CONTINUITY OF CARE MATURITY MODEL. James E., Gaston, MBA FHIMSS Sr. Director maturity Models, HIMSS Analytics

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1 CONTINUITY OF CARE MATURITY MODEL James E., Gaston, MBA FHIMSS Sr. Director maturity Models, HIMSS Analytics

2 Healthcare Care

3 Health [space] care must be the focal point of our efforts to improve the lives and health of our citizens, not the business of healthcare.

4 What is Continuity of Care? Citizens perspective Non-disruption of care provided to a patient throughout his/her care journey, across care settings and care givers Industry perspective Alignment of healthcare resources, across care settings, orchestrated in a way that delivers the best healthcare services and value possible for a defined population

5 Continuity of Care Maturation Model Model Overview Improve care coordination over diverse care settings Engages 3 key stakeholder groups Leverages an 8 stage maturity model, like EMR Adoption 4 key focus areas theme for each stage, across entire model Aspirational model drives value based care approach Simple assessment survey Action oriented, strategically focused deliverables

6 What is a Care Setting Affiliated Ambulatory Private Practice Healthcare Center Regional Primary Care Acute Care Facility Specialty Hospital Outpatient Surgery Center Dental Care Center Same Day Surgery Emergency Department Emergency Care Center Pharmacy Care Center Patient Home Group Living Care

7 Care Setting Orientation Traditional Silo ed Isolated Decisions Errors Increased Diagnosis Uncoordinated Care Isolated care episodes Lost efficiencies Lost opportunity Increased Costs Inefficient system usage Redundant services Systemic Inefficiencies Lacks health info. sharing Incomplete health picture Coordinated Health Information Exchange Health information sharing Consolidated EMR Semantic interoperability Coordinated Patient Care Coordinated treatment Reduced Errors Care team alerts Advanced Analytics Population health Patient specific CDS Patient Engagement Personalized alerts, goals EMR access, input Mobile access

8 Instead of this Health Information Exchange Move to this

9 Coordinated Patient Care Instead of this Move to this

10 Analytics Driving Healthcare

11 Patient Engagement Patient Engagement Personalized alerts, goals EMR access, input Mobile access

12 Continuity of Care Maturity Copyright HIMSS Analytics

13 Multiple Model Stakeholders Administrators CEO/COO/CFO/CSOs Forge agreements, policies, and standards that allow and enable progress Drive clinical activities that enable and enhance coordinated care, pop health Clinical/Medical Leaders CMIO/CNO/CNIOs Technology Leaders CIOs Build out Information & Technology that facilitates key strategies

14 Continuity of Care Maturity Model Survey Approach & Achievement Compliance statements for each stage in each key focus category Lowest is Stage 0, highest Stage 7 Compliance measured using a Likert Scale Overall and stage level achievement presented as a percentage Color and % conveys overall progress against compliance Identifies areas of strength as well as opportunity Achieving a stage requires 70% or > stage compliance On that stage and all previous stages Your Stage standing is the highest stage achieved Accommodates different approaches in priorities, resources types, and execution

15 Continuity of Care Maturity Model Stage Achievement 2 Overall Compliance 32% Example organization Achieved Stage 2 compliance 32% Overall compliance Has made progress through Stage 6 Stage 7 0% Stage 6 4% Stage 5 15% Stage 4 28% Stage 3 25% Stage 2 75% Stage 1 77%

16 Continuity of Care Maturity Model Engagement Process Define Scope & Contract Understand overall needs Breadth and depth of engagement Prepare and sign contract for engagement Identify Population and Care Settings Survey What care community of patients are we profiling What care settings are we looking at Ambulatory, Acute, Urgent, Long Term Care, Home On-site survey Discussion with leadership teams for each care setting Survey questions completed Findings Review & Presentation Review findings results

17 Findings Presented Executive Summary Summary achievement standings Description of achievement Overall recommendations By Stakeholder Group Individual achievement standings Individual recommendations Across Care Settings Individual achievement standings Individual recommendations

18 Example Recommendations IT Stakeholders Stage 1 Recommendations 1) Move to consolidate patient data with external care providers and settings in order to create a collective patient centered view, minimizing silo s of patient data. This allows a centralized approach to managing data as whole and is ideal for advancing data governance efforts. 2) Consider creative or diplomatic ways to include external reference data such as census, population data, or other types of data that enhance population health management abilities and insights. This may require coordinating activities with governance leaders to craft and implement policies or request exemptions, or working with clinical leaders who have strategic responsibilities that align with population health. Stage 2 Recommendations 1) Pervasive and automated user identity management is suggested to lay the foundation for future electronic secure and attributed communications and activities. 2) Work with governance leaders to define and implement standardized templates, procedures, and messaging protocols for clinical and financial data exchange across collaborating health care providers Advanced Stage Recommendations 1) Leverage semantic (discrete) patient data in support of multiple coordinated care initiatives, such as the oncology special treatment program being developed, providing actionable clinical decision support and advanced analytics, including drug interaction, age and sex appropriate findings, and diagnosis recommendations. Use semantic data in support of population health management including tracking vaccination programs, flu outbreak activity, and other epidemic/pandemic activities 2) Consider providing a comprehensive audit trail of whom accessed what information for both internal auditing and patient benefit. Extending this capability to allow automated alerts to be sent if data is over-accessed or inappropriately accessed should be considered.

19 Continuity of Care Assessment Value Proposition Prescriptive direction across 4 key focus areas Care Coordination Health Information Exchange Analytics Patient Engagement Actionable stakeholder group directives & alignment Actionable care setting profiles and directives Scalable across populations and care settings

20 Health [space] care must be the focal point of our efforts to improve the lives and health of our citizens, not the business of healthcare.

21 Thank you! James E. Gaston, MBA FHIMSS Sr. Director Maturity Models, HIMSS Analytics