Michigan s Vision for Health Information Technology and Exchange Secure Health Information Exchange (HIE) facilitates safe, timely, efficient, patient-centered care by delivering the right health information to the right place at the right time; while improving quality, cost, safety and efficiency across the care continuum. The state and federal government have been and will continue promoting the creation of HIEs in a movement toward national standards for secure electronic exchange of health information. Fewer early deaths, chronic disease, and obesity Improved mental health and reduced substance abuse Healthy child development Adequate nutrition and exercise Reduce health disparities associated with race, ethnicity, income, geography, or source of insurance Access to Patient Centered Medical Home Coordinated care Fewer hospitalizations and emergency department visits Reduce administrative complexity Reduced expenditures by payer due to a healthier population and reduced administrative complexity Slow the rate of spending through better utilization and efficiency, thus reducing insurance premiums Health Information Technology (HIT) and HIE in Michigan is Driven by its Blueprint for Health Innovation Michigan s Blueprint for Health Innovation provides a health system transformation plan that brings together the people and resources needed to enhance care coordination, strengthen Michigan s primary care infrastructure, and reduce healthcare costs while improving health outcomes for all Michiganders. It is designed to move the State away from fee-for-service payment structures by focusing on the development and implementation of innovative, multi-payer service delivery and payment models that are supported by the Blueprint s five core components: 1. Community Health Innovation Regions (CHIR) - Building on existing community coalition efforts, CHIRs will assess community needs, define and support regional health priority planning, and increase awareness and use of community-based services among healthcare providers and systems. 2. Accountable Systems of Care (ASC) and Patient- Centered Medical Homes (PCMH) - Creating PCMH programs with the Medicaid Managed Care Organizations to increase care coordination and accountability in the medical neighborhood, and encourage integration of behavioral health services, long-term care planning, and community resources. 3. Alternative Payment Models (APM) - Implementation of APM funding mechanisms that are linked to provider participation and performance metrics will encourage provider accountability in care quality, coordination, utilization, and the patient experience. 4. Health Information Technology and Exchange - A statewide foundation of HIT infrastructure will be leveraged to enable information sharing that supports care coordination as well as greater interoperability between healthcare and community entities. May 2017
Statewide HIT will also be vital in population health monitoring and enabling State Innovation Model (SIM) program performance evaluation. 5. Stakeholder Engagement, Measurement, Evaluation and Improvement - A stakeholder commission will be created and tasked with analyzing SIM program performance, leading data-driven discussions for model improvements, and evaluating the future implications of policy changes with SIM Centers for Medicare and Medicaid Services (CMS) initiative that partners with states to advance multipayer health care payment and delivery system reform models. Participation in the statewide Michigan Health Information Network (MiHIN) use case Admit Discharge Transfer (ADT) service provides foundational support to number 2 on the previous page, the Patient Centered Medical Home model of care, and helps practitioners receive timely notification when an ADT or emergency room event occurs. This is expected to result in better care transitions, improved health outcomes, and reduced hospital readmissions. The focus of the incentive structure continues to shift from the sending and receiving of Active Care Relationship Service (ACRS)/ADT data to the use of ADTs in improving patient transitions of care, expanding use of the state s shared infrastructure, and implementing the processes required to build a sustainable statewide model for data sharing. Michigan s Blueprint for Health is supported by SIM. Under this CMS initiative, The State of Michigan has received approval and grant funding to develop and test its SIM. Each state-led model aims to achieve better quality of care, lower costs, and improved health for the population of the participating states. Since Michigan began their SIM activities, following their February 2015 to April 2016 Strategic Approach, CMS has taken action that triggered meaningful consideration and an opportunity to update our SIM payment reform strategy. As a result, Michigan s SIM approach has recently been updated to implement broad-based pursuit of advanced alternative payment models (APMs) that align with provider-facing Medicare incentives, while allowing for market-based innovation between payers and providers, including providing directional goals for the percentages of healthcare payment made through APMs over the course of the next several