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How HIEs Are Making the “Patient Information Anywhere” Dream a Reality Today
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Housekeeping
• Webinar Moderated by Anthony Guerra, editor-in-chief, healthsystemCIO.com
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• Deck @ http://healthsystemcio.com/presentation/hie-webinar.pdf
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Agenda
• 12 minutes: Chuck Christian, VP Technology & Engagement, Indiana Health Information Exchange
• 12 minutes: Douglas Dietzman, Executive Director, Great Lakes Health Connect
• 12 minutes: David Kendrick, CEO, MyHealthAccess
• 10 minutes: Audience Q&A
STRATEGIC HEALTH INFORMATION EXCHANGE COLLABORATIVE©2017, SHIEC. All rights reserved, Proprietary & Confidential. Not for further redistribution.
How HIEs Are Making the “Patient Information Anywhere”
Dream a Reality Today
STRATEGIC HEALTH INFORMATION EXCHANGE COLLABORATIVE
This is SHIEC.
5
% of US Population Served
STRATEGIC HEALTH INFORMATION EXCHANGE COLLABORATIVE
This is SHIEC.
6
% of US Population Served
• 55 member HIEs across 35 states
• Provide person-centric health records
• Unbiased data trustees focused on better health
• Altogether currently serve >195M patients
• Rapid growth from foundation 2 years ago
• 30 Strategic Business & Technology Partners
STRATEGIC HEALTH INFORMATION EXCHANGE COLLABORATIVE
The PCDH Concept
Every person deserves to have their
complete, longitudinal health record
available whenever and wherever it is
needed for decisions that affect their care,
their health, and their well-being.
7
STRATEGIC HEALTH INFORMATION EXCHANGE COLLABORATIVE
3 Key Questions
• Where did my patients get care?
– Where do I need to query to get the information?
• When did my patients get care?
– Who is getting it right now that I don’t know about?
• Who is the patient that got care?
– Do my identifiers for the patient match all of the other
organizations’?
8
STRATEGIC HEALTH INFORMATION EXCHANGE COLLABORATIVE
How PCDH Works
9
PCDH + HIE Interoperability
10
STRATEGIC HEALTH INFORMATION EXCHANGE COLLABORATIVE
What should I know about HIEs?
All HIEs are not the same.
• Different geographies Different services
• PCDH is the standard platform on which HIEs
can successfully exchange data
11
CREATING CARE-CONNECTED COMMUNITIES
COVERAGE & VOLUME
Michigan’s HIE Company
129 Hospitals = 85% of Acute Beds
4,000+ Connected Participants
8,700,000 Unique Persons
1,000,000,000 Messages p/y
CREATING CARE-CONNECTED COMMUNITIES
“COLLECTIVE INDIVIDUALISM”
Behavioral Health
CREATING CARE-CONNECTED COMMUNITIES
FLINT COMMUNITY
• Working for years to integrate healthcare ecosystem across Flint region – Greater Flint Health Coalition
• Water crisis presented another “reason why” connected communities are vital to residents
• GLHC recognized need for advancing data infrastructure to support healthcare & wellness goals of those affected in short and long term
– Longitudinal health record, referral/care coordination, clinical messaging, active health monitoring, intelligent alerts
– Physical health, Behavioral health, Social services, Schools, Local public health
15
CREATING CARE-CONNECTED COMMUNITIES
PCDH APPLICATION
• Residents increasingly live/moving outside of Flint
• Increased awareness…
– to local clinicians when patients are seen outside the state
– to out-of-state clinicians who might not otherwise know of this background
• Collective individualism applies here as well
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
The Journey from Volume to Value:Infrastructure for improving health
and reducing costs
David Kendrick, MD, MPH
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Locations 1072
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
MyHealth Patient Population
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Disaster Case
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Critical National Infrastructure
HIE’s (with PCDH) can• Pre-disaster
– Organize medical records for all individuals– Resolve identities– Identify most vulnerable patients for prioritized
evacuation/assistance
• Intra-disaster– Provide access to medical records and demographics while
other systems down or inaccessible– Real-time monitoring of resource utilization and needs
• Post-disaster– Ensure medical records available to evacuated/relocated regions– Return records from evacuation sites to home
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Value Based Payment Models
• Here to stay . . .
