nevada state innovation model (sim) hit taskforce september 28, 2015 1
DESCRIPTION
DHHS, DHCFP - Nevada State Innovation Model (SIM) Project Prepared by Myers and Stauffer PROBLEM STATEMENTS A robust statewide Health Information Exchange (HIE) is needed to promote sharing of accurate and complete data at the point of care A method to measure population health and population health improvement is needed Greater adoption of Electronic Health Record (EHR)s by providers Not all provider types are eligible for Medicaid EHR incentive payments 3TRANSCRIPT
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2DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
AGENDA• Introductions• Review of Problem Statements• SIM HIT Solution– Purpose– Discussion Points
• HIT Plan Domains– Requirements– Nevada Content– Discussion Points
• Closing Discussion
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3DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
PROBLEM STATEMENTS
• A robust statewide Health Information Exchange (HIE) is needed to promote sharing of accurate and complete data at the point of care
• A method to measure population health and population health improvement is needed
• Greater adoption of Electronic Health Record (EHR)s by providers
• Not all provider types are eligible for Medicaid EHR incentive payments
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4DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
PROBLEM STATEMENTS
• Providers need a centralized, user-friendly method to access patient data that is payer neutral
• Moving to value-based reimbursement requires the availability of provider performance data available to the provider and payer
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5DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
PROBLEM STATEMENTS
• Value-based reimbursement calls for outcomes data that is typically not represented in the claims file and can be accessed/identified without regard to who paid the claim
• Unrealized opportunities exist to improve patient engagement and shared decision making through the use of HIT
• There are opportunities to create public dashboards regarding health status of Nevadans and certain key health metrics
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SIM HIT Solution
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7DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
SIM HIT SOLUTION
• Goal: To use the SIM efforts to foster greater HIT and data infrastructure and development in Nevada
• Increased adoption, implementation and meaningful use of EHRs
• Establish the availability and use of direct messaging to all providers
• Support the Regional Extension Center (REC)
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8DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
SIM HIT SOLUTION
• Encourage growth and contribution to statewide HIE• Explore regulatory authority to make HIE opt-out vs.
opt-in for sharing • Develop patient portal to promote patient
engagement and shared decision making• Create centralized provider portal– Concise patient profiles– Provider population health metric dashboard– Actionable alerts to bridge care gaps and support value
based purchasing (VBP) initiative
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9DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
PROMOTE EHR ADOPTION, IMPLEMENTATION, AND USE
• Purpose: To increase the transition to electronic records and facilitate the electronic sharing of health information
• Discussion Points– How can REC activities be supplemented to
promote EHR adoption?– Barriers from the provider group suggests costs
and expensive interfaces are problematic.
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10DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DIRECT MESSAGING FOR ALL PROVIDERS
• Purpose: To provide a basic mechanism for providers who may not have an EHR system to exchange patient information with other providers.
• Discussion Points– How easy/difficult is it to obtain a direct messaging
address?– Is there a need to promote awareness of this option?
• Priority and Timeline
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11DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
PROMOTE STATEWIDE HIE
• Purpose: To increase the use and utilization of a statewide HIE to provide better information at the point of care
• Discussion Points–What are the fiscal and operational barriers to
participation today? And what strategies could be developed to address barriers?
– Are there closed systems or regional HIEs today? If so, need to identify and obtain statistics on them
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12DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
PROMOTE STATEWIDE HIE
• Discussion Points (continued)– Should consideration be made to moving NV to an opt-
out for vs. an opt-in HIE sharing model?– Is there a sustainability plan of an HIE publicly
available?– Need concrete and documented statistics on percentage
of providers represented in HIEs and the estimated percentage of patient records contained within HIEs
• Priority and Timeline
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13DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DEVELOP AN ALL PAYER CLAIMS DATABASE (APCD)
• Purpose: To assist in measuring population health, quality, and transparency. An All Payer Claims Data Base (APCD) could supplement data used for public reporting and payment reform
• Discussion Points:–Will the data set include all submitted or final
disposition of claims?–Will the data include any fiscal information?
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14DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DEVELOP AN ALL PAYER CLAIMS DATABASE
• Discussion Points: (continued)– Would DHHS be the keeper of the APCD?– Infrastructure needed will be heavy
Master Patient Index to match patient data across all payers and data sources Reference files (e.g. claims, clinical, demographic, sister agency data, etc.) Health Insurance Portability and Accountability Act (HIPAA) compliant privacy
and security– Release an Request for Information (RFI) to shape final scope of the
APCD– Request for Proposal(RFP) for design, development and implementation
of APCD– What authority is needed to develop and mandate compliance?
