hitmpresentation06262013

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Leading the Transition to Value-Based Health Care Delivery and Payment Models

Health Information, Technology & Measurement Work Stream June 26, 2013

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Review Themes from Previous Meeting (6/5/13) (8:40-8:50)

Update on Major HITM Initiatives (8:50-9:25)

Identify Priority Technologies and Functions for Payment Reform (9:25-9:45)

Initial Identification of Barriers and Gaps (9:45-10:00)

Welcome, Introductions & Agenda Review (8:30-8:40)

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•#1: Share detailed information on several key technologies •#2: Identify high priority technologies that promote payment reform and improved care •#3: Initial discussion of barriers to accelerate adoption of priority technology

Meeting Objectives HITM Work Stream Meeting #3: June 26th

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Cross-Pollination Updates from other work streams

Work Stream Highlights

Clinical and Payment Innovation

• Payment Reform Summit June 19th: Subject matter expert presented on the different payment models that emerged under health care reform

Community Health Initiatives

• Identified and discussed the breadth of community based health related programs in Rhode Island

Workforce and Practice Transformation

• Built on original inventory taken in 2010 task force and identified additional achievements and gaps that appeared in Rhode Island since 2010

Policy and Regulatory Issues

• Introduced work stream goals; will regularly meet in July & August to discuss solutions proposed by other work streams

Population Focused • Identify critical delivery pieces that populations with complex health needs require •Identify attempts made to integrate care for special populations

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Review Themes from Previous Meeting 6/5/13 (8:40-8:50)





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Before we begin…

Established Meeting Ground Rules

1. Use and abide by an agenda 2. Good facilitation 3. Advanced distribution of presentation materials or meeting topics so members can come

prepared to participate 4. No side conversations 5. Talk about the problem, not the person 6. Be engaged and present during the meeting 7. Keep discussion on topic 8. Connection with relevant work streams – highlight efforts of other work streams 9. Share knowledge of documented work completed by other organizations 10. Operate on a consensus model that includes solutions everyone can “live with,” not

necessarily “the ideal”

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Areas to focus on:

3. High-quality, low cost care needs timely data • “A system needs feedback to improve”

• Risk models and high-quality, linked claims and clinical data

• Alignment of payers, providers, and insurers in approaching and understanding cost implications

4. Technology and measurement in practices: “Doctors are not business professionals” • Training, education are key

• Specialization (outsourcing) of analytic tasks for small groups

5. Learn from current work • CurrentCare

• CSI/Beacon

Areas to focus on:

1. Emphasize person-centered system • Information should follow the patient

• Direct flow of information from hospital to PCP (via CurrentCare)

• CurrentCare assist with patient registration (only give basic information once)

• Allow patients to see their own info in CurrentCare

2. Clear expectations for performance standards • Define “high quality care”

• Define and harmonize measures

• Neutral party to ID “best practices”

Lessons learned from RIQI October Strategic Session

HITM-related Highlights of the RIQI Strategic Sessions

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Map of Meeting Topics & Project Requirements Health Information, Technology, and Measurement (HITM)

Date Major Agenda Item Map June 5 HITM Possibilities & Inventory 1, 2, 3,

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June 26 In-depth analysis of existing HITM projects; define “priority” initiatives

1, 2, 3, 6, 7

July 10 What barriers exist to adopting and accelerating spread of priority HITM projects?

1, 2, 3, 4, 6

July 24 Develop recommendations for accelerating adoption of priority initiatives

1, 2, 3, 4, 5, 7

Aug 7 Refine recommendations and identify costs, implications

All

Aug 21 Finalize plan All

CMMI and SHIP Requirements

1 Accelerate adoption of HITM among providers

2 Ensure that HITM activities will reach hard-to-access providers

3 Coordinate Plan with all statewide HITM initiatives

4 Consider the impact of this Plan on MMIS, including planning and implementation timelines

5 Cost allocation plan or methodology for any planned IT system solutions/builds

6 Review and identify IT resources (including EHR) across providers that can support testing of multi-payer and payment reform model

7 Develop reporting mechanisms for outcomes

8 Develop approaches to ensure accountability across stakeholders

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Innovations and Projects in Rhode Island

Major Health Information, Technology and Measurement Initiatives

Health Information Exchange (CurrentCare)

All Payer Claims Database (APCD)

Unified Health Infrastructure Project (UHIP)

Trailblazers Action Plan

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Structure: State Designated Entity: The Rhode Island Quality Institute will oversee and operate

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Services Provided : – Clinical viewer (web based portal for query) – Alerts and notifications – Subscription to notifications – Home health monitoring – Direct Adoption

Update on Major HITMS Initiatives: RI’s Health Information Exchange Infrastructure (Currentcare):

!

