Transparency, Evaluation, and Health Information Technology … · 2017/9/19 · associated Reports for SPARCS, Vital Statistics, Favorites, My Reports, and Search. (3) Views: This

NEWYORK STATE OF OPPORTUNITY™

Department of Health

Transparency, Evaluation, and Health Information Technology Workgroup Meeting #14

September 19, 2017

September 19, 2017 2

Agenda # Topic Time Leader

1 Welcome and Introductions 10:30 – 10:35 James Kirkwood

2 Opening Remarks 10:35 – 10:40 Paul Francis

3 APD Update 10:40 – 11:00 Mary Beth Conroy

4 SPARCS Technical Alignment 11:00 – 11:20 Scott Franko

5 Consumer Tools and Transparency Update Working lunch 11:20 – 12:00 Natalie Helbig

6 SHIN-NY Update 12:00 – 12:30 Valerie Grey (NYeC)

7 Health IT Integrated Quality Measurement 12:30 – 1:00 Maria Ayoob (NYSTEC)

8 HITrust and Security Integration 1:00 – 1:30 James Kirkwood

9 Discussion and Next Steps 1:30 – 2:00 James Kirkwood

wvoRK I Department TEOF ORTUNIT'I:. of Health

3

Opening Remarks


4

Regulation update Federal update All Payer Website update Timelines Database Update Updated visualizations

wvoRK I Department TEOF ORTUNIT'I'.. of Health


Regulation Update On August 3, 2017 the APD regulations were approved by the State’s Public Health and Health Planning Council (PHHPC)

Regulations were filed with the Department of State on August 23, 2017 The regulations are published in the State Register and become effective on September 13, 2017

An Assessment of Public Comment was prepared The APD Guidance Manual was finalized for public release



Regulation Update – Data Submission Section 350.2 of the regulation (APD Data Submission) shall be effective on January 1, 2018

This will allow the Department additional time to develop the information technology for data collection from commercial third-party health care payers

If the Department does not have the infrastructure in place to accept submission from commercial payers by this date, the Department will issue guidance indicating the anticipated implementation and required compliance date



APD Advanced Planning Document An As-Needed Advance Planning Document Update (AN-APDU) was submitted to CMS on July 28, 2017 and was approved by CMS on August 3, 2017.

The AN-APDU outlined anticipated Design, Development and Implementation (DDI) as well as Operational costs for APD Data Intake, Hosting and Analytics.

The data intake is funded at the 90% Federal Financial Participation (FFP) rate. The analytics and hosting components are funded at 50% FFP.

The FFP requests were approved covering FFY 2018-2021.

Intake and Acquisition: Data Submission Technical Guidance

Entities that submit data to the APO r data submitters") will submit data to the APO using the Encounter Intake System (EIS). Currently, the APD's EIS accepts data submissions in the following formats:

• X12 Post Adjudicated Cla ims Data Reporting (PAC DR)

• National Council for Prescription Drug Programs (NCPDP) Post Adjudication Standard

DOH requires that data submitters submit post-adjudicated claims data for all members and for all llealth care related claims that have been adjudicated. After adjudication, claims data is submitted using X12 PACDR and th e NCPDP Post Adjudicati on Standard transactions. X12 PACD R is used

for institutional, professional , and dental daims. The NCPDP Post Adjudication Standard is used for pharmacy claims. The EIS Companion Guides define specific NYS DOH requirements to be used for process ing encounter data. It is important to note that the below three EIS Companion Guides

supplement and do not contradict any requirements in the X 12 Implementation Guides (Version 5010), the NCPDP Pos1 Adjudication standard Version 4.2 Implementation Guide, or relaled documents.

EIS: TRADING PARTNER INFORMATION COMPANION GUIDE Instructions Related to the Exchange of Electronic Data Interchange (EDI ) wlttl the EIS. Based on X12 Implementation Guides. Version 5010 and the NCPDP Implementation Guide, Version 4.2. The EIS Trading Partner

Information Companion Guide is intended to provide information needed by trading par1ners to exchange Electronic Data Interchange (EDI ) data with the Encounter Intake System (EIS). It includes information about reg istration, tesling, support, and other information.

EIS TRADING PARTNER INFORMATION COMPANION GUIDE: Instru ctions related to Transactions Based on X121mplementation Guides, Version 5010, and related documents. To acquire copies of the X12 Implementation Guides, Version 5010, and related documents, please visit

http:/lstore.x1 2.org/store/healthcare-5010-orig inal-guides.

EI S: STANDARD COMPANION GUIDE: Instructions related Transactions Based on NCPDP Post Adjudication standard Implementation Guide, Version 4.2, and related documents . To acquire a copy of the NCPDP Implementation Guide, Version 4.2, v isit http:/MWW.ncpdp.ora .

• TIER 2 EDIT DISPOSITION SPREADSHEET: lf a submiss ion fil e passes Tier 1 edrling (s1andard level syntax and structure editing), the EIS will perform Tier 2 editing on each claim. The EIS process will check to ensure functional edits are met (external code sets and logical validation).

This involves testing for valid Implementation Guide specific code set values and other code sets adopted as HIPAA s1a ndards , as w ell as DOH required edits. Edit descriptions and logic for each EIS edit are fou nd on th e Tier 2 edit document

~~:'0~0RK I Department ~oRTUNIT'< of Health


APD Website Updates The APD public webpage on the DOH homepage continues to be updated – recently EIS Data Submission Technical Guidance documents were added:

