Preparing Your Infrastructure for New Payment Models

Transcription

1 Preparing Your Infrastructure for New Payment Models For more information about WEDI webinars or if you are interested in speaking, please contact Samantha Holvey

2 JANUARY 29: Assessing Your Existing Program Inventory of the current payment model landscape Taking a deeper dive into evolving hospital payment models: drivers, challenges and opportunities How improved health care delivery can transition to innovative payment models and the role of the physician JANUARY 30: Alignment of Data Sources Overview of data sources used in innovative payment models Data Exchange with EHRs: A Must-Have for Effective Care Coordination Direct messaging overview and how it contributes to secure data exchange JANUARY 31: Common Challenges and Model Attributes A more detailed look at payment model attributes; common challenges based on survey results Learn from organizations currently participating in an innovative payment model

3 Agenda Assessing Your Existing Program Welcome and Administrative Details Speaker Introductions Emily Richmond - Overview of data sources used in innovative payment models Craig Sharp - How EHRs contribute to sustainable information exchange through improved data collection Sean Ramsey - Direct messaging overview and how it contributes to secure data exchange Q&A in Slide Text

4 Data Sources for Innovative Payment Models Emily Richmond, MPH Practice Fusion, Inc.

5 Using Data to Inform Care Delivery

6 Using Data to Inform Payment Models Patient reported data Registry data Sources of Data Claims EHRs Medical chart abstraction

7 Patient-reported data Strengths & Uses Obtaining information on treatments not necessarily prescribed by clinicians Obtaining intended compliance information. Useful when timing of follow-up may not be concordant with timing of clinical encounter. Limitations Validated data collection instruments may need to be developed. Loss to follow-up or refusal to continue participation. Limited confidence in reporting clinical information and utilization information.

8 Claims & Billing Data Strengths & Uses Data are commonly available and relatively inexpensive to analyze. Data are available for very large populations, allowing for more robust sample sizes. May produce a more accurate picture than even chart reviews. Limitations Potential errors or inconsistencies in coding Availability of required data sources may be constrained if components of benefits are administered by multiple sources. Lack of complete clinical information.

9 Medical Chart Abstraction Strengths & Uses Information on routine medical care and practice, with more clinical context than coded claims. Potential for comprehensive view of patient medical and clinical history. Limitations The underlying information is not collected in a systematic way. It is difficult to interpret missing data. Data abstraction is resource intensive. Complete medical and clinical history may not be available (e.g., new patient to clinic).

10 Electronic Health Records (EHRs) Strengths & Uses Information on routine medical care and practice, with more clinical context than coded claims. Efficient access to medical and clinical data. Use of data transfer and coding standards will increase the quality of data abstracted. Limitations Consistency of data quality and breadth of data collected varies across sites. Difficult to handle information uploaded as text files into the EHRs (e.g., scanned clinician reports)

11 Registry Data Strengths & Uses May include specific data not generally collected in routine medical practice. Can provide historical comparison data. Reduces data collection burden for sites, thereby encouraging participation. Limitations Must rely on the data quality of the registry Frequency of data included varies across registry type and provider type Inconsistencies in data elements collected

12 Data Exchange with EHRs: A Must-Have for Care Coordination? Craig W. Sharp Practice Fusion, Inc.

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14 Data analytics are fundamental to quality performance Transition from FFS to P4P Requires More Scrutiny on CQMs Recent evidence (e.g. Pioneer ACO report) has shown that success in a P4P model is not easy to achieve Constant monitoring of CQM performance is essential to meeting contractual commitments (and obtaining shared savings) Physicians (and payors) need to identify problem areas early on to establish corrective action

15 Effective care coordination requires constant communication between hospital and PCPs Enlisting PCPs to Combat Hospital Readmissions Avoidable hospital readmissions contribute to some of the largest expenditures in healthcare One of the best ways to prevent 30-day readmits is to empower primary care providers with information day lag makes claims data ineffective in controlling readmits Hospital discharge summaries must flow to the outpatient setting and be followed up with action by PCP Focusing on patients that you consistently see in the outpatient setting (and have data on) is only part of the puzzle and will limit quality performance

16 Incomplete data can lead to misguided decision-making

17 Choosing the right outpatient EHR can be the difference between success and failure Four Guidelines for Selecting Outpatient EHRs Limit the number of outpatient EHR vendors Choose EHRs that have a scalable connection model Cloud-based EHRs, or EHRs with a web-based exchange model, require less maintenance Ability to add additional providers without a complex integration process or large connection fee is fundamental EHRs should adhere to ONC standards for information exchange Transport protocol: Direct / XDS.b File format: CCDA Make sure all EHRs can capture the CQMs your organization must measure

18 Use EHRs as a cost saving tool, instead of a mandatory expense EHRs Can Make Care Managers More Effective Human capital costs required for care coordination are large and unsustainable Many modern EHRs have the ability to automate outreach to patients and providers Contact providers via (or within the EHR) about CQM performance Reach out to patients with identified care gaps (via , SMS or automated phone call) Enable care managers to be more efficient Deploy human resources on the cases that require the most attention

19 Beyond MU2, using Direct to Improve Patient Care Sean Ramsey President, Updox

20 Quick Background on Direct Direct Secure Started March 2010 as part of the Nationwide Health Information Network (NHIN) Goal to create simple, secure, scalable, standards-based way to send encrypted data to trusted participants (X509 Digital Certs) Received a big boost being required for the 2014 certification by EHRs 3 Tests for certification requiring Direct: b(1) Transition of Care Receive b(2) Transition of Care Send e(1) View, Download, Transmit (Patient Portal)

21 How EHRs Approach 2014 Cert Build Own HISP EHR Vendors PM EHR

22 How EHRs Approach 2014 Cert Built Own HISP EHR Vendors 3 rd Party HISP PM EHR

23 How EHRs Approach 2014 Cert Built Own HISP EHR Vendors 3 rd Party HISP PM EHR SOAP Capability

24 Beyond MU2 How Does it Work? Doctor s Office Hospital HISP (Joint Trust Bundle) HISP Members of DirectTrust.org Achieve 3 EHNAC certifications Registration Authority (RA), Certificate Authority (CA), Health Information Service Provider (HISP)

25 Beyond MU2 How Does it Work? Doctor s Office Hospital HISP HISP Messages C-CDAs medical records Documents Images

26 Beyond MU2 How Does it Work? Doctor s Office One-off Certificate Exchanges EHRs HIEs PHRs Hospital HISP HISP

27 Benefits of Adopting Direct Eliminate the Fax as the Gold Standard for healthcare communications Overcome the complexities of HL7 integrations in certain cases Simple Registration Process to get on Direct Network Every EHR who is offering Meaningful Use Stage 2 has to implement Direct Every provider and hospital attesting for MU2 has to set up a Direct address to be successful More work to be done to improve functionality even further

28 Benefits of Adopting Direct Even though not required, Direct opens up a HIPAA compliant truly electronic way for other groups to communicate with providers and hospitals, including: Payers, Post Acute Care Facilities, Physical Therapists, Chiropractors, etc. Can be set up as a secure POP account in Outlook etc. Stop making providers login to multiple portals to interact with each of their partners Create an electronic directory of providers Build value added services on top of the basic and payload capabilities

29 PCMH Examples

30 PCMH Examples

31 PCMH Examples

32 Questions? Sean Ramsey President Updox ext

33 Questions? Please submit your questions using the questions box in your GoTo Webinar Control Panel