years. This updated approach leverages existing and future clinical integration, and maximizes provider opportunity for participating in Medicare incentives. Collaborative Governance Leads to HIT-HIE Success The success of HIE and HIT in Michigan can be largely attributed to the governance model featuring a collaboration between the Michigan Department of Health and Human Service (MDHHS) HIT Commission (HITC) and the MiHIN Shared Services Governance Board, with representation by private health care organizations and the State of Michigan. Figure 1. Michigan s Coordinated Governance Model MiHIN is a public and private non-profit collaboration developed by and for physicians, hospital systems, health insurers and privacy officers throughout Michigan. Its governance structure is intended to be broad and inclusive, and relies on input from stakeholders from more than 20 organizations. MiHIN has been formally designated as Michigan s statewide health information exchange by a cooperative agreement between the Michigan State Health Information Exchange program and the Office of the National Coordinator for Health Information Technology. Therefore, MiHIN is a network for sharing health information statewide for Michigan. The HITC serves in an advisory capacity to the MDHHS. The HITC s objective is to recommend and advise MDHHS on policy decisions, business and technical needs, and general oversight for the HIT activities essential Michigan s HIT and HIE landscape. HIT and HIE Efficiency Improvements Achieved The vision of MiHIN was to improve Michigan s existing HIE by mitigating the duplicative infrastructure and processes of multiple HIE organizations and other data providers across the state. The existing HIE structure in Michigan was not replaced, instead, MiHIN leverages relationships with Michigan s sub-hie organizations to receive information from participating hospitals and skilled nursing facilities, identify patient care relationships, and transmit notifications to the State of Michigan and attributed physician organizations. This allows for an efficient, single access point to obtain daily emergency room and inpatient admission, discharge and transfer
Figure 2. MiHIN Shared Services High Level Organization alerts, as well as medication information for their entire patient population regardless of hospital affiliation or payer membership. A snapshot of the MiHIN shared service organizational efficiency can be seen in Figure 2. MiHIN created this statewide ecosystem to realize a statewide legal trust fabric; connect MDHHS and all health plans, HIEs, Pharmacies, appropriate Federal agencies, and others; maintain statewide master data sharing infrastructure; convene groups to identify data sharing barriers, reduce provider burdens, engage consumers, and enable population health; and align incentives and/or regulations to fairly share data and promote data standardization (via use cases). Through the collaborative governance and implementation of the shared services for health information exchange, Michigan continues to make progress towards a fully interoperable HIE infrastructure. Health care providers across the state have adopted and are using Electronic Health Records (EHR) to coordinate and improve the delivery of supports and services. The MDHHS, MiHIN, and other health care organizations have successfully established a shared infrastructure to support health information sharing across the Michigan health care system. Figure 3 (on the next page), provides a snapshot of the progress made to date in statewide use cases and scenarios made possible with the shared services infrastructure, as well as what is yet to come (conceptual and planning & development). The Forward Momentum of HIT and HIE in Michigan Again, Michigan s Blueprint for Health Innovation provides a health system transformation plan that brings together the people and resources needed to enhance care coordination, strengthen Michigan s primary care infrastructure, and reduce healthcare costs while improving health outcomes for all Michiganders. It is designed to move the State away from fee-for-service payment structures by focusing on the development and implementation of innovative, multi-payer service delivery and payment models that are supported by the Blueprint s five core components outlined earlier. Beginning in the fall of 2016, MDHHS began work with community partners and stakeholders to further develop and test the Blueprint model in five pilot regions in Michigan: Jackson County, Muskegon County, Genesee County, Northern Region, and the Washtenaw and Livingston counties area. Testing in multiple geographies will provide the opportunity to refine the model before it is expanded to additional payers and regions, proposed to begin in fall 2018. Michigan continues to be on the leading edge of HIE and HIT adoption under the policy guidance by the HITC and evidenced by the innovation of MiHIN. The forward momentum of HIT and HIE in Michigan will focus on improving public health, provider engagement and coordination of physical and behavioral patient health care. To facilitate this, electronic exchange will expand, as will sharing of health information resources.
