Health Information Exchange Should Extend Past Meaningful Use

The efficient sharing of medical data is key to improving patient care across the country, which is why the federal government has pushed forward the development of the state health information exchange (HIE). Ever since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009, the healthcare industry has been adopting certified EHR technology and attempting to improve connectivity among healthcare IT systems as well as develop effective medical data exchange.

To learn more about the progress of health information exchange developments, the Office of the National Coordinator for Health IT (ONC) has worked with NORC at the University of Chicago to evaluate the program over a handful of years.

In a finalized report called “Provider Experiences with HIE: Key Findings from a Six-State Review,” a summary of healthcare provider interviews detail the priorities and needs of the medical industry, case studies of health information exchange systems, and the challenges overcome during HIE program development.

Between March and May of 2014, the organization conducted site visits as well as general provider interviews and discussions throughout six states, which included Iowa, Mississippi, New Hampshire, Utah, Vermont, and Wyoming. The discussions revolved around viewpoints on state health information exchange programs as well as general attitudes toward medical data exchange.

A wide variety of medical facilities were visited such as long-term care centers, hospital associations, critical access hospitals, and physician organizations. Several key findings were uncovered. For example, HIE needs go beyond meeting meaningful use regulations or system connectivity. Providers now needs HIE systems to proffer important clinical data at the point of care to enhance the delivery of medical services along with care coordination.

“Meaningful use and payment reform are creating new requirements for health IT-enabled information sharing related to care coordination and management as well as new models for patient care,” the report stated. “Providers anticipate a growing need for vendor provided HIE services and infrastructure as expectations for electronic exchange of health information increase under this shift.”

The provider interviews also found that healthcare professionals encountered a variety of obstacles when it comes to advancing health information exchange at their facility. These challenges include competing priorities, difficulty managing the revenue cycle, lack of training or experienced staff, and insufficient support from their EHR or HIE vendors.

Some positive findings from the discussions revolve around the bringing of awareness for state health information exchange programs and the benefits of data sharing. Essentially, providers see the need for health information exchange. While the EHR Incentive Programs may not have targeted long-term care and behavioral health facilities, state HIE programs did further involve the participation of these providers.

“Awareness of and demand for HIE has been steadily increasing throughout the life of the program,” the report concluded. “Providers we spoke with in previous and current activities reported an appreciation for the State HIE Program’s role in communicating with providers of all types, bringing together stakeholders, and communicating the value of HIE. Now that HIE is better established—both in terms of visibility and available services—providers have identified new priorities and challenges. These have evolved from early issues surrounding basic implementation and awareness of the benefits of HIE into a search for solutions to meet greater demand for information, while balancing cost and multiple information exchange priorities.”

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Healthcare CIOs Discuss Top Healthcare IT Optimization Strategies

MINNEAPOLIS and CHICAGO, June 22, 2015 /PRNewswire/ – This past April, thirteen leading healthcare CIOs convened at the annual Scottsdale Institute CIO Summit to discuss the optimization challenges their health systems are facing and the strategies needed to maximize the success of optimization projects. The Summit was hosted by Scottsdale Institute, a not-for-profit membership organization of health systems advanced in IT, supported by Impact Advisors, a healthcare IT consultancy and moderated by Dr.Tonya Edwards, Physician Advisor at Impact Advisors. The group identified and focused the conversation on organizational drivers for optimization which include eliminating waste, improving efficiency, improving user and customer satisfaction, and improving the operational bottom line. The CIOs in attendance included:

• Mark Barner – Ascension; Advisor Panel, Scottsdale Institute
• Dave Bensema, MD – Baptist Health Kentucky; Advisor Panel, Scottsdale Institute
• John Delano – INTEGRIS Health; Advisor Panel, Scottsdale Institute
• Robert Eardley – Houston Methodist; Advisor Panel, Scottsdale Institute
• Jon Manis – Sutter Health; Advisor Panel, Scottsdale Institute
• Lee Marley – Presbyterian Healthcare Services
• Patrick O’Hare – Spectrum Health; Advisor Panel, Scottsdale Institute
• Marcus Shipley – Trinity Health; Advisor Panel, Scottsdale Institute
• Bruce Smith – Advocate Health Care; Board Member, Scottsdale Institute
• Alan Soderblom – Adventist Health; Advisor Panel, Scottsdale Institute
• Bill Spooner – Sharp (retired); Advisor Panel, Scottsdale Institute
• Richard Shirey – Hartford HealthCare
• Jim Veline – Avera Health; Advisor Panel, Scottsdale Institute

The report from the CIO Summit suggests seven key takeaways that CIOs need to consider and execute in order to maintain a successful optimization strategy within their health system. A copy of the report, “Optimizing Healthcare IT: Challenges and Strategies for Success” is downloadable for free at http://ift.tt/1Cqou6H and at http://ift.tt/UDZIv2.

