Connecting the Arizona Healthcare Community: An Update from the Statewide Health Information Exchange

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1 Connecting the Arizona Healthcare Community: An Update from the Statewide Health Information Exchange Melissa A. Kotrys, MPH Chief Executive Officer February 22, 2018

2 Agenda Current Services, Data & Functionality Who is Health Current & What Do We Do? HIE Services, Programs & Opportunities Available Data & Permitted Uses 2018 Areas of Focus & Activity Example Use Cases Health Plans Hospitals Providers ACOs & CINs Tying HIE & Data to Value Based Healthcare Practice Innovation Institute (Pii) Data Strategy Care Quotient Sample Reports Questions

3 Who is Health Current & What Do We Do? A public private partnership that improves health and wellness by advancing the secure and private sharing of electronic health information. Serves as a data trustee and data manager for the Arizona health care community. Manages and operates Arizona s health information exchange (HIE). Provides secure access to patient health information for Arizona s health care community.

4 Introduction & Update Play Video Video is on this page on website:

5 Health Current Governance

6 4 Pillars of Success Strategic Business Plan Sustainability Active Participation + Strategic Partnerships + Participant Value + Data Integrity = Sustainability Data Integration Data Acquisition Data Quality Core HIE Foundation Value-Added Services

7 HIE Accomplishments to Date 90%+ of hospital admissions with data flowing 8.0M+ patients with clinical data 65,000+ Alerts monthly Integrating physical & behavioral health information statewide Interstate connectivity Patient Centered Data Home Groundswell of interest 430+ Participants

8 Growth Since New HIE Platform in 2015 Areas of Growth 2015 Today Participating Organizations Inpatient Discharges 56% 95% ED Visits 51% 95% Patients 6.3 M 8.5 M Patients w/clinical Data 4.8 M 7.5 M Monthly Transactions Received 6 M 12 M Alerts Sent 0 65,000 Active Portal Users 8 678

9 Monthly & Projected Participant Growth

10 HIE Participants Current participants include 440 entities (as of 2/21/18) 180 Community Provider Organizations 76 Behavioral Health Organizations 32 Hospitals & Health Systems (95% of inpatient discharges) 21 FQHCs & Community Health Centers 81 Long Term & Post Acute Care Organizations 19 State & Local Government Organizations 14 Health Plans 14 Accountable Care Organizations (incl. Clinically Integrated Networks) 3 Reference Labs & Imaging Centers Hospitals, FQHCs and RHCs participating in the Medicaid EHR Incentive Program with AHCCCS (Arizona Medicaid) are eligible to receive financial incentives for HIE participation. Note: An HIE Participant is an organization that has signed a Participation Agreement. These organizations are either already connected to the HIE or in the process of connecting.

11 Statewide Participation

12 Phoenix Participation

13 Tucson Participation

14 HIE Services Data Exchange Push/pull and query/response functionality HIE Portal Secure online access to patient data, a summary view Alerts ADT alerts and other clinical results notifications in human & machine readable formats Direct Secure Secure for clinical information exchange; DirectTrust certified and HIPAA compliant Clinical Summary The delivery of a continuity of care document (CCD) based on an electronic request

15 Current Programs Transforming Clinical Practice Initiative (TCPI) Practice Innovation Institute (Pii), in collaboration with Mercy Care & Mercy Maricopa Integrated Care, supports 2,500 Medicaid providers with practice transformation and preparation for value based purchasing HIE Onboarding Program Assisting Medicaid providers with obtaining HIE services Statewide HIE Integration Program (SHIP) Integrating physical, behavioral health & substance abuse information Education & Outreach (E&O) E Prescribing education and general Meaningful Use support Targeted Investment (TI) Program AHCCCS program supporting integrated physical and behavioral healthcare

16 New HIE Services & Opportunities Alerts Additional Batch Reporting Functionality Accumulate ADTs for patient panel & deliver at regular frequency Crisis Tab within HIE Portal Emergency access to key pieces of information PDMP/HIE Integration Access to HIE portal can also show PDMP data to meet prescriber mandate for registered providers Patient Centered Data Home (PCDH) ADT alerts and follow up information exchange extended to Western Region and soon nationally Other Value Added Services Medication fill history and electronic image sharing under consideration

17 Patient Centered Data Home (PCDH) National Map Northwest Region Western Heartland Northeast Region Midwest Southeast Region Central

