AHCAHP Medicaid-focused Plans and Commercial Health Plans Find Similar Uses for Information Technology

Washington, DC – November 6, 2003 – A new survey of community health center affiliated health plans serving Medicaid and SCHIP populations shows how these plans use information technology (IT) systems to improve preventive care. The recent Institute of Medicine (IOM) report “Crossing the Quality Chasm: A New Health System for the 21st Century” concluded that IT must play a central role in the redesign of the health care system if substantial improvements in health care quality are to be achieved during the coming decade. Partially in response to the IOM report, the U.S. Centers for Disease Control and Prevention (CDC) funded a series of assessments, including this one, designed to describe the extent to which health plans use IT systems to promote or improve preventive health care services.

The new IT survey was a collaboration of the Alliance of Community Health Plans (ACHP) and the Association for Health Center Affiliated Health Plans (AHCAHP). It surveyed twelve AHCAHP plans, which are owned or affiliated with community health centers and serve primarily Medicaid and SCHIP clients.

“Medicaid and SCHIP focused health plans, such as the members of AHCAHP, are working intently to improve the health of the Medicaid population through preventive health measures.” said Margaret Murray, Executive Director of the Association for Health Center Affiliated Health Plans. “Technology is an increasingly important component of the plans’ methods to improve the health of the Medicaid population.”

“Information technology (IT) is essential to systematic efforts to improve health care,” said Jack Ebeler, President and CEO of ACHP. “This report provides a snap shot of how twelve Medicaid focused health plans are using new technology to support preventive services. It complements the findings of a similar survey of the ten members of ACHP.”

Some of the key findings of the study, “Promoting Disease Prevention in Health Plans: Information Systems & Technology Assessment,” include:

  • All twelve plans that responded to the assessment use IT to support preventive health activities for members.
  • Plans report using IT systems to support numerous preventive health activities, such as utilization management and disease management (e.g. generating preventive health reminders that are sent to members.)
  • Nearly all plans use pharmacy data to trigger or prompt specific actions designed to support the delivery of preventive health services to members (e.g., identification of members for disease management and health promotion programs.)
  • The vast majority of plans integrate claims and/or encounter data with other IT systems to promote preventive services (e. g. nearly all plans use IT data from the pharmacy system to enhance preventive services related to one or more conditions, such as asthma and diabetes.)
  • Although none of the plans can access clinical records from an electronic medical record (EMR) or a provider’s secure data warehouse, plans reported being electronically connected to a variety of provider types.
  • Several plans reported their intentions to increase web-based functionality for members and one of the plans reported that it already uses e-mail to communicate or distribute IT-generated preventive service reminders to members.
  • The types of IT investments that plans intend to make over the next two years are expected to yield improvements in enrollment and eligibility systems, web-based functionality for members, and claims and encounter systems.The study and survey instrument are available on the AHCAHP website at www.ahcahp.org. This study and the prior study of the ACHP plans are on the ACHP website at www.achp.org

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    The Association for Health Center Affiliated Health Plans (AHCAHP) AHCAHP supports managed care plans that are owned by, or affiliated with, community health centers and primarily serve Medicaid and State Children’s Health Insurance Program (SCHIP) populations. Now in its fourth year, AHCAHP currently represents 20 Medicaid and SCHIP focused health plans which collectively account for over 1.5 million beneficiaries, over 25% of all the beneficiaries in Medicaid and SCHIP focused health plans nationally. The AHCAHP mission and purpose is to improve the health of medically underserved populations through the development, survival, promotion and growth of community health center affiliated health plans.

    The Alliance of Community Health Plans (ACHP) Founded in 1984 as The HMO Group, the Alliance of Community Health Plans is a select group of leading health plans and provider organizations that have worked together for nearly 20 years to improve the availability of high quality and affordable health care in the United States. The members are characterized by a commitment to quality and to the communities they serve, and have stronger relationships between the plans and providers than is the case in many other health plans or insurers. None of the members are investor-owned. ACHP’s mission is to promote the highest standards of health care quality and health improvement through collaborative learning, innovation and advocacy. ACHP and its members seek to transform health care so that it is safe, effective, patient-centered, timely, efficient and equitable.