meaningful use stage two: the future of care coordination

Meaningful Use Stage 2 – The Future of Care CoordinationAdele AllisonNational Director of Government Affairs, SuccessEHS

New Focus – Care Coordination

• Big Tactic Step in next wave of health care reformoAccountable Care Organizations

(ACOs)oPatient-Centered Medical Homes

(PCMHs)• PPACA → CMS Medicare FFS:

Establish ACOs by 1.1.2012

• ACO Final Rule (Issued 10.20.2011, 696 pages)oNew Care Model for FFS Medicare

– anticipating 270 to contractoFocus on Care Coordination as a

CommunityoMust be Patient-Centered

(definition follows)

• Patient-Centered is defined to include: Patient Survey, Communication

and Involvement in governance Population Management Targeting high-risk patients Technologies to Coordinate Care Performance Measuring and

Ongoing Process Improvements

• PPACA → §3007 - CMS apply a MD value-based modifier by 2015 • CMS Payment Final Rule (Issued

11.2.2011, 1,235 pages)o2012 EHR-Based PQRS Reporting –

includes all 44 Stage 1 MU CQMsoParticipation in the PQRS EHR-based

Incentive Pilot satisfies MU CQM reporting and provides incentives above MU

• SuccessEHS is 2011 CMS Qualified for EHR-based PQRS reporting• SuccessEHS is testing for

2012

Key Stage 2 Recommendations

• > 60% structured lab results with at least 1 order in CPOE• 1 Radiology Test Ordered using CPOE• > 10% of patients – record care plan

fields (goals and instructions)• > 10% of patients - record care team

members (including PCP, if applicable)

• > 25 unique patients with advance directives• 25 patients sent secure online

messages• 20% of patients recorded for

preferences in communication• Summary of Care Record sent

electronically for 25 Transactions

Clinical Quality Measures & National Quality Strategy

•No “alternative core” measures → just Core• Selection from 69 NQF Measures – eReporting Ready• 23 new clinical measures proposed – ↑ provider diversity

• Menu measures divided into 6 domains to align with the 6 National Quality Strategieso Population and Public Health

Managemento Care Coordinationo Clinical Processo Patient and Family Engagemento Efficiency o Patient Safety

Practice Redesign Considerations

Clinic Culture Assessment• Think about Users and Roles• Create a Vision Statement• Identify Leadership (Formal /

Informal)• Communicate Plans

Workflow Self-Assessment• Identify sources of:–Assessment Worksheet–Inefficiency / Delay / Duplication–Risk / Liability / Non-Compliance

(e.g. HIPAA)–Quality concerns–High costs

Leadership in Administration• Remember – this is a Provider

Program• Remember – the Providers are

part of a Clinic / Group Practice• Plan for Administration Ease–Consistency in measures–Evaluate Technology and Workflows

Provider Assessment• Identify potential barriers before

reengineering⁻ Low comfort level with technology (Provider /

Support Staff)⁻ Gaps in Hardware ⁻ Impact on productivity⁻ What additional problems can be solved?

• Workflows MUST BE CONSISTENT for data capture and reporting

Practice Redesign• Compliant and Certified for

MU EHR Software• Senior Leadership and Staff –

Awareness and Understanding• Identified Champions – Formal

and Informal

Practice Redesign• Key Partner Collaboration– Lab Interfaces : (ORM/ORU)

Results to Patient Chart– Immunization Interface : (VXU)

Single entry / upload to Registry– HIE Interface : (CDA, C32, XDS)

Human Readable Format

Practice Redesign• HIPAA Security Analysis• Implementing New Technologies−Patient Portal, CDS, Formulary

Management, HIE, Structured Knowledge Base, etc.−IT Needs such as iPads, Smartphones,

Business Continuity Plans

Practice Redesign• Data Collection Considerations• Must be consistent• Like CDS - Identifying the “5 Rights” in

Workflow• Right Information• Right Person Collecting• Right Format• Right Channel (e.g. EHR, Portal, PM)• Right Time in Workflow

Practice Redesign• Consider Data Needs – E.g., Vitals,

Smoking Status, Rx Reconciliation, Refills, Health Disparities

Technology Partner – Critical Importance

SuccessEHS & HIE• SuccessEHS can produce a C32

message (CDA/CCD)• SuccessEHS has developed an

Interoperability engine to automate support of interoperability

SuccessEHS & HIE• This transport engine can be

leveraged to provide data to:o State Registrieso Lab results to public health agenciesoQuality Reporting to CMS and other

collaboratives

SuccessEHS & HIE• SuccessEHS will leverage this

transport/support engine for a variety of CCDs used in transitions of care

SuccessEHS & ACOs• SuccessEHS is strongly positioned

to integrate PCP into the ACO model

• EHR-based PQRS

SuccessEHS & ACOs• Health IT Tools SuccessEHS can deliver:

• Prospective / Retrospective Payment System• Utilization Trending and Reporting• Evidence-based Clinical Decision Support

Tools• Patient Survey Tools• Tele-health Tools

SuccessEHS & ACOs• Health IT Tools SuccessEHS can deliver:

• Population Management Technology• Digital Dashboard• Health Information Exchange• Lab, Radiology and Device Interfacing• Enterprise Business Intelligence

SuccessEHS & PCMH• SuccessEHS is working with the ONC CCBC

to recertify 13 of its CHCs for PCMH• SuccessEHS has created a PCMH

Development Branch that includes:• Secured Messaging to the Patient through

Patient Portal• Patient Questionnaires available through

Portal or Kiosk• Robust Order Tracking

SuccessEHS & PCMH• SuccessEHS has created a PCMH

Development Branch that includes:• Pre-defined, evidence-based clinical decision

support rules• Leveraging MEDCIN for use in Care Plan

workflows• Ability for patients to request test results /

consults through Portal• PCMH-specific reporting

SuccessEHS & PCMH• SuccessEHS has created a PCMH

Development Branch that includes:• PCMH data capture and reporting for referral

management and transitions of care

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