Behavioral Health Data Sharing: The Opportunities & Challenges In Health Information Exchange November 8, 2017 9:45 am - 11:00 am Sharon Hicks, Senior Associate, OPEN MINDS #OMTechnology 1 www.openminds.com 15 Lincoln Square, Gettysburg, Pennsylvania 17325 Phone: 717-334-1329 - Email: info@openminds.com 2017. All Rights Reserved.
Agenda I. Behavioral Health Data Sharing In The Era Of Value-Based Care II. III. IV. Robert Oldham, Public Health Officer & Director, Placer County Brandon W. Danz MHA, MPA, Director, Government Risk Contract Programs, WellSpan Health Matt Hall, VP Business Systems and Technology, Magellan Healthcare V. Chris Tjoa, M.D., Medical Director of Population Health, Community VI. Questions & Discussion 2 2017. All Rights Reserved.
Behavioral Health Data Sharing In The Era Of Value-Based Care
Reorganization Of The Value Chain Of Health & Human Services Is Underway Health Care Reform & Parity Legislation New Science Focus On Outcomes & Cost Value-Based Contracting Reorganization of the financing and delivery of health and human services with implications for consumers with mental disorders, addictions, and cognitive disabilities 4 2017. All Rights Reserved.
A Whole Person View Of Care Management Requires Complete Information A whole person view is the new focus of health care teams Social determinants of health Housing, transportation, poverty Effects of trauma Barriers to care 5 2017. All Rights Reserved.
Why Is Sharing Health Information Important? 29% of people receiving medical services also have a behavioral health disorder 68% of people being treated for a mental illness also have a medical diagnosis needing treatment Emergency room visits for people with a behavioral health diagnosis are 3.5 times higher than the general population 6 2017. All Rights Reserved.
The Current State Of Interoperability 52% of hospitals can electronically find consumer health information, 85% can send consumer summary of care records, 65% can receive such records and 38% can use or integrate those records into their own EHRs without manual entry The percentage of hospitals electronically exchanging laboratory results, radiology reports, clinical care summaries or medication lists with outside hospitals doubled between 2008 to 2014 from 41% to 82% 60% of non-federal acute care hospitals routinely electronically notify a consumer s primary care physician upon entry to the hospital's emergency department At last count, there were approximately 150 active HIEs in the U.S. 7 2017. All Rights Reserved.
The Path Forward To Data Sharing Technology to enable sharing has grown-new tech being developed all the time Many health plans are sharing data with provider organizations Many states are sharing data with their contracted health plans There are new programs to assure data sharing within the health plan community (e.g., PH sharing admission data with BH) Let s hear from our panelists about data sharing in the real world 8 2017. All Rights Reserved.
Robert Oldham, Public Health Officer & Director, Placer County
Behavioral Health Data Sharing: Field Notes from a Whole Person Care Pilot Robert Oldham, MD, MSHA Health Officer/ Medical Director Placer County Dept. of HHS November 8, 2017
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Placer County HHS and WPC 1. Population of ~375,000 2. Urban, suburban, rural, and frontier 3. Rapid growth 4. Housing: High cost, low volume 5. Safety-net system: a. No county hospital b. Limited FQHCs c. Transition of county clinics d. Medicaid plans 12
Homelessness in Placer 1. 2. 3. Low relative rates of homelessness High rates of chronic homelessness Homeless in Placer are: Older High rates of chronic illness Often disconnected from services Services often not coordinated 13
Placer Whole Person Care (WPC) Part of MediCal 2020 1115 Waiver For Medicaid beneficiaries who are high users of multiple health care systems, but still have poor outcomes Test locally-based initiatives to better coordinate: physical health behavioral health social services Placer one of only a few small-to-mid sized counties Placer target: High utilizers who are homeless Savings can be used to address SDoH (e.g. housing) 14
Service/ Payment Bundles Engagement Care Coordination Housing Medical Respite Admin infrastructure Delivery infrastructure Pay for reporting Pay for outcomes 15
Pay for Outcomes Metrics 70% of WPC members seen in ED will have a visit within 7 days 80% of WPC members with a SMI will receive a visit within 30 days following a discharge from a psychiatric hospital 30-day re-admission rate below: 45% (Year 2) 40% (Year 3) 35% (Year 4) 30% (Year 5) 70% of WPC members will have a shared assessment and treatment plan within 30 days of enrollment 16
Re-Prioritorizing HIT s Role in the Safety-Net Transitioning from low-tech, high-fte tracking/ reporting systems Maximizing use of and investment in our EMR Building platforms to share across various data systems Prioritizing data sharing and data governance Demonstrating the value of HIT investment EDIE /PreManage s role in Pay for Outcome success Client-level value-added 17
Questions? 18
Brandon W. Danz MHA, MPA, Director, Government Risk Contract Programs, WellSpan Health
There s No Magical Repository Of Social Determinant Data (yet) Everyone is interested in this data. It s an arms race. It is critical to value-based success.
