Government Technology - June 2008 - (Page 24)

24 JUNE_08 patients didn’t have private practice doctors, which led to the other goal of the project: to get more Medicaid patients into the care of private practice doctors. Once that happened, the OHCA could use IT to hold those doctors responsible when their Medicaid patients visited ERs inappropriately. But there was another obstacle. Many private doctors didn’t want Medicaid patients, said Fogarty. The program’s bureaucracy made those patients a burden to serve. Could IT fix that? The OHCA started by targeting the hassle of serving Medicaid patients. In 2003, the OHCA implemented its EDS-supported Medicaid Management Information System (MMIS) to connect medical providers and Medicaid patients to a centralized statewide database. The MMIS offered doctors a quick way to submit Medicaid claims for patients that eliminated the busy work of the old process. “They no longer deal with paper claim forms that get either mishandled at the provider or state level. You eliminate the state input person who takes a paper form and tries to interpret it. The provider literally puts in a claim, enters that claim on a Web-based system that edits it, and it immediately tells the provider if they’re leaving out a required element of that claim,” Mike Fogarty, Fogarty said. CEO of the In the past, providers mailed Oklahoma Health paper claims and could find Care Authority reduced inapproout weeks later that a claim was priate emergency missing information. Doctors room visits to cut had to correct those mistakes Medicaid costs. before receiving payment. Tracking patients By skipping that process, the through a beneﬁts electronic system enabled the management OHCA to accelerate payments system made to doctors. that possible. “Our system actually generates an electronic deposit to the provider’s account. If the claim comes in by midday Wednesday, there will be an electronic deposit processed and payment of that claim no later than Thursday of the following week. Providers understand that kind of cash flow is real money. It has more value because it’s quick,” Fogarty said. The system also enables providers to determine instantly whether a patient is eligible for Medicaid. “One of the most difficult things for doctors doing business with a Medicaid program is determining whether the person they served was eligible. You can submit a perfect claim, but if it’s rejected because the person you treated wasn’t eligible, you’re really not making progress,” Fogarty said. Another problem existed. Many smaller Oklahoma medical providers didn’t have intra-office patient databases, raising questions as to how they’d electronically submit records. The OHCA doesn’t purchase care from health maintenance organizations (HMOs), which means many of its providers are small, less IT-savvy practices. The OHCA system means a doctor’s office merely needs a computer and Internet connection. The solution proved popular with providers. Roughly 95 percent of the 3 million claims processed annually by the OHCA now go through the automated system. Oklahoma private practices receive almost $30 per month for each Medicaid patient. Fogarty said the arrangement offers doctors predictable revenue. It can be a sizable chunk of change for doctors who treat Medicaid patients. Changes to the payment and eligibility process seemingly have made Medicaid patients more attractive to Oklahoma physicians. In 2004, the state had contracts with 23,366 providers. By 2007, that number rose to 25,647, roughly a 9.7 percent increase. “If they’ve got a panel of 500 or 1,000 patients, they know how much a month they’re going to get paid for that,” Fogarty said. “It also is a way for us to hold the physician responsible for making sure that patient is being taken care of. We require the physicians to submit ‘encounter data.’” That information lets the OHCA track all treatment the doctor gives the patient. The OHCA notifies each practice when any of its patients visits an ER inappropriately. Naturally the agency doesn’t want to pay an ER to treat a condition that it already paid a private doctor to handle. “If a person with a sore throat goes to see their primary care doctor, we’ve already paid for that. If that same person goes to an ER, we’ve paid twice,” Fogarty said. War Against Diabetes Better citizen health is critical economic medicine for the Delta Regional Authority (DRA), an organization focused on growing prosperity for 240 counties and parishes in eight Mississippi Delta states. Populations in many of the region’s counties and parishes peaked before 1980, and 238 of them have per capita incomes at or below the national average, according to the DRA. The DRA’s Healthy Delta program aims to change that by targeting citizen diabetes using early medical intervention. A call center and database will power that strategy. The organization’s theory goes that a work force can’t become more prosperous if it is not as healthy as competing work forces. Roughly 10 percent of DRA citizens suffer from diabetes compared to a 7 percent average for the United States as a whole, according to the DRA. The organization uses marketing campaigns to report potential symptoms of diabetes to a special call center. The DRA also collects this information at health fairs. Call center and fair workers refer citizens to health-care providers. The organization feeds this information into a database. The DRA hopes that in a few years, the database will enable states to reduce diabetes by revealing symptoms they can catch earlier. http://www.govtech.com

Table of Contents Feed for the Digital Edition of Government Technology - June 2008

Government Technology - June 2008 Contents Point of View The Last Mile Big Picture On the Scene Four Questions For... 3 Technologies That May Change Your Job ...And Your Life Loosening Medicaid's Grip Better Living Through Technology Immersive Itineraries Help Yourself Taking the Bait Shared Connection Up Close Spectrum Products Personal Computing signal:noise Digital Communities Contents Digital Tactics for a U.S. Recession E-Dilemma Stifling Community Innovation Leadership Interview Estonia Becomes E-Stonia If It Were Up to Me …

Government Technology - June 2008

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