– MACRA passed with strong bipartisan support
• House: 392 FOR to 37 AGAINST
• Senate: 98 FOR to 2 AGAINST
– Demonstration projects showing promise (and savings)
• CPC, CPC+
• ACO’s
– Significant Commercial payer buy-in
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Many programs, common deliverables
SIM
CPC+
ACO
APM
MIPS
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
MIPS Components: Final
Quality Reporting60%
Advancing Care Information
(interoperability)25%
Clinical Practice Improvement
Activities15%
Resource Use0%
2017 MIPS COMPONENTS FINAL
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
• 68 practices, 265 docs
• OK Payers require MyHealth Participation
• >30 hospitals affiliated
• Four payers (BCBS, CCOK, Medicaid, Medicare)
• >90% of covered lives
• Shared savings Y3-4
Comprehensive Primary Care “Classic”
$100M in Care Management and Practice Transformation fees to PCPs
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
CPC+ in Oklahoma: 181 Practices
• BCBS• CommunityCare• United• OHCA• CMS
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Claims DataClaimed diagnoses, procedures, medications
Patient Out of Pocket
EHR 1
EHR 2
EHR 3
EHR 4
EHR 5
EHR 6
EHR 7
EHR 8
EHR10
EHR 9
Ind
epen
den
t P
har
mac
ies
Pu
blic
Hea
lth
Dep
artm
ent
Sure
Scri
pts
Fed
eral
So
urc
e (
VA
/Do
D/I
HS)
Claims: Medicaid
Claims: Commercial 1
Medicare
Commercial
Claims: Commercial 2
Claims: Commercial 4
Claims: Commercial 3
Patient A
Patient B
Patient C
Patient D
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Fragmentation quantified
43% of all patients have records in 2 or more systems
Average PCP must coordinate care with 225 other providers in 117 other organizations
Mai Pham, NEJM
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Fragmentation: Pt’s with DM
66.6% of patients with DM have records in 2 or more places
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Quality Payment Program
Get your Data to CMSIndividual Group
QCDR (Qualified Clinical Data QCDR (Qualified Clinical Data Registry)Quality Registry) Qualified Registry
Qualified Registry EHREHR Administrative ClaimsClaims CMS Web Interface
(groups of 25 or more)CAHPS for MIPS Survey
AdvancingCareInformation
ImprovementActivities
AttestationQCDRQualified RegistryEHR Vendor
AttestationQCDRQualified RegistryEHR Vendor
AttestationQCDRQualified RegistryEHR VendorCMS Web Interface(groups of 25 or more)
AttestationQCDRQualified RegistryEHR Vendor
14
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
MIPS Components: Final
Quality Reporting60%
Advancing Care Information
(interoperability)25%
Clinical Practice Improvement
Activities15%
Resource Use0%
2017 MIPS COMPONENTS FINAL
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Scoring MIPS/CPC+
5.2 4.0 4.6 7.5 3.2 4.8 3.4 3.9
Summary6 MIPS measures: 30
Electronic Submission bonus: 6Additional Measures bonus: 6
Total: 42/60 = 70%
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
MIPS Components: Final
Quality Reporting60%
Advancing Care Information
(interoperability)25%
Clinical Practice Improvement
Activities15%
Resource Use0%
2017 MIPS COMPONENTS FINAL
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
9 of 15 Achieving Care Interoperability measures
MEASURE NAME OBJECTIVE NAME
REQUIRED FOR BASE SCORE
PERFORMANCE SCORE WEIGHT
Clinical Data Registry ReportingPublic Health and Clinical Data Registry Reporting
No 0
Clinical Information Reconciliation
Health Information Exchange No Up to 10%
Immunization Registry Reporting
Public Health and Clinical Data Registry Reporting
No 0 or 10%
Provide Patient Access Patient Electronic Access Yes Up to 10%
Public Health Registry Reporting
Public Health and Clinical Data Registry Reporting
No 0
Request/Accept Summary of Care
Health Information Exchange Yes Up to 10%
Send a Summary of Care Health Information Exchange Yes Up to 10%
Syndromic Surveillance Reporting
Public Health and Clinical Data Registry Reporting