Figure 3. Statewide Shared Services Practically Applied through Valuable Use Cases and Scenarios Now that the technical infrastructure for health information sharing has been built, the Michigan HIT Commission has been exploring how the infrastructure can be leveraged to support critical statewide health care efforts. Three topics of particular focus by the Commission are: 1. U sing Health Information Sharing to Improve the Management of Prescription Drugs 2. U sing Health information Sharing to Advance Business Integration and Strategic Alignment within MDHHS 3. U sing Health Information Sharing to Support Health Care System Transformation One example of the practical application would be to address the alarming rise in prescription drug and opioid over-prescribing and misuse 200% rise, on average, across the nation between 2005 and 2014 by proposing www.mipcc.org needed legislation, such as statewide adoption and use of Electronic Prescribing Controlled Substance (EPCS), by helping physical and behavioral health providers access critical information to prevent dependency and misuse, and by supporting the Prescription Drug and Opioid Abuse Task Force recommendations for Prevention, Treatment, Regulation, Policy & Outcomes, and Enforcement. Another practical example would be continued efforts and improvement in support of meaningful use reporting requirements for state public health and Medicaid systems, MDHHS, in partnership with Michigan Department of Technology, Management and Budget (MDTMB) in connecting all the state systems that are part of the meaningful use requirements to a State mini HIE, the MDHHS Data Hub. By bringing all the state meaningful use health systems into an HIE environment, all of the systems can leverage the same HIE technology, and 517-908-8241
providers will have a single gateway to access or report to these systems. The MDHHS Data Hub will allow complete interoperability based on national standards, easily share information within the state in a secure way and leverage technology investments made by other programs and departments. In addition to the two main Medicaid systems, CHAMPS and the Data Warehouse, all of the other state government health related systems would be connected to the MDHHS Data Hub. To accomplish these examples, and many other critical use cases and scenarios, MDHHS and MiHIN will be driving to: Align new use cases with network participant readiness: Incentives; Policy levers Focus on revenue-generating opportunities to drive participation: Death Notifications; Immunization History-Forecast Focus on use cases that simplify workflow: Newborn screening bundle w/ birth notifications, common key assignment; Birthing hospitals can report once for five use cases Leverage existing infrastructure: Tobacco free e-referrals Interstate sharing of public health data starting with: Immunizations; Blood lead results Now that the technical infrastructure for health information sharing has been built, the Michigan HIT Commission has been exploring how the infrastructure can be leveraged to support critical statewide health care efforts. MDHHS and MiHIN, along with the many HIE stakeholders, will be driving to make this happen. Measuring Success An important take-away as you consider the current forward movement of HIT and HIE in Michigan is the accumulated successes. There are many more that could be listed, but below are some noteworthy stats: Participating Provider Organizations (PO) are receiving daily ADT and ER visit notifications for more than 7 Million Michigan patients, and 85% of Patient-Centered Medical Home practices in participating POs are currently engaged in the HIE Initiative Medication reconciliation data going through MiHIN represents over 70% of discharges in Michigan As of December 2016, notifications sent to the statewide service by participating hospitals represented almost 91% of the total volume of admissions statewide As of December 2016, notifications sent to the statewide service by participating hospitals represented almost 91% of the total volume of admissions statewide As of April 30, 2017, MiHIN reported a cumulative use case transactional total of 1,220,945,629 messages, which is up from 431,446,911 since Q3 2015 The combined efforts of MDHHS, MiHIN, and the many stakeholders in Michigan s HIT and HIE movement will continue to prove and improve secure HIE which facilitates safe, timely, efficient, patient-centered care by delivering the right health information to the right place at the right time; while improving quality, cost, safety and efficiency across the care continuum. Source List: Value Partnerships-BCBS of MI 2017 PGIP Fact Sheet: Health Information Exchange Initiative Michigan Health IT Commission 2016 Annual Report MiHIN.org Frequently Asked Questions (FAQ s) MiHIN Strategic Plan Michigan Health Information Technology Commission presentation, February 16, 2017 MDHHS Michigan State Innovation Model Kick-Off Summit, 8/10-11/2016, Accountable Care Breakout Session www.mipcc.org 517-908-8241