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Electronic files will aid Medicaid

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The state is mobilizing to make an important advance toward delivering more effective, less costly health care through the "health home" approach for people receiving Medicaid — the state-administered health coverage for the poor and other vulnerable populations.

Health policy experts these days often bandy about that term (sometimes called a "patient-centered medical home"), but most of the patients themselves may not know it. The basic idea: A patient in a health home has care that’s coordinated by all of his doctors and other providers, rather than having to bounce from one doctor’s office to the next, sometimes getting duplicate tests.

Coordinated care is clearly good for patients, whose providers will be far better informed, but it also saves taxpayer money by avoiding some of the waste that has crept into the infamously inefficient U.S. health care system. It’s one of the end goals of the federal Affordable Care Act that will take effect more fully in 2014.

Establishing this new delivery system will require far better use of electronic health records, so that patient information can be shared among the doctors. Creating this shared data system is the first step in what will be a long road toward more efficient, effective health care.

The transition will be painful in the short term: Recession-driven budget cuts have compelled the state Department of Human Services to reduce its Medicaid rolls and place its highest priority on the most vulnerable groups among the poor — children, pregnant women, the disabled and elderly. Yesterday, DHS announced some of its service reductions for the immediate future.

But in the long term, electronic health records should garner savings and better service, so state lawmakers acted responsibly by funding the initial investment during the just-completed lawmaking session.

The health care reform act enables improvements by matching every dollar states spend on creating their new electronic systems with $9 in federal money. So the $3 million lawmakers appropriated will draw in $27 million more to help providers who serve Medicaid patients convert their records into a sharable electronic format.

DHS officials hope to have the system in place when health care reform is fully implemented in 2014, and is aiming to have a statewide plan securing a federal match by January. Between now and 2012, there are many questions that will need answering, not the least of them: How will these records be shared without compromising the security of private health information?

It will be a transition of great complexity, but it’s good that Hawaii embarked on the journey as soon as possible. Speaking at a Medicaid briefing yesterday, Gov. Neil Abercrombie described the various aspects of system reform as "an opportunity for transformation." From here, it looks like a daunting proposition, but once the work is done Hawaii should see this as an opportunity, too.

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