https://www.health.ny.gov/technology/all_payer_database/

https://www.health.ny.gov/technology/all_payer_database

system Secu rityWorkbooks

ODS Test - SIT

ODSTest - UAT

ODS Test- Defect Solution Development

8/11/201 7 - 9/2 9/201 7

8/21/201 7 -9/25/2017

---------------- 9/29/2017 -10/19 /201 7

L'lll,,._ ODSTest-UAT .,...- 9/19/2017 I

~ system Security Workbooks ,...- 9/29/201 7

10/20/2017 -

10/26/ 2017

ODSTestDefect

..... Solut ion Development 10/26/201 7

2017 Wee k 1 2 3 4 5 6 7 8 9 10 11 12 2017 ...

Today 9/ 25/2017

ODS Test- SIT

.--J1~:'0~0RK I Department ~oRTUNIT'< of Health


Enterprise Member Timeline

ODS Build

ODS les-t - SIT

ODS Jest- UAT

ODS les-t - Defect Solution Development

6/ 8/ 2017 -9/18/2017

9/ 5/ 2017 -9/ 25/ 201 7

9/ 26/ 2017 -10/16/ 2017

ODS Requirements and Design

9/18/2017

ODS Build

1

.... 9/ 25/ 201 7

10/23/ 201 7 -

11/10/2017

-

11/13/ 2017-

11/17/ 2017

ODS Test-UAT 11/10/2017

ODS Test Defect

Solution ..... Developm

ent

11/17/2017

2017 Wee k 1 3 5 7 9 11 13 15 17 19 21 23 2017

Today 1 ... 10/16/ 201 7

ODS Jest - SIT



Enterprise Provider Timeline ODS Requirements and Design

ODS Requirements and Design

ODS Build

ODS Test- SIT

ODSTest -UAT

ODS Test - Def ect Solution Developm ent

ODS Requ irements and Design 10/25/2017

10/9/2017- 11/ 17/2017

ODS Build ... 11/ 17/2017

11/ 6/2017 - 12/1/2017

ODS Test - SIT 12/1/2017

12/5/2017- 12/19/2017

12/20/2017 -12/29/2017

ODS Test - UAT 12/ 19/2017

ODS TestDefectSolution Developm ent 12/26/2017

2017 Wee k 1 ___ 3 _____ 5 7 9 _____ 11 _____ 13 2017



Claim Timeline

ADM Bu ild

ADM Test - SIT

ADMTest-UAT

ADM Test- DefectSolution Development

7/28/201 7 -9/25/201 7

ADM Build I...,_ 9/2 9/2011

9/2 5/ 2017 - 10/20/2017

ADM Test-SIT 10/20/201 7

10/23/2017- 11/10/2017

11/13/2017 - 11/17 /201 7

ADMTest- UAT 11/10/2017

ADM Test - Defect Solution Development 11/17/201 7

2017 Wee k 1 3 5 7 9 11 13 15 17 2017

Today



SPARCS / Vital Statistics

Di!l.2.1 - lfok8m-etl Ttoir.lr!ia 11oto1'<'l'".bb

Consolidaltt Dl!llwtabl!lltl • Ma1'1 Data ~" ,

'oAfalidaPN ~a'bilit Del JO - Daf a

Vol'i'dcrt.ion Auln

- - -

ronsdidal~ ~ or/7 - 0IIPfQ'

hlida bl Rwe1 ~ ,onnats:

wvoRK I Department TEOF

oRTUNIT'I'.. of Health


Deliverables – 3rd Quarter 2017

.l Welcome, Preetham C• Sign Out

,J~ IDepartment lAI• ~"" of Health Da......, I) ,. Uome APO Repor ts .. Trc;1.ining Oocum ent.~tion Met~data About Help Desk

tJQ•IM+i,f+ SPARCS

Vital Statistics

Favorites

My Reports

Search

Views

Summarized Adherence % by Condition

ASTHMA

CANCER

CHF

...1 0.... 20 .... 40"* 60.... 80"* 100 ....

Low Birth Weiglit l,eliveries

15

10

5

0 NOV D(C .>AN PU NAJt IJl'lt NAY JUtii JUL AUG H , OCT

4 View Announcements

09/12/201)' A new flle for Busk'lMs ;and Technk;al spedRc•tlon

Doc:umerus h:ave been loaded to the NY APO Portal for testing. The file conUIM bol:ll SPARCS and Vital St:aei.slks.

Pleo.se click to .see. lhe prevJous NY A.PO

announcement History.

5 What is in the NY APD

D<lta SUbjectAree load Dete Date Range

5oun:e

HF15 PnNkler -

12/13/16 l/01/00 -

Fedlltles 9/23/16

OHIP 1/01/14 -

D<lta SPARCS 12/18/16 3/31/16

Mart

NYS- Votal 2/01/17

1/01/14 -DOH 5tatlstlcs 12/31/16

WYORK I TEOF ORTUNIT'I'..



APD Portal Home Page (1) Tabs: Home, APD Reports (drop down includes easy

access to SPARCS, Vital Statistics, Favorites, My Reports, Search)

Training - includes links to training documentation along with calendar

Documentation - includes applicable documentation to the APD

Metadata - accessible link to metadata About - content explaining the NY APD Help Desk - link to Help Desk support

information (2) APD Reports: Quick and easy access to the

associated Reports for SPARCS, Vital Statistics, Favorites, My Reports, and Search.

(3) Views: This feature will be available for future release. Views will consist of dashboards.

(4) View announcements: Most recent announcements will display and previous announcements will be accessible through the link.

(5) What is in the NY APD: The Data source along with Subject area, Load Date and Date Range. This will be updated as new files are received.

f =, 1Department lAIIP"'f'r ~ ·" of Health D,tabast

WNi~iHWfh-MM 1' Home APO Repons -~ Documentation Metadata About llelp Desk

APD Search APD Standard Reports @ * c1;, k10Addfovurile,,

[ Q Search APD Repo<ts

Q P sPARcs PtJ VITAL STATISTICS

[ Am1NL1~v-y$v~ry

I "~"'""""'' I [ ,.,u.w~.acha.-g,;i,PiMD~ t

[ Averog ~ e,ve,Pio,01,d,1~

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[ A11erogelen!;Jtt.OfS t1y ]

I ''""""""""'" I ~~ ~ I ch.,""""''" I ~~ [ Doc:: ~thl:~rlOOO DIJ j ~

SPARCS AMOUlATORY SURGl;; RY

EMERGE NCY OEPARTMENT

INPATIENT

OUTPATIENT

I VITAL STATISTICS VITAL STATISTICS

* Ambulatory Surgery Procedures

* Ambulatory surgery utili2alion

* Ambulatory surgery Utili2al:ion Rates

* Emergency Department frequent Us:ers

* Emergency Department Procedures

* Emergency Oei;iartment utilization Rates

* Emergency Department Utilization Summary Report

* Necessity Df Emertiencv Department Visits:

1( Prima()' Eme.-oency Oei>attment Diaono~

A AHRQ IQI R~Pol'l

* AHRQ POI Report

* AHRQ PQI Report

* AHRQ PSI Report

* DRG SeYerity of Illness ReportfORG seruic:e Intensity Weights

V DRG Sum mary Report

V Inpatient utll i;z.atlon Rates

V Inpatient Utiliz.ation Summary Fleport

* Prim.ary lnpatie.nt Oiagnoses

V Principal Inpatient Procedu res

-A Tarceted Inpatient Disease Conditions Report

* Hospital Outpatient Procedures

A Hospital Outpatient utilization

A Hospital Outpatient Ulilitation Rates




APD Portal Search Page (1) Dynamically search for a title of a

workbook.

(2) Check the applicable box for the category (SPARCS or Vital Statistics), only applicable tag words and workbooks will display.

(3) Clear button will remove any search words, categories, and tag words.

(4) Tag words can be clicked and it will dynamically display the applicable workbook.

(5) The Star next to the workbook can be clicked and it will add the workbook to a list of favorites for the user.

Overview - Inpatient - Targeted Disease Conditions

- About the Report

This r@pon @v a,luat@s Inpat l@nt (IP) hospita l servlc@s by tar g@t@d conditions (Ca rdiac AMI and stroke) and opioids.

The users can eval uate and compare targeted condit ion specifi c IP utll lzatron and charge information by se'lecting from the metrics, se lection fi lters, and stratifi ca t ion var iables descnbed be low. The report contains mu lt iple v iews t hat can be used to evaluate utl ll zat lon tram multlpl@ pe rspectives .

A deta iled descr ipti on of the metrics, selection f ilters, and strati fication variable.s included in th is report Is also available In the documentation section ot the APD home page.

General Informat ion c.Jic.& ium w, ~eol:' rj~ View Info rmation t,1ic.Ammh,~eo~n1<1.11"1!'