“Recognizing the challenges that health systems face related to optimization is a critical step to organizational success,” said Shelli Williamson, Executive Director of the Scottsdale Institute. “The CIOs who participated in the Scottsdale Institute Spring CIO Summit are leaders in the industry and their expertise is insightful as they describe these strategies for optimizing organizational performance and IT’s critical role in supporting this.”

“Healthcare CIOs continue to have a challenging role as it relates to optimization,” said Andy Smith, President of Impact Advisors. “As the healthcare industry shifts from a strong focus on implementation to the need for optimized systems, best practices and key takeaways paired with flexible and agile executives will be extremely important to the success of healthcare organizations.”

About Scottsdale Institute
The Scottsdale Institute (SI) is a not-for-profit membership organization of prominent healthcare systems whose goal is to support its members on their journey to clinical integration through information technology. SI facilitates knowledge sharing and collaboration among an exclusive group of senior executives as well as among their teams across the enterprise. We provide intimate and informal forums that accomplish this goal through collaboration, education & networking. For more information visitwww.scottsdaleinstitute.org.

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HSE launches new workplace health expert committee

HSE has appointed a new committee to provide independent expert knowledge and advice on workplace health.

The workplace health expert committee (WHEC) will be made up of nine members who will provide expert opinion on emerging issues and trends, new evidence relating to existing issues and, on the quality and relevance of the evidence base on workplace health issues.

Working under the leadership of an independent expert Chair, the WHEC will provide scientific and medical advice to HSE’s Chief Scientific Advisor and Director of Research Professor Andrew Curran and to HSE’s Board.

The committee will encourage collaborative working with stakeholders and partners whilst helping to identify issues of potential concern to Government Departments and business.

In particular, the WHEC will focus on chemical and physical hazards and human behavioural or organisational factors in the workplace (such as shift work) that could lead to physiological and psychosocial ill health. It will not focus on wellbeing, sickness absence management or rehabilitation as these issues are dealt with elsewhere in government. The committee will not consider individual cases of ill health or disease.

Professor Andrew Curran said: “I’m very pleased to have secured such a world-class team of experts in workplace health issues which will supplement our own in-house expertise in this area.

“Our statistics show that around 13,000 people die each year from occupational lung disease and cancer as a consequence of past workplace exposures, primarily to chemicals and dusts. In addition, an estimated 1.2 million people who worked in 2013/14 were suffering from an illness they believed was caused or made worse by work, of which 535,000 were new cases which started in the year.

“I look forward to working with the Committee to help us develop new strategies to reduce these and other causes of workplace ill-health”.

Chair of the committee, Professor Sir Anthony Newman Taylor said: “I am delighted to chair this important new HSE committee.

“Policy for health and safety needs to be informed by the best contemporary scientific evidence. It is our role to provide HSE with robust evaluation of emerging evidence of new hazards and new evidence of well recognised hazards. I greatly look forward to working with this distinguished panel of experts to achieve this.”

Notes to Editors:

1. The Health and Safety Executive is Britain’s national regulator for workplace health and safety. It aims to reduce work-related death, injury and ill health. It does so through research, information and advice, promoting training, new or revised regulations and codes of practice, and working with local authority partners by inspection, investigation and enforcement. hse.gov.uk
2. The Committee membership is as follows:

Chair – Professor Sir Anthony Newman-Taylor

Sir Anthony Newman Taylor is the President’s Envoy for Health and Director of Research and Development in National Heart and Lung Institute, Imperial College. Professor Newman Taylor is Professor of Occupational and Environmental Medicine in Imperial College and a Non-Executive Director of Imperial College Healthcare NHS Trust.

