Risk Pharmacy Utilization 32 Final Project Miles
Overview: For this assignment, due in Module Three, you will submit your scenario selection and factual overview.
Electronic Medical Records and Quality Improvement
Next, prepare a draft of your factual overview of the scenario. Communicate clearly which scenario you selected. Identify the questions that you will resolve in
your proposal. Be sure to do this from the perspective of the reader and ultimate audience—the executive. Never make your reader guess about the issues you
will address. As you create a factual overview, think about the level of detail necessary to support your entire proposal. You want to aim for sufficient detail as a
foundation for the rest of your final project. At the same time, you do not want to overwhelm the executive. Your overview needs to address background
information as well as key principles to inform your executive’s actions.
Specifically, the following critical elements must be addressed:
II. Factual Overview and Identification
A. Clearly state the questions from the scenario that need to be resolved. B. Identify applicable principles of management theory and population health improvement, and explain why they are applicable to the situation. C. Identify applicable methods for financing, evaluating, and improving healthcare delivery, operations, and facilities that are reasonably or
legitimately raised by the scenario.
D. Discuss healthcare delivery principles and technology relevant to the scenarioo
THE SCENARIO I CHOSE:Electronic Medical Records and Quality Improvement
SCENARIO LISTED BELOW:
Wall County is in the State of Drake. Wall County (the “County”) has a local public health department, Wall County Health Department (the “Department”) that
offers a variety of services, including primary care and outpatient behavioral health services for children and adults. The County serves predominantly uninsured,
Medicaid, and Medicare patients in multiple locations around the County. Wall County is a mix of urban and rural areas. In many communities within the County,
the Department is sole provider of physical and behavioral health services.
The Department receives the bulk of its revenue from providing direct physical and behavioral health services. Some additional revenue flows to the Department
from the County’s general fund and by way of small grant programs to support environmental health and nurse home visiting activities. The Department’s budget
year aligns with the County’s budget year and runs July 1 through June 30. The Department’s largest expenses are provider salaries and operating overhead in
each of the four locations where the Department offers services throughout the County.
Drake’s largest Medicaid managed care and Medicare Advantage insurer (the “Insurer”) has approached the Department about joining the Insurer’s network. The
Department has learned from other entities in the Insurer’s network across the State of Drake that network payment rates typically exceed those rates offered by
other payers. However, the Insurer has a history of decreasing payment rates over time for those network providers that do not manage their populations to
improve health outcomes and decrease emergency department utilization. At this time, the Department has not made a decision about whether to join the
Insurer’s network.
For the past 10 years, the Department has paid a nominal fee to use the statewide electronic medical record (“EMR”) system provided and maintained by the
State Department of Health and Human Services (“DHHS”). The EMR system allows the Department to generate limited reports for its providers, including:
Treatment gap lists and risk
Pharmacy utilization reports
Immunization status reports
The EMR system is the only system used by the Department to create and store medical records. Utilization of the system varies widely by provider and by
location, but in general, utilization of the EMR system is lower among behavioral health providers than among physical health providers. Some Department
locations in the County have trained providers on workflows to navigate the EMR system and other locations have not.
Five days ago, on January 2, DHHS notified the Department that it will cease maintaining the EMR system in the next 120 days. DHHS explained that EMR system
users will be allowed to access the EMR system for up to 12 months after maintenance termination, but no user support or security patches will be available
during that time period. Unfortunately, DHHS has experienced a round of severe budget cuts that have limited its ability to respond to questions about the EMR
system or related service requests; DHHS will not offer any information technology support or technology training for the Department.
You are the director of quality for the department. Your supervisor, the director of public health for the department (with the backing of the Board of County
Commissioners), has directed you to brief her on the issue and recommend a course of action. Specifically, the director of public health has asked you to create a
policy proposal for her review.