Stony Brook PPS PAC

State of the SHIN-NY Strategic Planning Update

Val Grey

Executive Director

March 21, 2017

DSRIP Project Milestones Include SHIN-NY

Suffolk Care Collaborative Projects with SHIN-NY Requirements:

• 2.a.i: Create an Integrated Delivery System Focused on Evidence-Based Medicine / Population Health Management• 2.b.iv: Care Transitions Intervention Model to Reduce 30-Day Readmissions of Chronic Health Conditions• 2.b.ix: Implementation of Observational Programs in Hospitals• 3.b.i: Cardiovascular Health Evidence-Based Strategies for Disease Management in High-Risk / Affected Populations

SHIN-NY

Direct Exchange

Alerts

Patient Record Lookup

Integrated Delivery System

Care Coordination

Transitional Care

Disease Management

HIE ValueDSRIP VBP

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Hospitalization Event Notifications and Reductions in Readmissions of Medicare Fee-for-Service Beneficiaries

in the Bronx, New York

Journal of the American Medical Informatics Association

October 7, 2016

An Empirical Analysis of the Financial Benefits of Health

Information Exchange in Emergency Departments

Journal of the American Medical

Informatics Association June 27, 2015

Improve patient outcomes

Less time testing and more on patient care

Shared savings opportunities

(MACRA, DSRIP, APC, Commercial)

Improve accuracy and speed of

diagnosis

Value Based Care

SHIN-NY Update

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SHIN-NY: A Network of Networks

Qualified Entities (QEs) Core Services (funded by government, free to providers) include:

• Secure messaging

• Notifications & alerts

• Results delivery

• Patient record lookup & clinical viewer

• Consent management

• Public health access

QEs offer value added services (for a charge)

Why Do We Need SHIN-NY & NYeC? Patients Are Mobile & EHRs Are Not Interoperable

QE% of PatientsOverlapping

other QEs

HEALTHeLINK 13

Rochester 12

HealtheConnections 19

Hixny 11

HealthlinkNY 34

Bronx 41

Healthix 12

NYCIG 46

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Statewide Patient Record LookupImplemented in 2015 & Working

Allows QEs to query and get important clinical information from other QEs to share with providers

Cross QE AlertsBeing fully implemented in 2017

Allows QEs to receive, without querying, important clinical information from other

QEs to share with providers

Wave 2

• HealthlinkNY

• HealtheConnectionsQtr. 2

Wave 1

• Healthix• Hixny• NYCIG

Live and working

Wave 3

• Bronx• HEALTHeLINK• Rochester

Qtr. 3

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Statewide AdoptionSignificant Progress But More Work to Do

We need to focus on increasing adoption

92% providing complete minimum data

97% of FQHC

98% of Hospitals

47% of Home Care Agencies

81% of Public Health Departments

55% of Long Term Care Facilities

57% of Physicians

New expanded DEIP program designed to help

*All are current adoption rates as of March 18, 2017

Statewide UsageCore Services in Past Year

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SHIN-NY Service Utilization is Growing

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• This chart shows how often a SHIN-NY user has interacted with SHIN-NY patient data by service utilization type.• Hixny corrected the way they calculate Results Delivery, resulting in a higher count for January. Historical corrections are pending. *Updated January 20, 2017

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SHIN-NY Services Used Differently Across Regions

January 2017

• In January, HIXNY altered their method of measuring results delivery which resulted in increase of volume. It may be adjusted historically for future reports.

*Updated January 20, 2017

Consent Distribution By County

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NYeC is recommending changes to consent policy to facilitate the use of HIE to improve healthcare delivery including:

• Patient alerts without consent to those with treating relationships

• SHIN-NY consent could be incorporated into other consents

Longer-term: Exploring opt-out system like used by 38 other states

18 counties representing total population of 12 million people have less than ½ their population consented

NYeC’s Memo regarding Consent Recommendations: http://www.nyehealth.org/nyec16/wp-content/uploads/2016/04/SHIN-NY-Proposed-Consent-Recommendations_Board-Memo-003.pdf

NYeC’s Consent White Paper: http://www.nyehealth.org/nyec16/wp-content/uploads/2017/02/SHIN-NY_consent_white_paper_022817.pdf

*Updated January 20, 2017

Innovation is HappeningA Sampling

Some QEs are piloting integration of clinical data with Medicaid claims

GNYHA coordinating pilot to facilitate sharing of care plans

Some QEs are testing quality reporting via extraction from network

Work being done to integrate public health registries and cancer registry

Image exchange across the state is expanding

Statewide patient portal is being tested

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Strategic Planning

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Game Plan & Target Timelines

THROUGH SEPTEMBER2017

THROUGH OCTOBER 2017

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Multi-Year Roadmap

Long-Term Vision

What’s In It

• Mission

• Vision

• Guiding Principles

• Long-Term Objectives

Operational Plan

What’s In It

• Strategies

• Action Plan

• Metrics & Measurement

• Budgeting

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Listening & Seeking Customer and Stakeholder Input

Stakeholder Focus Groups

• All Provider Types

• Health Plans

• Consumers

• Qualified Entities

• DOH Workgroups

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• What are the most significant barriers to adoption?

• If you are using QE / SHIN-NY services today, what do you find most valuable?

