HIE Data: Value Proposition for Payers and Providers
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1 HIE Data: Value Proposition for Payers and Providers Session #21, March 6, 2018 Laura McCrary, Executive Director, KHIN Tara Orear, Senior Ambulatory Systems Analyst, Newman Regional Health Dirk Rittenhouse, Director at Anthem 1
2 Conflict of Interest Laura McCrary, Ed.D. Executive Director of KHIN Has no real or apparent conflicts of interest to report. 2
3 Conflict of Interest Tara Orear, Senior Ambulatory Systems Analyst, Newman Regional Health Has no real or apparent conflicts of interest to report. 3
4 Conflict of Interest Dirk Rittenhouse, Director at Anthem Has no real or apparent conflicts of interest to report. 4
5 Agenda Introduction to KHIN Introduction to Newman Regional Health Medical Partners Introduction to Anthem/Amerigroup Overview of KHIN Data Analytics Products Overview of Data & Analytics for Providers-Provider Perspective Overview of Data & Analytics for Payers-Payer Perspective Challenges & Findings Conclusion & Questions 5
6 Learning Objectives Describe how KHIN is aggregating data for business intelligence and analytic purposes. Detail how providers are using KHIN data for Value Based Payment Models, MIPS reporting and Improved Patient Outcomes. Detail how payers are using KHIN data for HEDIS reporting and other use cases. Discuss future opportunities to use HIE data. 6
7 Kansas Health Information Network: Overview 501c3 Not for Profit-2010 Over 25 million patients available for query through connections with other exchanges 9,900 providers 5.2 million unique patients in KHIN 1,000+ healthcare organizations in production with CCDs and HL7v2 120,000 HL7 messages daily 9,000 CCDs daily 7
8 Newman Regional Health: Overview 25 bed inpatient CAH: Rehab Unit, OT/PT/ST, OB with Level 2 nursery, ER (6 physicians), Hospitalists (2 physicians, 3 APRNs, 1 RN), ICU, Cath Lab, Breast Center Outpatient services: Lab, Radiology, OT/PT/ST, infusions, Pain Clinic, Wound Care, Cardiopulmonary and Sleep Lab, Express Care, Occupational Health Provider Based Outpatient Clinics: 24 providers: Orthopedics, Cardiology, Pediatrics, Family Medicine and General Surgery 8
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11 KHIN Analytics Process: Fragmented Clinical Data High-cost patients see 10+ providers annually with data spread across care settings Unified, Normalized Clinical Data Ready for Analytics Office Visit Specialist Referral Ambulatory Center Hospital Stay Post-Acute Care
12 Successful Integrations With EMRs 12
13 Products and Services 2018 CONNECT HEALTH INFORMATION EXCHANGE WEB-BASED PHYSICIAN PORTAL LONGITUDINAL PATIENT RECORD BI-DIRECTIONAL IN EHR ANALYZE ANALYTICS DASHBOARDS INCLUDE: HIGH RISK QUALITY METRICS READMISSIONS DISEASE REGISTRIES POPULATION HEALTH CONTROLLED SUBSTANCES* ENGAGE ONC CERTIFIED PERSONAL HEALTH RECORD VIEW, DOWNLOAD & TRANSMIT PATIENT EDUCATION SECURE MESSAGING SECURE CLINICAL MESSAGING/DIRECT STATE LEVEL INTERFACES SUCH AS: IMMUNIZATIONS SYNDROMIC SURVEILLANCE REPORTABLE DISEASES CANCER REGISTRY (AND OTHERS) DATA EXTRACTS PATIENT ELECTRONIC ACCESS ALERTS CERTIFIED IMMUNIZATION RECORD TRANSFORM 8 13
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16 Provider Utilization of KHIN Data Data Sharing XDS.B Direct Messaging (CCD) HL7: demographics, admissions, discharges, transfers, progress notes, diagnosis, procedures, lab results, medications 16
17 Provider Utilization of KHIN Data Clinical Impact Increased Continuity of Care Medication reconciliation Immunization records Problem List Lab Data 17
18 Provider Utilization of KHIN Data Patient Impact More complete history Patient information is imported directly to EHR Transition of Care simplified Less re-telling of history, data at the provider s fingertips Higher Patient Satisfaction Scores!!! 18
19 Provider Utilization of KHIN Data Financial Impact Payer Incentive Program + $230,000 in reimbursement for
20 Payer Utilization of KHIN Data Anthem Use Cases: Quality Measures and Care Gaps Risk Adjustment Programs Care Management Notification, Care Coordination, Re- Admission Risk, Medication Reconciliation Pay for Performance 20
21 Payer Utilization of KHIN Data Benefits: Reduce Medical Records Requests Improve Quality Scores HEDIS/STARS More Accurate Member Health Profile Analytic Capabilities Value Based, Population Health, Predictive Analytics 21
22 Payer Utilization of KHIN Data Clinical Data is Incremental and Additive: Incremental to Existing Data: Diagnosis, Procedures, Medications, Lab Additive to Existing Data: Allergies, Vitals (Ht., Wt., BP, BMI) Smoking Status, Immunizations, Race, Ethnicity, Medication Orders, Medical Reports (H&P, Imaging, Discharge Summary, Progress Notes, etc.) 22
23 Payer Utilization of KHIN Data 23
24 Conclusions: 1. Data Derived from Health Information Exchanges can be utilized for a variety of purposes as allowed under HIPAA and respective Participation Agreements. 2. Combining the HL7 v.2 and CCD/CCDA data together produces the richest and most robust data set. 3. Normalizing and de-duplicating the data is a complex task. 4. Move from a focus on interoperability to data quality and quantity. 24
25 Questions Laura McCrary, EdD Tara Orear Dirk Rittenhouse 25
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