mco/registry data exchange initiative a collaboration between every child by two & the american...

MCO/Registry Data Exchange Initiative

A Collaboration Between Every Child By Two & The AmericanImmunization Registry Association

July 2002 ECBT Hosted Health Plan Executives

Aetna Incorporated AMERIGROUP AvMed Health Plan Blue Cross Blue Shield Chartered Health Plan CIGNA Corporation Geisenger Health Plan

July 2002 ECBT Hosted Health Plan Executives Health Partners Incorporated Health Right Health Net Independence Blue Cross Kaiser Permanente Mid-Atlantic Permanente PHP TennCare United Healthcare University of Pittsburgh Medical Center WellPoint Health Networks

Benefits of Data Exchange Increased coverage rates Disease prevention Decreased missed days of employment

by parents who must care for ill children

Cost savings by eliminating necessity for manual record pulls

Cost savings by eliminating duplicative immunizations

Increase in data completeness and quality

Benefits of Data Exchange Public relations value for benefits

managers who can compare services offered by various MCOs

Broader impact on preventive services Improved quality ratings for

managed care Consistent data reporting for providers Increased provider and member

overall satisfaction

Benefits of Data Exchange Increased provider satisfaction by

eliminating chart reviews by managed care

Promotion of quality care by providing current recommendations and adding new vaccines

Move toward electronic CIS Increased quality of care by utilizing “real

time” information (current immunization status, recommendations, etc)

Benefits of Data Exchange

Assists families when moving by providing access to children’s records 

Potential for long-term access to immunization information -alleviates need for record archiving by providers

Shows that health plans care about their participants - GOOD PR Value

Potential Challenges Addressing privacy and confidentiality

regulations Ensuring legality of disclosing immunization

data to public health from managed care Ensuring legality of disclosing immunization

data from public health to managed care Participation of Providers Requirements – should providers be required

to submit data? This does not always prove to be effective in increasing registry data because there are few ways to enforce. 

Potential Challenges Incentives – there are many examples

of managed care organizations providing incentives to providers that exhibit high immunization rates, can there be incentives for providing data to the registry?

Important to ensure that usage of registry is simple & user friendly – ability to look up reports, attain batch data

Potential Challenges

Registry functionality Information technology financial investment

by health plans must be modest Provider and health plan have varying

technological capacity to access registry Data quality issues Financing registries/sustainability Standardization of performance measures Must be Internet based

MCO/Registry Data Exchange Advisory Committee Therese Hoyle, Michigan Dept. of Comm.

Health Marcina Robertson, Intermountain Health

Care Dennis Michaud, Mass DOH/CIRSET Chair Dr. Allan Lieberthal, Kaiser Permanente, CA Kim Salisbury-Keith, Rhode Island DOH Reid Kiser, Natl. Cmte for Quality Assurance Debbie Mccune Davis, Arizona Partnership

for Imm.

MCO/Registry Data Exchange Advisory Committee James Resnick, Health Resources Services

Assoc. Julie Jones, Centers for Medicare & Medicaid Linda Murphy, Centers for Medicare &Medicaid Jennifer Zavolinsky, American Assoc. of Health

Plans Angela Salazar, CDC/NIP Janet Kelly, CDC/NIP Aurora Oliva, American Imm. Registry Assoc. Amy Pisani, Every Child By Two

Goals of the Advisory Group To identify key issues and

resources to facilitate data exchange between MCOs and registries

To create a “how-to” manual to guide and articulate the challenges & successes of data exchange

Advisory Group Activities Spent time discussing issues &

initiatives The Vendor Recruitment Model California’s SIIS Conference Workgroups Partnership for Prevention – Insights from

registries/MCOs Examples of data exchange partnerships HIPAA ramifications Medicaid/Commercial health plan variations

