Tag Archive for project

LA County Environmental Health Launches $5.7M Tech Project

Thanks to the Los Angeles Public Health Department’s Environmental Health Division’s newest technology project, field employees from 16 county district offices can now record inspection data on a tablet and provide a printed inspection report in the field, according to a press release. And in the next three months, the remaining 15 district offices will come aboard this mobile system.

Using the EnvisionConnect Software Suite, which includes a mobile inspection app, the Environmental Health Division manages environmental health services such as inspections and permits for retail, food, swimming pools and housing programs, as well as smaller programs that deal with theaters, pet stores and self-service laundry facilities.

One phase of the project involved migrating more than 107,000 facility records and 117,000 permit records into the EnvisionConnect database, and another part of the migration process includes the county’s deployment of 300 tablets to meet its automation goals.

In the near future, the county is set to implement an EnvisionConnect portal to allow the public to submit online complaint forms and other applications. Through the portal, the public will have access to inspection results and closures.

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Lessons from Idaho’s Medicaid Readiness Project

Reaching an eligibility decision on the same day a customer applies for services — not 20 to 30 days later — is more than wishful thinking. It’s a reality in Idaho, where just over 70 percent of SNAP applicants and half of Medicaid applicants get same-day eligibility decisions.This is the story of how Idaho is creating a new model of service delivery. Extending its heritage of family-centered service, the Idaho Department of Health and Welfare is taking a cautious and prepared approach to the Affordable Care Act (ACA) through its Medicaid Readiness Project. The Department sees the law as a springboard to change — streamlined eligibility determination with integrity that delivers lasting human and business value.Implement immediate improvements early and often.Make improvements that have immediate business value and increase business capacity.Implement incremental end-to-end business changes for constant functional validation. Increase decision making at the first point of contact with the customer. Define business changes at the process level.Resolve conflicts in circumstances and verification in every customer interaction.Reduce non-productive tasks and reduce administrative costs.Leverage unprecedented 90-10 federal funding. Use 90-10 funding for core improvements to benefit all programs and services.Facing Ever-Escalating DemandsThe health and human services community has faced significant challenges in recent years. The economic downturn has driven huge increases in caseloads for SNAP, cash assistance and Medicaid programs. Budget cuts and federal oversight only intensify mounting administrative pressures. Idaho has not been immune. In fact, the state saw a 123 percent increase in food stamp caseloads between 2007 and 2010 — the second highest growth rate in the nation.When the ACA was signed into law in 2010, it was introduced into this complex environment. Already overwhelmed, many health and human services practitioners viewed the responsibility of implementing such sweeping change as daunting, if not impossible. While states are taking their own approaches to implementation, confusion is common. What do the new rules mean? How must enabling technologies change? What must be done to accommodate growing Medicaid rolls? For many, questions outnumber answers. Turning an Obstacle into OpportunityThe Idaho Department of Health and Welfare found a pragmatic answer. Working thoughtfully and strategically amid uncertainty over the law’s future, the Department sees the ACA as an opportunity to reinvent eligibility processes and modernize service delivery structures — welcomed outcomes no matter what happens with the ACA. Grappling with the ACA challenges shared by other states, Idaho had an “aha” moment. The Department realized that within the complexity of the law is a fundamental focus on streamlining and modernizing Medicaid eligibility determinations. For example, the ACA provides new paths for verifying household information and making eligibility decisions in real time, which reduces the red tape for both agencies and families, improves same day service, and decreases backlogs and paperwork for staff. What’s more, the ACA improves eligibility determination at both application and redetermination points, which drives integrity in decision making and reduces the number of administrative closures. Focusing on the processes without getting weighed down by the policies, it became clear that these process improvements aligned with the Department’s own modernization agenda. More specifically, there was a common thread with the Department’s commitment to work as a customer-focused, process-driven organization that provides same day service, minimizes churn, maximizes retention, reduces administrative burdens and costs, relieves staff workload and improves timely service to Idaho’s families. A forward-thinking approach was born from this commonality. Why not use the ACA to improve Medicaid eligibility and transform eligibility determination across all programs—extending the work that was already being done?Transforming the Business Model (a critical first step)The first step for Idaho was to clearly define a service delivery model that effectively and accurately delivered decisions and services. Idaho’s “New Service Delivery” model was then coupled with new ACA eligibility stipulations to provide an overarching service delivery design supporting all eligibility programs. The model incorporates fundamental and transformational redesigns, lowers operating costs, and improves program integrity by:• Resolving information and making eligibility decisions on the day of application.• Bringing eligibility decision makers “to the front”—they are the first contact. • Seeking all necessary information to verify a family’s status.• Operating from a customer’s perspective rather than from a program or service perspective. • Providing “informed choice” to help customers understand their application options.• Managing customer volume and traffic to match decision-making resources.• Tracking all case management tasks with auto-alerts only when actions are needed.Taking a Cautious and Prepared ApproachOnce developed, this business model informed decisions around planned ACA technology and system changes, positioning Idaho to leverage available 90-10 federal funding while realizing immediate and incremental wins throughout the life of the project.After reviewing pending rule changes, Idaho designed a three-phase, 23-month project centered on ACA requirements that began in February 2012. This Medicaid Readiness Project is allowing the state to move forward on aspects of the legislation that will provide immediate value while taking a wait-and-see approach to unresolved issues. It is also an example for other states to gain ideas for process changes, technology pursuits and rule interpretation while taking advantage of time-limited federal funding opportunities. The initiative includes the following phases:Modernization. This modernizes eligibility and payments systems in line with ACA requirements for online access, simplified application processes and improved verification systems. Focusing on modernization early can minimize future costs of administering Medicaid to a caseload that could almost double if ACA remains and creates a foundation for sustained capacity and performance improvements. This phase will take a bulk of the time and funding but all functionality will benefit all programs and will be value added improvements to the eligibility process despite pending policy or rule changes.Medicaid Expansion. The Supreme Court gave options to states around the expansion of Medicaid to new eligible populations, Idaho is seriously assessing the costs and benefits associated with this new optional piece of ACA. The expansion phase of Idaho’s Project was purposely placed later in the project to ensure a decision by the Supreme Court could help inform long term decision making at the state level and allow time for all Medicaid requirements and options to be clearly assessed. The timing of this phased approach also allows political and budget questions to be fully vetted to ensure clear support for the Department’s approach to Medicaid expansion.  Connection. Once all decisions related to the first two phases are fully vetted, Idaho will focus on the requirement for Medicaid systems to connect to a health insurance exchange.By taking an opportunistic ACA approach that drives necessary outcomes no matter Idaho’s decision to expand Medicaid or build a state or federal exchange, Idaho is providing eligible, low-income families with service access and continuity to help families find stability and greater self-sufficiency with less administrative burden for all and at a lower administrative cost.Lori Wolf and Greg Kunz are deputy administrators of the Idaho Division of Welfare — Department of Health & Welfare; Debora Morris is the public assistance lead for Accenture’s Human Services Group for North America.This article was published previously in Policy & Practice, the journal of the American Public Human Service Association.

