Update: Alabama’s Recent Actions

Calling Regional Care Organizations (RCO) the cornerstone of Alabama’s Medicaid transformation plan, state officials asked the federal government to approve a plan to move Medicaid away from a fee-for-service payment model to a decapitated managed care system.

Legislation passed by Alabama in 2013 and 2014 calls for the state to be divided into regions and for community-led regional organizations to coordinate the healthcare of Medicaid patients in each region with networks ultimately contracting with the state to provide care.

To discuss the topic, a meeting was held last summer with representatives from seven Alabama organizations that wish to apply for status as a Probationary RCO. The representatives were able to meet with agency officials and consultants to review the application process and receive preliminary data. So far, twelve organizations have submitted a Notice of Intent to apply for Probationary Certification.

According to Dr. Don Williamson, Chair of the Alabama Medicaid Transition Task Force www.medicaid.alabama.gov, “Probationary applicants, feel that they need both access to the data and also to process claims. Medicaid will need to figure out how to crosswalk that data since we will need access to common data sets to compare and contract across RCOs.” Applications to achieve probationary status submitted by September 30, 2014 may be granted probationary status http://medicaid.alabama.gov/CONTENT/2.0_newsroom/ at the Agency’s discretion.

Dr. Williamson also announced that since CMS has approved the implementation of comprehensive care management in four networks also known as Health Homes. A Request for Proposals (RFP) to expand the state’s Health Home program for Medicaid networks statewide is scheduled to be released January 2, 2015 with a planned start date of April 1, 2015.

Also, the state has helped healthcare professionals connect EHRs to One Health Record® http://onehealthrecord.alabama.gov/technology.html which is the State’s HIE. The system is using Truven Health HIE Advantage as the core backbone for the HIE. In partnership with Care Evolution, the HIE enables providers and hospitals to interface with the Exchange without having to purchase major upgrades for their existing EMRs.

So far, 13 physician practices have connected to the cloud-based Exchange. This is the first time that individual providers have been able to connect to the State system simply by connecting to their own in-office EHR system regardless of the type of system used.

With the new connection, providers are able to retrieve information while receiving notices when patients are admitted, discharged, or transferred between hospital and home or to another care location.  The system also allows for the exchange of patient information between primary care providers and specialists.

According to HIE Operations Consultant Bill Mixon, “The connections are a continuation of a pilot project in East Alabama to help providers test new technology to exchange patient data. The pilot will eventually connect EHRs at East Alabama Medical Center in Opelika, Lanier Memorial Hospital in Valley, four referring clinics in the area, and approximately 15 local physicians.”

While the pilot is focused in east Alabama, Mixon is interested in hearing from physicians in other areas of the state who want to connect to the new system. For more information physicians should contact Project Manager Meghan Youngpeter at 334-353-4463 or email neghan.youngpeter@medicaid.alabama.gov.

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