Medicaid data management a healthcare IT success

Medicaid data management a healthcare IT success

Madison, Wis. – It’s a story you won’t find in Michael Moore’s “Sicko” or other commentary from those who claim America’s healthcare system is beyond repair. But it’s a true story, and it demonstrates how good ideas, partnership, and the right technology often combine to quietly make healthcare better.
In 1999, a vendor hired by the state of Wisconsin to build a computerized system to track child vaccinations went bankrupt. The project was turned over to Electronic Data Systems, known today as EDS, which had been handling the state’s Medicaid claims since 1977. Working with the state and private providers, EDS designed a system to be compatible with a variety of data sources, to ferret out multiple identities, and to reduce vaccination errors.
It could also give healthcare providers up-to-date information about vaccine expiration dates. For parents, it meant being able to check a child’s vaccination record online versus carting paper records from appointment to appointment.
Before long, clinics, schools, and parents were logging on, and other states were inquiring about how they could use the Wisconsin Immunization Registry. Today, it’s working in nine states and three more states are coming on line, including New York. Since 2003, registry clients and immunizations have doubled, and the percent of children with current immunizations in the first 12 months of life has grown from 55 percent to 80 percent. More properly immunized children means fewer cases of dangerous disease – and lower treatment costs through prevention.
IT flap
That’s just one example of how the right information technology can help improve healthcare while controlling costs. The case is instructive given the recent flap over the state’s overhaul of its Medicaid computer system.
Work on the state Medicaid Management Information System is running behind schedule, and costs are higher than expected, due to reasons that range from changes in state and federal rules governing Medicaid to “mission creep.” There’s probably enough blame to go around for the state and EDS, but pointing fingers won’t help much with the project nearly done. It’s far better to focus on getting the computers up and running – and to begin capturing the benefits of a 21st century healthcare information system.
Gov. Jim Doyle and his administration decided a few years ago the state had milked the state’s 30-year-old Medicaid computer system for all it was worth. Patchwork changes to 1970s technology could only go so far, and the state needed a system with more flexibility. Medicaid providers, who often wait far too long for payments, needed a system that could quickly process claims and fix errors without requiring long delays.
Similar systems installed by EDS in other states have given policymakers and healthcare providers the ability to better analyze healthcare trends affecting large populations. A current example that worries most public health officials is Type 2 diabetics. Better information can help stave off the disease in some Medicaid patients and control treatment costs for Type 2 (adult) diabetics. Because Medicaid patients are largely poor, improved healthcare management from better information could save Wisconsin millions of dollars while saving and improving lives.
Real-time claims processing
In Kansas, the EDS system has been working for about four years. In a recent interview, Christiane Swartz, deputy director of the Kansas Medicaid program, said operating costs are down and client satisfaction is up. Happy users include providers, who file claims online and learn within seconds if those claims are accepted by the system – or how to make real-time corrections to rejected claims.
“Every time we hold a provider meeting, they remind us about how much they like our website,” Swartz said. “It has been wonderful for communications.”
The new system in Wisconsin may also serve as a platform for other healthcare information systems, ranging from BadgerCare to FamilyCare to reforms that could take place at the state or federal level. It’s what the techies call a “multi-player system,” meaning the technology can handle other tasks and databases. Even Michael Moore should like that.
Doyle and his team did the smart thing deciding to replace Wisconsin’s outdated Medicaid data system. Have there been glitches? Sure. But if the goal is a system that will work for patients, providers, and taxpayers alike for decades, the state is on the right path.
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Tom Still is president of the Wisconsin Technology Council. He is the former associate editor of the Wisconsin State Journal in Madison.
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