated how to assist states in improving their data systems for years, raising value while reducing costs — and simultaneously “addressing the whole person” and understanding how residents’ health issues may drive how they use health care. The states selected differ in size and makeup, but share a desire to focus on “cross-sector data sharing,” linking intra-state data systems more effectively and building the governance to make that happen.
“When I say governance, that means data-sharing agreements and figuring out standards that work across, perhaps, different systems that currently don’t talk to one another. These eight states really were all focused on wanting to make improvements in their data systems in a way that we thought was very complimentary to the work that we wanted to help them with in this project,” Tewarson said.
Considerable interagency teamwork around health-care data already exists in three states contacted by Government Technology, but as staffers in Colorado put it, “assessing the opportunities for improvement requires a view across programs, including sharing and integrating data.”
The state of Arkansas hired its first chief data officer, Richard Wang, in July, and Adita Karkera, Arkansas’ deputy state chief data officer, said the state is interested to engage health-care systems, public- and private-sector partners, and drive collaborations to the state CDO network, learning from peers during the NGA project and potentially educating them as well.
What states accomplish could positively impact their Medicare and Medicaid systems; Karkera said Arkansas has a need to eliminate Medicaid payments to state prisoners who should have become ineligible but continue to receive benefits. Manual work has already generated a cost-savings for the state, and the deputy CDO said automating the process and drilling down on identity matching should yield additional results and enhance partnerships with other agencies.
“I think our overarching long-term goal is to create some sort of a uniform and secure method of data exchange, for exchanging information between the health-care sector as well as law enforcement. We’re hoping to create some sort of strategic governance model that can be used to integrate these two sensitive and highly regulated data sets,” Karkera said.
The state’s first NGA-related project will likely focus on better identifying so-called “frequent fliers” in its crisis stabilization unit, which works to keep residents experiencing mental health crises out of prison when possible. Any new policy for a secure data exchange methodology, she added, would need the blessing of the CDO’s data and transparency panel.
In Colorado, the eHealth Commission and the Governor’s Office of eHealth Innovation (OeHI) developed the online Health IT Roadmap to coordinate intra-state health IT. The state also offers the Two-Generation Program, a view across multiple age groups; the Government Data Advisory Board, centered on intra-state data sharing and governance; and is partnering with the University of Denver’s Evaluation and Action Lab to evaluate health and human services programs across programs.
Officials including state Chief Data Officer Jon Gottsegen and members of the OeHI, who responded collectively by email, said these and other initiatives reflect recognition of “a general need to improve the way data and systems may be leveraged and integrated to provide more effective services to Coloradans” while ensuring data security and privacy. Their specific objectives in joining the NGA project are to develop common data-sharing policies, including with counties; a data-sharing infrastructure; and to “effectively utilize integrated data to inform state policy and practice.” The state’s interest also includes achieving cost efficiencies by improving health-care delivery and highlighting inefficiency or fraud.
“Currently, it is acknowledged that state personnel often spend significant amounts of time in responding to data requests and developing the necessary data-sharing protocols, but the state does not have a clear measure of the magnitude of effort spent in these data-sharing scenarios,” the officials wrote.
Colorado will do initial process mapping of some data sharing using a lean approach to quantify the time spent and likely make it more efficient by identifying the most time-consuming steps. While likely not visible to residents, their NGA collaboration will yield improved outcomes, the officials said.
In Washington state, officials work frequently in cross-sector data, with health care, social services and criminal and juvenile justice information, Thea Mounts, the state's All-Payer Claims Database Program Director and NGA project coordinator, said. But joining the NGA initiative should help the state identify methods for cross-sector data sharing and drill down on issues outside health care that affect its outcomes, including housing, transportation, food security, employment and education.
The state hopes to address existing needs around enterprise data governance, infrastructure, an enterprise privacy and security framework and sustainability of its efforts, specifically exploring the possibility of a federated data system where information can be more easily linked and shared. Like their counterparts in Arkansas, they're looking at options for identity matching, including master data management, that could serve as groundwork for any future universal ID efforts.
“The idea about linking and sharing and using the data for research is to support policy development and program development. And then another piece of that would be the focus on the security and the privacy of the data. It would hopefully be beneficial to the citizens of Washington,” Mounts said, noting, as did her peers in other states, that their efforts may not quickly yield visible results but should result in a road map of where data sharing may be headed.