Briefing Document on CHCANYS Center for Primary Care Informatics August, 2014

Transcription

1 Briefing Dcument n CHCANYS Center fr Primary Care Infrmatics August, 2014 BACKGROUND New mdels f care delivery and payment require primary care prviders, including federally qualified health centers (FQHCs), t make significant imprvements in patient access t care, quality f care, patient and ppulatin health utcmes, and cst cntainment. Health care prviders, lcalities, and the State, amng thers, must target limited resurces t address high-pririty gaps and yield the greatest results. Having nging access t in-depth and high-quality data and advanced analytical supprt is critical t achieving these gals. In respnse, CHCANYS has launched the New Yrk State Center fr Primary Care Infrmatics (CPCI) t supprt the targeting, design, and implementatin f imprvements; health care system planning; and plicy develpment. The CPCI has three majr cmpnents: 1. A Statewide Data Warehuse 2. Data Analysis and Supprt 3. Quality Imprvement Technical Assistance STATEWIDE DATA WAREHOUSE As a central CPCI strategy, CHCANYS has implemented a statewide data warehuse with extensive analytic and reprting functinality. The CPCI data warehuse builds upn the electrnic health recrds that all New Yrk State FQHCs have adpted, drawing clinical, peratinal and financial data frm the EHRs and practice management systems nightly. It rganizes and presents data t give FQHCs the infrmatin they need t allcate resurces t maximize their imprvement effrts, and enables the sharing f data acrss health centers t benchmark perfrmance and facilitate cllabrative imprvement initiatives. All three cmpnents f the CPCI listed abve prvide intensive supprt t guide and drive significant imprvements in patient access t care, quality f care, patient and ppulatin health utcmes, and cst cntainment. The sftware platfrm fr the CPCI data warehuse was created specifically fr FQHCs and is licensed frm Azara Health Care. The Azara prduct is in use in 12 states in ver 100 FQHCs. In just 2 years, nearly half f New Yrk s 63 FQHCs have been cnnected t the CPCI data warehuse. When all health centers are cnnected, the CPCI data warehuse will include annual data n 1.7 millin patients with ver 8 millin visits at 580 FQHC center sites. The data warehuse autmatically prduces standard reprts n ver 120 clinical quality and key perfrmance indicatrs. The data warehuse als enables FQHCs t drill dwn t view data at the health center, health center site, prvider and patient level (depending n level f access granted t a given user). (Fr a screensht f a sample f measures see the Appendix.) It als allws users t filter data by a standard list f parameters t assess patterns in their data, including payer class, service line, and race and ethnicity. Data are shwn in easy-t-understand visual charts and tables. Clinical quality measures are calculated based n widely accepted standards (e.g. NQF, CMS, HEDIS, and New Yrk State). The prduct is in cntinuus develpment t meet the changing needs and reprting requirements f its user cmmunity. Fr example, the April, 2014 release included 15 New Yrk State HEDIS measures fr the first time as well as 25 newly-certified Meaningful Use measures eligible fr submissin as part f prvider incentive payment attestatins. 16 Financial & Operatinal measures are als available. 1

