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Health Information Exchange in the Era of Accountable Care
PANELISTS • Mark Stevens - Vice President, Best Practice Partners • Karen Bell, MD, MMS - Chair, Certification Commission, CCHIT • Mark Jacobs, MHA, CIO - Delaware Health Information Network (DHIN) • James Younkin - Director, Information Technology, Geisinger Health System • Salim Kizaraly - Chief Corporate Officer and Principal Consultant, Stella Technology, Inc
MODERATOR • Kate Berry – Chief Executive Officer, NeHC
October 15, 2013
• Recognition as a contributor to national discussions on the future of health IT
• Networking with public and private sector health IT thought leaders
• Leadership opportunities in strategic workgroups
• Learning through free NeHC University classes and materials
• Access to members-only resources and information
• Visibility through discounted sponsorship of NeHC programs
• Insights from semi-annual member briefings and strategic discussions
Benefits of being a NeHC member include:
Learn more at www.nationalehealth.org/NeHC-membership
Join the NeHC membership program
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NeHC Members § 2311, LLC § AARP § ADVault (MyDirectives) § AEGIS.net, Inc. § Alere Wellogic, LLC § American Academy of Nursing § American College of Physicians § Audacious Inquiry § Axesson § Azuba § Beaumont Health System § Best Practice Partners § Booz Allen Hamilton § CAQH § CareCompanion § University of Alabama at
Birmingham § Cherokee County Health Services
Council (SMRTNet) § Coastal Connect § Continua Health Alliance § DataWeb, Inc. § dbMotion § DC Smart AV/IT Consulting and
Training § Defran Systems, Inc. (Netsmart) § Delaware Health Information
Network § Denver Health § DigiCert, Inc. § Digital Collaboration Solutions
§ Electronic Behavioral Health Information Network (eBHIN) § Elsevier § George Washington University § GetWellNetwork, Inc. § Governor's Office of Electronic
Health § Greater Houston Healthconnect § Hawaii Health Information
Exchange § Health Information Associates § HealthCrowd § HEALTHeLINK § HealthLINC, Inc. § HealthShare Bay Area § HealthTechture, LLC § Healthwise § Iatric Systems § Ignis Systems Corporation § Indiana Health Information
Exchange (IHIE) § Inland Northwest Health Services
(INHS) § INRange Systems, Inc. § iPhysicianHub § Joseph H. Kanter Family
Foundation § Kaiser Permanente § Kansas Health Information
Network, Inc. § Kidney Cancer Association
§ Kinergy Health, LLC § Koss on Care, LLC § Krames StayWell, LLC § Kroll Advisory Solutions § MedAllies, Inc. § Michigan Health Connect § Mosaica Partners § My-Villages, Inc. § National Quality Forum (NQF) § NCHICA § Neighbor's Keeper § NEOS § Next IT Corporation § OCHIN § Ochsner Health System § OneCare § OneHealthPort § Optum § Oracle § Orion Health § Patient Engagement Systems § PatientPoint § Pharmacy e-Health Information
Technology Collaborative § Point-of-Care Partners, LLC § Polyglot Systems, Inc. § Privacy Analytics, Inc. § Quality Insights of Delaware REC § Rhode Island Quality Institute
(RIQI)
§ RISC Management & Consulting § Rochester RHIO § Sajix, Inc. § Sharp Healthcare § Standard Register § Surescripts § Texas Health and Human Services
Commission, Office of e-Health § The Connected Health Economy § The National Council for
Community Behavioral Healthcare § TLD Systems, Inc. (CME Online) § Tower Strategies § U.S. Department of Veterans
Affairs § UCF College of Medicine
Innovation Team § University of Michigan Health
Informatics Program § Valley Hope Technology – iAC/ESS § Vital Health Software § WellSpring Consulting § West Virginia Health Information
Network (WVHIN) § Whatcom Health Info Ntwk, LLC
(HInet) § Yeaman and Associates § Zweena Health
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NeHC University Thanks Our Sponsors!