He was previously Head of the National Heart and Lung Institute and held the roles of Medical Director, Director of Research and Deputy Chief Executive within the Royal Brompton Hospital. He has worked as an advisor to government bodies in Greece, Spain and India in his specialist field of occupational causes of lung disease.

His research interests have included the occupational and environmental causes of respiratory disease, the determinants of childhood allergy and asthma and immunogenetic-environmental interactions in occupational asthma.  He is the author of chapters in many medical textbooks, including the Oxford Textbook of Medicine and Hunter’s Textbook of Occupational Diseases.

Members – Professor Tar-Ching Aw

Professor Aw was interim Dean of the College of Medicine and is currently Director of the Institute of Public Health at United Arab Emirates University. He has previously worked at the University of Kent in Canterbury where he was Professor of Occupational Medicine, as senior lecturer at the Institute of Occupational Health in Birmingham, and at US CDC as an Epidemic Intelligence Service (EIS) Officer.

Professor Peter Buckle

Professor Peter Buckle is currently a Research Professor at the Royal College of Art within the Helen Hamlyn Centre for Design. He is also Director of the Robens Institute. He holds visiting professorial positions at three leading UK universities (Imperial College, London; University of Nottingham; University of Leeds.) He is a Fellow and a past-president of the Chartered Institute of Ergonomics and Human Factors (CIEHF). His specific areas of expertise are in optimising the performance and quality of the work system whilst simultaneously minimising errors and health risks to the work force such as accidents, musculoskeletal disorders and stress.

Professor John Cherrie

Professor John Cherrie is Professor of Human Health at Heriot Watt University and Principal Scientist at the Institute of Occupational Medicine (IOM) in Edinburgh. He has been involved in a wide range of research relating to human exposure science and occupational epidemiology, particularly related to cancer. He is a Fellow of the Faculty of Occupational Hygiene and a former President of the British Occupational Hygiene Society.

Professor Paul Cullinan

Professor Paul Cullinan is Professor in Occupational and Environmental Respiratory Disease, Department of Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute (Imperial College), London. He is also an Honorary Consultant in Respiratory Medicine at the Royal Brompton Hospital, London. He is a member of the Industrial Injuries Advisory Council, and is also Deputy Editor of ‘Thorax’. His academic interests include the epidemiology of occupational lung diseases; in particular of occupational asthma; and also other environmental determinants of lung disease.

Emma Donaldson-Feilder

Emma Donaldson-Feilder is an Occupational Psychologist who specialises in working with organisations to achieve sustainable business performance through improvements in employee health, wellbeing and engagement. Emma is Director and Co-Founder of Affinity Health at Work, a specialist consultancy and research group.

Professor Len Levy

Professor Len Levy is currently Emeritus Professor of Environmental Health within the Institute of Environment and Health at the University of Cranfield, UK. Previously (up till October 2005) he was Head of Toxicology and Risk Assessment at the UK Medical Research Council’s – Institute for Environment and Health based at the University of Leicester. Len is an internationally well-known occupational and environmental toxicologist and risk assessor and holds a doctorate in experimental pathology from the Institute of Cancer Research, London.

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Patients are not commodities; neither is their personal health information

Physicians’ first priority is patient care. They’ve taken an oath to do no harm. But the current electronic health record environment puts patients at risk because vital health information may not be available at the point of care when health information technology systems fail to communicate with one another.

When doctors across town must consult one another, their electronic health records should communicate with each other immediately as well. That virtually instant transmission of information is–after all–one the most important functions for a seamless health care system if we’re going to ensure that each patient gets the right care at the right time in the right place.But in today’s health care environment, effective EHR interaction doesn’t dependably happen–much to the detriment of high-quality patient care. Subspecialists seeing patients for the first time need to know about their medical histories, allergies, medications and multiple other health issues. Primary care physicians must have records of subspecialist- or hospital-ordered tests and procedures to ensure continuous, coordinated care and to avoid duplicative and unnecessary testing and treatment. Without reliable communication, already-completed medical tests are repeated, patients receive prescriptions that adversely interact with medicine they’re currently taking, risks for complications rise, and costs go up for the patient and the health care system.

“To make informed health care decisions, providers and individuals must have timely access to information in a form that is usable,” the U.S. Department of Health and Human Services Office of the National Coordinator (ONC) for Health IT says in its recent Report on Health Information Blocking. “When health information is unavailable, decisions can be impaired–and so too the safety, quality, and effectiveness of care provided to patients.”