No 0
View, Download and Transmit (VDT)
Coordination of Care Through Patient Engagement
No Up to 10%
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
MIPS Components: Final
Quality Reporting60%
Advancing Care Information
(interoperability)25%
Clinical Practice Improvement
Activities15%
Resource Use0%
2017 MIPS COMPONENTS FINAL
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
13 Improvement Activities (2 req)ACTIVITY NAME SUBCATEGORY NAME ACTIVITY WEIGHTING
Leveraging a QCDR for use of standard questionnaires Achieving Health Equity Medium
Leveraging a QCDR to promote use of patient-reported outcome tools
Achieving Health Equity Medium
Leveraging a QCDR to standardize processes for screening Achieving Health Equity Medium
Participation in a QCDR, that promotes collaborative learning network opportunities that are interactive.
Beneficiary Engagement Medium
Participation in a QCDR, that promotes implementation of patient self-action plans.
Beneficiary Engagement Medium
Participation in a QCDR, that promotes use of patient engagement tools.
Beneficiary Engagement Medium
Participation in a QCDR, that promotes use of processes and tools that engage patients for adherence to treatment plan.
Beneficiary Engagement Medium
Use of QCDR data for ongoing practice assessment and improvements
Patient Safety & Practice Assessment
Medium
Use of QCDR data for quality improvement such as comparative analysis reports across patient populations
Population Management Medium
Use of QCDR for feedback reports that incorporate population health
Population Management High
Use of QCDR patient experience data to inform and advance improvements in beneficiary engagement.
Beneficiary Engagement Medium
Use of QCDR to promote standard practices, tools and processes in practice for improvement in care coordination
Care Coordination Medium
Use of QCDR to support clinical decision making Beneficiary Engagement Medium
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
MIPS & CPC+ Benchmarks: Advantage QCDR
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
MIPS & CPC+ Benchmarks: Advantage QCDR
Other initiatives supported
PCDH with real time nationwide alerting enables:
• PDMP Services and medication data to facilitate management of Opioid abuse
• Business continuity support during outages or cyberattacks
• Qualified Clinical Data Registry (QCDR) services to support analytics and MIPS Reporting, Value Based Payment models
• Connect and support behavioral health improvement
• Track and address health related social needs (AHC)
• Enable the generation of new knowledge per 21st
Century Cures ACT
Growth: National Model with
Multiple Regions
Northeast Region
Southeast Region
Western
Central
Heartland
Northwest Region
Regional Gateway Connections
Implications of PCDH
Centralization of all data on each patient in their PCDH enables:
Nationwide ADT alerting (with complete histories)
More accurate care gap analysis (support quality)
More accurate quality measures (support VBPM’s)
National patient identity assurance
Possibility of centralized patient consent management
Patient access to their entire record in one place– for the first time (patient empowerment & engagement)
Costs:
Relatively little– must maintain governance, geographic relationships, and minimal technology
©2017, MyHealth Access Network. Contents may not be copied or distributed without permission.
Discussion
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• Thanks to our speakers: • Chuck Christian • Doug Dietzman• David Kendrick
• Thanks to YOU!
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Certificate of Attendance
This bearer of this certificate has attended the healthsystemCIO.com-Produced Web Seminar, entitled, “How HIEs Are Making the “Patient
Information Anywhere” Dream a Reality Today” on 10/3/17
Contacts:
Anthony Guerra, Editor-in-Chief, healthsystemCIO.com
Nancy Wilcox, Director of Sales and Marketing, healthsystemCIO.com