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For more information, contact [email protected]
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Upcoming NeHC University Programs
Mark Your Calendar
October 18: National HIE Governance Forum Meeting 12:30-2:00PM EST
http://nationalehealth.org/hie-governance-forum
October 22: Improving Health Literacy to Improve Patient Engagement
1:00PM to 2:00PM EST Leslie Kelly Hall, Healthwise Karen Baker, Healthwise
http://nationalehealth.org/HealthLiteracy
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Upcoming NeHC University Programs
Mark Your Calendar
November 12: Assessing and Improving Consumer Engagement: The Consumer eHealth Readiness Tool (CeRT) in Action
1:00PM to 2:30PM EST Kate Berry, NeHC Rose Maljanian, HealthCAWS
Gary Ozanich, Center for Applied Informatics Kerry Kelly, PrimaryPlus
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November 15: Groundbreaking Work: ACOs and Innovation Grants
12:00PM to 1:00PM EST Dr. Craig Samitt, DeVita Healthcare Partners Chuck Podesta, Fletcher Allen Health System
http://nationalehealth.org/InnovationGrants
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Presentation slides are available at http://www.nationalehealth.org/NoHIENoACO
A recording of the webinar will be posted within 48 hours of the
conclusion of the webinar
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Please enter your questions in the Questions window on the right side of your screen.
You can also send us an email at [email protected], tweet a question using hashtag #NeHC, or comment on our Facebook
page at www.facebook.com/nationalehealth
Mark Stevens Vice President
Best Practice Partners
Karen Bell Chair-Certification Commission
CCHIT
Mark Jacobs CIO
DHIN
James Younkin Director, Info. Technology Geisinger Health System
Salim Kizaraly Chief Corporate Officer Stella Technologies, Inc.
Kate Berry CEO NeHC
The CCHIT ACO HIT Framework A Guide to Success while Assuming Accountability for Cost, Quality, and Patient Engagement
Karen M Bell, MD – Chair, CCHIT National E-Health Collaborative | Webinar October 15, 2013
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© 2013 | Slide 10 | September 10 2013
Why an ACO HIT Framework? § Changing reimbursement policies encourage greater accountability
for cost, quality, and patient focused care § Federal ACO/MSS rule § Commercial insurers offering multiple types of ACO models § Some states mandating accountable care from Medicaid providers § More than 450 providers groups in some form of financial risk
arrangement
§ Different from HMO capitation of the 1990s § Emphasis on quality of care as well as patient engagement § No designated “gatekeepers” -- patients seek care where they wish § Belief in the power of HIT to support new structures and processes
§ Many new provider groups unclear about what they will need and where to start their HIT roadmaps § No structured comprehensive public discussion at the
implementation level on how to achieve healthcare transformation
© 2013 | Slide 11 | September 10 2013
Silos Preclude Person Focused Health and Care
Payer Care: Focused on the Member (Employer) and Costs • Contracts with multiple providers • Benefits vary per member • Available networks per member • Claims (what was paid for) • Diagnoses (on claims) • Clinical data extracted for quality
measurement purposes (HEDIS) for NCQA, PQRI, etc.)
• Emphasis on measurement
Provider Based Care: Focused on the Patient and Care Workflows • Reimbursed by multiple payers under
multiple contractual arrangements • Cares for multiple patients with multiple
benefit structures/networks • Cares for patients who see multiple
other providers • Has information on care generated at
point of care only
Community Based Care: Focused on Individual Needs
• Outcomes and goals • End of life wishes, living wills, etc. • Cultural preferences • Health risks • Patient monitored data • Pastoral, social, familial caregiver
support • Public health interventions • Independent of payer or provider
© 2013 | Slide 12 | September 10 2013
© 2013 | Slide 13 | September 10 2013
Users of the Framework § Provider groups taking on financial risk -- self assessment and
roadmap development, depending on organizational goals
§ Payers -- assess readiness of proposed AC partners to take on risk; partnership opportunities
§ Developers -- fill gaps
§ Policy makers – HITPC ACO WG recommendations
§ All of us -- enhanced structured discussion and understanding of what it means to move along the continuum from current care to a transformed delivery system
© 2013 | Slide 14 | September 10 2013
The Framework Part 1: Summary
§ Represents a provider orientation -- how care delivery functions at the organizational level
§ Grounded in goals and objectives of care delivery
§ Process oriented in the accountable care delivery environment with necessary functions outlined for each process
© 2013 | Slide 15 | September 10 2013
© 2013 | Slide 16 | September 10 2013
© 2013 | Slide 17 | September 10 2013
Important Consideration § Emphasis on Primary HIT requirements common to all
organizations in the accountable care arena and to all processes § Sharing of health information – among providers internal and
external to organization as well as with patients and their designated caregivers § Data integration from multiple sources -- clinical, operational,
financial and patient derived § Specific patient safety features § Strong privacy and security protections
§ Can be implemented in multiple ways
§ Can be implemented by different partners
© 2013 | Slide 18 | September 10 2013
Sharing of information
§ Crossviewing
§ Single system access
§ Secure unidirectional “push,” disparate systems (Direct Protocols)
§ Access to data warehouse
§ Portals
§ LAND and SEE technology
§ Bidirectional Health Information Exchange among disparate systems
© 2013 | Slide 19 | September 10 2013
The Framework Part 2: HIT Capabilities
§ Each process and its functions are defined in detail
§ HIT capabilities optimally supporting each of the 64 discrete functions are outlined
§ Patient safety features are bolded
§ MU 2014 criteria are starred
© 2013 | Slide 20 | September 10 2013
Care Coordination
Care Coordination involves two different but related aspects of patient care. One provides information to the clinician who must be able to access from and provide relevant clinical data to multiple sources in order to determine and provide for appropriate next steps in diagnosis or treatment. The other is to assure that patients are in the appropriate setting as they transition among multiple levels of care. Both are important for providing high quality care as well as mitigating excess, both must incorporate patient needs and preferences, and both are highly dependent on the ability to quickly and easily send and query health information on a given patient to and from multiple electronic sources.
