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HIT PICDecember 9th, 2016 10AM-12PM
Welcome & Introductions
• Joseph Reilly, CNYCC CIO email: [email protected]
• Michele Jacobson, CNYCC Project ManagerData and Performanceemail: [email protected]
• Peter Nolan, CNYCC Project ManagerHealth Information Technologyemail: [email protected]
• Kris Hebert, CNYCC System Analyst Health Information Technologyemail: [email protected]
Agenda
• Recap & Review• Planning Payment Delay• Consent Survey Update
• Data Sharing Roadmap• Implementation Plan Updates• Review of Upcoming Deliverables• Population Health Management Update• Reporting - Updates• Q&A/Next Meeting
Recap & ReviewPlanning Payments
By developing processes to assess the current state and needs of partners, CNYCC can provide the rightoversight, align the right IT resources according to need, and help ensure partners are on the path to achieveCNYCC DSRIP goals and objectives.
CNYCC IT Gap Assessment
Categorize partners for each functional area based on responses
Initial HIT Assessment
(Survey/Site Visits/HIE)
Start2nd Round
Current State Assessment
Clarify/validate/collect additional information
Partners Phase 1: Confirm any changes since
previous survey, general IT readiness Phase 2: Understand project-specific
readiness
Tier 0Tier 1
Tier 2
We are Here
Distribute Implementation
Plans
Assessment and Planning Process: Overview
$Payment Triggered
End
Target Date: 12/23/2016Requirements for Payment
• Completion of HIT Assessments• Phase 3 Contracting Survey• Phase 1 HIT Survey• Phase 2 HIT Survey
• And/Or Completion of HIT Implementation Plans (as applicable)
Payment Eligibility Verification Process• Missing 2ai Project Agreement• Partner type clarification Addendums• Unchecked/Incorrectly Checked Payment Type
Next Steps• Contract Executions (Due 12/8/16)• Submission of Clarifying Information• Payment Processing
Assessment and Planning Process: Payment Update
Recap & ReviewConsent Survey Update
Consent Survey - Overview• Payment Type
• Lump sum for executed RHIO agreement with workflows for capturing patient consent.
• Payment Trigger*• Receipt copy of executed RHIO
participation agreement & completed consent management workflow questionnaire.
Benefits of consent workflow• Allows for quicker adoption of future
data sharing needs• CNYCC evaluating data sharing
consent extensibility
• Gain insight on:• Staff used in process• Timing• Consent Storage• Consent Transfer• Consent Maintenance
• Informs:• Future Consent based activity for
CNYCC• Current Best Practice
* Payments were made as part of CNYCC’s accelerated payments
Consent Survey - Results
Question Result
Organizations with a consent workflow 90%
Timing of consent request 33% Before41% During26% After
Use of informed consent script 70%
Electronic consent storage 80%
Stored within the Medical Record 69%
Consent sent to RHIO within 24 Hours 63%
All new patients asked for consent 90%
Outcomes• High adoption of workflows among
partners surveyed • Consistent workflows among partner
organization• High utilization of RHIO’s materials • High rates of electronic storage and
submissionOutlook• Strong use of best practice will allow
for PPS to leverage data to aid in the development of Population Health
• Information with help CNYCC model consent workflow in future applications
Data Sharing Roadmap
Data Streams 1. PHI from State Medicaid Sources
2. PHI Generated Within the PPS
3. PHI Generated by a MCO
4. PHI Managed in a Qualified Entity (QE)
Data Type(s) Demographic data, members rosters, claims and encounter data originating from NYS data sets
Demographic data, members rosters, claims data, clinical social and behavioral data originating from PPS Partner Organizations
Demographic data, members rosters, claims and encounter data, and clinical data originating from MCO
Various types of clinical or claims/encounters data (scenario dependent)
Main Relationship(s)
PPS Lead and NYSDOH PPS Lead and PPS Partner Organizations
PPS Lead and MCO PPS Lead, QE, and PPS Partner Organizations