2 The CPCI data warehuse includes 50 additinal reprts, including: 11 patient registries 14 Meaningful Use reprts 4 NCQA Patient-Centered Medical Hme-related reprts 8 tables required fr the federal Unifrm Data System (UDS) reprt 8 types f individual prvider reprt cards 2 reprts specific t CHCANYS grant-funded initiatives Financial and peratinal reprts CHCANYS will als add external data t the CPCI data warehuse (e.g., payer claims data relating t services rendered utside the health center, data t assess wrkfrce shrtages and unmet health care needs). The additinal data will supprt mre rbust analyses f quality and utcmes in relatin t csts as well as planning activities related t primary care capacity and wrkfrce develpment. The initiative benefits the FQHCs, CHCANYS, and the larger health care system in effrts t imprve the quality and csteffectiveness f patient care by: Supprting the identificatin f needs and pprtunities acrss the State t imprve quality, utcmes, and csts and allwing the targeting f resurces t areas f greatest need and pprtunity. Supprting FQHCs leadership and participatin in new integrated delivery mdels, including New Yrk s Delivery System Refrm Incentive Payments (DSRIP) Perfrming Prvider Systems, Accuntable Care Organizatins, and independent practice assciatins (IPAs). Enabling FQHCs that d nt have the in-huse expertise r resurces t cmpile and use their data t track their perfrmance and implement quality imprvements, as fllws: Users at participating FQHCs can access and view the data they are authrized t view via the web. CHCANYS will help health centers understand the data, implement imprvements, and teach health centers hw t d it themselves. Supprting patient, panel, and ppulatin management at the health center and prvider/care team level, including: Patient registry reprts that list patients with specific chrnic cnditins r preventive care categries and identify actins that need t ccur in rder t meet quality gals. Fr example, the diabetes registry reprt prvides a list f patients wh have nt had their A1c test. In additin t the date f their last test, the list includes a phne number s teams can call patients t schedule a test. Fr a screensht f the Obstetrical Registry see the Appendix. Patient visit planning reprts that list all patients scheduled t see a prvider r team fr a single day. It is rganized by prvider and then by patient scheduled appintment time t make it easier fr care teams and prviders t review alerts and t prepare in advance f the patient s visit. Fr a sample f the Patient Visit Planning reprt see the Appendix. Risk and care management reprts that integrate external payer claims data t identify high-cst, high-risk patients fr fcused care management services. Payer claims data prvides the infrmatin n use f hspital inpatient and emergency services that can be used t calculate risk scres fr each patient. Fr a mck-up f this reprt, which is in develpment, see the Appendix. Referral management reprts that list pen referrals fr services utside the FQHC, by type f referral and length f time pen, t assist FQHCs in the difficult task f clsing referrals t ensure that patients receive the specialty services they need and the data is entered int the electrnic health recrd in a manner that allws the FQHC t get credit fr the service in varius clinical quality measures. 2

3 Enabling FQHCs t benchmark their perfrmance with that f their peers and against natinal benchmarks Prducing standard measures and reprts 1 required by HRSA, natinal Patient-Centered Medical Hme recgnitin, EHR Incentive Prgram Meaningful Use dcumentatin, Health Hme reprting, and thers.; There is a ne-time cst assciated with cnnecting each FQHC t the CPCI data warehuse and validating the data that is transmitted. On an nging basis, FQHCs pay a quarterly subscriptin fee based n the number f primary care patient encunters. This subscriptin allws health centers t access their wn data, run autmatic and standardized reprts, and cmpare their perfrmance with that f their peer health centers. CHCANYS has secured grant funding t cver the netime cnnectin csts and t subsidize a prtin f the subscriptin csts. CHCANYS effrts t secure ther funding will be nging. DATA ANALYSIS AND SUPPORT Under the CPCI, CHCANYS has develped advanced analytic capacity t cnduct custmized analyses t supprt FQHCs, the State, and ther health care stakehlders in plicy, planning, and prgram initiatives. Fr example, CHCANYS Data Supprt Team has develped a variety f tls using publicly available data frm state and federal surces t assist FQHCs in their applicatins fr federal funding and their participatin in majr New Yrk State initiatives, including the DSRIP prgram. The Data Supprt Team has als prvided custmized data analyses fr FQHCs, n request, in cnnectin with these initiatives. This analytic supprt cmplements tls available t the FQHCs thrugh the CPCI data warehuse. The Data Supprt Team has als licensed the Salient tls fr accessing Medicaid claims data, and is explring uses f this data in relatin t the clinical data in the CPCI data warehuse. QUALITY IMPROVEMENT TECHNICAL ASSISTANCE In cnnectin with the CPCI data warehuse, CHCANYS has develped an accmpanying prgram f related technical assistance t supprt data quality, clinical quality imprvement, health center planning, advcacy, and fund develpment statewide. CPCI prvides technical assistance tailred t the specific needs f each health center and cmbines a variety f mdalities frm the ecnmies f scale ffered by distance learning, t ne-t-ne caching via telephne, t the higher tuch in-persn assistance needed by sme health centers. Quality imprvement (QI) activities have generally fcused n imprving wrkflw, data flw and clinical prcesses arund specific chrnic diseases, including diabetes, hypertensin, and ther cardivascular cnditins; cancer; besity; depressin; HIV and hepatitis C. CHCANYS Quality Imprvement Specialists prvide instructin n QI techniques and tls; bring in external cntent experts t speak with the FQHCs; cach health centers thrugh the planning, executin and evaluatin f their QI activities; and facilitate the sharing f best practices and lessns learned amng FQHCs. The CPCI Warehuse plays an integral rle in all f CHCANYS QI initiatives, prviding tls fr measurement and feedback t the FQHC prviders; benchmarking perfrmance against each ther and established targets; and supprting care planning, care crdinatin and patient utreach. Examples f funded technical assistance prgrams include a partnership with New Yrk State Department f Health s Bureau f Chrnic Disease Cntrl and IPRO, New Yrk s Quality Imprvement Organizatin, in the CDC-funded Innvative Demnstratin Prject t Advance Ppulatin-Based Cancer Screening and Treatment. This five-year prgram is funding technical assistance t imprve rates f screening and fllw-up fr breast, cervical, and clrectal cancer amng FQHC patients statewide. All f New Yrk State s FQHCs are eligible fr participatin in this prgram. Other quality imprvement prgrams are currently cnducted thrugh CHCANYS Health Center Cntrlled Netwrk, a prgram funded by the Health Resurces Services Administratin f the federal Department f Health and Human Services.34 FQHCs are participating in this prgram. Fr mre infrmatin, please cntact: Lisa Perry Sr. Vice President, Quality & Technlgy Initiatives lperry@chcanys.rg 1 The vendr will autmatically update reprts as the reprting requirements change. 3

