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The Business Case for HIEWhat the Health System Now Expects From
You & How You Can Be Ready
Fall ConferenceSeptember 29, 2016
Craig Patnode, CEO/President, Eldermark Software │ Simply
ConnectMark Anderson, Senior Vice President, Eldermark Software │
Simply Connect
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Objectives
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Understand HIE, its intentions and its use cases for the
long-term-post-acute-care provider
Discover the importance of health system partnerships & how
to become a Preferred business partner with HIE
Learn what else the health system needs from you to demonstrate
your Value as an HIE partner
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HIE Defined and Put Into ContextAnswering: what is HIE? – what’s
possible with HIE?
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What is Health Information Exchange (HIE) ?
Health Information Exchange (HIE) occurs when two or more
entities electronically exchange health-related data using
established and recognized technology and security standards.
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The HIE Environment for LTPAC
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HIE enables collaboration to
improve outcomes
Who Benefits from HIE ?
Patients / Residents Providers Payers
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HIE = COMMUNICATION
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Communication Tools in HIE
EHR HIEEHR Data CCD, Query
EMAR Data Medication Reconciliation, Master Med List
Clinical Assessment Tools Cloud Storage, Direct Messaging,
CCD
Management of Changes in Well Being Direct Messaging
Communication
SBAR Communication Tool or Similar Direct Messaging
Communication, Cloud Storage
Early Identification of Adverse Drug Reactions Direct Messaging
Communication
QA/QI Initiatives Cloud Storage, Direct Messaging, Analytics
Identification of Care Partner Role Care Coordination Alerts,
Direct Messaging
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Givers and Takers in HIE
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VENDOR/CARE PARTNER WANTS TO SEND - Give WANTS TO RECEIVE -
Take
Pharmacy eRx, med history, immunizations eRx, CCD, eligibility,
lab results, immunizations, payer info, demographics
Primary Physician eRx, CCD, forms, immunizations, orders,
transcription CCD, eRx, immunizations, ADT, eligibility, lab
results, imaging results
Laboratory lab results CCD, lab orders, ADT, eligibility,
demographicsImaging Service imaging results, images CCD, imaging
orders, eligibility
Rehab Agency reports, forms orders, CCD, eligibility,
demographics, advance directives
Home Care CCD, demographics, advance directives CCD,
eligibility, demographics, advance directives
Hospice CCD, demographics, advance directives forms CCD,
eligibility, demographics, advance directives
Hospital ADT, lab, imaging CCD, eligibility, demographics,
advance directives
Insurer/Payer eligibility, med history ADT, CCD, eligibility
Public Agency immunizations, reportable labs CCD, eligibility,
demographics, ADT, CCD, labs
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How Easy Is It To Use HIE?
Let’s take a look at a real HIE and find out…
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Maxine Allburg
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Why Partnerships Are / Will Be Important
There are benefits for the preferred business partner – that can
be YOU
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It Starts at the Top
Hospitals& ACOs
Clinics/Physicians
SNF
Senior Living
Other Community-Based
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$ Billions federal funds & resources to connect hospitals,
clinics, physicians = achieve Meaningful Use requirements (ACA
mandate)
$0 federal funds Yet, you have to be connected Why? PARTNERSHIPS
now
needed to manage new payment models
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A New $hift in Thinking About Health¢are
• Shift from Volume (‘heads in beds’) to Value & Shared
Savings
• By 2018, 50% of payments will be to alternative payment models
(CMS)
• More than ever, partnerships with hospitals & ACOs are
necessary, not just advantageous
• CMS ups the reportable readmission measures in 2016 - adding
All-Cause
V =(Value)
Q + S(Quality) (Service)
$(Cost)
Volume Value
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Skilled Nursing Facility Readmission Measure (SNFRM) NQF #2150:
All-Cause Risk-Standardized Readmission Measure Draft Technical
Report – CMS – RTI Project Number 0214077.001.000.002.001
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Why Connect to HIE?
Transition Events
• AL to Hospital and back again
• Data has to be ELECTRONIC
Medication Reconciliation
• Rx partnership• Master
Medication Record
Physician Workflow
• Orders• Meds• Labs• Mobile Imaging• More
Direct Messaging
• CCD• ADT• More
Connect Vendors / Care Partners
• Home care• Hospice• Lab• Pharmacy• DME• Rehab• More
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Access to Data When and Where
Needed
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Why Hospitals Need Your Help…
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-Bay Area Hospital Working to Lower Readmission Rate.
http://www.kcby.com/news/health/Bay-Are-Hospital-working-to-lower-readmission-rate-283104981.html
“If someone fractures his leg after being hospitalized for
pneumonia and is readmitted, that would count toward a readmission
penalty. It is hard to understand why hospitals would be penalized
for an event we cannot control and that is unrelated to the care
the patient received.”
- Paul Janke, President & CEO, Bay Area Hospital, Coos Bay,
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“The growing body of evidence suggests that the primary drivers
of variability in 30-day readmission rates are the composition of a
hospital’s patient population and the resources of the community in
which it is located – factors that are difficult for hospitals to
change.”
- Karen E. Joynt, M.D., and Ashish K. Jha, M.D., M.P.H. -
-Joynt KE & Jha AK. (18 April 2012). Thirty-Day Readmissions
– Truth and Consequences. New England Journal of
Medicine.http://www.nejm.org/doi/fukk/10.1056/NEJMp1201598
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Partnering with the ACO / HospitalWhat are they looking for from
LTPAC?
