Barriers to Meaningful Use in Medicaid

Providers who serve a high proportion of Medicaid-insured patients may have lower rates of electronic health record (EHR) use. This project looked at factors that might explain this finding, including specific features of the Medicaid Meaningful Use (MU) Incentive Program, and whether the program creates participation barriers for Medicaid providers. In particular, the project team looked at whether the work-environment or characteristics of the Medicaid population itself creates these barriers. It also looked at whether the Medicaid MU Incentive Program combined with available technical assistance is sufficient to mitigate these barriers. The ultimate goal of the project was to develop findings and recommendations to inform policy related to MU among Medicaid providers.

The objectives of this project were to:

• Identify the barriers to eligibility for the incentive payments; barriers to adoption, implementation, or upgrading of EHR systems; and barriers to achieving meaningful use.
• Develop actionable recommendations to overcome barriers identified above, including but not limited to, technical assistance that could be made available to Medicaid providers.
• Provide data to inform the meaningful use objectives being developed by the Centers for Medicare & Medicaid for Stages 2 and 3 of the EHR Incentive Program.

The project conducted seventeen focus groups with 68 Medicaid EHR Incentive Program-eligible professionals. Of the 17 groups, 12 were users of EHRs and five were non-users. Participants were asked about their own experiences with EHRs, including barriers and facilitators of their use. Participants were noted to have differing levels of knowledge about the Medicaid MU program.

The project team found that in general the barriers to adoption and meaningful use of EHRs were similar to other groups, and not unique to those providers serving a primarily Medicaid-insured population. Providers noted that there were few differences between their Medicaid versus private-insured populations, and pointed out that many individuals come on and off Medicaid depending on their employment status. Barriers that were identified were specific to the types of providers who are eligible for the Medicaid MU program but not the Medicare MU program – specifically dentists and pediatricians.

The project team made four recommendations as a result of their research that may be found in their final report Barriers to Meaningful Use in Medicaid: 1) promote a more proactive approach by Medicaid agencies to assist Medicaid providers in achieving MU; 2) provide more targeted, coordinated technical assistance tools, methods, and processes for Stage 1 MU for Medicaid providers; 3) promote planning for the Stage 2 Meaningful Use requirements; and 4) create a short- and long-term research agenda that addresses many of the sociocultural, technical, and training/technical assistance needs of Medicaid providers and other providers who were identified in this study.