Generalized Guideline Components
• DEAA• State approved BAAs with downstream partners• Security Assessment Affidavit• Opt-Out Process• Co-mingled vs. Purely Derivative Data Definitions
• HIPAA Compliance Requirements• Other FederalRegulations (Substance Abuse Regulations)• NYS Laws and Regulations• CNYCC Partner Agreements
• Following Opt-Out process regarding PPS’ attributed members data
• Contractor: BAA• HIE: DEAA with the State and BAA with the PPS Lead
DOH Guidance on Privacy and Data Sharing Within DSRIPOverview
Data Sources Data Sharing Mechanisms
Privacy and Data: 1. PHI from State Medicaid SourcesData Sources, Flow and Access Mechanisms
• Medicaid Analytics Performance Portal (MAPP)• Snapshot Reports• Performance Reports• Patient Lists
• Raw Medicaid Claims Data• Attributed Member Roster Files• Salient Interactive Miner (SIM)
• Direct Data Access • PPS partner organizations receive raw data files
from PPS lead• Comingled Data (1a): Dataset maintains NYS
Medicaid claims/encounter data• Derivative Data (1b): Dataset maintains only NYS
Medicaid name and CIN Number
• Facilitated Data Access (2)• PPS partner organization is granted access to
NYS data through PPS Lead’s IT systems (e.g. PHM Infrastructure)
NYS DOH
PPS Lead Entity
PHMVendor
PPS Partner
Orgs.
1a
2
1b
Data Flow
Data Sources Data Sharing Mechanisms
Privacy and Data: 2. PHI from State Medicaid SourcesData Sources, Flow and Access Mechanisms
• Partner Data Feeds• Claims, Clinical, Demographics, Encounter,
Social and Behavioral Data • Partner Provided Patient Lists
• Monthly Patient Engagement Files• Patient Reports (e.g. CG-CAHPS)
• Derivative Data Created by PPS Lead from State Data Sources
• PPS Partner to PPS Lead Entity (1)• PPS partner organizations share data directly with
the PPS lead
• PPS Partner to PPS Lead Entity to NYS DOH (2)• PPS Lead entity sends data it has received from a
PPS partner to the NYS DOH for DSRIP program purposes (e.g. patient engagement submission)
• PPS Partner to PPS Lead Entity to Business Associate Contractor (3)
• PPS Lead entity sends data it has received from a PPS partner to a Business Associate Subcontractor that is performing work on behalf of the PPS Lead Entity, or PPS partners (e.g. CG-CAHPS patient survey lists)
• PPS Partner to PPS Lead Entity to PPS Partner (4)• PPS partner organization is granted access to
data provided by another PPS partner through PPS Lead’s IT systems (e.g. PHM Infrastructure)
Data FlowPPS
Partner Orgs.
PPS Lead Entity
PHMPPS
PartnerOrgs.
NYS DOH1
3
2
Business Associate
Subcontractor
1
4
1
Implementation Plan Updates
Implementation Plans: Partner Engagement Timeline
August 2016 October 2016
July 2016 September 2016
Implementation Plans
Plans Sent:7/11/2016
Plans due: 8/26/2016
We are Here12/09/2016
March 2017
DY2Q3 UpdateDue 12/31/2016
First Project Milestones Due
3/31/2017
Payment Deadline
10/21/2016
Implementation Plans: Tracking Progress
Submit Web Forms (email)
Generate Report on Current Status
Inform Partners of Status, Milestones
and Project Updates
Gathering of Supporting
Documentation
Generate Web Forms for Update
(email)
Submit Project Implementation
Plans
Upload Initial Data DSRIP
Tracker (Performance
Logic)
Generate Report on Current
Status
Continue Execution of Project Plans
Generate Web Forms for
Update
Partner
CNYCC
Both
Key:
Execution of Project
Plans
We are Here
Custom Software (Interim Strategy)• Plans uploaded to Local Database• Reports sent out individually 12/06/2016• Personal approach
• All plans custom to each organization based on:• Project Participation• Available Partner Types• Safety Net Status
Performance Logic (Long Term Strategy)• Working with performance logic developers
• Uploading feedback• Integration into overall DSRIP project plan• Performance Reports• Real time implementation Status
Implementation Plans: Tracking Progress
Tracking Progress: Email (Example)
Review of Upcoming Deliverables
• CNYCC PMO department currently evaluating requirements from NYS to establish recommended documentation requirements for project activities.