© 2013 | Slide 21 | September 10 2013
© 2013 | Slide 22 | September 10 2013
The Framework Part 3: An ACO HIT Glide Path § Based on how the care environment will likely change as
provider organizations become more and more accountable for quality, costs and customer loyalty
§ Acknowledges accountable care as really about healthcare transformation
§ Each organization will have a unique glide path, commensurate with its own short and long term goals
§ Functions and HIT capabilities may be more limited in early stages of healthcare transformation and grow incrementally as needed
© 2013 | Slide 23 | September 10 2013
The Goal: Healthcare Transformation Focus Current Situation Transitioning
Environment Transformed Future
Clinical Culture Physician centric, individualistic, authoritative
Primary care based teams, may include patient and designees
True collaboration with all providers, patients and designees
Cost Efficiency Cost measurement based on silos of payer claims
Care coordination and care management processes
Strong business analytics, contracts and improved clinical processes
Reimbursement Incentive Mostly FFS, moving into upside financial risk
Significant up and downside risk
Most patients under global payment arrangements
Patient Involvement Patient satisfaction surveys (to the patient)
Patient outreach and follow up (for the patient)
Patient as partners (with the patient)
Quality of Care Reporting on a myriad of measures to a myriad of entities
Manage specific cohorts to individual goals
CQI based care process reengineering
© 2013 | Slide 24 | September 10 2013
© 2013 | Slide 25 | September 10 2013
Health Information Exchange Required § Care Coordination -- access insurance information and benefits, get
information about care from multiple sources
§ Cohort Management -- engage all providers (including home based and community) in working together to meet patients’ needs and goals
§ Patient Relationship Management -- communication and collaboration with patient or designated caregivers
§ Clinician Engagement -- easy access to all necessary info about a patient and his/her care options at point of care;
§ Financial Management – information on costs of care outside of ACO
§ Reporting – to payers, public health, research, etc.
§ Knowledge Management -- social networking, a learning environment
© 2013 | Slide 26 | September 10 2013
Financial Management: It’s All About the Data § Data sources - all payer data bases, consolidated clinical data
from multiple EHRs, operational systems § Business Intelligence Analyses § Descriptive – reports, dashboards, trends, etc. § Predictive – applied statistics and modeling § Prescriptive – linear programming and regressions to analyze options
§ Revenue Cycle Management § Book different types of reimbursements and their cycles § Pay clinicians other than straight FFS § Identify and plan for areas of loss § Supplier management
§ Other: attribution, leakage, program evaluation
© 2013 | Slide 27 | September 10 2013
Knowledge Management: With a Little Help From Your Friends § CDS beyond alerts and reminders to clinicians § Diagnostic and treatment options § CDS to patients and designees
§ Document management and search engines for advanced business analytics
§ Personalized medicine
§ Outcomes based on patient supplied data with respect to function, overall health and meeting of goals
© 2013 | Slide 28 | September 10 2013
Patient Engagement: Keep your Pasture Greener § Simplify: easy to seek all care with or through you
§ Inform: easy to get directions to providing information about all aspects of health care (includes insurance, your delivery system, HIT, care in the community)
§ Educate: “to” the patient
§ Communicate: “for” the patient including follow up and making appointments as in PCMHs
§ Incorporate: “with” the patient including both their preferences and their advice
© 2013 | Slide 29 | September 10 2013
Clinician Engagement: Culture Eats Technology for Lunch § Provide good data on practice and patients
§ Administrative simplification
§ Support for collaboration
§ Supply or link to useful information § Assessment tools § Up to date clinical information programs § Relevant payer, public health, research, community resources and cultural
links
© 2013 | Slide 30 | September 10 2013
How to Use the ACO HIT Framework
§ Step 1: Map short and long term goals and objectives to the broad areas on the Glide Path and corresponding processes and functions
§ Step 2: Assume 2014 ONC Certified products; focus on Primary HIT Requirements
§ Step 3: Conduct internal assessment of HIT capabilities that support the identified processes and functions that match your goals
§ Step 4: Roadmap the gaps: functions first, then HIT support
© 2013 | Slide 31 | September 10 2013
The ACO Workgroup
§ Reports into the HITPC
§ Recommendations due end of December 2013
§ Initial focus on developing certification criteria for Meaningful Use Stage 3
§ Current direction § Assessing what exists now in MU against ACO needs § High priority interoperability standards § Data integration policies to support business analytics § Other Federal policy levers to support ACOs
© 2013 | Slide 32 | September 10 2013
The Goal of Health Reform
Patient Focused Health &
Care
Providers Payers
Community based care
© 2013 | Slide 33 | September 10 2013
Thank You!