Problem 1: How To Collect It? SDOH Data Collection Continuum Database- Sourced Person- Specific Person- Sourced Lower Value Easier to Acquire Less ROI Higher Value Difficult to Acquire More ROI
Database Sourced SDOH Data: Typically include SDOH data at a defined geographic level. Can identify specific geographic areas to target for interventions, but does not identify individual people within those areas. Strengths: Easy to acquire Easy to attribute to populations at geographic level Weaknesses: NOT person-specific Can be costly Data may be outdated
Person-Specific Data: Data that is at the individual level, but collected and distributed by another organization An up-and-coming field Strengths: Person-specific Immediately available Weaknesses: Data integrity is not guaranteed Can be costly
Person-Sourced Data: Data that is collected directly from patients typically in realtime and used in-house. This approach offers the best data. For those who you re able to collect it from. Strengths: Immediately actionable Data validity is strong Weaknesses: Time intensive Data only available for patients who utilize
Problem 2: Storing & Sharing the Data There are few standardized SDOH storage protocols. EHRs vary in their SDOH storage functionality & interoperability. There are few (but growing) SDOH data sharing pathways.
5 Steps to a SDOH Data Sharing Partnership Identify your partners Determine scope Establish data sharing protocol Promote internally and externally within the community Monitor & Improve 1 2 3 4 5
Contact Information Brandon Danz MHA, MPA Director, Government Risk Contract Programs WellSpan Health bdanz@wellspan.org www.linkedin.com/in/brandondanz For Open Minds 2017 Technology & Informatics Institute 11/8/2017
Matt Hall, VP Business Systems & Technology, Magellan Healthcare
Behavioral Health Data-Sharing: Opportunities & Challenges November 7, 2017 Matt Hall Vice President, Business Systems and Technology Public Markets Operations
Magellan Health: One company, two unique platforms 31
Behavioral health data-sharing HIE / data-sharing adoption Sample use cases Concerns Keys to success 32
HIE / data-sharing adoption: Models of data-sharing Health Information Exchange (HIE) Directed exchange direct, secure messaging communicates patient-level information in a point-to-point fashion (essentially, secure healthcare emails). This is a push transaction at the time data changes. Example: Pediatric immunization notification to state department of health. Query-based exchange service providers communicate through a portal or other means to access patient information when necessary. Example: Hospital ER looking up medication lists. Consumer-mediated exchange the patient controls access to his/her own health information and provides access to providers as necessary. This would be the personal health record. 33 Private exchange: Provider systems and community portals Typically operated by the covered entity, providers, support organizations and other member-level stakeholders collaborate at the patient level. Patient authorization is obtained to provide this level of access. Users are managed independently and their usage tracked.