• Once these are determined they will be aligned with our functional areas.• CNYCC IT will distribute an update/plan to each partner on tasks they have
identified as completed.• This will plan include:
• All project requirements that have been identified as completed by partner• The requirement to prove completion of task• Due date for receipt of documentation
Review of Upcoming Deliverables: Process
Review of Upcoming Deliverables: State Documentation Requirement Example
PPS in the process of selecting one Data Source Per project requirement or “functional area”
Review of Upcoming Deliverables: Example Documentation
Reporting
Copy of Report
Outline of Report Process
Documentation Requirements
Evidence of Integration
Policy, Procedure or
workflow
Workflow Optimization
Evidence of Integration
Policy, Procedure or
Plan
Alerts
Evidence of Integration
Policy, Procedure or
workflow
OrOrOrOr
Review of Upcoming Deliverables: State Documentation Requirement Example
2.a.i RHIO Alerting
Population Health Management Updates
Planning and Integration Prep• Analyzing local and population data sets for integration• Developing strategy for most efficient integration strategy
• How do we get diverse data?• How do we get significant volumes of data ?• How quickly can we accomplish both ?• How can out initial data set represent the entire care continuum ?
• Analyzing PPS partners for most efficient integration method• Project plan build out• Completing contracting
Implementation Planning and Integration Prep Updates
• Guest Speaker • LaShawn Fergus• Director of Project Management for IBM Watson Health
• High Level Overview CNYCC Integration• General Project Milestones• Project Framework• Implementation Structure• Relative Timelines• CNYCC and Partner Roles and Responsibilities• Integration Methodologies
• Direct EMR Integration• Flat file extracts
• Estimated Time Commitments of Partner Resources• Questions and Answer Session
Population Health Management Updates: IBM Watson Health
CNYCC Board of Directors
Clinical Governance Committee
IT and Data Governance Committee
COMPLIANCECOMMITTEE
WORKFORCECOMMITTEE
FINANCE COMMITTEE
REGIONAL PROJECT ADVISORY
COMMITTEES
LEARNING COLLABORATIVES
AND PROJECT WORKGROUPS
Executive PHM Steering Committee
Advisory Oversight
Informed and provides advisory
services asneeded
PHM Implementation: Overall Governance Structure
PHM ImplementationProject Team
*Transitional role, active until the associated milestone is achieved and then as-needed for support
Primary Focus: Application and Clinical ContentCNYCC Team Members• Clinical Lead• Operations Lead • Quality Lead• Care Management Lead• Training Lead • Systems Analyst, Application DevelopmentPartner Team Members• Behavioral Health SME*• Acute SME *• Primary Care SME*
Primary Focus: Data Source IntegrationCNYCC Team Members• Team Lead• Quality Lead• Clinical Lead• Interface Analyst, Interface SupportPartner Team Members• Technical Lead(s), Clinical Lead*
Primary Focus: TrainingCNYCC Team Members• Team Lead• TrainersPartner Team Members• Super user(s)
• Post Acute SME*• CBO SME*• Care Management SME*
New Teams
Tech
nica
l Int
egra
tion
Trai
ning
/Cha
nge
Man
agem
ent
Clin
ical
and
Ope
ratio
ns
CNYCC Team Members• Manger, Communications
CNYCC Team Members• Project Managers Partner Team Members• DSRIP Coordinators• Project Workgroup Participants• Learning Collaborative Participants
CNYCC Team Members• Chief Compliance Officer
Existing Teams
CNYCC Team Members• Project Manager, Data and
Performance• Data Analyst
Com
mun
icat
ions
PMO
&Be
nefit
Tea
ms
Com
plia
nce
Perf
orm
ance
&
Rep
ortin
g
PHM Implementation Project Team
Team Lead• Director of Finance
Fina
nce
Population Health Management UpdatesIBM Watson Health Presentation
Reporting