Where are the roadblocks? Many vendors provide EHR software that operates differently from their competitors. They use their own platforms, and their applications don’t easily communicate with other products. Virtually none will accept, download and integrate the health record from a competitor’s software. Important and often time-sensitive communication among health professionals lags while the physician prints a patient’s records and faxes, emails or hand-delivers them to the hospital or other health team member, who often must manually type important data into their own independent EHR system.

Perhaps, one wonders, whether fax machines and paper records aren’t equally efficient.

Worse, market competition–where information is power–creates business incentives for both vendors and health institutions to block the legitimate exchange of health information, according to ONC’s report.

The ONC report outlines actions that limit physicians’ ability to coordinate care. Among them: setting contract terms that restrict physicians’ access to their own EHR data; charging high prices for each request to send or receive a medical record or to download an interface with an outside health professional; and developing software that locks physicians in to the vendor’s system.

Equally obstructive are hospital or health systems that block information “to control referrals and enhance their market dominance,” the ONC report notes. For example, despite the privacy rules’ specific permission for exchanging protected health information for treatment decisions, institutional health providers cite privacy as a reason to refuse providing that information.

Health records should not be held hostage to the business interests of EHR manufacturers or health systems.

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Health insurance companies look to consolidate and boost leverage

Rumors have been swirling for the past few weeks: Some of the nation’s largest health insurance giants are looking to buy their rivals.

No deals have been announced, but many analysts and policy experts agree that there likely will be fewer companies offering health insurance in the not-too-distant future. But is less competition a bad thing? It depends on whom you ask.

Among the possible combinations: On Saturday, Anthem, the nation’s second largest insurer, said it made a $46 billion bid for Cigna, but that a deal was being held up in part over what role Cigna CEO Cigna CEO David Cordani would have in a merged company. Also late Saturday, the Wall Street Journal reported that Aetna, the nation’s third largest health insurer, had made a bid for Humana, though details were not provided and neither company confirmed the offer. Reports earlier last week also said UnitedHealth Group, the nation’s largest health insurer, was eyeing a possible combination with one of its rivals.

Whichever way the deals are struck, it could have a significant impact on the health care industry, especially on the market in Missouri. The St. Louis region could see the number of health insurers reduce by half.

But some experts say that isn’t necessarily a bad thing. They argue that larger insurance companies would be able to drive harder bargains with hospitals and other medical providers, leading to lower costs for patients.

The merger rumors among health insurers are merely the latest sign of a dramatically changing health care landscape since the passage of the Affordable Care Act.

Hospital systems are growing larger through mergers, acquisitions and affiliations as they look to boost their footprints. Pharmaceutical companies are consolidating. States are increasingly looking to the private sector to provide health care to vulnerable populations. Clayton-based Centene Corp. has been at the forefront of this effort, and it too has been identified as a prime acquisition target by analysts.

Now the other large nationwide health insurers, also having had their business model radically overhauled by the federal health law, are looking to get in on the action.

“What’s fueling this consolidation is a more pressured operating environment because of (Affordable Care Act) mandates and greater competition,” Vishnu Lekraj, a Morningstar analyst who covers UnitedHealthcare.

Anthem, UnitedHealth, Aetna and Cigna combined for about three-quarters of Missouri’s entire comprehensive health insurance market last year, according to statistics from the state insurance department.

Consolidation among already dominant players in a market would normally draw raised eyebrows. But it’s a more nuanced story when it comes to health care.

“Less competition generally means higher prices, but in health care it’s more complicated,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation.

Health care has long belied traditional market forces and increased government regulation under the Affordable Care Act has made it even more complicated. Because of this, Levitt says consumers could see a benefit from the mergers.

He points to a government safeguard called the medical loss ratio as an example. The ratio forces insurance companies to spend a certain percentage of consumer premiums on medical claims. If a company doesn’t meet that threshold, it must refund their customers a certain amount.

Levitt also said that the insurance mergers could lead to more expansive provider networks, a recent consumer complaint.

“I think consumers care a lot more about choice of doctors and hospitals than they do insurers,” Levitt said.

Some analysts also say that larger insurers have the ability to influence lower pricing, making care cheaper for consumers.

“The bigger you are the better off you are as an insurer,” Morningstar’s Lekraj said. He characterized the potential deal as a “net benefit” for consumers.

