Some health information exchanges are playing a key role in helping their states with new Medicaid work requirement verification rules. Healthix, a public HIE serving New York City, Long Island and surrounding regions, has been working on a pilot with New York City’s Department of Health and Mental Hygiene to identify those likely to qualify for medical frailty or other exemptions.

Todd Rogow, Healthix CEO, recently appeared on a panel at the Civitas Networks for Health meeting along with HIE leaders from other states, including North Carolina, that are working with their state governments on the Medicaid changes. Some Medicaid members are at risk of losing coverage because of a failure to keep up with the paperwork, not because they're actually ineligible. Healthix notes that under the new rules, states check their own data before asking a beneficiary for documentation, but most states don't have the infrastructure to do that well. Affected beneficiaries are being shifted to six-month renewal cycles, which leaves a much shorter window to verify eligibility.

“North Carolina has been my north star,” Rogow said in a recent interview with Healthcare Innovation. “They work closely with their Medicaid office at the state level. The HIE is actually part of government there, so it's a different setup. They work hand in glove with Medicaid and they had a really good head start on this. Hearing the work they were doing was a call to action. I thought ‘What can I do about this in New York?’”

Rogow explained the potential impact of the new rules in the New York region. Of the 2.3 million adults  in New York City on the Medicaid program, it is estimated that the number of people at risk of losing their coverage because of the new work and community engagement requirements is between 475,000 and 900,000. “That would be a huge hit happening in a very short period of time,” he said.

New York State has the SHIN-NY for interoperability among its HIEs and also with the state Department of Health for treatment use cases. “The Medicaid work requirements are a little bit outside of that realm and haven't been as much of a focus until recently,” Rogow said, “when there has been a lot of concern about what’s going to happen when all these people are uninsured.”

Healthix is doing a pilot with the New York City Department of Health and Mental Hygiene, creating dashboards to identify who's most at risk of losing coverage and who might fall into the exemption categories. “We want to make those lists actionable,” Rogow said. “Through their partnerships in the community, whether it's a health insurance plan or a provider partner, they can reach out to these members and make sure they stay enrolled. We’re going to be creating reports and sending out alerts to the departments within hospitals and provider organizations that do that outreach.”

The state is building an API to help with the eligibility aspect, he explained. The state has access to employment records and some educational data. “They're building that API that I can query from a Healthix standpoint on behalf of our providers,” he said. 

From a clinical workflow perspective, highlighting these individuals is a manual process for provider organizations today, but the volume is going to go way up, he said. “We went to our customers starting in April of this year to ask what they needed,” Rogow said, noting that Healthix is good at automation and at moving data, providing alerts and creating reports. Customers mentioned several things that would be helpful:

• They want Healthix to identify Medicaid members at risk of coverage loss and medically frail populations. 
• They want eligibility and clinical data turned into actionable outreach lists.
• They want Healthix to help determine who would likely qualify for an exemption, so they can reach out to them to get them to go through the paperwork.
• They would like Healthix to enable targeted outreach through diagnosis, demographics, and geographical filters. 

“They want to focus on the patient populations they serve, and then support coverage retention and continuity of care for vulnerable members because those are the ones who may not have the wherewithal to easily fill out paperwork and connect all the dots,” Rogow said. 

“We bring this health-related social needs data into Healthix. We're starting to work with these organizations to do outreach for the medically frail and the work exemption categories,” Rogow said. “How can we identify these Medicaid members based not only on the clinical but the non-clinical data? We share that with a community-based organization or social care network that deals with these people directly, because we don't have that direct relationship. They reach out because they're already coordinating food delivery or other services, and they're in the best position to help navigate them through the process to keep their coverage.”

In a separate announcement focused on the HIE’s role in research, Healthix revealed a partnership with Vitruvia Labs to deploy Vitruvia's secure Research Enclave designed to make Healthix’s extensive longitudinal clinical data more accessible and useful for approved research.

Healthix maintains longitudinal clinical information and transcribed documents representing more than 20 million active patients and thousands of healthcare and community organizations across southern New York. Vitruvia Labs provides their capability for data enrichment, de-identification, tokenization and transformation to the Observational Medical Outcomes Partnership (OMOP) common data model. Patient-level data remains inside the Healthix firewall, with privacy, permissions and audit controls built into the model, the organizations said.