The Value of a National
Enrollment Database
Eric A. Flowers, MBA
July 8, 2013
v1.0
Agenda
A Familiar Concept
Benefits of National Database
Historical Concerns and Problems
What is Different Today?
ACA has created opportunities
ADAP – the Logical Starting Point
Ultimate Benefits
Conclusions
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A Familiar Concept
•States sharing a common enrollment platform
•As part of actual Client Enrollment Process
•As a periodic data transfer
•Check for other third party coverage
•Check for enrollment in any other ADAP program
•Aggregation of demographic information that is
searchable utilizing real time data
•Capacity to incorporate drug utilization and cost data
•Creates a rich data warehouse available to all states
that participate
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A Familiar Concept
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A Familiar Concept
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Benefits of a National Database
• Preservation of Payer of Last Resort status
• Eliminate interstate ADAP enrollment
• Data warehousing enables benchmarking
– Cost per client (Direct vs. Rebate or Hybrid)
– Client outcomes (tracking CD4 and Viral load)
– Enhanced cost modeling
• Utilizes current data vs. Prior Year
• Business Continuity and Disaster Recovery
• Expandable Platform
• Multiple means of submitting data
• Defrayed Cost
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Historical Concerns and Problems
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Privacy and Security
Cost
Varied technical capacities amongst States
Varied quality of data amongst States
Lack of consistent support from stakeholders
Numerous competitive efforts at State and
Federal levels
• Leadership?
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What’s Different Today?
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The Affordable Care Act
Accountable Care Organizations (ACO’s)
Concept of Medical Home
More healthcare dollars available
Increased need for Case Management
Improved Technology
– Data Analytics (Big Data)
– Cloud Computing
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ACA Opportunities – ACO’s
• Accountable Care Organizations
– Organizations working together to lower cost and
improve outcomes
– Begins to change the economics of healthcare
– CMS has begun ACO payment reform
– Platform for Evidence Based care
– Chronic conditions require coordination and
success measured over time
– Ideal ACO organizations
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ACA Opportunities – Medical Homes
• Concept of Medical Home
– Term originally coined in 1967 by American
Academy of Pediatrics
– Shares some characteristics of ACO’s
– More loosely defined than ACO’s
– Patient-centric care
– Can work hand in hand with ACO’s
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ACA Opportunities – Medical Homes
The Seven Tenants of Medical Homes
1. Personal Physician
2. Physician Directed Medical Practice
3. Whole Person Orientation
4. Coordinated and Integrated Care
5. Quality and Safety
6. Enhanced Access
7. Payment Reform
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ACA Opportunities – Continued
• Greater Healthcare Dollars Available
– Mostly through Medicaid
– Dramatic increase in number of FQHCs
• Coordination will require case management
• Health Information Technology
– Can help meet growing case management needs
– Interoperability of EMR required for coordinated
care
– Data Analytics aka “Big Data”
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ADAP – The Logical Starting Point
• Potential Short Term Cost Savings
• Source of valuable utilization and payer data
• Utilize national data to promote learning, efficiencies
and better care
• Can Start Lo-Tech/low cost while positioning for the
future
• ADAP’s are the largest cost driver in RWHATMA
• Opportunity to start aligning the RWHATMA with
ACO’s and Medical Homes beyond Part B
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Ultimate Benefits
• ADAPs have the opportunity for a leadership role in
how ACA will impact RWHATMA
• ADAPs have access to the data that can demonstrate
efficacy of ACO’s and Medical Homes from both cost
and quality of care perspectives
• The extensive national network of HIV/AIDS service
providers is an asset that has serviced state
governments and communities
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The Future
Primary Care
Pharmacy Benefits
Individual
Care Plan
ADAPs
Social Services
Case Worker
Mental Health
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Conclusions
• ADAPs should look to future of Healthcare in the US
• Start with and move beyond a national data base
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Integrate utilization data (de-indentified)
Integrate EMR data (de-identified)
Implement comprehensive needs assessment
Develop comprehensive case management tools
Develop benchmarks and metrics for best practices
Let the data and lives saved make the case
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Questions
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