About th'" R.,port Targ"t"d Conditions n .. nd

Metrics Targeted Conditions by County

Selection Filters Opioid Trend

-------------------------------~

,-----~ I I I I I I I I I I I ______ .,!

r----• I I I I I I I I I ____ __ .J

Stratification Variab les ~ \L' Opioid by County

---====='===-: ----------- 6 -------------•

Data Sources and References N'@w York State SPARCS databas@ Is the pr imary data source. Further Info rmation r@gardlng t h@ SPARCS database ca n be found by clicking the following link- https :/ / healt h.n y.gov/statistics/ sparcs

Targeted Cond iti ons Trend

• lhll 'o'IIW ~ ti I WM ,;IBph IINI tab le of IP Utllat 'On by wv,t:411 concf.~

• UMl'll Coll'I llldo: -I t tot.II ~• dltKNr;a; b'y" U'9*ttd ConcMSoll Cf UM tM 51111"'1::lon fl tt•l"5 on u,ell!i)h1; ti;, IQQk ..it Mit!l;t.~P.Jtlpt;iP',II.JtlOR5-

• ~ r"$ c;11n ~ ;a tlfflolll period on ~ I m: ch.ut ;and tr,en u--..i:c ttl(; ;tr.at:11".atlon drop do',r,,Tl fllWr to ltnC:lfV 'Ill • mwt: ,er thll ~ i:tf!d tlm• s:,e r1od ,

4 RffUIUtr,111 ollJP'llill" In • to.r,;r• pl'I .M tflil ~cftlle..,..wfor'IM HlillcUid tffl'II p4f'IOO,

Opioid Trend

• 11111 '111~ ~O'fldu -1 I M ~ NI ii Ub.11 o1'0$1d rtl'-11:e-d IP vtlllutlan,

· ~w1nlDQl::¥1.t(lhll~ttJ..,.IOcdl5cNrJJU~aploldQ/tlllgolryorl.lMUlllMIKtiont'llbq;onthe right to loct ilt 511«:t:cd wtl~latlDf'II,

• U$en, ,c,11n ~ lect,. tl m it _pedOd ori the ln.- cti.rt md tMl'l 11 g the ~,.t,1k1t1«1 drop dGwn fllteri:o i.ntlly 11M mdrk tor tl"I HIKtld time p,w1od,

Se lection Filters TIM! ~lOII iwt.r dr«i doWn b(iMH an be~ u, lltn.'l tM dlt-1 dll~ 11'1 CM! duil't! and ~apm fortll l!' ,eJ~ ~l~tlctl. 1111!' ,el~ filleRtMt•re-1 ... 111bli!' are:

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Inpatient Targeted Disease Conditions Workbook | Tableau Clicking the respective icon will provide relevant information about the contents of the report and specific view.

Landing Page

Targeted Co111diUons Trend

.. U:;c: lthi:: sdi:ctioo tilte r:.: cm ~ righ t to :.c:h:ct datt: , di:sp:i !'!d mi::tric~ .;:mid :subp,:ipuliJtli i::mi5. ln tt..: line gr.1 pl,, d ick on ,3 p:iint to :.i:i:- ri:::ult:: ~ .::t lifil!iJ by U t:1 1! l~ l 1!!.I ~\J .:1 Lifi la-dliitm Y.:t'" idi.i ll!~ Th~ 1.-d~I!'! will ,:1 ~ .:I~ Ll i~µl-:fY rl:"1l..l llb- ~'ii y~,:H , Lr I.h i! :-1:':"ei.: 0 l.lfl l ~ tu1M i11 1/) ~ rt'!l!rel (fl::;r.h.lf{lt1$1r M b..=ir WIii ;ir,pi=iiH'' I n iti tl '!:)r.lfth , l''U"I f'i~l'"lt Will ,lfl~r lf'"I tM rn¥1i11 ~Fil f'i , ;.n(j thiJI Ci1 II -..111 hA h~iffl k in t t u:i Tiil hlA. TI 11! ~ Ii i\ '!" iw11 un ll~ 1i!J.H ~-.. ill , i:!~l d rn,· i.. l 1d1.l1:!1i~i..'!! lk Hi to · t 11 · ~ TI1 1! l\t!~t!l I iii.ii!~ n ut q~y lu tf11! l'¾ L1Ki d1 ~;J D d l t:- ~ lt!~tm Ml Q8;_ r n Ril\l ik.on .ilt tMI b :'ittf"lm ci lTIA .ig R -.. 111 rtiiAt thA !)l'.itph:!ii ro rhR a r1 :,11n;i1 ~iAl'r.

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Inpatient Targeted Disease Conditions Workbook | Target Condition Trend

Targeted Conditions By County

Usg t h,Q ,s,i;ilcction fi~~ ,an th.~ right t c, :;elect 11.ltc .ind dis;pl.i~d metric . c lick on .i Q;: 11 in the ~bkl to :;i::c dic m;ip ""'it h thr.: :;ch;:ction filt cs:; o:ppll&d . [f tti0 i;01ect1 onis cont.i ln 10 OI' f ew;;ir ,jlsc;hanJes., no Tot ill Dli;chr1r<1 es w111 <1pp,aar In the t (IQltlp ar.l! the ce111-.1 be blani.: 11 11 tne l.t bl t! . Tlll(! Re,s.et t1 1ter ~ n -on thte r11Jll( 1-. 111 r,:!set; any (tlaramr1 st1,;.s ~ck t o "All" , The Res~ tHt er ~ not appl'y ro t /lte Metc1c; ano Oat~ ,seleakN'l fil l t!IS . T hi!! flt!Y~l ir.:1.:m dl lhl' l.11,tWrn IJf Litt! P<I Yt!" \~i ll l '!~t!l Litt! !Jl -d~h ~ lo 'I.h it! t1 rig ir1dl vit! W.

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Inpatient Targeted Disease Conditions Workbook | Target Condition by County

NYS SPARCS Payor

Payor Profi le Focus on Self-Pay

NYS SPARCS Payo r Profile

Ovl!r;:il l flcn.:1.:11t Chid tlUI.! 111 C l.t11, i 1~ f 10 111 2014

Medlcilld &SAO% MedlciJn! A .2. 7 1% Commerclt1 I Seit Pay OthE!r 1'-0.97%

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Per cen t Clt1 1ms fOf 2015

• comm Iii

I npatient Emergency Department

Percen- t.:hange In Cl .alm s from )U Ja

Inpatient Emergency Depa,rtment

-.4.45% . Co rnrr1eido:d 10.23%

1 1.27% M@<Jir:aid . 5.IB%

10.f-, I% Med icare . S .14%

-J.47% . O~ r -o.41% I 154 'lo 5ell -l'oy 10.98

• ot~ r

Ambu latory Su rgery

17 .191!-'~

Ambu latory Surgery

Comm er r::i t:11 1 0.71%

Med iDJiid 11.92%

Medica re 1 1.6)%

Ut h-P- r - 1.2 5% I Self-P.:iy - 4.93%




Story Telling Example -Payor Profile

NYS SPARCS Payor

Payo r Profile Focus on Self-Pay

--• NYS SPARCS Self -Pay Ut1l1zat1on Trends by Service Type

Puo2r1l Chtmyl! 111 Self-Pd\'" Cldnr1-,; frum 2014

Inpatient T - 15 .47% Emergency Department T-10.98% Ambu latory Su rgery A4.93%

'"'

Seit Puy Clulms Trend by Quur ter 202'1 ;md 2015

· ll~ t!lll

I npat ient Emergency Department Ambulatory Surgery

'"'

Si?- lf f-lr1y c lc11ms hy t-;Kll l ty I ocr1rIon :Jll l '1

.. ! OK E

a

~ ' t,CA

/

N ew York City Res.t of Stute Ne w Yo rk Clt 'p' Rest o f State Out of Stme ~.7.l<l(5.4'1b)

1 33,.('11Q (4 .2'1i,J

2,200[4. l'lb)

I J R, l JA(Sa .~ 1 l n ,N ~l,.1.4%)

12 3.1n 1c.11 .:v.t. ) - 266,77:(:n .e.~ J

I D.96"1(62 5'!il.) J 2or)Sl (J7,5¼)

1,.s.n 4 1s~.4'lb) l n ,16.J"I U ~ )

- SOO, l l &- l6 l .N:1111 2s1,067 (JJ .S~'iiJ

l l l ,.5 17 ( sa.lJ~I

P.-ffrr, 1 c hrt rl !)C' In S{' lf-P.:iy urll l7nHrn1 from /11 14 hy ACJf! c~ro11 p

Inpatient

-0, .1 %

-7.S.4% -

· 15 .4%

- I S.D-% -

- 22.C, % -

-2[).~ -- 32. 7%

- 38 .9'>'i-

Emergency Department

-.1 . 1% .