Access to the interactive CCHIT ACO HIT Framework with User’s Guide www.cchit.org/hitframework
We welcome general comments and feedback regarding either CCHIT’s work or the ACO WG activity
Contacts: [email protected] Karen Bell, Chair & ACO Workgroup
[email protected] Sue Reber, Outreach Director
Health Information Exchange for Accountable Care
Jim Younkin IT Director, Geisinger Health System
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From Beacon to ACO
Patient Activation
Care Coordination
Community Engagement
IT Infrastructure
Keystone Beacon 5-counties
Hospitals: • Bloomsburg • Evangelical • Geisinger • Shamokin • Select Specialty (LTACH)
Practices (# locations): • A Community Clinic • Bloomsburg Physician Practices (12) • CPGI Endoscopy Center • Central Penn Gastro Associates • Columbia Co. Volunteers in Medicine • Danville Family Practice (Dr. Eckel) • Elysburg Family Practice (Dr. Bobeck) • Evangelical Medical Services (14) • Eye Center of PA (7) • Family Practice Center (10) • Geisinger Medical Group (12) • Kanouse Medical Group • Dr. Peter McNeil • Medical House (Dr. Abdul) • Pagana & Pagana-DeFazio • Dr. Sanjay Sen • Susq Valley Medical Specialties
Nursing Homes: • Bloomsburg Healthcare Center • Golden Living – Mansion • Grandview Health Homes • Maria Joseph Continuing Care • Mount Carmel Nursing Home • Riverwoods (Albright Care)
Home Health: • Family Home Medical • Geisinger Homecare-Hospice • SUN Home Health • Susq Valley Home Health Care • VNA Health Systems
Goals: • Reduce re-admissions for patients with CHF
and COPD • Improve patient and clinician satisfaction.
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Mifflin Mifflin
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Bradford
Bucks
Butler
Cambria
Cameron
Carbon Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Delaware
Elk
Erie
Fayette
Forest
Franklin Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Monroe
Montgomery
Montour
Northampton Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill Snyder
Somerset
Sullivan
Susquehanna Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
Blair Dauphin
About KeyHIE®
38 Unique Healthcare Organizations 21 Hospitals 172 Physician Practices 28 Home Health locations 70 Long Term Care Facilities
1 Pharmacy and 1 LTACH
Copyright 2013 Keystone Health Information Exchange
Facilities publishing Qty Hospitals 16 Practices 82 Long Term Care 13 Home Health 4 Payers 1
Patient information Qty Total unique patients 3.5M Patient Authorizations 866K # accessed current month 16K Total MyKeyCare Activated 2,950
Usage information Qty Total Users 1,663 # active current month 209
Information available Qty Encounters (ADT) 31.6 million Discharge Summaries 184,343 ED Summaries 330,143 History & Physicals 274,555 Lab Results 10.2 million Imaging reports 2.57 million Continuity of Care Documents “CCD”
315,092
About KeyHIE®
Copyright 2013 Keystone Health Information Exchange 37
How ACOs benefit from HIE
Analytic reporting
Patient engagement
Care coordination
Patient record linkage
Copyright 2013 Keystone Health Information Exchange 38
HIE for Providers
View HIE Documents Receive Alerts/Notices Direct Messaging Scan/upload docs
Publish Documents Consume Documents Direct Messaging
Connected EHRs HIE for Patients
View HIE Documents Patient Education Health Reminders Direct Messaging Medication History Scan/upload documents
Copyright 2012 Keystone Health Information Exchange ®
HIE Services
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PATIENT PRIMARY CARE
HIE Notifications
HOME HEALTH/ LONG TERM CARE
PHARMACY/PBMs
PAYERS
HOSPITALS CASE MANAGERS
LABS
ADT
Notification
Notification Notification
PROVIDER PORTAL
Copyright 2013 Keystone Health Information Exchange 40
Coordinating with LTPAC
MDS or OASIS Clinical Summary
41
Developed with AHIMA, HHS, and S&I (LCC workgroup) HL7 Balloted. Nationally available Web service.