Larger insurance companies can have more bargaining leverage with hospitals and other medical providers. If insurers can spend less on medical care through lower prices, then they may not need to charge consumers as high of premiums.

“The more power they have in dictating prices to hospitals … that should eventually lead to lower growth in premiums longer term,” Lekraj said.

Consumer advocates agreed when asked about the possible mergers.

“As consumers, we hope that insurance companies are going to negotiate for us and negotiate lower prices that lead to lower premiums and lower overall health care costs,” said Brian Colby, policy analyst at the Missouri Health Advocacy Alliance, a consumer group.

But others see the situation differently, pointing to general economic rules.

Leemore Dafny, health economist and professor at Northwestern’s Kellogg School of Management, asks, “If you have less competition, why would you decrease prices?”

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Health insurance on the line

After countless hours of courtroom argument, dozens of briefs, and seemingly endless legal maneuvering, the fate of President Obama’s Affordable Care Act comes down to the meaning of six simple words.

On June 28, 2012, when the U.S. Supreme Court first narrowly upheld the law, it seemed the bitter struggle over Obama’s huge expansion of federally funded health care had come to an end.

But the calm was short-lived.

Within a few months, conservative legal theorists seized on a little-noticed sentence in the law that seemed to limit federal assistance for consumers to buy health insurance purchased on state-established exchanges, or marketplaces. People in states that declined to set up their own exchanges, and instead bought insurance on the federal government’s exchange, were legally ineligible for aid, the legal critics said.

Now, with the Supreme Court set within days to rule on that challenge in a closely watched case known as King v. Burwell, supporters worry that language in the law limiting subsidies to “an exchange established by the state” could become the basis for eliminating health insurance for millions.

If the law is struck down, it is estimated, as many as 8.2 million people who obtained health insurance through the federal exchange will lose coverage.

Thirty-four states, including Pennsylvania, New Jersey, and Delaware, have so far declined to set up their own exchanges, instead relying on the federal exchange. Pennsylvania and Delaware recently have moved to develop exchanges because of the uncertainty over the subsidy issue, and last week received preliminary approval from the Obama administration to create their own.

The Urban Institute, a liberal think tank based in Washington, estimates that absent state exchanges, 329,000 people would lose health insurance in Pennsylvania, along with 24,000 in Delaware and 239,000 in New Jersey.

Hospitals and insurers that are counting on revenue from an influx of newly insured patients also would take a hit if the challengers’ position is upheld.

“The court has a way of surprising on cases like this,” said Michael Moreland, vice dean of the Villanova University School of Law. “You may end up with an odd coalition on one side of the court or another.”

Obama, in remarks at a news conference in Germany on June 8, lashed out at the Supreme Court for even deciding to hear the case, saying it had little legal merit.

Yet, legal experts say the conservative challenge isn’t quite as fanciful as the president suggests.

Last year, the U.S. Court of Appeals for the Fourth Circuit endorsed the government’s arguments and upheld the law, saying insurance subsidies could be paid both through state and federal exchanges.

But the circuit court said it was a close call.

“There is no question that there is a certain sense to the plaintiffs’ position,” according to the Fourth Circuit’s ruling. In the end, that court ruled in favor of the government, citing case law mandating that when there are multiple possible interpretations, the agency that administers the law has the final say.

Even legal scholars who support the Affordable Care Act say the conservatives’ legal argument has some weight.

“It’s not crazy,” said Robert Reinstein, a constitutional law professor at Temple University Law School, whose writing was cited in a June 8 Supreme Court decision upholding the president’s authority to recognize foreign governments.

Reinstein said the government’s legal arguments are convincing and the law should be upheld. But he points out there is reason for Affordable Care Act supporters to worry because the Supreme Court seems to have gone out of its way to take the case. He bases his conclusion on the fact that the high court agreed to take up the issue, even though there was no split among lower courts, often a threshold requirement for taking a case.

“There are four justices on the court who clearly dislike this law and they are very unsympathetic,” Reinstein said.

The origin of the case dates to 2011 and the research of Michael Cannon, an economist and health policy analyst at the Cato Institute, a libertarian think tank in Washington, and Jonathan Adler, a law professor at Case Western Reserve University. Cannon said it was Adler who first came across language that seemed to limit subsidies to state-established exchanges, and the two decided to explore the issue further.

