Program summary
The Health Information Exchange (HIE) Onboarding Program supports the initial costs of connecting (onboarding) priority Medicaid providers to a community-based HIE that provides meaningful HIE opportunities and plays a vital role for Medicaid in that community. The Program launched in January 2019.
Why it’s needed
Currently, there are many forms of health information exchange in Oregon. However, significant gaps in HIE coverage remain, and those gaps make it more difficult for critical Medicaid providers to provide efficient, patient-centered, coordinated care. Community-based HIEs can help meet critical Medicaid providers’ HIE needs through a wide range of HIE services that support referrals, coordination of care, and transitions of care.
What the program will do
- Support Community-Based HIEs
- At a minimum, provide core HIE services: community health record and/or results delivery
- Open to priority Medicaid providers regardless of ownership affiliation or EHR used
- Support a portion of HIE-side costs for certain onboarding priority Medicaid providers
- Require HIEs to make a meaningful financial contribution to provider-side costs for providers that face barriers (in-kind or otherwise)
- Support a variety of Medicaid provider types (phased)
- Leverage existing infrastructure
- Support a network of networks
What the program will not do
- Support entities that are not Community-Based HIEs
- Will not support HIEs that do not provide core services
- Will not support HIEs that require a particular ownership affiliation to qualify for participation
- Will not support EHR-based solutions that require providers to use a single EHR vendor in order to participate in exchange
- Provide funding directly to providers, clinics, hospitals, or health systems
- Establish a state-run HIE
- Establish new HIEs
- Support the ongoing costs of HIEs after onboarding is complete, operational costs, or purchase EHRs
Phase I priority Medicaid providers
The program will support onboarding of critical Medicaid providers designated as “priority.” Phase 1 of the Program will focus on supporting integrated care: behavioral health, oral health, and physical health (see table below). Phase 1 will also include MajorTrading Partners. Onboarding Major Trading Partners early will help create the value proposition for other Priority Medicaid Providers.
Phase I Priority Providers
Behavioral health: Community Mental Health Programs, Certified Community Behavioral Health Centers, behavioral health homes, Assertive Community Treatment (ACT) teams, mobile crisis teams, and other Behavioral Health programs licensed by the state of Oregon.
Oral health: Clinics and providers serving Medicaid members, including those contracted with managed care entities and those serving fee for service (i.e., open card) population.
Critical physical health: Medicaid providers who participate in: Patient-Centered Primary Care Homes (PCPCH), Federally Qualified Health Centers (FQHC) (incl. FQHCs using alternative payment models (APMs)), Rural Health Centers (RHCs), Comprehensive Primary Care Plus (CPC+) tribal health, equity-focused clinics, county corrections health.
Major trading partners in behavioral, oral, and critical physical health: Major trading partners, including those at interstate borders, and espcially those that affect the value of HIE for smaller and rural/frontier providers. This includes hospitals, health systems, independent commercial laboratories, and major multi-specialty clinics.
The roadmap for later phases includes long term services and supports, social services, and other critical Medicaid providers as priorities. Funding The Program will be funded under the Health Information Technology for Economic and Clinical Health (HITECH) Act through the Centers of Medicare & Medicaid Services at 90% Medicaid federal funds and 10% state funds.
HITECH funds may be used to support HIE onboarding of providers and hospitals eligible for federal electronic health record (EHR) incentive payments (“eligible providers”) and those Medicaid providers who are not eligible providers (including behavioral health, long term care, corrections, etc.). Onboarding must connect the new Medicaid provider, with or without an EHR, to an eligible provider and help that eligible provider meet meaningful use.
Stakeholder and Tribal Engagement
The program was developed after extensive engagement with a wide variety of internal and external stakeholders. This included OHA stakeholder groups, like the Health Information Technology (HIT) Oversight Council, the HIT Advisory Group (with Medicaid Coordinated Care Organization representatives), and the HIT/HIE Community and Organizational Panel. OHA also formed a short-term advisory group composed of stakeholders across the state. OHA met individually with stakeholders from corrections, long-term services and supports, behavioral health, social services, frontier providers, supported housing, and others. OHA interviewed eight states with similar programs about best practices. Finally, OHA received helpful information through a request for information open to organizations operating an HIE in Oregon. OHA will continue to engage with stakeholders throughout the program.
For more information, please contact Kristin Bork at kristin.m.bork@dhsoha.state.or.us.