March 29, 2012

1. Improving Health Outcomes for Children in Foster Care: the Role of Electronic Information Exchange March 29, 2012

2. Overview • Need for improved information sharing in the provision of health care services to children in foster care • How electronic information exchange (EIE) can be used to improve health outcomes • Strategies for developing EIE for children in foster care • Ventura County Foster Health Link: an EIE demonstration project

3. About The Children’s Partnership (TCP) • TCP is a national nonprofit, nonpartisan child advocacy organization with offices in California and Washington, DC • Mission is to ensure that all children grow up to lead healthy and lead productive lives • Expertise in research, analysis and policy development to benefit all children, especially the underserved • Expertise includes

4. About TCP (cont’d) • Primary focus has been on securing health coverage for uninsured children and expanding access to technology to underserved children • TCP’s e-health work includes development of Express Lane eligibility and enrollment system, telehealth, electronic record systems, and now, foster care coordination

5. Health Care Challenges Facing Children in Foster Care • Large number of children in care • Poor health status and significant unmet health care needs • Greater utilization of services and disproportionately high health care expenditures • Fragmented care and poor health outcomes

6. Factors Contributing to Inadequate Health Care and Poor Outcomes • Placement instability and variability • Resource and staff limitations in child welfare services • Lack of coordination and information sharing between service providers

7. Electronic Information Exchange (EIE): The Means to a Solution • EIE can support information sharing and address coordination gaps • EIE can support provider practice changes, especially through the use of electronic health records • EIE can help assess the changing health status and needs of a population

8. Why Development of EIE for Children in Foster Care Should be a Priority • Gives providers access to more comprehensive information about a child • Facilitates communication between providers for purposes of coordinating care and delivery of services • Provides youth with a record of health conditions and services received as they prepare for permanency or emancipation

9. Basic Elements of EIE for Children in Foster Care • Data Included • Basic health information including allergies, immunizations, diagnoses, and provider contact information • Medical service claims, pharmacy claims, lab data • Access • Medical providers, child welfare workers, foster parents and foster youth

10. Basic Elements of EIE for Children in Foster Care (cont’d) • Additional Functions • Reminders about a child’s needs, warnings of gaps in care or medication interactions • Potential for Expansion • EIE can be expanded to include other responsible entities such as schools and courts, with appropriate safeguards

11. Early Evidence Supports Use of EIE for Children in Foster Care • Improved Health Outcomes • Better preventive care • Decreased hospital stays • Improved clinical conditions • Cost Savings • Decrease in expensive avoidable illness and hospital stays • Reduction in pharmacy costs

12. Strategies for Developing EIE for Children in Foster Care • Identify public and private funding • Medicaid, including Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), Medicaid Management Information Systems, and standard Medicaid administrative match • HITECH, including Innovation Grants • State and county sources • Private funding, primarily foundation grants

13. Strategies for Developing EIE for Children in Foster Care (cont’d) • Identify and develop stakeholders and strong leadership • Development process may be long and require complex negotiations • Involve stakeholders, including foster parents and youth, early in the process • Programmatic champions from state and local government help drive the process

14. Strategies for Developing EIE for Children in Foster Care (cont’d) • Address privacy and confidentiality concerns early and often • Laws are complex and there are unique and varied privacy concerns for children in foster care • Key considerations: • Who controls information into and out from EIE? • Who has access to information contained in the EIE? • What role do foster parents and youth play in contributing to and controlling information in the EIE?

15. Strategies for Developing EIE for Children in Foster Care (cont’d) • Scope EIE Project Appropriately • Important to balance need for including enough information to improve outcomes with need to avoid including so much information the system becomes unwieldy • Select an EIE architecture that allows a narrow approach at first and broadening of scope over time

16. Strategies for Developing EIE for Children in Foster Care (cont’d) • Discuss evaluation and sustainability early in EIE development • Important to build key evidence base to demonstrate improved outcomes and cost savings as soon as possible • Long-term sustainability depends on: • Secure funding • Engaged leadership and stakeholders • Clear privacy and confidentiality protections • Demonstrated improved outcomes and cost savings

17. Ventura County Foster Health Link (VCFHL): an EIE Demonstration Project • Why Ventura County? • Manageable size—population of about 825,000 (2010) with about 800 children in foster care • County-operated system of hospitals and clinics—ease of implementation • Strong leadership in both county human services and health care agencies

18. VCFHL Project (cont’d) • Primary Goals: • Connect health and child welfare information for all children in foster care • Leverage existing technology • Provide appropriate access to real-time information

19. VCFHL Project (cont’d) • Key Components • Master Person Index • Record Locator Service • “Youth-facing” Portal • Interface with state CWS and health databases

20. VCFHL Project (cont’d) • Current Status and Next Steps: • Partnering with State for $1 million federal Medicaid HIE funding; submission of IAPD-U • Nonfederal $100,000 match in place—county funds and foundation grants • Governance structure for EIE developed; developing MOUs and contracts • Once federal funding received, 22-month project timeline

21. For more information • TCP Website: • www.childrenspartnership.org • Contact me: • Ginny Puddefoot, Director HIT Initiatives for Vulnerable Children The Children’s Partnership 916-572-7340 gpuddefoot@childrenspartnership.org