- 1.R'!l> I

-3 . 1% .

-ll. l ~~ -

· l <U% -

-1 0 .5~~ -- 11.2%

- l1.1%

- 2].]%

Ambulatory Surgery

. A.7%

• ~- Q'!,b

- 2 1.4%

-:!i . l '!b l -].~• 1 -11.6'¼

- 28 .0 ~"i-

--17.=i;~~

WYORK I TE OF ORTUNIT'I'..



Story Telling Example – Self-Pay

Ac-Hoc:: r:h,porl Tl"II OllG 'M,Tgl.riJ-090617

I ' t I (

.. Data AnillytlCS ( ,.. ~

asPARCS_INPATltNT_Utll (

ADMlT_SOURCE_DESCR

AOM!i _ TYPE_DESCR

AGE_ORP

APD_CNTY_CO

CAU'SE_Of _INJ_DESCR CCS_DfSCR

0 CWT'V_NM

- Currft)t.Apr~

- CurrtntAp,$01

- C:U8RfNl_APR_~c_o

A"""' 4%3141¥91

w

[!, iHftHY,!IIL&W

l11Colimns

APR DRG Claim Count

cut1;ENT_APR.,_D1'.13_QES .. Abdo...,~I llaln

Aborll,;in.,/<;>OM:,~t. .

Ac:uta-S.Sub.ocut:11 Endo<":;,r ..

.1.c:ut .. ""'°"'ty&.o..i~un -

Ac:uteMa30rl:"1"9lnfecbon1

Acut e Myoc.ardia l Infarction lli,,58&

~...,,tn.,\Oi:,ord•~&M.. .l,760

01!.CM_"IR

(Nil {!) 20u

ZOl:5 2ou;

- C:URRUiT_APR_MCC_D M Hoc Report Test Dl!G ~Tot.Bl 0906 17 "

~meemc-~Vi/6

'ltimeemc~w,,quldil

s 'lb2CS.f'lfflfflfle0y~a,i

- - , P• - , ; \! -, , rl

F+ El ~- i!' , ,· v It. ,.- !:· f..· I Cl · !l".il· 'i'

a SPA.RC:SJ NPATIENT . LJnL (._.

Dirni::n~:J

'4S1, .. 1iry~

ADMIT _SOt.lftCE_[)[SCR

A01i'JT_T'Yf:'E:_D£SC:R AGE_GRP

APD_CNTY_CO

CAUS[_Of _INJ_DESCR

OC:SJ)ESCfl:

0 CNTY_M.I

~~prSo1

CURRENT_i!JIA'_DPO_O_. CURRENT_APR_MDC_D_

O.,:;;,~l!C'[OI"

Measura:

-;i 'M.1DH1nc1>yv•

ii- "'l-l'relr iC by'v1111~1C1. r

--" At2dinm tritby~,tr

.it ~D1sthilll'!5 IIIT\lttd ~IL

--:i ~ Olsch;qes-onlydat! L n i;tToufDKcturgH

.ii 2dimMi:ll'iC$byVilt'iabl

, . .:;11aw l.l,hUIM1s·M•"ifi•M

CD Automauc

Ill •

IIIColi,m~

= Riwo, +=•m 1i&M•¥·M·IMt hies-Claim Count by Age Group

CI..AAE NT_1.., AGE_atP Abdomnill ll @w bofri P,m

1·2

3·S

lid•

15·1'3 ,. ... 45 64

1>5•74

75.94 . ..

,, 21

331 ...... ..,., '"" .,, 408


Ol'SCM_V R.

{Air]

-' 101.C

::!'OL~

2011!",



Ad-Hoc View Connected to a ADM Table – Examples

(1) A blank Tableau worksheet with all available dimension and measure data fields is shown for ad-hoc query and reporting.

(2) Claim counts by APR DRG for Discharge Year 2014 are illustrated.

(3) Claim counts by APR DRG and age group for Discharge Year 2014 and Abdominal Pain APR-DRG are shown.


22

SPARCS Technical Alignment



SPARCS Technical Alignment with APD SPARCS has been in existence for over 35 years, and is one of the most widely used datasets in the Department of Health and a commonly requested dataset from external researchers

Health care facilities submit data directly to SPARCS through the HCS and the data is currently stored on the DOH Mainframe

SPARCS is being technically aligned and modernized through the development and operations of the NYS All Payer Database

Optum Government Solutions will modernize the intake, translation and storage of SPARCS data through development of a new processing system



Why Change SPARCS Submission? The current method of SPARCS data submission from facilities to the Department is:

Inconsistent with claim submission to payers. Inefficient, inflexible and difficult to modify. Built on outdated technology. Not collecting all relevant content available in the transaction. At times, delayed processing and response to submitted files. Key Information Technology Services (ITS) staff retiring soon.



Project Overview NYSDOH has partnered with Optum Government Solutions, Inc. (Optum) for the new processing system. Solution components include:

24X7 Submission and Processing Window

Edits that more closely align with industry norms for claim submission editing

Facilities will now receive back error reports and files that are: Standardized nationally More clear and concise than what is produced now.



Project Overview (cont.) Current SPARCS Input Specification is:

Often confusing because it contains instructions for multiple versions that have been retired (UB04 and 4050 837R).

Not always consistent with the X12 Implementation Guide (IG) standard.

Being retired and the X12 IG will now be the primary specification source. NY specific instruction will be detailed in a companion guide, which augments the X12 IG.



Project Overview (cont.) Files can include both inpatient and outpatient transactions. Individual claims will be classified as inpatient/outpatient using the Facility Type Code.

Many NYS specific requirements have been eliminated. For example:

Edit requiring Admission Date to equal Statement From Date

Edit prohibiting zero charge amounts

Limitation of facility type codes

:: ~ ••••• •••••

/



SPARCS New File Upload Process

APD

Other Internal electronic Units Output FilesOptum Clearinghouse • Identifiable

• Non-IdentifyingData fed • Encryption directly to the APD

Optum Edits applied

Article 28 Health

Facilities



New File Upload Process Facilities will be logging into a Optum’s clearinghouse portal.

The look and feel will be similar to the Health Commerce System (HCS)

Facilities will have the option to automate uploads (not available with HCS)

Files sent real time

System checks for duplicate file

System will have the ability to handle larger files

Facilities have the option of receiving error reports as files or hard copies

All files upload with have status information attached to them



Help Desk Support

Facilities will no longer contact NYSDOH initially about file processing issues. Instead the Optum Help Desk will be the first point of contact. NYSDOH will be monitor the Help Desk and assist where necessary.

Allows state staff to perform other duties within the bureau

The Optum Support Desk is staffed 8:00 am – 7:00 pm ET, Monday through Friday



Help Desk Support Process Each support issue will be assigned a help desk ticket that will be tracked updated and reported until the issue is resolved and resolution is communicated to the submitter.

Each ticket is assigned to a technician who is accountable to resolve the issue.

If the issue involves extensive research and/or IT development, the Technician will contact the submitter and provide continual updates until the issue is resolved.

At the start of each business day, an internal operational meeting is conducted by the clearinghouse team to review the status of all outstanding issues.