LTPAC HIE
Copyright 2013 Keystone Health Information Exchange
http://transform.keyhie.org 41
CONTACT: Jim Younkin IT Director, Geisinger Health System Director, Keystone Health Information Exchange [email protected] Phone: (570) 214-8833 42
Health Information Exchange in an Era of Accountable Care
Mark J. Jacobs, MHA, CPHIMS, FHIMS October 15, 2013
DHIN Participants Present & Planned
Positioning DHIN as an Enabler
– Broad Based Participation • Payers • Providers • Community
– Bi-Directional Data Exchange • Community Health Record • Results Delivery • CCD Exchange
– Population Health 2.2 million transactions per month
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Certified DHIN EHR Interfaces
iKnowMed McKesson (Practice Partners & Horizon)
PhysiciansXpress SequelMed
Varian Elekta
ADS
Allscripts (Including Eclipsys) Bizmatics/Prognosis
Cerner electronic Clinical Works (eCW)
GE Healthcare (Centricity) GEMMS
Greenway Glenwood/Glace
InfoQuest Med Plus - Care 360
MicroMD NextGen
Office Practicum (Connexin Software) STI Computer Services
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8
4
0
5
10
15
20
25
ContractBetaCertified
Athena HealthFusion
ACOs & HIEs • ACOs Value Based (Changing Payment)
• HIEs Exchange Based (Changing Behavior)
• Private • Public
ACOs : Appears to be emerging faster where there is no Public HIE
HIEs : Enabler for an ACO ACO HIE
Must manage a Patient Population Can Exchange data on a Population
Must deliver high quality, coordinated care at a total cost that is less than what would otherwise be expected
Can reduce costs and improve quality
Need to evaluate the likelihood of future events—using numbers, not crystal balls.
Can be an Enabler
Find creative ways to reduce the likelihood of undesirable events.
Can function as an Innovator
Decrease the impact of undesirable or complex clinical event will occur
Can Provide Value Added Services
Challenge to Operationalize Can be a Leverage HIT/HIE Infrastructure
Thank You
No HIE? No ACO! Health Information Exchange in the Era of
Accountable Care
Agenda
• How HIE features can serve ACOs • Specific use cases from HIE communities • Parting thoughts
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HIE Features That Serve ACOs
53
HIE Platform
HIE Features That Serve ACOs
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HIE Platform
Care Coordination
HIE Features That Serve ACOs
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HIE Platform
Care Coordination Clinical Messaging
HIE Features That Serve ACOs
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HIE Platform
Care Coordination Clinical Messaging
Data Capture
HIE Features That Serve ACOs
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HIE Platform
Care Coordination Clinical Messaging
Data Capture
Patient Engmt &
Retention
Public Health
Reporting
Payer Information
Centralized Information & Services
HIE Features That Serve ACOs
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HIE Platform
Care Coordination Clinical Messaging
Data Capture
Patient Engmt &
Retention
Policies & Procedures
Public Health
Reporting
Payer Information
Centralized Information & Services
Parting Thoughts…
• You can build your own – but don’t have to! • No one size fits all – but no need to reinvent
the wheel…
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Thank You!
Please enter your questions in the Questions window on the right side of your screen.
You can also send us an email at [email protected], tweet a question using hashtag #NeHC, or comment on our Facebook
page at www.facebook.com/nationalehealth
Mark Stevens Vice President
Best Practice Partners
Karen Bell Chair-Certification Commission
CCHIT
Mark Jacobs CIO
DHIN
James Younkin Director, Info. Technology Geisinger Health System
Salim Kizaraly Chief Corporate Officer Stella Technologies, Inc.
Kate Berry CEO NeHC
National eHealth Collaborative
1250 24th St. NW, Suite 300 Washington, DC 20037
(877) 835-6506 [email protected]
www.NationaleHealth.org
Thank you for your participation!
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