Leveraging HIE to Bolster Accountable Care Organizations. Healthcare Unbound / July 12, 2013

Transcription

1 Leveraging HIE to Bolster Accountable Care Organizations Healthcare Unbound / July 12, 2013

2 Types of Health Info. Exchange Direct (Point-to-Point) Query-Based 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 2

3 It Takes a Community

4 Public vs. Private HIE? Participation Data Fluidity Patient Care Population Health & Data Analytics Financials & Structure Policies & Data Protection Public HIE All health care providers can participate Data is fluid and is available where needed No matter where the patient goes for care, their data can follow them Deidentified, aggregated patient data available to improve population health, research to support chronic disease mgmt., etc. Nonprofit, only charge fees to cover costs; some ARRA funding to cover initial start-up costs Common set of policies (rules) that protect data from misuse Private HIE 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution Limit participation to only some providers Data is siloed or walled off no true longitudinal record on a patient Not all providers can participate, so data is fragmented and may not be available when it s needed Does not generally support population health, but if the network is big enough, some research may be possible. Either for-profit organizations or large non-profit health systems (hospitals) leveraging HIE to increase revenues / patient retention Less stringent policies on data use; patients have less visibility into use and rights pertaining to opt-out 4

5 Who We Are Vision About CORHIO Colorado Regional Health Information Organization A nonprofit, public-private partnership The state-designated entity for health information exchange (HIE) in Colorado Shared health information for all individuals in every Colorado community promoting the right care, at the right time and the right place. Goals for 2015 Health information exchange deployed in every community 85% of providers are meaningful users of electronic health records (EHRs)

6 Medicity Technology State/Regional Public HIEs: Colorado, Delaware, Greater Houston HealthConnect, Hawaii, Michigan, Mississippi, North Carolina, Ohio, South Dakota, Vermont, Wisconsin More Than 280,000 End Users More Than 125,000 Physician Users 1,000 Hospitals Integration w/ More Than 185 Unique Clinical Systems

7 CORHIO By the Numbers 44 Hospitals Connected or in Implementation (29 are already connected to the HIE) 115 Long-Term, Post-Acute Care, Home Health Facilities Connected or in Implementation 1,800+ Office-Based Physicians/Providers Connected or in Implementation 2,282,000+ Unique Patients With Clinical Data in the HIE Data current as of July 1, 2013

8 HIE Across Colorado Participating Hospitals

9 How Query-Based HIE Works Patient comes to see physician 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 9

10 How Query-Based HIE Works Community Health Record Physician or medical assistant searches for patient in the HIE 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 10

11 How Query-Based HIE Works Public Health Departments Laboratories Hospitals Radiology Centers Reportable Conditions Immunizations Hospital ADT info Consult Reports Transcription Notes Lab/Rad Newborn Screening Results Lab Results Pathology Reports Community Health Record Radiology Reports Immunizations 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 11

12 How Query-Based HIE Works Public Health Departments Laboratories Hospitals CIIS Pharmacy Information Radiology Centers Immunizations Reportable Conditions Immunizations Hospital ADT Info Consult Reports Transcription Notes Lab/Rad Public Health Alerts Newborn Screening Results Medications lists Lab Results Radiology Reports Pathology Reports Community Health Record Diagnostic-Quality Medical Images (with CTN) Data Analytics Immunizations Future Orders CCD CCD Upload 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 12

13 Physician Health Partners (PHP) Formed by primary care physicians in 1996 Mission: Drive High-Quality, Cost-Effective Healthcare Privately held and led by primary care physicians PHP providers supply care to approx. 500,000 patients and manage care for more than 140,000 patients Provide managed care services to approximately: 300 primary care physicians 100 PCP practices in the Denver metro area 50,000 Medicare FFS and Medicare Advantage patients 42,000 Colorado Medicaid patients

14 Physician Health Partners Pioneer ACO 2 Independent Physician Associations (IPAs) Primary Physician Partners (PPP) South Metro Primary Care (SMPC) 230 primary care providers participating 24,000 Medicare FFS beneficiaries aligned One of 32 Pioneer ACOs selected in the US