• How integrated is your usage of the SHIN-NY into your current workflow?

• Are there ways to better integrate SHIN-NY data within your current workflow?

• Are there changes that could be made to make the functionality more useful and easier to use?

• Are you able to receive, share, and use the data you and your partners need?

• Is there other statewide data that you would find beneficial?

• How can we be most helpful for value-based care and population health work?

• What is the best way to maximize SHIN-NY benefit and build-in a way that is flexible and evolving?

Our Burning QuestionsSHIN-NY & “Finishing the Job”

What Providers Are Asking For

Simplicity & ease of use

(SSO)

Speedy relevant

information

Better quality & complete

data

“Search –ability”

Finish the basics

Information that goes

across borders

Alignment & Standardization

Easy reporting

Output that matters

EHR integration

Highest privacy & security

Consent policy

changes

Help educating patients

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Driving Forces

Health System & HIE

Contraction in Funding

Care Delivery Changes

Consolidation

Competition

(Opportunity?)

Consumer Expectations

Continuous Technology Advances

Future Considerations & Trends

Data Quality Assurance

Patient Engagement &

Customer Needs

Quality Reporting

All Payer Database

Social Determinants

of Health

Population Health

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Health IT Quality Reporting

US Physicians spend > $15.4B to report quality measures; 785 hours per doc; > $50K per PCP; and,

this doesn’t count insurer costs

WHY?

• Make providers & payers lives easier

• Simplify/align measures

• Continuous quality improvement for patients &communities

Healthcare Association of NYS (HANYS)

“Measure Madness” & “Quality Reporting Madness”: Hospitals are very frustrated and

eager to simplify and streamline

Integrating Social & Medical Data

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• Opportunities to connect and integrate data

• Newer ICD-10 claims data contains z-codeso Z-codes, eventually,

should capture social determinants of health information that could help provide more holistic care and support

• NYS All-Payer Database

WHY?

• Supports value based care

• Helps patients and allows holistic approach based on consistent information

• Promotes healthy communities

Vision & Mission

SHIN-NY

Our mission is to improve healthcare through the

exchange of health information whenever and

wherever needed

NYeC

Our mission is to improve healthcare by collaboratively

leading, connecting, and integrating health

information exchange across the State

Shared Vision

Our vision is a dramatically transformed healthcare

system where health information exchange is

universally used as a tool to make lives better

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Some Planning Assumptions

• Pressure on government funding

• Need to supplement with other funding and work toward sustainability

• Current “network of network” approach will be retained but will likely change

• Better integration and alignment with State and Federal health reform initiatives

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• Stakeholders will demand improvements

• NYS will set clearer (fundable) priorities

• More competition to create tools for providers and plans

• Roles and responsibilities will shift and change, sometimes significantly

Proposed Guiding PrinciplesPassionate Beliefs

• Patient-centered

• Public benefit

• Support reform initiatives

• Stakeholder inclusive

• Consensus building

• Customer-focused

• Regional markets

• Statewide good transcends individual interests

• Operational excellence• Trust, security and transparency• Efficiency--value engineering• Leverage private investment• Highest quality, integrated data• Leading technology• Standardization• Influence & alignment with federal

standards

Strong advocacy and using all levers at federal, state and local level to promote robust SHIN-NY

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DRAFT SHIN-NY Long-Term Objectives

Work toward

sustainability

Integration &

accessibility

Reach maximum potential

• Adoption close to 100%• Full data contribution by all (CCDA)• Highest data quality• Info shared for 95% of patients• Enhance functionality/customer satisfaction• Highest level security & system reliability• Effective, efficient, affordable

• Data standardized and normalized• Data both pulled and pushed• Useful tools for VBC (including care plans)• Clinical & other useful data can be integratedo Claimso Registrieso Social determinantso Consumer reported

• Data used for quality reporting• Integrated with APD• Data available to patients/consumers

• Because the SHIN-NY is of high-value, and used by virtually everyone, users will enthusiastically support via user fees or other mechanisms

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DRAFT NYeC Long-Term Objectives

Connect HIE &

Ensure Access to Statewide

Data

Advocacy &

Education

Lead SHIN-NY Efforts*

*in partnership with New York State

• Provide thought leadership & collaboration• Recommend policy, governance, operations,

functionality• Contract for SHIN-NY enterprise including QE core

services• Ensure oversight, performance & consistent

measurement• Achieve maximum SHIN-NY potential• Create self-sustainability options when maximum

potential reached

• Advocate on behalf of SHIN-NY for funding & policy• Promote best practices & learning systems• Support federal efforts for interoperability• Present united voice & force with EHR vendors• Help providers transform, use EHRs, and connect to

the SHIN-NY

• Successfully connect QEs to facility data sharing (sPRL)• Create master provider index• Ensure access to statewide data (“wire once”)• Ensure technical standards & system performance

• Continue stakeholder engagement on Operational Plan

• Develop recommendations and priorities

• Goal of Operational Plan is for completion by July

• Then … on to QE performance-based contracting

• And implementation and execution of the Roadmap

• To support providers, plans, and communities achieve the “Triple Aim”

Next Steps . . .

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The Road Ahead

40 Worth Street, 5th Floor New York, New York 1001380 South Swan Street, 29th Floor Albany, New York 12210