ORK wv I Department TEOF ORTUNIT'I'.. of Health


Timeline and Implementation

Key Milestones* Sep 13th DOH holds Stakeholder Forum in Albany Sep 25th Security provisioning file created by DOH and sent to

Optum Nov 6th Optum Clearinghouse begins user provisioning process Dec 1st Facility training webinars begin Dec 31st Health Commerce System (HCS) submission process

decommissioned Jan 23rd Facility transaction testing begins Mar 24th New system in production

*Milestone dates are representative of current plan and are subject to change.

NEWYORK Department ~~~EOF I I h

~oRTUNIT'<. of Hea t


Timeline and Implementation

Security provisioning

Now thru Sep 25th Users to review user profile and provide updates to DOH where appropriate

Now thru Sep 25th DOH proactively contacting facilities regarding returned email traffic

Sep 25th thru Nov 6th DOH and Optum transition DOH user info to the Optum clearinghouse

Nov 6th thru Dec 1st Users will receive email from Optum clearinghouse with instructions for user ID and Password creation. Users should confirm email will not be treated as spam.



SPARCS Stakeholders Forum Held on September 13th 2017 on the ESP concourse Over 335 people attended representing 187 facilities and vendors Presented detailed edit and file format changes Presented facilities with examples of new submission portal through Optum and new error reports

Held three webinars prior to this meeting on upcoming changes Webinar and meeting materials are available on the SPARCS homepage on the DOH public website: https://www.health.ny.gov/statistics/sparcs/submission/

https://www.health.ny.gov/statistics/sparcs/submission


35

Consumer Tools and Transparency



Where we are: September 2017

• 65% of New York State residents say there is not enough information about how much medical services cost.

• 80% of New York State residents think it is important for their state government to provide people with information that allows them to compare prices before getting care.

• 53% of insured New Yorkers with deductibles have tried to find price information before getting care. In contrast, 45% of insured residents without deductibles have done so.

• 20% of New York State residents have tried to compare prices across multiple providers before getting care.

“How People in New York State Use Health Care Price Information” A research brief from Public Agenda by David Schleifer, Rebecca Silliman, and Chloe Rinehart. APRIL 2017

Where we are: September 2017



• 38% of New York State residents who only have Medicare have tried to find price information before getting care

• 53% of New York State residents with insurance only through their employers have tried to find price information

• 44% of New York State residents whose insurance is not employer based have done so.

• 56% of New York State residents who have not tried to find price information before getting care indicate they would like to know the prices of medical services in advance. However, 53% of those who have not tried to find price information indicate they are not sure how to do so.


September 19, 2017 New York S·tate re-~iderit:s turn to the following :sources for pri~ irifomuitiori~

Figure 5. Percent who s;ay they have tried to find prfce infarmati'on before getting care, from the fallowing sources:

T he' U1tsuraoce, oompam11. by plhooe or wel:l ..

A f1iend\, re lam.e 01 odlleague

A receptionst or oliher doctor's o Ice staff

Their doctor

A hospital's bi ll.mg department

A nurse·

A. mobile phone app

1he ililtsneI, other than !heir wuraooe c.ompany':s webs.ire.

• NMionllll

34% 31%

28% 29%

19% 17%

18% 20%

50% 48%

4-9%** 55%:r*

49% 45%

44% 46%

8-:tt.Miri.:1 ... 1nd-prioa b rradc.al c, ... in Hl.anca m laut '"""" Nm:,n.i_ n • 1,(119; i.-'t!a' S..t-.n•.381.

•8-: tlw,a ·triod ... mdl ... tp,i.... b rnaical c.a-. in ~..an::::a

• l.lallllll: DrEa .and cunwrn:1-j Dt"

~ aai..d: Nr.i::sial., n • 9'117; W..-'la !ut-.n • 3'7.£.

... ,._ mam ,;,a.ap •dffln1 .... rt.DI ,...,..;..ii:, diS.nutl,, .. .,,1c,r..., ,thao,

"'-' 111• ,,.,;,,;..it, dill,...,, •• , .. p,c.QS- .--f1~:'0~ 0 RK I Department

~ oRTUNIT'f: of Health

38

• New York State residents who have not ever tried to find price information before getting care say they would be likely to use sources similar to those used by people who have tried to find price information.


Awareness of pl'iee variation is l[m itec:I.

!=igure & : Percent who say they thin'k the following about docto.-s in their insurance networks o r in their areas:

• Same dinrge mon:: thwirn a th.i::~ for the same 2 rvic-es

• They d,- p,:tty much the same prices for "the snme 5ef',;l:c:es

NewYortc 44% 33%

Natlonal 44% 37%

.--f1~:'0~ 0 RK I Department ~oRTUNIT'< of Health

September 19, 2017

Where we are: September 2017 • 59% of New York State residents who have tried to compare multiple providers’ prices before getting care report saving money, while only 22% of those who have tried to check one provider’s price report saving money.


Table 1. Ratings of Online Cost and ,Quality Tools offered by NY Healltt, lnsut'lance P'lans

Aattngs ) Health inruronce co5t and quality tools • • • e WO il~£ BETTIER

Plan Nama Overall Score Featuras

.. !ii j;-

j!! ~ .. t- .. \;i ,., "!!I .. ·:! •:, .. ~a ...

11 Ill => = • ii ~ 8 .. c: ,; ~ .. ' !! * i j ! '= ... 11 j~ .. .. ~= f ... 0~

HEA!LliH I NSU,RANCE COMIPANI ES

Cigna ll=!i e 0 " e e " e e UnitedHealtlu:ane 11·:f e 0 G e e G Aetna 0 " e e " 0 • BlueShielld Northealilern NrY/ ff 0 0 G e e • 0 BlueC,oss BillueShield We&tern NY

MVP Health Care, 0 0 e e • e 0 Excellus 0 • e e G 0 Anthem/Empire B'lue C1ros.1> Blue Shield 0 0 e e " e 0 Humane 0 • e G e • Oscar e 0 0 e " e Fidefi1,Care rnllll 0 0 • • e • Independent Heahh • e " e • Department

of Health

September 19, 2017

Consumer-Facing Healthcare Cost and Quality Tools; Consumer Reports Issue Brief; November 2016


September 19, 2017

Additional New York Specific Research

Ne,Y Lens for Consumer Transparency

SEPTEMBER 2015

REPORT AUTHORS: PalnckM1ller.Pt!rcConsultinQGrouplLC. Consultant lo the APCD Council

Ashley Peters, APCD Cour-..::il Institute for Heallh Po hey and Practice. Umv11rs1ty of Nl!'W Hampshire

Jo Porter,APCD Couricil. ln51.itule for-Health Polq and Pr.ictice. Univef"§ily of Ne-w Hampshire

Emitt Sullrvan.APCD Council.Nahonal As50Cialion of Health Data Organizations

September 19, 2017

The NYS APD and Consumer Transparency

NYS Health Foundation sponsored a study in September 2015: New York's All-Payer Database: A New Lens for Consumer Transparency

Conducted through the national APCD Council, completed in September 2015.

The report provides insight and analysis of challenges and barriers specific to the NYS APD environment, and recommendations for ensuring a quality system that achieves goals and meets stakeholder needs and expectations.

