State government CIOs are focusing on upgrading IT systems to support some 24 million people expected to be using state health insurance exchanges by 2019 as part of the national health care legislation passed by Congress late last year.
A National Association of State Chief Information Officers (NASCIO) study released last month found that CIOs are preparing for new standards and provisions coming under the so-called Patient Protection and Affordable Care Act .
The study, dubbed Profiles of Progress 4: State Health IT Initiatives , is a compendium of activity underway by CIOs in U.S. states and provinces.
By 2019, provisions in the Patient Protection and Affordable Care Act are projected to increase Medicaid enrollment by 16 million people, according to the Congressional Budget Office. Combined with current enrollees, the number of people getting health insurance through state programs is expected to reach 24 million.
"The main concern of CIOs right now seems to be anticipating what's to come," said Chad Grant, a NASCIO policy analyst.
"Their IT infrastructure needs to be prepared for the massive influx of new [Medicaid] recipients," Grant added. "If they're not prepared, it could jam up the system. They need to make sure legacy systems, if outdated, get updated."
Grant said it's encouraging that CIOs are planning to use an "enterprise-wide" approach to link various agencies, and that they are working to find ways to connect future statewide health information exchanges (HIEs) to the larger National Health Information Network currently being developed by the U.S. Department of Health and Human Services.
"Sharing information is one goal," he said. "That's going to save money from not having all that additional overhead."
Over the next four years, provisions under the health care legslation, signed by President Barack Obama in March, will offer incentives to businesses for providing health care benefits and establishing HIEs. The exchanges will allow patient information to be accessed by multiple authorized state agencies, as well as by providers of medical care.
In March, 56 states, eligible territories, and qualified State Designated Entities received more than $547 million in federal money to begin rolling out IT systems that support an expanded Medicaid system.
Last week, the U.S. Department of Health and Human Services released an additional $51 million to the states to help set up HIEs by 2014. The legislation called for establishing HIEs to make it easier for consumers and businesses compare health insurance coverage options.
Under the legislation, states are responsible for increasing connectivity among patient information systems as a way to improve the quality and efficiency of care. The legislation requires that states undertake critical IT projects to ensure collaboration among agencies in creating governance, policy, technical services, business operations and financing mechanisms.
The state IT operations must perform these tasks during a period of likely budget cuts. For example, a survey of state CIOs conducted last spring by Grant Thornton LLP and released earlier this month found that two-thirds expect IT budgets to be cut from 2011 through 2013. About 64% of CIOs surveyed said they believe state IT budgets will shrink, while about 13% expect a budget increase and 23% expect them to remain flat through 2013.
The survey found that some state CIOs are planning to cut personnel, consolidate IT resources and share services with other agencies in order to reduce costs. Over the next three years, most of the survey respondents indicated they plan to increase shared services and managed services.
Many of the CIOs also indicated that they shoulder much of the responsibility for statewide IT governance, yet they don't have an equal share of authority. And, almost three out of five CIOs indicated their states have a formal IT enterprise portfolio management process, but on average give these processes a grade of C for effectiveness.
When it comes to where they will spend their money, half said they plan on investing in cloud computing and one-third said they are already running active or pilot cloud projects. Two-thirds of the CIOs also said state agencies use social media sites such as Twitter and Facebook, and three out of five said they are preparing policies to address the use of social media sites.
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