4 Appendix: A Sample f Clinical Measures in the CPCI Data Warehuse (All calculated using natinally accepted standards) Cntrlling High Bld Pressure Diabetes: Ft Exam Weight Assessment and Cunseling fr Nutritin Diabetes: A1c>9 and Physical Activity Diabetes: Hemglbin A1c Test fr Pediatric fr Children and Adlescents BMI Patients Weight Assessment and Cunseling fr Nutritin Diabetes: Urine Prtein Screening and Physical Activity fr Children and Adlescents Diabetes: Lw Density Lipprtein (LDL) Cunseling fr Nutritin Management Weight Assessment and Cunseling fr Nutritin Ischemic Vascular Disease (IVD): Use f Aspirin and Physical Activity fr Children and r Anther Antithrmbtic Adlescents Cunseling fr Physical Activity Ischemic Vascular Disease (IVD): Cmplete Lipid Preventive Care and Screening: Tbacc Use: Panel Screening and Cessatin Interventin Ischemic Vascular Disease(IVD): LDL Cntrl Breast Cancer Screening HIV/AIDS: Medical Visit Cervical Cancer Screening Preventive Care and Screening: Bdy Mass Index Chlamydia Screening fr Wmen (BMI)Screening and Fllw-Up: >=65 Years Clrectal Cancer Screening Preventive Care and Screening: Bdy Mass Index Use f Apprpriate Medicatins fr Asthma (BMI) Screening and Fllw-Up: Years Childhd Immunizatin Status Hypertensin: Imprvement in Bld Pressure Preventive Care and Screening: Influenza Primary Care Preventin Interventin as Offered Immunizatin by Primary Care Prviders, including Dentist Pneumnia Vaccinatin Status fr Older Adults Children Wh Have Dental Decay r Cavities Diabetes: Eye Exam HIV/AIDS: RNA Cntrl fr Patients with HIV 4

5 Clinical Registry f Obstetrical Patients 5

6 Registry & Preventative Care Alerts rdered by prvider and appintment time, in ne reprt. Patient Visit Planning Reprt: shwing a prvider s scheduled patients fr the day, including clinical services due 6

7 Reprt in Develpment: Using payer claims data t calculate patient risk scres, calculate ttal patient cst, and identify use f external services 7

8 Reprt in Develpment: A registry t identify pen referrals by pririty, type, date. Will supprt fllw-up & clsing f pen referrals. 8