NC HIEA Awarded Federal Funding for New Use Cases Supporting Medicaid

NC HIEA Awarded Federal Funding for New Use Cases Supporting Medicaid

Author: Jessica Hagins

The Centers for Medicare and Medicaid Services has approved $20.7 million for the N.C. Health Information Exchange Authority to support three new use cases for NC Medicaid.

The new use cases will leverage the state designated health information exchange, NC HealthConnex as follows:

  1. Digital Quality Measures (dQMs) – Develop the capabilities to calculate a selected set of Medicaid’s high-priority quality measures combining both administrative data (claims and encounters) with clinical information from providers' EHRs to allow for more timely results.
  2. Health-Related Social Needs (HRSN) – Develop the capabilities to share Medicaid members’ responses to HRSN screening questions with other providers, Prepaid Health Plans (PHPs) and NC Medicaid to prevent unnecessary rescreening and facilitate referrals.
  3. Care Management (CM) Data Exchange – Improve the ability to exchange claims/encounter data and care management interaction details between prepaid health plans and local care management entities to facilitate seamless transitions of care.

The goals of the new use cases are to facilitate a number of data exchange services in the care management space with NC Medicaid, its health plans and providers and to assist with the development of dQMs for Medicaid’s high priority conditions, such as high blood pressure and diabetes.

The funds will cover staffing and technical design, development and implementation for the next two federal fiscal years. The total cost will be split with 90 percent ($18.63M) federal funding and 10 percent state funding ($2.07M).

If your organization is interested in being an early participant in our efforts to support digital quality measures or collect standardized health related social needs data, reach out to our business development team at hiea@nc.gov.