18 Data Available (varies by data source) Demographics Allergies/Adverse Reactions Medications Diagnosis/Problem List Procedures/Treatments Diagnostic Test Results Immunizations Vital Signs Advance Directives Payers Family History Social History Clinical Documents Discharge Summary Emergency Room Report Encounter Summary History & Physicals Operative Notes Consultation Notes Others (50+ possible)

19 Health Current Participants Providers & Data Types updated monthly network/the network participants/data providers data types/

20 Current Permitted Uses 1) Treatment 2) Care Coordination 3) Case or Care Management 4) Transition of Care Planning 5) Population Health 6) With a Valid HIPAA Authorization 7) Health Current Uses New Permitted Uses (effective April 2018) 8) Payment 9) Certain Healthcare Operations

21 2018 Areas of Focus and Activity Social determinants of health Opioid epidemic support Emergency medical services Interstate connectivity Patient Centered Data Home Advanced directives Connectivity to data sources with advanced directives, including Sec. of State s registry HB 2076 Pilot to test access to advanced directives in emergencies via HIE

22 Example Use Cases Health Plans Hospitals Providers ACOs & CINs

23 Health Plan Examples 1. Data feed of all patient data for beneficiaries to the health plan ingested into health plan applications for regular use by plan or provider networks 2. ED Registration Alerts for a subset population of beneficiaries, followed by team coordination to intervene in ED preadmission if needed 3. Inpatient Admission Alerts to case managers/care coordinators to coordinate and monitor high risk, high needs patients 4. CRS patient Alerts for coordination between health plan and CRS clinics 5. Look up of new patients to review medical history via HIE Portal

24 Hospital Examples 1. Patient CCD with 90 day lookback pushed to facility based upon receipt of a patient registration event (ADT) 2. Query response to bring data into EHR at registration with single sign on connection 3. HIE Portal use by ED physicians and staff may include checking for drug seeking behavior or crisis summary information 4. Immunization reporting from EHR to ADHS via HIE

25 Provider Examples 1. ED and Inpatient Alerts driven by patient panel plus HIE Portal access is most common a) Subset of population typically tracked by disease state, by high cost/high needs, etc. b) Alerts support building daily worklists for care coordinators c) Ability to check HIE Portal for more detailed information d) Batch Alert Reports available with aggregated information over period of time for easier organization and sorting 2. Query response functionality supported by some EHRs 3. Crisis network and ED use of crisis summary information via HIE Portal 4. Utilization of health plan applications fed with HIE data

26 ACO & CIN Examples 1. Data feed of Alerts and other clinical data to ACO applications for analytics, population health and downstream provider network usage 2. Batch Alert data pushed to ACO applications for care coordination 3. One time push of CCD based on patient panel received by ACO applications and used for variety of functions

27 Tying HIE & Data to Value Based Healthcare

28 Practice Innovation Institute Supports 2,500+ Arizona providers in receiving timely information to understand current performance on clinical process and outcome measures including actionable patient specific information Supports achieving improved outcomes on 23 selected measures through integrated claims/hie clinical information. HIE tools = provider portal, patient alerts summary reports, EMR interfacing, and provider requested reports Care Quotient = quality, cost, and utilization software supporting TCPI performance goals on 3 Pii selected measures. Provides web based trended performance reports including process and utilization measures, provider stratification of metrics and patient information, provider/patient attribution. 28

29 Emergency Patients with Multiple Visits June Dec 2017 Emergency Patients 2 visits visits 33 4 visits 12 5 visits 7 6 visits 3 7 visits 1 8 visits 0 9 visits 1 Total

30 Care Quotient Sample Data 30

31 Care Quotient Sample Data 31

32 Care Quotient Sample Data 32

33 Care Quotient Sample Data: High Cost Patients Miscellaneous Professional Services 2017 Total Spend $14,922,139 Number of patients 16,494 30% of Patients 80% of Cost $11,937,221 33

34 Developing a Dashboard 34

35 Value Based Healthcare The Value of Data & HIE 1. The more data that is available high quality data the more options that providers and plans will have to use information for care coordination, analytics, population health and addressing care gaps 2. HIE serves as the data trustee for Arizona s health care community to facilitate secure data sharing to get the information where it needs to be to achieve these goals 3. Critical to focus on Health Current s four (4 pillars) of data integration, data acquisition and data quality and value added services, to support these efforts

36 Strategic Business Plan 4 Pillars of Success Sustainability Active Participation + Strategic Partnerships + Participant Value + Data Integrity = Sustainability Data Integration Data Acquisition Data Quality Core HIE Foundation Value-Added Services

37 Questions? Melissa A. Kotrys, MPH Chief Executive Officer Follow Us:

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