Available on the APD page on the DOH website under “Reports” or at the direct link: http://nyshealthfoundation.org/resources-and-reports/resource/new-yorks-all-payer-database-a-new-lens-for-consumer-transparency

http://nyshealthfoundation.org/resources-and-reports/resource/new-yorks-all-payer-database-a-new-lens-for-consumer-transparency

Perspectives on Health Care Decision-Making Qua I ity. Cost and Access to Information Lirida'Neiss.FtiO I MayaScherer.MPH I Antt.:JnySlih.MO.MPH

September 19, 2017

Phase 1: Consumer Focus Groups

Presented results at the December 2015 APD stakeholder meeting

Phase 2 work is building off offindings from Phase 1

Report is available on the APD page on the DOH website under “Reports or at the direct link: https://www.nyam.org/publications/publication/consumer-perspectives-health-care-decision-making-quality-cost-and-access-information/

https://www.nyam.org/publications/publication/consumer-perspectives-health-care-decision-making-quality-cost-and-access-information/

January 20171 New" York Stfrte Department Df Health

September 19, 2017

Phase 2: Environmental Scan

Study aim: Selective overview of cost and quality information available for ‘shoppable services’to individuals who may need to makedecisions regardinghealth care goodsand services

OF 33 GOODS AND SERVICE:S ., Literature revi·ew: Nearly 100 art ides from Pu bMed. Google Scholar! Grey

literature

- Search terms: 'hea lt h ca re transparency. ~shoppable, services/ and l ransparency tool

., List incl 1.Jdes:

- Goods and servi'ces considered ishoppa ble''

1• lln ose tin at can be pla rnn ed in ad va nee and for wh icln tin ere is both suffic:i ent i tnf orrmat ion atn d compet it i 0111 u · on wl, ich to base a d ecisi a rn

- Goods and services people actually shop for

- Othe,rs: Services re lated to health reformm cons1.Jmer preferences~ 11goods" [e.g. , prescri ption med i'cations. durable, mediical equ i'pment) I


September 19, 2017

"30'' SCR.EENING ,AND llnAGNOSllC. Sf:RVICfS

1. Bone Oimsify 5.t!!in

2. Ro~tine 5cr Min!J ,Co!onosrnpl,,'

3. ,CT Scan

4. Ro~tine 5creening Mo.irunagram S. MRI 6. Si11.ep Sttidy

7. Wtmsound 8. Ro~tine UoDer Gastro lntiestin!!il ,E'm:loscol:lv 9. X-R!!iy MiStON 111 CataNd Surg11.,ry ORffl O:PED&CS H. Hip Repl'acement 12. klii !!' Afthi'DSC.Opy

n. k,n e Rq1facemeM

OiHIER SURGERY

14. ,Cam ac ,Bypass S11~ery

S. Gallbiadder R!!!mDilttl, lapttll!SCOpit::

16. H11.m a l!ptll l

17. Tonsi/Jectomr and Ari · 0 ctoml,,'

18. Vas,ectomr

11l:!1fflCIE \l'ISlrTS, SPEC JAIL n' 1CARIE,, AND1 EMIERGE CY SER.VICES

191_ Routi.tae Dental Ch,1u-k. p

20. lkrmatalogy Sc:ree.niag ~

2 L fm,erqency ,Df,partment V"ilS-it

.U . Obs tetr1ts (pr,tqrmact a d childbirth)

13. Mfflta1 Heatrh

.M . Plry:sical fher,a:py

25. 5malcirJg Cessation C.ouns.€1il'l!i1' and M't!'dirntion

.26. PtimtliJ Car€

11w1HIUJ IC CUS!EM!E MANAGIEME:Nl

21'. Asthma ma aqemle!nt

2&. Diabetif!.s ma.raaqemimt

.2.91. 1-l~tttetts/-on ma.raaqM1,1mt

M rtSCEl.ilANIEC!llJS

30. l.aoor!Ilnl'}I 5-fwioo:s

3L Drirable €dicai Eqriipment

3.2. Pt€St:rlption Met:fimrioos

33. flu Shot I Department of Health

September 19, 2017

lected Goods and Services for !Interviews

I SCREENING AND D:IAGNOSIIC SERVICES Screening Colonoscop y

MRJ

Sfeep Study

VISION Cataract Surqery

I ORTIHOPEDl:CS Hip Replacement

Knee Arthroscop y Knee Replaoemen t

I OJHER SURGERY Cardiac Artery Bypass Graft (CABG)

I OFFICE V1ISllS, SIPECIALJV CARE,.AN D EMIERGENCY SIERVIICIE S

Routine Dental Check-up

Obstetn·~ (pregnancy and childbirth)

Mental Health

Physical Therapy

Urgent Care I CHRONIIC DIISEASE MANAGEMIENf

Diabetes Manaqement

September 19, 2017

Phase 2: Consumer Interviews

Study Aim: To understand how New Yorkers choose providers for ‘shoppable procedures’, including:

Information consumers use to evaluate the quality of providers

Where they look for cost and quality information

Perspectives on standard cost and quality indicators likely to be available through the APD

Consumer recommendations for making data available


September 19, 2017

Phase 2: Consumer Interviews Eligibility: Live in New York State Age 18+ Have received one of the selected services in the past year Have searched for quality data prior to seeking care Recruited through Facebook ads and Craigslist ~ 600 responses to screening questionnaire from all over the state)

Total # of interviews: 35 Interviews completed to date: 11 Looking to complete by this Fall

California Healthcare Compare

O*l!;OU1C..UDl'fW1-l'INJIIIIIIM'.lntt

a;Jrqfi:&,~

P.-odi»e1R.Jllng'IA.-Z

Topics

Let's get started Wh.lt typo o(spoc!allst aro,oo loolang ror?

'""'rUNl•J' ....

CHRONIC

I ENOOCRINEI HWT,WNO, NERVOUS:

CONIIITIONS, MFl-'IIOU<M At.ID BUIOO SYSTEM& MAINJENil.NCE BEHAVIOR I PAEVENTIVE , ... ~. t ~ r ,

( '7: > FIND QUALITY RATINGS FOR CALIFORNIA HOSPIT~ see now ,oum

Fn:I a F'nwkler D:,, Name

HSN Wtlc>Dn'IIIOHt;JIUll'JotlNI!

Wt:mmltUl)'lllllflllll',iltlyilfldN!cty'*»!l!ll".ioll!onNG'WYOfki,

~ ~nomt'i. nomt~~.,w;I ~ VO!,iQ11*1-

~l'lll)n'n.D;inCflOQl;:10lf,

Flncl PIOVkJers Near You

a - 0 - 0 .......

September 19, 2017

Phase 2: Consumer Focus Groups Study Aim: Testing of Messages, Products, & Information Display

Will conduct 6 focus groups, 8 participants each

Look at models of different digital tools & messaging

Focus on ‘shoppable’ products from Phase 1 & 2

Focus on functionality, utility, comprehension, and potential different approaches to presenting health care costs and quality

Starting late Fall/Early Winter

~oRTUNITY.. I of Health

September 19, 2017

Moving the needle… Improvement Area

Support New Yorkers Finding Tools

Strategies • Create an online tool that helps NYers find resources • Create public health messaging campaigns • Work with other organizations to promote finding tools • Work with primary care doctors & facilities to promote

price shopping & awareness

Goals Increase the % of New York State

Residents that have used an online tool

• Help NYers find insurer price calculators Increase the % of New York State Providing Good, Reliable • Publish better price & quality information Residents that are aware that prices Data

& quality vary

• Create public health messaging campaigns Increase the % of New York State Improve Awareness & • Create value-driven visualizations or infographics Residents that regularly compare Comprehension of Price • Work with primary care doctors & facilities to promote ‘shoppable’ products and choose the and Quality Variability

price shopping & awareness right provider for them • Create “games” or “apps” that illustrate the ways price

and quality vary


September 19, 2017

Discussion

What does success look like? What are other strategies? What are other goals? What are some challenges? What are some opportunities?