• Priority and Timeline
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15DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DEVELOP POPULATION HEALTH MANAGEMENT AND ANALYTICS
TOOL• Purpose: Measure, track and publish
population health metrics and improvement at a provider, payer and population level
• Discussion Points– DHHS maintain responsibility of tool– Initial data sources: Claims/All Payer Claims
Database + HIE + State Registries– Integrate in additional data sources
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16DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DEVELOP POPULATION HEALTH MANAGEMENT AND ANALYTICS
TOOL• Discussion Points (Continued)– Population Health Analytics Tool sitting on top of
data sources– Serving data for administrative reporting, provider
portal and patient portal–May alert providers/patients to treatment gaps or
educational opportunities
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17DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DEVELOP POPULATION HEALTH MANAGEMENT AND ANALYTICS TOOL
• Challenges: Enterprise Master Patient Index, security, privacy, ownership, participation, data comparability/normalization, etc.
• Priority and Timeline
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18DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
PROVIDER PORTAL• Purpose: Create a portal for providers to view their
patient’s comprehensive health care history and the provider’s population health metrics
• Discussion Points– Population health vendor will develop provider portal– Provide population health measures for physician’s attributed
patients– Push alerts and care gaps to provider– Will be multi-payer but may roll out incrementally – Suggest inclusion as part of population health analytics tool
RFI/RFP• Timeline and Priority
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19DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
PATIENT PORTAL• Purpose: To promote patient engagement in their health
care decisions and promote health literacy.• Discussion Points
– Population health vendor will develop patient portal– Will include portable patient health record– Prevention and wellness topics – Landing page customized to patient’s diagnosis codes and with
relevant educational materials– Pushes alerts about gaps in care– Scope of requirements will be influenced by the population health
tool RFI and included in RFP• Timeline and Priority
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20DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
HIT PLAN REQUIREMENT• Required component of the SHSIP• Draft Due to CMS 11/30/2015• Required Domains of the HIT Plan– Governance– Policy– Infrastructure– Technical Assistance
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21DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
HIT GOVERNANCE• Components Discussion Points:– Organizational structure and decision making authority related to
SIM HIT DHHS staff would constitute governance structure
– Organizational capacity Multi-Payer Collaboration (MPC) will provide support to DHHS
agenda– Stakeholder engagement
HIT Stakeholder engagement o Committee under the MPC?o Stand alone advisers to DHHS?
– Leveraging existing assets Leveraging existing assets
o Statewide HIE
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22DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
HIT POLICY AND REGULATORY LEVERS
• Alignment with other HIT efforts• Methods to improve transparency• Promotion of patient engagement and shared
decision making• Multi-payer strategies
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23DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
HIT POLICY AND REGULATORY LEVERS
• Discussion Points– Existing HIT Efforts
Statewide HIE Regional Extension Center Public Health registries Hospital provider data reporting
– Improve Transparency Tool/dashboards for public access
– Patient Engagement Patient portal
– Multi-payer Strategy Multi-payer collaborative APCD
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24DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
INFRASTRUCTURE• Analytical tools, data-driven, evidence-based
approaches, telehealth access and remote monitoring
• Plans to use standards based health IT to enable electronic quality reporting
• Integration of DPBH electronic data to drive quality and improvement at the point of care
• HIT to support fraud and abuse prevention, detection and correction
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25DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
INFRASTRUCTURE• Discussion Points– Population health analytics tool– Increase number of telemedicine presentation sites and
utilization– Utilization of the Quality Reporting Document
Architecture (QRDA) for quality reporting– Link public health data and registries with an HIE
which will feed the provider portal and patient profiles– The APCD will combine provider data across multiple
payers which can be used to facilitate detection of fraud and abuse patterns
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26DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
TECHNICAL ASSISTANCE• Provide technical assistance on HIT matters to
providers• Focus on providers not eligible for meaningful
use incentive payments• Discussion Points– Promote and support an REC efforts– Develop a technical assistance resource center for
providers desiring to achieve meaningful use, connect with a statewide HIE, or otherwise share patient records electronically
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27DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
POPULATION HEALTH MEASUREMENT – INTERIM APPROACH
• Interim Approach - the strategy for measuring population health prior to availability of an analytics tool with access to all patient level data
• Aggregate existing quality/outcome metrics and other data points – Reported manually from each payer to central
entity– Supplemented by existing state registries
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28DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
POPULATION HEALTH MEASUREMENT – INTERIM APPROACH
• Phase I: Highly Manual– Payer submit outcomes data to administrator– Administrator aggregates data and normalizes based
on payer covered lives– Omits uninsured/self-paid claims
• Phase II: Some Automation– Provider or Payer submits QDRA III to payer who
contributes electronically to clinical repository– Programmers create basic queries against data
• Phase III: Long Term Solution
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29DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
POPULATION HEALTH MEASUREMENT - LONG TERM APPROACH
• Long Term Approach - the strategy for developing a tool to measure population health and conduct robust data analytics across multiple payers and data sets.