Products Survey of current registry data sharing

activities Data exchange guide for registry offices Business template to be developed by

registry staff MCO marketing card Available electronically/limited #

printed

Registry MCO/Data Exchange Survey Results CDC/NIP 2002 annual report data

showed that 41% of grantees provided data to health plans to assist in HEDIS Data did not delineate whether

electronic, paper, or by MCO staff designated to download

Registry MCO/Data Exchange Survey Results

Our Survey sent to all 64 of 317 grantees

38 registries returned survey 14 of the 38 are electronically

exchanging data

Survey Results - Reasons for Not Exchanging Data Nine due to technical reasons

Registry system being upgraded System relatively new, staff focused on

deployment to providers and health depts. Not HL7 compliant

Eight due to legal or policy issues State laws or local interpretation of HIPAA not

favorable to exchange Consent-based registry policies act as a

barrier

Survey Results- Reasons for Not Exchanging Data Six due to other issues

Desire to focus on enrolling private providers

Awaiting higher data saturation to make it worthwhile to health plans

Lack of staff resources Lack of marketing skills

Anecdotal Findings Several of Arizona’s commercial

and Medicaid plans used registry as primary source of information to conduct HEDIS assessments. Costly record reviews conducted only when information not found in registry

Key Findings - Arizona Review of imm. coverage levels for four

health plans from 1998 (when registry was launched) and 2001 showed avg. increase of 8 percentage points for 4:3:1 series

One of largest AZ health plans used reg. to raise adolescent levels

Levels rose by 18 and 22 points for MMR & Hep B in just three years time

How to Guide Outline Health Plan Attributes and Needs

Quality performance measures Registries benefits to health plans Health plan benefits to registries

Increased immunization rates Increased data completeness/quality

How to Guide Outline Health plan benefits to registries

Increased Medicaid enrollment in registry

Promote the awareness and use of registries by providers

Provide funding to registry Educate members and providers about

importance of immunizations and registries

How to Guide Outline Getting started

Evaluate registry’s resources and assets How much time/staff can registry office

allocate Does your registry have enough imm. records

to make it worthwhile for health plans

Making it Happen How to identify health plan contacts Identify health plan structure

How to Guide Outline Determine the requirements

Check with your legal department and agency staff

What laws/rules in your state/county influence data exchange

HIPAA Interpretations

Special Cmte. On Aging hearing “HIPAA Medical Privacy and Transaction Rules: Overkill or Overdue?”

Status from federal agencies on implementation & impact of policies on providers and consumers

HIPAA Interpretations Richard Campanelli, director of

HHS Office of Civil Rights Testimony dispelling much

misinterpretation www.ecbt.org/news sept/october Majority of registries are not “covered

entities” – therefore not governed by HIPAA

HIPAA Interpretations While registries not covered

entities, most users of registries (health plans) are

Rule allows covered entities to “disclose to a public health authority authorized by law to collect…”

HIPAA’s Good Intentions Jarad Adair – Director of CMS’

Office of HIPAA Standards reported that there are 400 different formats used to submit insurance claims…HIPAAA requires that there be just one.

HIPAA – Arm Yourself with Pro- Data Sharing Examples

“resources should be devoted to proper and vigorous implementation (of the rule), and not to using misunderstanding and mishap to build public opposition to the law.” Health Privacy Project’s Director-

Janlori Goldman

How to Guide Outline

Issues to Consider HIPAA – clear examples of pro data

sharing interpretations included NY State Immunization Information

System explanation MOU’s from various states

How to Guide Outline Making it Happen – Cont.

Meet with immunization department staff to discuss how this initiative fits in with strategic plans/goals of entire department

Create specific marketing plans Individualize for staff models, network

models, Medicaid, commercial plans

Specific Marketing Plans Sept, 2003 JAMA reported that quality

of care for commercial MCOs was significantly higher than that of Medicaid MCOs

# of Complete Childhood Imm. Series Commercial MCOs 64% , Medicaid 49%

# of Adolescent MMR Shots Commercial MCOs 52%, Medicaid 43%

$ Make a Good Sales Pitch $ “Think like a business person, not a health

care professional” – Dr. Allan Lieberthal Use sales techniques Deal with health plan decision makers Highlight cost savings on manual record

pulls, decreased duplicative imms, data collection

Highlight public relations/sales benefits Improved data quality and consistency