Given the above frameworks, the present review was designed to emphasize the initiatives the system has taken to address various efforts of improving quality and patient safety. The Institute of Healthcare Improvement’s Triple Aim focuses on three aspects of care, cost, and health. The Institute of Medicine’s six aims for improvement encapsulates elements of high-quality patient care. Of the many quality management frameworks, Beauchamp and Childress’s four principles of biomedical ethics presents aspects of patient centeredness in clinical care. Patient safety is one of the overarching goals of patient care and quality management. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. As Boughn sees it, it won't be a hard problem to overcome, given the short term focus – it will help define the right modules to direct suppliers and vendors to interface with the big data warehouses.Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The challenge will be getting states and vendors to work together to anticipate the right modular fit for the program. "This is the CMS saying the rules have fundamentally changed and the states need to step up to the plate to get this to work because Medicaid is too important," she said. Medicaid needs to focus on the short term rather than the long term, Boughn said. In fact, CMS is putting that responsibility into the hands of the states to make the definitions for short-term changes. "This final rule is crucial for the CMS' efforts to modernize state eligibility systems to make real-time, accurate eligibility determinations and promote enrollment of eligible low-income people in Medicaid and CHIP," she added.Įffective January 1, the ruling will also no longer approve the "big bang" or wholesale Medicaid Management Information Systems. This is a significant departure from the past, Boughn noted. Each department will establish its own system. The system doesn't need to wholly function for changes to go into effect. But what's most important, Boughn says, is what CMS is accomplishing through its modular system. The 90/10 ruling permanently extends funding of Medicaid's E & E systems. "And CMS feels like Medicaid is really a key driver for what providers need to achieve Triple Aim and they want to support the states in this area," she added. It's not getting us the results that we want," Boughn said. "I feel this regulation is CMS saying, we don't think the way that we've done it in the past is effective. Perhaps one of the biggest changes is retiring outdated systems and transitioning into more modernized technology.Ĭognosante executive and former CMS CIO Julie Boughn, talked to Healthcare IT News about the ruling and its effects on Medicaid and the overall healthcare system. This new funding will implement initiatives, such as automated applications and renewals, efficient claims processing and integrated human services programs. Specifically, federal funding is increased from 50 to 90 percent for new eligibility and enrollment systems and Medicaid Management Information Systems. The ruling is just one of the latest efforts by CMS to support states attempting to modernize and develop more effective Medicaid IT systems. CMS recently passed the 90/10 final rule, extending the 2011 regulation on federal funding for Medicaid Eligibility systems.
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