Tuesday, September 4, 2012

Alabama's Medicaid News

The Alabama Medicaid Agency intends to release a Request for Proposal (RFP) in the near future seeking healthcare consulting services. In the meantime, the State Medicaid Agency on August 15, 2012, released a Request for Information (RFI) seeking ideas on what needs to be included in the future RFP. The response to this RFI needs to describe specific suggestions to be included in the scope of work in the future RFP such as:

·        The economic impact of the possible Medicaid expansion options under the amended provisions of ACA
·        The way to handle the influx of several hundreds of thousands of newly eligible individuals
·        The internal organizational structure for operating Alabama’s Medicaid Agency
·        The current revenue streams and financing mode of the Medicaid agency and recommend alternative models.

Go to www.medicaid.alabama.gov/content/2.0_newsroom/2.4_Procurement.aspx to view the RFI due September 14, 2012. For more information, email Kathy Hall at Kathy.hall@medicaid.alabama.gov.

Alabama’s HIE called One Health Record® when fully implemented will offer interoperable sharing of data for providers who have federally-certified EHR systems. However, providers are able to take advantage of a messaging tool within One Health Record called “Direct”.

“Secure messaging via the One Health Record web portal will help providers who want to enjoy some of the benefits of HIE but are not yet in a position to adopt and use a certified EHR system,” according to Gary Parker Project Director for the HIE.

The Direct messaging system was first available last February and has more than 400 enrolled providers. Parker is now coordinating an effort to link four community hospitals and the University of Alabama at Birmingham though Direct.

“Direct messaging offers a significant advantage for the mental health community, even though mental health professionals are not eligible for the federal incentive program”, said Parker. “Most mental health centers cannot afford to upgrade their computer systems. With direct messaging, case managers can log in, pull up the patient’s information, see what prescriptions have been filled, and determine if the person has been to the doctor or the emergency room”.

Alabama Medicaid’s “Patient Care Network” program has been in place for one year, performing well, and has saved money for the state. The Care Networks are set up to function as medical neighborhoods where doctors, pharmacists, and others work together to coordinate care. The networks have been particularly effective in controlling emergency room use resulting in a 15 percent decrease from July 2011 to January 2012.  

Kim Eason, Executive Director of the Care Network of East Alabama attributes the program’s first year successes to strong relationships built between primary care providers and case managers.

The East Alabama program is one of three pilot sites started during the past year that has successfully reduced costs to the state while improving the quality of care. The three network areas serve 80,000 Medicaid recipients through the Patient 1st program.

Care Network of East Alabama now plans to expand during their second year by strengthening their relationship between primary health providers, local mental health agencies, and substance abuse providers. A full time pharmacist has also been hired to assist physicians and community pharmacists with medication issues for patients. 

In addition, MedNet of Tuscaloosa was selected to pilot test a six county network in West Alabama and another pilot program was established in North Alabama. Plus a fourth pilot program, the Gulf Coast Patient Care Network covering Mobile and Washington Counties was launched in July.