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Mining data for state CDC, Maine HIE pilot project aims for population analysis

The Maine HealthInfoNet is aggregating and analyzing health information exchange data at the population level, with the aim of finding trends and specific figures that currently evade most tools of epidemiology.

In a pilot project funded by the Centers for Disease Control and Prevention, HealthInfoNet, Maine’s statewide HIE, is collecting and assembling data for the Maine CDC, using the open source software popHealth. The project focuses on 13 Meaningful Use clinical quality measures using the ABCDS — aspirin therapy, blood pressure, cholesterol and diabetes control and smoking cessation.

It should let public health researchers find out, for instance, what percentage of Mainers with diabetes have sugar levels under control and what percentage of hypertension patients had their blood pressure checked during their last medical visit.

[Related: CDC to use Direct protocol for health safety network.]

These and other public health measurements, at least of large populations, have eluded researchers for a while, said Stephen Sears, MD, Maine’s state epidemiologist.

“If you want to know how many diabetics within a database there are within a certain age group,” Sear said, “that’s almost impossible to get right now unless you have a data set like the Maine HealthInfoNet registry.” Plus, you need the technology to sift through it all while staying HIPAA compliant.

Sears is cautiously optimistic that they’ll be able to find all of what they’re looking for in the various clinical areas. “What I’ve seen is that it suggests that for certain parameters it looks like its going to be able to work.”

The data basically runs from HealthInfoNet and its vendor, Agilex, to popHealth and then to the Maine CDC. The U.S. CDC’s role is mostly funding and support, through its program Demonstrating the Preventative Care Value of Health Information Exchanges.

The project and a lot of data collection started a little less than a year ago. Now HealthInfoNet and the Maine CDC are essentially testing their capabilities.

[See also: A look at how Maine’s HealthInfoNet is turning grant money into actionable outcomes data.]

“For every person, each month we’re producing different measures for people based on conditions,” said HealthInfoNet CEO Devore Culver. They’re able to make comparisons like how many diabetics who’ve had a hemoglobin lab test scored under 9, an indication of diabetes control.

“The state CDC expends a significant amount of energy and effort trying to gather and compile data that allows them to draw conclusion about trends of health in Maine,” Culver said. “Up until now, it’s been a fairly manual-intense process and the data is not always clear.”

Culver noted that the project is first of its kind and could be a boon to the Maine health department and CDC.

“It’s really a first foray into whether you can repurpose information, not violate patients privacy or expose providers, and use it for something of value and see how health is progressing in the state,” Culver said. “This is a very low cost, with a lot of value.”

If Maine can prove the analysis works, the goal is to eventually take the model to other states, said Dr. Taha Kass-Hout, Director of CDC’s Division of Informatics Solutions and Operations.

[Feature: A new age of biosurveillance is upon us.]

“We’re building a way for state health departments to use the data that’s circulating around their state health information systems,” Kass-Hout said. “The whole goal here for us is to be able to create shared services and platform for local and state health department to use this data.”

First, though, HIE organizations need to be able to meet certain technology and policy criteria that lets them navigate potentially rough waters, he said. HIPAA compliance is a major challenge, as is maintaining providers’ privacy.

“Maine Health InfoNet has the right governance, the right policies and it’s independent, non-for-profit — free of much political or industry influence,” Kass-Hout said.

The pilot project runs until the end of the year. Kass-Hout wouldn’t say if the CDC will renew funding for another year.

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