How Minnesota Secured Medicaid Funds for Immunization Registry Planning

Minnesota was the first state to have a Planning APD approved by HCFA. This is the story of their experience. Minnesota's Medicaid and immunization programs are in separate state agencies - Medicaid in the Department of Human Services (DHS) and immunizations in the Minnesota Department of Health (MDH) - but there is a history of collaboration between the two, particularly in DHS funding of MDH activities and in various data sharing agreements. Most recently, DHS funded Minnesota's regional immunization registries through the EPSDT program. The 2000 MMIS Conference in Salt Lake City sparked our interest in using HCFA funds to build a statewide registry "hub" to connect our regional registries.

Identifying the Win-Win
The first order was to identify the "win-win" in this collaboration.

• Increase Medicaid immunization rates
• More efficient and timely measurement of immunization rates for children on Medicaid
• Maximize federal financial participation
• "Score points" with legislators for inter-agency collaboration.
• Leverage one another's expertise: DHS's in building and managing large information systems and MDH's in immunizations.
• Leverage Medicaid infrastructure; e.g., provider numbers, user authentication tools, HIPAA compliance.

The Challenges
As in any collaboration, there are inherent challenges:

• Different organizational cultures and perspectives
• Different languages
• Figuring out who's in charge
• County perception of the MMIS system and concerns that the registry hub will become an unresponsive behemoth or always take second place to MMIS needs.
• Figuring our how a new regional registry application will fit into the MMIS - registry hub infrastructure.

The APD as Prelude to Project Planning
Our approach was to focus on those decisions and agreements that were essential to getting the planning APD written:

• Convening a planning team with the right people.
• Securing senior management approval.
• Determining the leadership (who's in charge of what?)
• Mapping out the planning process.
• Clarifying the goals.
• Identifying the funding needs.
• Working in advance and informally with regional HCFA office. So they are prepared for the final APD when it comes through, and there are no surprises.

With those fundamentals in place, we are using HCFA funds to hire a consultant to conduct the needs assessment, facilitate the project definition, propose alternative architectures, and make the final recommendations. This approach basically maximizes HCFA funding as a way to minimize existing state agency staff time.

Machiavelli, in commenting on the challenges of embarking on a new course, said, "There is nothing more difficult to take into hand, more perilous to conduct, or more uncertain in its success, than to take the lead in a new order of things."

The "new order" of HCFA support for public health activities is exciting but not without its "perils." The potential for disagreements and misunderstandings is high, especially if there is little history of working together. And while the lure of federal HCFA funding is high-and money tends to drive programs-we also know a registry's design and operations must derive from its users and from public health for the registry to be effective. The key to successful collaboration is to focus on the project goals and the "win-win" that brought the partners together in the first place.

For more information, contact Bill Brand at bill.brand@health.state.mn.us (Source: Bill Brand, Minnesota Department of Health)

Source: Ayesha Gill, CA SIIS Coordinator.

June 2001 SnapShots Headlines