Focus is on Quality of Care Provided, evidenced by:• Hard data /
statistics• National comparisons – how does your data compare?•
EHR/EMR use and capacity for interoperability• Claims history• For
SNF – star rating• Demonstrated quality programs and outcomes•
Readmission rates – how well are you managing TRANSITION
events?
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Partnering with the ACO / Hospital
What can the LTPAC provider do?
Have a plan if an ACO / Hospital Partnership is in your future:•
If you haven’t already, collect baseline data on quality programs
and readmissions• Reinforce your value proposition with your data
so the ACO/Hospital can see the
value in partnering with you• If you don’t have one already,
develop and implement a process to REDUCE
readmissions to the hospital – value-based proposition for the
ACO/Hospital health system
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Engaging ACOs & Hospitals with Your Care Management
EffortsWith the right technology, you can demonstrate your Value as
a care partner
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Accomplished by a Collaborative CARE TEAM Enabled by HIE
Med Management
Data
QA/QI Clinical Initiatives
Data
Condition Change
Management Data
Care Team Workflow
Clinical Assessments /
SBAR Data
EHR Care Data
Timely Collaborative Care Team Communication
Clinical Alerts & Event Notification
Access to Care Data When & Where Needed to Effect Care
Outcomes
Primary Physician Case Manager Responsible Party Social Worker
Other
Text Message Secure Email Desktop Alert Dashboard Alert
other
CCD, Query Master Med Record Advance Directives
/ POLST Labs, Xrays, etc. Other
HIE = Pathway to Meet Care Goals
Direct Messaging Cloud Storage Personal Health Record CCD Master
Medication Record
Health Information Exchange Technology
LTPAC Setting
CARE MANAGEMENT GOALS:• Timely Communication & Access to
Data• Early Identification of Altered Status• Early Intervention•
Enhanced Disease Process Management• Prevention/Mitigation of
Potential
Transition Event• Enhanced Patient Outcomes• Reduced Costs in
Care
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Why You Should Engage the ACO / Hospital
• Transitions of Care require 2 partners• The best effort to
send information to the other care setting is only
meaningful if the receiver gets and uses the information• HIE
participating providers can influence methods of communication
and transitioning patients from care setting to care setting•
HIE participating providers can demonstrate their value-add in
an
increasingly competitive post-acute care environment by lowering
the cost of care
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Benefits to the ACO / Hospital
1. They will know that you are working to limit preventable
readmissions2. Decreased patient bounce backs are good for their
bottom line –
avoiding penalties3. All-Cause Readmission tracking is necessary
and now possible4. Partnering with providers that are HIE
Participants who also implement
quality improvement programs like care coordination contribute
to reducing preventable admission and readmission rates among a
very high-risk community population
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Building & Enabling the Partnership
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Become an HIE Participant to Share Your Data
Identify who sends you referrals and who your care partners
are
Join or develop a collaborative care team across the
continuum
Develop and communicate goals
Identify and support a ‘Re-Admission Champion’ in your
organization
Communicate improvement processes
and processes under improvement
Invite your collaborative care partners into your improvement
process
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Partners: SNFs Now – ALs Soon
• Many hospital patients come from assisted living = those
communities can help keep their residents healthy
• CMS is moving toward a site-neutral payment system = ACOs can
use its $ to partner with all kinds of providers
• It costs less to care for a resident in AL than in SNF• ACOs
will be looking for contracted partners to best achieve their
goals
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Case Studies
Atlantic ACO CareOne
EssentiaHealth
“Assisted living is an attractive target partner for ACOs,” says
the AHCA’s James Michel, Director of Medicare Research and
Reimbursement at the American Health Care Association. “It costs
less to care for a resident in assisted living than in skilled
nursing.”
Michel expects to see more examples of ACOs partnering with
assisted living facilities in the coming year.Source: Seniors
Housing Business, May 22, 2015
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ConclusionsAnd Next Steps…
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Conclusion & Call to Action
• Establish an Electronic Health Record – interoperable – and
connect to HIE –manage your DATA!
• Understand that partnerships are in your future – you will
need to build and maintain them
• Track and trend quality outcomes to determine required
improvements• Focus on Readmissions – transitions of care•
Analytics will be KEY – data to manage outcomes and prove your
value• Demonstrate your care improvements• Engage with local
hospitals to demonstrate your value-add now
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Comments – Questions - Discussion
Craig Patnode – [email protected] Anderson –
[email protected]
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The Business Case for HIEWhat the Health System Now Expects From
You & How You Can Be Ready
Fall ConferenceSeptember 29, 2016
The Business Case for HIEObjectivesHIE Defined and Put Into
ContextWhat is Health Information Exchange (HIE) ?Slide Number 5HIE
= COMMUNICATIONCommunication Tools in HIEGivers and Takers in
HIEHow Easy Is It To Use HIE?Slide Number 10Slide Number 11Slide
Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number
16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Why
Partnerships Are / Will Be Important It Starts at the TopA New
$hift in Thinking About Health¢areSlide Number 24Why Connect to
HIE?Why Hospitals Need Your Help…Partnering with the ACO /
HospitalPartnering with the ACO / HospitalEngaging ACOs &
Hospitals with Your Care Management EffortsSlide Number 30Why You
Should Engage the ACO / HospitalBenefits to the ACO /
HospitalBuilding & Enabling the PartnershipPartners: SNFs Now –
ALs SoonSlide Number 35ConclusionsConclusion & Call to
ActionComments – Questions - DiscussionThe Business Case for
HIE