At first, Cannon said, he was convinced the language was a drafting error. But the more he and Adler dug into the legislative history, the more he came to think Congress intended to restrict health subsidies to state exchanges.

The reason, he said, is at the time the bill was drafted, some Senate Democrats, notably Ben Nelson of Nebraska, voiced concerns that allowing the federal government to operate a health-insurance exchange would give it too much power. The language giving states sole authority to establish exchanges was added to placate those Democrats, Cannon says.

But if that is so, why have federal exchanges in the law?

Cannon argues the congressional drafters never intended for the Senate bill to become law. The idea was that after the House and Senate passed their versions of the health reform bill, differences would be ironed out in a conference committee. The conference committee rewrite was to have been sent back to the House and Senate for final approval.

But Democratic congressional leaders got trapped by circumstances. After the Senate passed its initial version of the bill on Christmas Eve 2008, Scott Brown, in a special election in Massachusetts, was elected to the Senate as a Republican. That deprived Democrats of the 60-vote majority they needed under Senate rules to bring a bill up for a vote. Then Democrats were forced to take the Senate bill that had already passed and send it to the House for a final vote, flaws and all, where Democrats still held an effective majority.

They passed it on March 21, 2010, with all Republicans voting against it.

Democrats reject this analysis. Solicitor General Donald B. Verrilli Jr., in his brief urging the Supreme Court to uphold the law, said the statute – despite the language on state exchanges – clearly authorizes the federal government to set up exchanges if states fail to do so.

That, along with commentary during legislative debate that the goal was to create a nationwide safety net, shows that Congress never intended a two-tiered system, he wrote.

No matter how the high court decides, the issue is unlikely to go away. If the court upholds the law, conservatives no doubt will mount further challenges. If it is struck down, Moreland of Villanova law school foresees a scramble on Capitol Hill to either fix the law to comport with the decision or craft an alternative.

“In the event the court reads the statute narrowly to say there can be no subsidies on federal challenges, that will only be the first move,” he said. “That will put tremendous pressure on the president and Congress to come up with a fix.”
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FG: Healthcare Investment Yields Threefold Increase in Performance at PHCs

The federal government onSaturday said robust healthcare investment in the sector has yielded a threefold increase performance at Primary Healthcare Centres (PHCs) across the country.

Speaking at the Annual Review meeting of the project in Abuja, Executive Director of the National Primary Health Care Development Authority (NPHCDA), Dr Ado Muhammed said the project under the Nigerian State Health Investment Project (NSHIP) has yielded threefold increase in performance of healthcare facilities at the pilot states.

According to him, “what the project has done is a new approach to service delivery in which the approach is to shift from input to output as they are now looking at results in terms of what the funds has resulted to. Muhammad said:
“The focus is on performance as we look at how many lives have been saved, what disease burden has been reduced, how many immunisation sessions are taking place, the outcome in terms of maternal mortality reduction, and how many women have attended antennal care?

“The essence of today’s meeting to carefully review how far we have gone at delivery in terms of performance and to see how we can further improve on the programme.”

Muhammad contended that “For these three years we have seen improvements in service delivery as more women now go for antenatal care, there are skill birth attendants during delivery, more children are been immunised and we have seen a threefold improvement in terms of performance.”

Muhammad noted that service delivery at the implementing states have improved, adding that that he envisages that at the end of the day, the states will take over the programme as they hope to entrench it within the system so that even by the time project is over, those good practices will continue in the system.

Earlier, the Director of Primary Health, Care Systems Development at NPHCDA, Dr. Nnenna Ihebuzor, stated that the difference between this project and others is that its financing is based on performance as facilities must report on agreed targets.

She said the essence for implementing health facilities is to scale health services, “If you agree that you are going to increase your coverage by a certain per cent, we will then check at the end and you will get an incentive for this in terms of bonus for the facility and it will be given some financial autonomy to use that and improve its services.”

Ihebuzor observed that “when you increase the utilisation of healthcare services with increasing the quality, you may actually be doing harm”.
NSHIP, a World Bank health system financed project piloted in three states of Adamawa, Nasarawa and Ondo is aimed improving interventions targeted at maternal and child healthcare. It is also meant to increase the delivery of high impact maternal and child health interventions and to improve the quality of care at the selected health facilities.

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