Thank you.

Questions?


53

SHIN-NY Update

NEW YORK eHEALTH COLLABORAT I VE

.-fl~:K I Department ~ATE of Health

2020 SHIN-NY Roadmap

Val Grey Executive Director

September 19, 2017

~ ~5: ;:(~I~ ~6U A 06 0 •• OW i

Key SHIN-NY Strategies: Informed by Stakeholders Using performance-based contracting, policy changes, and advocacy:

Supporting Value-Based Care (Tools, Supports, and Services)

Promoting SHIN-NY Efficiency and Affordability

1

2

3

4

5

Ensuring Strong HIE Foundation

Enabling Interoperability and Innovation

Advocating Collectively

55

Strategy 1: Ensuring Strong HIE Foundation Using performance-based contracting, policy changes, and advocacy:

Connections, Contribution, Completeness and Quality

• 100% of hospitals participating and contributing full data (CCDA) by 2020

• 70% of all other providers participating and contributing full data (CCDA)* by 2020

• New TBD measurement for data quality

Security

• QEs and NYeC HITRUST certification by end of 2018

Reliability, Sharing, and Customer Satisfaction

• New TBD measurement for SHIN-NY enterprise-wide availability

• Customer satisfaction survey

• 95% of patients consent*

* Target will be adjusted if NYS does not move to “Opt-Out” system 56

Strategy 2: Supporting Value-Based Care Using performance-based contracting, policy changes, and advocacy:

Enhanced Functionality (up to 3)

• Single sign-on for Health Commerce System (I-STOP, others)

• Smarter, actionable alerts • MACRA/MIPS compliance • Care plan exchange • Additional EHR integration • Patient-centered data home • Others

Additional Data and Services (up to 3)

• Medication fills • Quality measurement

reporting • Standardized data formats • Medical claims (via APD) • eMOLST • EDRS • Registries • Housing/hunger/other

SDOH indicators

Policy Changes

• No written consent for alerts when treating relationship

• Incorporation of SHIN-NY consent with other forms

• Exploration of opt-out • Data governance • Others

57

Prioritizing Value Based Care Support Looking for your Input!

• We Surveyed the QEs • For each category (Enhanced Functionality & Additional Data and Services):

o SHIN-NY Participant Interest (would the initiative increase SHIN-NY usage) o Impact on Health Outcomes (most value to patients, providers, and health plans) oQE Resources (time, complexity, and cost)

• Results on the following 2 slides: oWhat do you think? o Agree ….. Disagree …. Different Point of View? oOther areas we should consider?

• We will be sending you the survey on 9/20 and asking for your written respond by10/4 • We will also be surveying other providers and plans

58

• • •

40

QE Prioritization Survey Draft Results Enhanced Functionality

Weighted Scores

35

30

25

20

15

10

5

0 Advanced Alerts Add'tl EHR Integ Care Plan Exchg Single Sign On MACRA/MIPS Patient Centered

compliance Data Home

Participant Interest Impact on Health Outcomes QE Effort/Resources

59

I I I 111

• • •

QE Prioritization Survey Draft Results Additional Data and Services

Weighted Scores 45 40 35 30 25 20 15 10

5 0

Participant Interest Impact on Health Outcomes QE Effort/Resources

NOTE: Roadmap includes integration of claims data and APD connection which DOH plans to implement with SHIN-NY 60

Strategy 3: Enabling Interoperability and Innovations Using performance-based contracting to promote market-based solutions:

Interoperability and Innovations

• Patient engagement tools • Value-based care

tools/services • HL7 FHIR pilot/discrete data • Blockchain • Artificial intelligence • Machine learning • Natural language processing • Others

61

Strategy 4: Promoting SHIN-NY Efficiency and Affordability

Using performance-based contracting to promote market-based solutions:

Core Infrastructure Policy Changes Payments to Encourage

• Group purchasing • New “wire once” / “pay once” policy • QE specialization

• Standardization • Shared services • Potential QE mergers

62

Strategy 5: Advocating Collectively Working together using all available resources:

Value, Funding and Policy

• Academic studies • Consistent messaging • Consumer education • New advisory groups • Strong advocacy with

Executive and Legislature Funding levels Proposed statutory changes Support for provider

assistance programs Others

EHR Vendors

• Adherence to CCD/C-CDA • Lack of certified EHRs • Prioritization of QE

participants • Responsiveness to

development of gateways • Inconsistent pricing and

charging for HIE connections

Interoperability and Standards

• Participate and influence federal discussions

• Collaborate with other states and regional HIEs

• Promote standards statewide

63

Performance Based Contracts Basic Core

Payments (BC)

Performance Payments (PP)

Innovation & Interoperability

Competitive Pool (II)

Payment for: • Patient identity management, HIE platform, security, EHR connectivity, data

availability (standardized), consent management

Gap to Goal payments on: • Some current metrics • New metrics (including data quality and others)

Bonus payment for all QEs if enterprise hits overall statewide targets

Investments in process or technology innovations via competitive applications: • Must align with statewide goals • Work and results shared statewide • Only high-performing QEs eligible • QE partnerships encouraged • Local match required

64

NEW YORK eHEALTH COLLABORATIVE

40 Worth Street, 5th Floor New York, New York 10013 80 South Swan Street, 29th Floor Albany, New York 12210


66

Health IT Integrated Quality Measurement



Current State Assessment Objectives

Understand stakeholders’ needs related to quality measurement Focus on where clinical data is needed to supplement or replace other data sources used

to generate measures Document specific needs including:

What needs to be measured The purpose for the measurement (e.g. payment, performance monitoring) What requirements apply, e.g which specifications need to be used

Understand the current state of QE activities related to quality measurement

Understand the availability of reliable, accurate and complete clinical data in the SHIN-NY

Identify policy barriers or enablers, e.g. privacy laws Identify and evaluate technical options for data exchange



Current State Assessment Activities

Initiatives Research/ Evaluation Interviews Surveys • Quality Measure Crosswalk • OQPS and OHIP staff • VBP Pilot survey VBP • Literature review on current state • Health plans

APC and plans for quality • Planned: VBP measurement for each initiatives Contractors/Providers DSRIP

QE • 8 QEs Activities

Other • Literature review on clinical and • National HIEs: VT, Cincinnati, States claims data integration in other ME and OK

states

HEDIS • Literature review and analysis re: • Met with health plans (Excellus • VBP Pilot survey electronic clinical data for HEDIS and Healthfirst) to discuss measurement supplemental data flows



Current State Assessment Key Findings

Barriers

General

HIE Role •Data Delivery – standardized data for use in other systems •Proxy measures •Actionable data

•Data quality is a key barrier, especially unstructured data and local codes •Prior investments •Varying capabilities among stakeholders (e.g. data intake)

•Many ways to use HIT/HIE for quality measurement •Prior and parallel initiatives with rich findings can inform the future state •New HIE use cases are driving data quality improvement efforts •Choice of measure specifications depends on purpose and data source •HEDIS/QARR data is being leveraged by DOH for VBP/SIM