• Partners submit Actively Engaged Patient Rosters for Payment MONTHLY to CNYCC
• Rosters are due by 10am the Monday following the Second Thursday of each month
Reporting Overview - Reminder
Month of Engagement Patient Roster DueNovember 2016 December 12, 2016
December 2016 January 16, 2017
January 2017 February 13, 2017
February 2017 March 13, 2017
March 2017 April 17, 2017
April 2017 May 15, 2017
May 2017 June 12, 2017
• CNYCC encountered the following problems that has resulted in changes to our Actively Engaged Patient Roster Submission Process
• Inaccurate/Incomplete File Naming
• Incorrect Roster Formatting including not using CNYCC Issued Rosters
• Data Quality Issues:
• Timestamps in “Date” fields
• Incorrect “CIN or MCO Subscriber ID” fields
• Blank fields
• Same CIN with Different Names
CNYCC Reporting Problems
• CNYCC has implemented a tool for Actively Engaged Patient Roster Validation
• Ensures accuracy
• Increases efficiency
• Simplifies roster submission
• New Actively Engaged Patient Rosters need to be used
• Distributed in early November
• No spaces are found in the column headers
• Member side of CNYCC has been updated to reflect new rosters
CNYCC Reporting Solutions
CNYCC Actively Engaged Patient Roster Process Flow
CNYC
CSF
TP S
itePa
rtne
r
Partner Submits Excel Files to SFTP
Site
Valid File Ext?Correct data in columns?Correct column headers?
Correct filename?
START
NO
File Rejection Email
Final Payment Results File
sent via Secure Link
Payments Processed
File Rejection Email Sent to Partner (No
File Attachment) Requesting
Resubmittal of File
• These new guidelines went into effect for the November 14th file submission. Files with incorrect naming or headers were rejected and Partners were notified
• Rejection of files will cause delay in payments and may result in non-payment for activities
Newly Enforced File Naming Conventions
PROJECT NUMBER ENCOUNTER MONTH, YEAR PARENT ORGANIZATION NAME 2aiii – DSRIP Care Management Month and Year that the patients were engaged Name of YOUR Organization2biii – ED Care Triage2biv – Care Transitions2di – Patient Activation (PAM®)3ai – Behavioral Health Crisis Stabilization3aii – Behavioral Health Crisis Stabilization3bi – Cardiovascular Disease Management
Acceptable File Naming Conventions:PROJECT NUMBER ENCOUNTER MONTH YEAR PARENT ORGANIZATION NAME ACTIVELY ENGAGED PATIENT ROSTER
ORPROJECT NUMBER ENCOUNTER MONTH YEAR PARENT ORGANIZATION NAME PATIENT ROSTER
• CNYCC has begun to distribute Reconciled Actively Engaged Patient Rosters to Partners who have received payment from CNYCC
• The first file that was distributed includes files from April 1, 2015 to October 31, 2016 for all projects that a payment was made
• Starting with November Actively Engaged Patient Rosters, Partners will receive a monthly file that includes all projects that were paid for the month
• Files will be distributed the 3rd and 4th weeks of the month to coincide with payments made
• Rosters will include the original information that was submitted to the PPS in addition to reconciliation codes indicating whether a patient was included in the payment and if not, the code which indicates the reason why
Monthly Actively Engaged Patient Roster Reconciliation Report
Actively Engaged Patient Roster Reconciliation Report
Code Key:A – Above TargetD – DuplicateC – Does not align with Reporting RequirementsP – PAIDQ – Error – Data Quality
Actively Engaged Patient Roster Processing Timeline
1st of the Month
Roster Submission(Monday following 2nd Thursday)
Payments sent to Processing(Friday following Roster
submission)
Roster Reconciliation Reports Created
(Week after Roster Submission)
Last day of Month
Roster Reconciliation Reports Delivered to Partners
(Week after Roster Creation)Rejection emails sent
(within 2 days of Processing)
QA
FIN