Healthcare in Montana

Montana’s Governor Steve Bullock’s Council on Health Care Innovation and Reform met in June to discuss the present state of healthcare and to review the Montana Health Care Innovation Plan http://dphhs.mt.gov/healthcare/innovation. The plan describes the Council’s efforts to improve community health while making healthcare more affordable.

The Council examined physical and behavior health integration, social determinants of health, and disparities among American Indians and other populations, plus discussions were held on future moves to develop the health IT infrastructure in the state.

The plan indicates that the use of health IT is growing in the state to help more than one-half of the state’s population living in rural or frontier areas. The Plan describes HIT usage by focusing on publicly available data related to EHR adoption and meaningful use among Montana’s hospitals and providers.

All Indian Health Services (IHS) and tribal-operated facilities in the state use the IHS Resource and Patient Management System (RPMS) www.ihs.gov/RPMS, to capture and store administrative and claims data. The RPMS EHR system is certified for meaningful use.

Montana tribal and IHS leaders have identified issues related to health IT that need to be addressed in the future. One issue is that RPMS upgrades are needed to support participation in patient-centered medical homes and other delivery models. Currently, RPMS is not able to meet Medicare (PQRS) reporting requirements.

The Billings Clinic www.billingsclinic.com  launched the first Montana-based Project ECHO hub last January as an addictions and behavioral health collaborative to support clinicians within the Department of Corrections https://cor.mt.gov.

Project ECHO makes it possible for healthcare professionals to consult independently or as a team through the ECHO Hub when delivering care. The multidisciplinary team shares strategies, best practices, and the appropriate testing needed, along with pharmacy recommendations.

The Montana Primary Care Association (MPCA) www.mtpca.org is actively involved in providing technology solutions. Fourteen community health centers have adopted, implemented, and are meaningfully using eClinicalWorks (eCW) practice management systems and EHRs.

Four beta sites have implemented the eCW aggregation/analytics tool as of Q1 2016 with remaining sites to be implemented through fall 2016. Also, MPCA is leading a grant funded initiative with 16 community health centers ready to build a data aggregation and population health analytics network

State owned and operated healthcare facilities are using disparate EHRs across state facilities including the Montana State Hospital http://dphhs.mt.gov/amdd/MSH.aspx, Department of Corrections https://cor.mt.gov, and the Montana Chemical Dependency Center http://dphhs.mt.gov/amdd/mcdc .

This makes it difficult for information to support care transitions and managing population health difficult. The state is evaluating requirements and considering opportunities to transition to a single EHR platform.

Recently, a new alliance of providers and payers in billings began work on a pilot related to the Health Information Exchange. The Governor’s Council is observing the pilot, while the Montana Medical Association and the Montana Hospital Association have established a statewide group of stakeholders to monitor the pilot and build toward expansion to a statewide HIE.

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