The state of Missouri is saving money and improving health care by sharing data. Through a multi-agency effort built over the past 10 years, the state’s Information Technology Services Division (ITSD) has, in recent months, added new functionality -- functionality that has reduced hospital use by 20 percent and emergency room visits by 12 percent among enrollees in the state’s Medicaid program, known as Health Homes.
The program, modeled after Medicaid's Medical Homes model of care, provides a team of providers to coordinate and treat patients with co-occurring medical and mental health needs to improve outcomes while containing costs.
The reduction in emergency room visits alone is estimated to save an estimated $8 million annually. All agencies involved in the effort have more data to be shared, opening the door to potentially more cost savings and improved quality of care, said Joe Parks, director of MO HealthNet.
The Missouri Department of Health and Senior Services (DHSS) has captured emergency room data for years, and now that data is being shared daily with the Missouri Department of Mental Health (DMH) and the Missouri Department of Social Services (DSS). The program works by keeping health-care professionals informed when Medicaid-enrolled patients are admitted to an emergency room, ensuring continuity of care and proper long-term treatment.
"If you are a new diabetic and you went to the emergency room because your blood sugar got too high, and I’m your physician, I’m going to have my office get [in touch with] you in the next day so I can do the long-term adjustment," said Parks. "I don’t just want you going off with whatever that ER physician did. Also, I’ll want to make sure you’re following through with what the ER physician told you. Large numbers of people get instructions in the emergency room and either don’t understand them or don’t follow them.”
In most circumstances, the information from an emergency room visit would not be available to a physician unless their patient told them, which can result in improper or incomplete care. But in Missouri, state agencies began sharing data in 2003 and the program has been slowly building to meet new goals since. Health data sharing in Missouri has improved medication prescribing practices, reducing the instance of physicians prescribing high doses, irregular medication combinations, or multiple medications of the same type.
“My duty as a physician is to practice within the usual standards of practice, but how do I know what the heck that is?” Parks said. “Part of it is what it says in the published literature, but part of the standard of practice is what we’re doing as a group -- all physicians that are practicing in a community -- and there’s no way for the individual physician to know if they are right in the middle of the pack or trailing the pack or ahead of the pack. We use our pharmacy data to show them how they’re doing compared to their peers and it helps physicians make better decisions and improve their practices.”
The data collected is turned into a short-term medical record, and provides about half the information a physician wants, Parks said. Doctors can see their patients’ diagnoses, which medications they’re taking, whether they’re getting their medications refilled, and who is providing the patient with treatment. The data is accessible by any Medicaid prescriber through a Web portal the state has had in place since 2004. The system, which also allows electronic prescribing, is now also available on the state’s health information exchange.
“The other thing I might find out is that you’ve been to three ERs recently getting pain medication and you haven’t told me and now you’re asking me for pain medication,” Parks said.
The system enables the sharing of data with local primary care practices and community mental health centers that are responsible for what the industry calls “high utilizers,” patients with multiple chronic illnesses. “The original goal was to identify outbreaks,” Parks said. “Our goal is to use the same data to improve individual treatment. In most cases, your physician doesn’t find out you’ve been to the emergency room until the next time you visit them in their office.”
In addition to the cost savings, Parks says data sharing is making the state healthier. “In terms of the quality of clinical care, we are seeing better blood sugar control from people with diabetes, lower blood pressures for people with hypertension, and lower levels of cholesterol for people with heart disease, and we’re seeing it at levels that really cause long-term reductions in death by heart disease or blindness due to diabetes,” he said.
There is room for improvement in sharing health data, Parks said. Emergency room data is now shared by pulling it from the DHSS computer and emailing it to Medicaid health-care providers each morning. But there is an opportunity to integrate that data into their care management tool, he said. There’s also a large gap in the patients who are being reached. Some patients, like those being treated for substance abuse, have stronger restrictions on how their data can be used, which means those patients are being discriminated against and therefore receiving a lower standard of care than has been demonstrated to be possible, Parks said.
A third limitation is that the state’s emergency room data sharing is also only applicable to Medicaid enrollees, but it would benefit other insurance providers, too, Parks said. “In our program as the payer, we automatically send [the data] off to that physician, they don’t have to figure it out, they don’t have to send a request. And that’s better for us as a payer because that’s better care and it saves us money,” he said. “Why wouldn’t every payer do this? It’s in their interest. It reduces costs. Why would an insurance company withhold information from the people it’s paying to treat those lives? But that is the industry standard right now and that’s what we want to see changed.”
State CIO Tim Robyn says that the tangible results they’ve seen are a positive indication of continued development around healthcare data sharing.
“As demonstrated by this project, appropriate data sharing can garner both monetary benefits and better clinical outcomes for Missouri citizens,” Robyn said. “Missouri is committed to this kind of data sharing among state agencies and has already begun sharing appropriate data via Missouri’s health information network Missouri Health Connection.”