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Workforce quality of life.  For all providers, Medi-Cal could undertake assessing specific issues that make Medi-Cal difficult to work with and address those.  Given the difficulty of working with private insurance, providers may be more tolerant of low payments from easy-to-work-with programs.

5-B. Health Information Technology

Health care is one of the few industries in America that has not yet reaped the efficiency benefits offered by innovations in information technology.  For example, electronic medical records can help reduce medical errors, as well as costly duplication of services for patients when paper records are missing and unavailable.  Health information technology (HIT) can also help reduce the administrative costs of health care if it helps providers and insurers share information easily.

This has long been ascribed to the challenges of the current multi-payer insurance system, where providers, insurers and purchasers do not share the same incentives to invest in or benefit from HIT.  Notably, adoption of HIT has been mostly limited to the Veteran’s Administration and very large health care systems, where there are cost saving incentives to invest in the technology.  Many policymakers have reached the conclusion that government will need to provide significant leadership and funding to help spread the use of HIT, and its likely system efficiency improvements.

The federal government has taken a first big step on this front by dedicating by more than $30 billion in the American Recovery and Reinvestment Act (ARRA) to promote and expand the use of HIT – including ensuring that everyone has an electronic medical record by 2014.  This funding will be used to create HIT research and regional extension centers to provide federal implementation assistance, in addition to grants to support state-level activities.  A significant portion of the funds will be distributed by state Medicaid agencies as incentive payments to encourage Medicaid providers to adopt electronic health records.

Medicaid programs across the country have been using financial and other leveraging sources to help participating providers adopt health information technologies as a way to boost quality and improve safety.  There is significant work taking place:

Health Information Exchanges.  Twenty states currently facilitate Health Information Exchange (HIE) through participation in Regional Health Information Organizations (RHIOs), which often include Medicaid participation as well. The most significant challenge for these efforts is creation of a sustainable business model.47

Disease Registries.  Many states have created electronic immunization, cancer and other types of disease registries to improve the coordination and reporting among

47 e-Health Initiative. 2008 HIE Survey. http://www.ehealthinitiative.org/HIESurvey/ 2008KeyFindings.mspx. Accessed September 18, 2008.

Health Management Associates/Harbage ConsultingPage 40

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