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RI’s Health Information Exchange Infrastructure (Currentcare): Update on Major HITMS Initiatives:

• Rhode Islanders enrolled (opt in): 300,000 • Data submitters:

–9 Hospitals sending ADT feeds (83%)

–6 Hospital Laboratories (58%), 2 large clinical laboratories

–20 Medical practices are sending clinical summaries (CCDs) from their EHRs

–2 Community mental health centers (including 42 CFR Part 2)

–4 Large chain pharmacies sending dispensed medications • Data users via Clinical viewer:

–104 Practices using viewer

–1 Emergency Department

–12 Long term care sites

–32 Community mental health centers • Adoption of Direct messaging: 125 sites • Receiving hospital notifications:72 sites • Sharing Behavioral Health Records

Status:

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RI’s All Payer Claims Database (APCD):

Update on Major HITMS Initiatives:

Goals: – Create a comprehensive data system that allows tracking an individual

across insurance carriers and time – Allow for robust reporting and analysis including calculation of risk

scores

Structure: APCD is a partnership initiative administered by an interagency workgroup which includes:

Department of Health (DOH) Executive Office of Health and Human Services (EOHHS) Office of Health Insurance Commissioner (OHIC) Health Benefits Exchange (HBE)

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Status: • Conduct RFI followed by RFP to select Analytic Vendor: TBD

– Responsible for receiving data extract from Aggregator; data checks and validation; enhancing and organizing data; calculating risk scores

– Producing identified reports

• Conduct RFI followed by RFP to select Hosting Vendor: TBD – Responsible for providing data extracts for research and internal state

users – Acts as State’s repository for data

• Development and Implementation: (runs until Dec 31, 2014)

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Status: • Regulations will be promulgated shortly; include strong privacy protections and

data review boards • Hired Project Management Vendor: Freedman Healthcare

• Hired Encrypted Unique Identifier Vendor (“Lockbox”): HMS

– Responsible for creating Unique ID, attaching to payer’s eligibility files, and returning data to payers

• Hired Data Aggregator: Onpoint Health Data

– Responsible for preliminary intake/collection; data structure and format checks; creating person-level extract

– Convenes Data Submission Workgroup (payers) to clarify process

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Structure: UHIP is a interagency initiative between

– Health Benefits Exchange (HBE) – Executive Office of Health and Human Services (EOHHS) – Department of Human Services (DHS) – Office of Health Insurance Commissioner (OHIC)

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Unified Health Infrastructure Project (UHIP):


Goal: – Create a single technical platform that will support the Health Benefits Exchange,

Medicaid eligibility, and other state human service program eligibility

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Unified Health Infrastructure Project (UHIP):


Status: • Technical Vendor Chosen: Deloitte • Numerous stakeholder sessions held to validate business requirements • Development will be phased: initial deployment for October 1, 2013 will include

Health Benefits Exchange and Medicaid eligibility for expansion population and will include basic functionality

• Outreach and communication about health benefits exchange and Medicaid

expansion will begin over summer (mass media and targeted approaches) • Metrics and evaluation plan under development: hope to eventually include

quality measures to assist individuals when purchasing insurance and choosing providers.

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Trailblazers Action Plan:


• Identify, harmonize, and define use of measures: – Local/National –Quality/Payment Reform –Public/Private Reporting

• Create a statewide quality measurement system: – Collects once and used by many (payers, federal gov’t, state gov’t

etc) – Electronically generated (and aligns with Meaningful Use) – Individual or aggregate – Governance – Feedback systems

• Authoritative shared provider directory: needed by HIE, HBE, APCD, Licensure, Medicaid, etc

• Link de-identified datasets: claims with clinical (APCD with HIE)

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Identify Priority Technologies and Functions for Payment Reform (9:25-9:45) Initial Identification of Barriers and Gaps (9:45-10:00)


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Identifying Priority HITM

Which technologies, measurements, and functions are priority?

Which are must-haves? Nice-to-haves?

• Build on – but don’t be limited to – past and current projects

• Consider options that drive both payment reform and quality

• Emphasize initiatives that we can achieve in the medium-term (within 5 years)

If the goal of HealthyRI is to design a model that ensures 80% of the state's total population moves to value-based

payment and delivery models within 5 years…

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1.

Identifying Priority HITM Suggestions: Priority Functions, Technologies & Measurements

Healthy Rhode Island

1. Interoperable technology a) Streamline patient and provider portals b) Single sign-on for EHR, HIE

2. Improved communication among and within user groups – patients, providers, payers, state

3. Timely claims and clinical (EHR) data 4. Comprehensive provider directory 5. Harmonized measures (alignment of

measurement types and definitions) 6. Predictive modeling and actuarial data 7. Unblinded and public provider data for quality

measurement 8. Linked claims and clinical data

Guidelines for Narrowing

Which are priority?

Which are must haves?

What will drive both payment reform and higher-quality care?

What can we achieve in the medium-term (within 5 years)?

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Healthy Rhode Island

#2 Evolving environment

#1 Legal Barriers

Ease of interoperability

Identifying Initial Gaps and Barriers

#3 Current Care’s Opt-in Provision

Link Clinical and Claims Data

Patient Engagement; HIE

Documents

hitmpresentation06262013