HIE / data-sharing adoption Help with adoption Programs run by the HIE. Some states are running programs to help. Arizona has an open RFP for HIE onboarding services. Payer assistance for private exchanges: Adoption programs, getting started resources, etc. The Sequoia Project Chartered by ONC in 2012, The Sequoia Project is an independent organization chartered to advance health information exchange connecting with individual agencies to avoid multiple point-to-point agreements and interfaces. 34
Behavioral health data-sharing HIE / data-sharing adoption Sample use cases Concerns Keys to success 35
Sample use cases: Event notification - ADT Inpatient facilities ADT transaction ADT (Admit, Discharge, Transfer): A simple set of transactions showing patients in or out of the inpatient facility. Usage example: Inpatient provider submits ADT to state HIE ideally this happens in real-time. This is a push to the HIE. Managed care organization or accountable care organization is alerted that the patient has been admitted or discharged from the inpatient facility (behavioral health facility only with appropriate consent). This is a push to the recipient. Case management teams begin discharge planning and other services or referrals. 36
Sample use cases: Event notification - ADT Sample ADT transactions (Florida HIE) A01 Admit/visit notification A02 Transfer a patient A03 Discharge/end visit A04 Register a patient A05 Pre-admit a patient A06 Change an outpatient to inpatient A07 Change an inpatient to an outpatient A08 Update patient information A11 Cancel admit/visit notification A12 Cancel transfer A13 Cancel discharge/end visit A18 Merge patient information A40 Marge patient identifier 37
Sample use cases: Clinical data C-CDA Consolidated-Clinical Document Architecture (HL7 CDA) Typically used for care coordination and patient engagement. This transaction is a pull at the time it is requested by the data-receiving agency. Data is either housed in the HIE itself or the HIE brokers the transactions to participating agencies in real-time. 38
Sample use cases: Clinical data C-CDA PCP or BH usage The CDA information can be used to provide a rich set of predefined health information. Typical usages are to transition a patient from one provider to another or to provide the clinician with a full, member-centric view of information during a clinical encounter. The information can include: Patient demographics Care team identification Medications and medication allergies Care plan Problem list Lab tests and lab test results Procedures and vitals Encounter diagnosis Cognitive status Functional status Discharge instructions Immunizations 39
Behavioral health data-sharing HIE / data-sharing adoption Sample use cases Concerns Keys to success 40
Data concerns Timeliness of data: Is the data fresh or stale? When was the information created? A hospital admission (ADT) that happened a week ago is much less valuable than one that happened this morning. Likewise, an incomplete ADT record or record showing admit, but missing a transfer from ER to inpatient bed, is much less valuable. What is your expected useful life of data? A CDA without end dates on medications may not show what the patient is really taking. A problem list from months ago may not give a good current picture. Is the HIE or data-trading partner able to timestamp information? Does the recipient s view of the information show when the information originated, in addition to effective dates? 41
Data concerns Completeness of data Is the data complete when it arrives? Does the data arrive more than once? Are episodes terminated? Is it all here? Often, behavioral health data is not transmitted for compliance reasons. ADTs for substance abuse treatment may be filtered out in compliance with 42 CFR Part 2. ADTs for self-pay episodes from hospitals may be filtered out in compliance with 45 CFR. 42
Behavioral health data-sharing HIE / data-sharing adoption Sample use cases Concerns Keys to success 43
Keys to success Bi-directional participation If we don t all participate, the ultimate product will be incomplete. How can we manage with incomplete information? Behavioral health + Physical health = Whole health Trust, but verify Each step along an organization s journey, from standalone to interdependent datasharing, should be validated with thoroughly audited test cases. Don t just assume because an organization sent data that it s always 100% timely or correct. 44
Chris Tjoa, M.D., Medical Director of Population Health, Community
DATA XENOPHOBIA Chris Tjoa, MD Medical Director of Population Health Community Behavioral Health Philadelphia, PA
Case Study - ICP 20 year old BH-MCO participating in PA value based payment initiative (Integrated Care Program) focused on improving care coordination processes and outcomes for individuals with SPMI by promoting partnership with peer physical health MCOs.
Data history
More history Joint care coordination program stipulates requirements for care coordination activity and daily ADT notification and periodic data exchange Shortly after implementation begins, symptoms of malaise, irritability, and trust issues emerge
Diagnosis Data Xenophobia Fear of other people s data (OPD)
Subjective Complaints Fear of having foreign data HIPAA 42 CFR part 2 better talk to legal get rid of it put it on a different server Fear of using foreign data: There s something wrong with the data It s missing a lot of important stuff
Causes System complexity of a modern MCO
Causes System complexity of 2 collaborating MCOs
Causes Antiquated, ambiguous and inconsistent healthcare privacy regulations
Endowment effect
Unopposed forces
Prevalence & Remedy
Prevalence & Remedy Unable to share data as it is proprietary
Questions & Discussion
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