1. Confidentiality
   
   
   1. HIPAA/Consent Concerns: MCOs need out of plan immunizations to make their participation worthwhile. But family consent concerns are important.
   2. Performance Measures: incentives and disincentives. Difficult to get a provider registry up and running within a year given disincentives to participate.
   3. Access to data/use of data: Who has access to data? Does MCO have the right to get aggregate data for its providers?


2. Roles and Responsibilities
   
   
   1. Facilitate Provider Participation: Need to make it easy, need to enable electronic reporting through existing provider systems.
   2. Privacy/confidentialy: Need to conduct ongoing education in this area.
   3. Funding: Ideally funding from the state, but may need to explore fee-for-service model with parents and/or MCOs paying.


3. Working with Providers
   
   
   1. Obtain buy-in from nationally-recognized organizations (like AAP); encourage collaboration.
   2. Develop cooperative training programs, perhaps with free CME credits, with medical schools or other training facilities.
   3. Provide grant funding in the form of technology (computers) or services (software integration with provider practice systems).


4. Business Case Within the MCO: Tie to other initiatives whenever possible
   
   
   1. Overall improvement in NCQA-HEDIS scores and compliance with EPSDT rates.
   2. Overall improvement in patient care through better linking of patients to providers (through data) to enable better health plan management.
   3. Cost savings through improved prevention, patient identification, and early detection of other medical conditions.


5. Information Technology
   
   
   1. Uniformity of data needed to make the exchange of information possible.
   2. Issue of systemic inadequacies of data needs to be addressed.
   3. Need to ameliorate differences in technical capabilities betweeen system participants.