Provider Directory Services (PDS)March 12, 2015

Karen Hale, Senior Policy AnalystOffice of Health Information Technology, Oregon Health Authority

karen.hale@state.or.us503-373-1767

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Why tackle a statewide provider directory?

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Problem

• Multiple, isolated provider directories in use today• Limited in scope (e.g. missing provider HIE addresses) and

accuracy• May not meet national provider directory standards

Opportunity• Medicaid Coordinated Care Organizations (CCOs) have told us a

statewide provider directory is needed for foundational near term needs• Common credentialing efforts that place standards for data are

underway in Oregon• Emerging national standards for data models and protocols “federated

health care directory” (F-HPD) have recently been adopted

Provider Directory Subject Matter Expert (SME) Workgroup

• In 2014, we convened a 12-member SME workgroup who provided guidance on scope, uses, problems, and parameters for provider directories

• Work informed and shaped our requirements for the request for information (RFI) and funding request to CMS

• Members were from:

FamilyCare Health Plans PacificSource Jefferson HIE Portland IPAMid-Valley Behavioral Care Network / WVCH Health IT Committee

Providence Health and Services

Moda Health Regence Blue Cross Blue Shield

OHSU’s Center for Health Systems Effectiveness

Samaritan Health Services

Oregon Medical Association Women’s Healthcare Associates

What are we going to do?

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• Procure for Provider directory services (PDS) that will allow healthcare entities access to a state-level directory of healthcare provider and practice setting information.

• The project comprises design, development, implementation, and maintenance of the technical solution as well as operations and ongoing management and oversight of the program.

• PDS will leverage data existing in current provider databases and add critical new information and functions.

• Leverage existing data sources:• Connect but not replace existing disparate provider directories• Oregon’s Common Credentialing data which requires providers to

confirm the accuracy of their information every 120 days• EHR and HIE directories via recently adopted national standards

called HealthCare Provider Directory – Federated (F-HPD)• Access to the provider directory services

• via web portal, through an EHR/HIT, or through a flat-file exchange• Funding

• Use 90% federal Medicaid funding for initial design, development, and implementation for Medicaid. Use federal/state funding for Medicaid share of ongoing operations/maintenance costs.

• With enabling legislation (HB2294, 2015) PDS can be expanded beyond Medicaid and sustained by fees

• Approach to development will be incremental where each phase will build upon the last

What is our approach?

PDS Principles

• Build incrementally to ensure success, but must have value right out of the gate

• Scalable solution to allow for future enhancements and additional functionality

• Establish clear expectations regarding quality of provider information

• Contract both for implementation and operations• Work in collaboration with Common Credentialing

database/program (under development)• Centralize where needed but allow for federation of

existing provider directories

• Operations• Complete, accurate source of provider data for referrals and care

coordination• Validation source of provider demographic, specialty, location, and practice

information• Health Information Exchange (HIE) - Access to HIE "address book"

• Facilitate HIE outside clinic or system• Enable providers to meet stage 2 meaningful use

• Data available for research and analytics

Key Uses

• Providers and clinics• Hospitals• Health Systems• Health Plans and CCOs• State programs such as PCPCH and the Medicaid EHR Incentive Program• State departments such as Public Health, Medical Assistance Programs,

Addictions and Mental Health, Health Analytics• Local HIEs

Users and/or Sources of data

PDS Uses and Users

PDS concept

PDS activities underway

• Review RFI responses, RFP planning and refining requirements• State procurement approval processes• Assemble stakeholder groups - Provider Directory Advisory Group

(PDAG), internal OHA users• Continue analysis of governance model/criteria and policies

Winter 2015

• Procurement processes continue • Convene stakeholder groups• Continue analysis of governance model/criteria and policies

Spring 2015

RFI status

• PDS was one of three projects addressed in our “bundled procurement” RFI that was issued on November 18, 2014

• Closed on January 15, 2015• Received a total of 20 responses for one or more

bundled procurement components; 10 were specific to the PDS

• Analysis is underway on those responses and will inform our approach to the Request for Proposal (expected release in spring/summer 2015)

• permitted use, data sources, quality of the data, security, and accessPolicies

• scoping the operations of the program (onboarding processes, ongoing monitoring of the processes, and modifications) and if OHA has the legislative authority, fees and fee structures

Programmatic aspects

• Refining requirements, phasing approaches, and technical considerations

Technical aspects

Provider Directory Advisory Group (PDAG)

We will be convening an advisory group to inform:

PDAG ScheduleFeb 5, 2015 Send out nominations

Mar 5, 2015 Nominations due

Mar 12, 2015 Nominations decisions

Mar 18, 2015 Membership notifications

Apr 2015 Convene monthly, 2-3 hour PDAG meetings

Envisioned to meet through 2016

For more information on Oregon’s HIT/HIE developments, please visit us at http://healthit.oregon.gov

Provider Directory Subject Matter Expert Workgroup (2014)http://

healthit.oregon.gov/Initiatives/Pages/PD-Workgroup.aspx

Karen Hale, Provider Directory Lead, OHAKaren.Hale@state.or.us