15 Drivers to ACO Success Primary Drivers PCP engagement Partnerships across care settings and in the community Patient support and clinical programs Timely access to data and performance measurement Secondary Drivers Evidence based guidelines and protocols Innovative payment models Performance-based reimbursement Physician leadership and commitment to excellence Provider education and communication Community engagement Building hospital relationships Ancillary services coordination Specialist and PCP compact Innovative care management models Identifying high risk patients Practice level quality improvement services Patient education EHR implementation support Clinical outcomes measurement Exploration of other data sources and tools Analysis of program effectiveness Financial reporting

16 Health Information Exchange Public vs. Private Advanced MD MicroMD Praxis Aprima Sage Intergy Greenway Practice Partner Ingenix CareTracker GE Centricity emd LSS Allscripts Pro Epic Amazing Charts eclinical Works Nextgen # of Practices

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20 Existing Data Warehouse PHP is challenged in leveraging information from new and existing information sources. MA Claims FFS Claims Lab Feeds Registry data Fragmented Information Lack of visibility and access to Information. Frequent challenges delivering IPA information requests 46+ sources New Data Sources New consolidated data sources of information cannot be leveraged. HIE Data cannot be effectively leveraged due to current information issues Future: Semantic services, which can mine Big Data from the data warehouse, social media and other public sources. Data Architecture Information modeled in the system does not reflect business. For e.g., Provider master tables cannot be used across multiple programs Changing data requirements (ICD-9 to ICD-10) No Single Source of Truth Many Data elements entered multiple times so departments can function. i.e. Practice and provider lists Need to identify and correct data ineffectiveness to establish an industry leading Information Management Center to support future growth

21 Extract, Transform and Load (ETL) Data Extraction and Presentation Enterprise Data Warehouse Hub and Spoke Architecture Integration Services/Data Staging & Cleansing Enterprise Data Warehouse with Subject Area/LOB Data Marts and Integrated BI Semantic Models Reporting & Analytical Services Internal Data Sources External Data Sources Business Rules Data Profiling Data Integrity ODS Operational Data Store (Real time Operational feeds) ETL MDM Master Data Management (Reference Data Non Transactional) ETL ETL EDW Enterprise Data Warehouse (Conformed and normalized) ETL ETL ETL Subject Area 1 Data Mart (De-Normalized Dim and Fact Tables) Subject Area 2 Data Mart (De-Normalized Dim and Fact Tables) Subject Area 3 Data Mart (De-Normalized Dim and Fact Tables) Subject Area 4 Data Mart (De-Normalized Dim and Fact Tables) OLAP Ad-Hoc querying and batch reporting Operational analytical reporting Data mining, predictive analytics ETL Internal/External Applications

22 Physician Practice Current State Process Flow Current Hard and Soft Costs: Process consumes 4 hours per day (½ FTE). 2.5 reams of paper per week; $1,620 per year. Manual retrieval of hospital records may increase patient wait / encounter time.

23 Future Hard and Soft Costs: Realized hard and soft costs from previous page. Physician Practice Future State Process Flow

24 Current Soft Costs: Process requires 12 hours per day (1.5 FTE s). PHP Census Current State Process Flow

25 Future Soft Costs: PHP will realize the labor savings. PHP Census Future State Process Flow

26 Data Warehouse Opportunities for Efficiencies Near real-time population data Clinical Reporting PQRS Reporting PACO Reporting STARS Reporting Meaningful Use Reporting NCQA Reporting Registry Near real-time auto-population Outreach and Disease/Population management Risk / Care Management Near real-time auto-population PatientCare 360 CORHIO single portal real-time web based application

27 Questions?

28 Appendix

29 PHP Care Management Multidisciplinary team of RNs, social workers, facility/co-located team, triage coordinators and census coordinators Partners with physicians, patients, and families Coordination of care in a variety of settings Education and patient advocacy Transitions of care No direct care administered

30 PHP Care Management Services Assessing and administering medical and psych-social evaluations Conducting home visits and providing eyes and ears for PCPs Educating patient on medications and diseases management Coaching to increase self-management skills Facilitating transitions in various care settings Linking with community resources Helping to navigate the complex health systems Admitting directly to skilled nursing facilities Monitoring patient progress and developing care plans w/ PCP