Current State Assessment Key Findings Administrative/ Hybrid Proxy

Claims-Based eCQM

Numerator Derived from Claims Derived from Claims & Chart Review

Derived from EHR or CDR


Denominator Derived from Claims Derived from Claims Derived from EHR or CDR


Additional Information

Uses/ Example

Supplemental data may be used to find numerator events &

denominator exclusions

A sample of the population is

targeted for chart review

Health plan HEDIS reporting/APC/VBP

Health plan HEDIS reporting/APC/VBP

Approximates spec using available electronic data

May “loosen” the spec

Frequent measures to drive pop health

mgmt

Specification is used to build a query of

the clinical data source

Monitoring, Required Reporting

CLINICAL QUALITY MEASURES - METHODS

EHR – Electronic Health Record CDR – Clinical Data Repository

0~ ~ ,!,wvo•• I Department

~1JR%Nir< of Health


Lab

NYS Current State Assessment Key Findings

Enrollment Data

HIE

Lab Results

Enrollment Data

Lab Results

Lab

Lab Results

EHR Data

Plan

Aggregator Providers

Providers

Measures

Providers

Enrollment Data

EHR Data

EHR Data

Measures

EHR Data

EHR Data

Measures

• Ml r e

~~:'0~oRK I Department ~oRTUNIT'f: of Health



HIE

Lab Results

Lab Results

Enrollment Data

Lab

PlanA B

Lab

Lab Results

Enrollment Data

Plan

Current State – Lab Data Delivery B. Lab Connects to PlanA. HIE as Intermediary • Labs connect directly to plan• HIE aggregates lab data • Send data in a flat file• Plan provides enrollment file to HIE

• HIE delivers batch file or individual lab results as alerts

• •

•

.--f1~:'0~ 0 RK I Department ~ORTUNIT'f: of l-llealth

PlanPlan



EHR Data

Providers

Enrollment Data

Aggregator Providers EHR Data EHR Data

A

B

C HIE Providers

Enrollment Data

EHR Data EHR Data Plan

Current State - EHR Data Delivery A. HIE as Intermediary B. Data Aggregator • HIE aggregates patient data • Aggregator sends data extract to plan • Plan provides enrollment file/list of C. Provider EHR Extracts

members missing services to HIE • Providers submit data • HIE delivers batch file directly to plans

•

.--f1~:'0~oRk• 1 Department ~oRTUNIT'f: of Health



Measures

Providers

Plan A

B

CHIE Providers

Measures

Aggregator Providers

Measures

Current State – Measure Delivery A. HIE B. Aggregator • HIE calculates proxy measures for • Data aggregator produces

monitoring based on clinical data “HEDIS-like” measures • Specifications modified per data C. Plans

availability • Plans produce measures




USER BUSINESS NEED PURPOSE

OTHER REQUIREMENTS

PLAN

S Single Source of Lab Data

Single Source of EHR Data

• Supplement claims data for HEDIS • Reduce the number of chart

reviews required • Enable more frequent measures

Reduce the number of feeds

PRO

VIDE

RS Data on Services Performed by Other Providers

Timely, Actionable Measures

• Determine whether patients have received needed services

• Feed a pop health platform

• Monitor Performance and improve quality

Data in a Standard Format and Vocabulary • Build solutions for intake once • Access consistently coded data

t ion Dat

~------------Patient ua-ca------,

Patient Darra-----------

Enrollment <NEWYORK r--" irATEOF

OPPORTUNln'..

~ I Department of Health



77

HITRUST and Qualified Entity Security



Qualified Entity SHIN-NY Certification 2018 Annual Attestation Calendar year certification cycle NYSDOH specified evidence, artifacts & live demonstrations will be required HITRUST V.9 Certification - Two year certification cycle (1st year Full and 2nd year

Interim Assessment) Enhanced focus on Cyber Security and IS Risk and Controls

Why HITRUST? CMS recognizes HITRUST

Aligns with CMS Qualified Entity certification for Medicare Access to Medicaid Confidential Data

Emerging requirements from Payers and Hospitals Future funding opportunities

ISO 27002/27799

F,n I Omnibus Rl.le

Stage 2 Meaningful Use

NIST 800.53166

CMSARS

MARSE

PCI DSS 3 0 NRS 603A (State of Nev)

FTC Red Flags Rule

21 CFR Par111

Joint Comm SStOn

rexas Health & Safety Code

rtUe 1 Texas Admtn Code

Infrastructure Cyl>ersecunty V 1

CORE Secunty ReQutrements IRS Pub 1075

201 CMR 17 00 'State of Mass ) CSA Cloud Controls latnx V 1

__nEwvoRK I Department STATE OF

~oRTUNIT'f: of Health


Introduction to HITRUST Normalized framework of security requirements for healthcare organizations, including specifics for

HIE, that provide specific implementation requirements. HITRUST’s HIE CSF and Assurance, informed by CMS requirements, establishes controls to manage

the confidentiality, integrity and availability of PHI with HIEs and connecting organizations. HITRUST Common Security Framework (CSF) incorporates required security governance

(organization, policies, etc.) and security control practices (people, process, technology) HITRUST Scope scales according to type, size and complexity of each organization based on

organizational, system and/or regulatory risk factors. A single benchmark to facilitate internal and external measurements that incorporates applicable

standards and regulations. See below. HITRUST will facilitate a consistent methodology for State Designated Entity and Qualified Entities to

achieve HITRUST certification.

HITR

UST

is in

form

ed b

y:

CSF DOMAINS 1. Information Protection

Program

2. Endpoint Protection

3. Portable Media Security

4. Mobile Device Security

5. Wireless Security

6. Configuration Management

7. Vulnerability Management

8. Network Protection

9. Transmission Protection

10. Password Management

Source: HITRUST CSF

11. Access Control

12. Audit Logging and Monitoring

13. Education, Training and Awareness

14. Third-Party Assurance

15. Incident Management

16. Business Continuity & Disaster Recovery

17. Risk Management

18. Physical & Environmental Security

19. Data Protection & Privacy

~~:'0~0RK I Department ~oRTUNIT'f: of Health


HITRUST CONTROL DOMAINS

Compares to SSP Workbook Control Families

Prior certification/security work can be leveraged in support of HITRUST Certification

THE ROAD TO CSF ASSURANCE

••••••••• •. .. . . ' . . ,. . ... •.

j t t • I • • ~ I 0

•

1 I • " - t • I • . -

~ HITRUST ASSESSMENT SCOPE

Scope dynamic to systems being certified.

Scope creation critically important.

Scope to include all systems that interact with PHI, PII , MCD.

Self mapped scopes created by SOE and QEs will be compared on behalf of NYSDOH by HITRUST to ensure consistency and sufficient security coverage. 4-:o~oRK I Department

ORTUNIT'I:. of Health Scopes are created in MyCSF which requires a subscription .


The Path and Players to HITRUST Certification CSF Assessors CSF Assessors are organizations that have been approved by HITRUST for performing assessment and services associated with the CSF Assurance Program and the HITRUST CSF.

http://hitrustalliance.net/csf-assurance/

https://hitrustalliance.net/understanding-leveraging-csf/



2018 Qualified Entity Certification Timeline

Aug - Sep 2017 – Retain Certified HITRUST Assessor Sep 2017 – HITRUST scoped by SDE & QEs Oct 2017 – HITRUST compares scopes Nov – Dec 2017 – HITRUST CSF Self Assessment scored

2017 Activities 2018 Activities Jan - Mar 2018 – Submit QE Certification Attestation and supporting evidence & artifacts to NYSDOH Jan – Dec 2018 - HITRUST Remediation and Validation Activities Apr – May 2018 - QE Certification Live demonstrations Jul 2018 – QE Certification Compliance Letters & Findings issued Aug 2018 –If applicable, QE Certification Remediation Plans due to NYSDOH Dec 2018- Proof of HITRUST certification submitted to NYSDOH


83

Discussion and Next Steps

Documents

Transparency, Evaluation, and Health Information Technology … · 2017/9/19 · associated Reports for SPARCS, Vital Statistics, Favorites, My Reports, and Search. (3) Views: This