• After sustainable funding identified:– Release Request for Information (RFI)– Refine and Finalize Design– Release Request for Proposal (RFP)– Develop, Design, and Implement (DDI) Solution
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30DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DATA ASSET INVENTORY• Data asset inventory- A review of data available
and/or desired for inclusion in the population health information management tool
• Checkpoint on complete data from key payers– Medicaid/CHIP– PEBP– Indian Health Services– Culinary Health Fund
• Gap identification• Strategy for closing gaps
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31DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DEFINE BUSINESS NEEDS• Define business needs – the process of identifying the
goals and objectives related to how data will be used to measure and influence population health.
• Provide a population health analytics tool to measure population health and population health improvement
• Incorporate information and data from other sources that are not historically considered to be medical in nature
• Present useful information at an aggregate level as well as payer, provider and possibly patient level along with a public view
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32DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DEVELOP CONCEPTUAL MODEL
• Develop conceptual model – identification of the inputs, outputs, data sources, and data uses. The conceptual model will influence the RFI and RFP process.
• Clinical Inputs– HIE: hospital, physician/clinic, dental, pharmacy, laboratory, school-based
clinics, Department of Corrections (DOC), Department of Juvenile Justice (DJJ)
– Clinical registries– EHRs– Clinical Claims Database (CCD) of case management records from payers
• Administrative inputs– Payer claims
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33DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DEVELOP CONCEPTUAL MODEL• Reference Information– Patient– Provider– State Demographics – Zip, County, Population,
Income, Etc.– Codes – International Classification of Diseases
(ICD), Current Procedural Terminology (CPT), Health and Care Professions Council (HCPC), American Dental Association (ADA), Diagnostic and Statistical Manual (DSM), National Drug Code (NDC)
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34DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
DEVELOP CONCEPTUAL MODEL• Other Inputs
– Public Assistance Programs: SNAP, TANF, WIC and other programs
– Department of Education (DOE): Attendance; Scores/Grades– DJJ and DOC Encounters– Foster Care/Adoption Assistance Flags
• Identify Outputs and Usage– Administration and oversight of Nevada’s population health
improvement – Public reporting on progress and reporting– Source for provider and patient portal
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35DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
NEXT STEPS• Define formats and standards to transmit
clinical metrics for interim approach• Identify sustainable funding to move to long
term solution• Develop RFI and ultimately RFP• Implement long term solution
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Reference Slides
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37DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
Analytics Tool
Clinical Administrative Other Reference
Provider Administrator Patient Public
Views
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38DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
Patient
Demographics
Claims
Medical Records via HIE
Behavioral Health
Corrections and Juvenile Justice
Public Health• Summary• Individual
Education
Enrollment in other Public Assistance Programs (SNAP, TANF, WIC, etc.)
Population Health Analytics Tool
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39DHHS, DHCFP - Nevada State Innovation Model (SIM) Project
Prepared by Myers and Stauffer
GLOSSARY OF TERMSADA – American Denatal Association HIT – Health Information Technology
APCD – All Payers Claim Data HIPAA - Health Insurance Portability and Accountability Act
CCD – Clinical Claims Database ICD - International Classification of Diseases
CPT – Current Procedural Terminology MPC – Multi-Payer Collaborative
DHHS – Department of Health and Human Services NDC – National Drug Code
DJJ – Department of Juvenile Justice NGA – National Governor’s AssociationDOC – Department of Corrections QRDA - Quality Reporting Document Architecture
DOE – Department of Education REC – Regional Extension CenterDSM – Diagnostic and Statistical Manual RFI – Request for Information
EHR – Electronic Health Record RFP – Request for Proposal
HCPC - Health and Care Professions Council SIM – State Innovation Model
HIE – Health Information Exchange VBP – Value-Based Purchasing