THE STANDARDS GROUP SUPPORTING SYSTEM TRANSFORMATION Laura Vredeveld June 2014 Improving Outcomes Conference
America's health care system is neither healthy, caring, nor a system Walter Cronkite
Changes to TSG Board Previously: 18 PIHP reps 3 MDCH reps 3 Consumer/Stakeholders Paid for by PIHPs Effective January 1: 10 PIHP reps 7 CMHSP reps 5 Provider reps 3 MDCH reps 4 Consumer/Stakeholders Paid for by MDCH
TSG is Supporting MDCH Vision Vision of Michigan Department of Community Health (MDCH 2014) Improve the experience of care, improve the health of populations, and reduce cost of health care
Supporting MDCH Strategic Priorities Reduce disparities in health outcomes Implement an integrated chronic disease strategy that addresses comorbidities, mental health, and chronic care hot spots Provide comprehensive population health monitoring Strengthen mental health, substance abuse, and physical health integration Excerpts from James Havemen's presentation to House Appropriations Subcommittee on Community Health February 12, 2014
Supporting MDCH Strategic Priorities Support the adoption and awareness of Health Information Technology to improve communication, efficiency, customer experience, and health outcomes Improve information technology systems to ensure they are current, deliver timely results, and have increased inter-operability Improve upon the secure sharing and management of data Excerpts from James Havemen's presentation to House Appropriations Subcommittee on Community Health February 12, 2014
Centers of Excellence are measurement driven and technology enabled Linda Rosenberg Nat l Council BH, May 2014
To achieve these goals, TSG is working on: Having access to meaningful data Sharing information across systems & providers Promoting understanding of the total health of the populations we serve Building staff proficiencies to take effective action
To achieve these goals, TSG is working on: Using common language and measurement Using standardized tools Building better models of care Creating system efficiencies
One quarter of Medicare beneficiaries have five or more chronic conditions, sees an average of 13 physicians each year, and fills 50 prescriptions per year. Clayton M. Christensen, The Innovator's Prescription: A Disruptive Solution for Health Care
Accessing meaningful Data Barriers to Accessing Meaningful Data Data is naturally distributed across multiple payers and providers No single care provider has the total picture of an individual s health conditions SUD confidentiality constraints Lack of Medicare data
Accessing Data To be useful, data must be: Legally obtained Technologically possible Operationally feasible Clinically relevant
Accessing Data Information being provided to PIHPs by MDCH via access to: Data Extracts from MDCH Data Warehouse Care Connect 360 portal
Access to Care Connect 360 PIHP, MHP and ICO will designate individual(s) who have administrative/approval role (SUME & MEs) Access to Care Connect 360 will be granted to Personnel within PIHP/CMH/MHP/ICO/MDCH with legitimate need in order to perform their job No access yet for subcontracted providers. This is being planned for later this summer.
15 Demographic Information and Chronic Conditions
16 Claims Tab
Sharing Information Historical barriers to exchanging behavioral health information: No Standardized BH Consent Form No Standard way of organizing the content that behavioral health providers might share. No Technical Infrastructure to Handle BH Health Consent within Michigan s HIE System
Sharing Information Significant HIE Efforts of CIO Forum in past 12 months: Standardized BH Consent Behavioral Health CCD Electronic Consent Management System standards
The reality is that performance measurement, quality improvement and public accountability are highly controversial concepts with all of the hugging appeal of a porcupine Dennis O Leary, President, Joint Commission on Accreditation of Healthcare Organizations, USA
20 Promoting Understanding through Data Analysis Cost Analysis/Risk Mitigation - Population Level Utilization/Cost Management, Program Evaluation/Effectiveness - Program/Service Level Care Coordination & Wellness- Individual Level
Promote Understanding - Individual DOES YOUR CURRENT SYSTEM: Provide at-a-glance dashboards of individual-level care information across the care continuum? Identify chronic conditions Gaps in care Utilize predictive data algorithms? Trends/patterns in utilization and accessing care Opportunities to proactively address issues before high cost or high risk problems emerge
Promote Understanding Program DOES YOUR CURRENT SYSTEM: Aggregate and group data in meaningful ways at local and program level? Provide comparative analysis of utilization, cost and outcomes data to evaluate program effectiveness and impact of interventions? Identify cohorts of individuals who could benefit from a program or model?
Promote Understanding Population DOES YOUR CURRENT SYSTEM: Aggregate data in meaningful groupings to provide a picture of the health needs and care trends of your population? Use algorithms built from large population data sources that include public behavioral health to assist with risk stratification? Allow you to identify trends in utilization, costs, health outcomes across a population?
He uses statistics as a drunken man uses lamp posts for support rather than for illumination Andrew Lang, Scottish Writer
Using Standardized Tools & Measures Use of standardized tools Supports Intensity Scale (SIS) Individuals with Intellectual/Developmental Disabilities Use of Screening Tools, Service Selection Guidelines, Level of Care Determination across regions Increase knowledge of and Use of HEDIS measures Use of clinical care guidelines/protocols Michigan Quality Improvement Consortium (MQIC) Use of CMS Core Measures
Promoting Use of CMS Core Measures Measure Selection Process Conditions that contribute to the morbidity and mortality of the most Medicare and Medicaid beneficiaries Conditions that represent national public health priorities Conditions that disproportionately drive healthcare costs and could improve with better quality measurement Measures that would enable CMS, States, and the provider community to measure quality of care in new dimensions, with a stronger focus on parsimonious measurement Measures that include patient and/or caregiver engagement
CMS Adult Core Measures Adult Recommended Core Measures Controlling High Blood Pressure Use of High-Risk Medications in the Elderly Preventive Care and Screening: Tobacco Use Screening and Cessation Intervention Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan Documentation of Current Medications in the Medical Record Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Closing the referral loop: Receipt of specialist report Functional status assessment for complex chronic conditions
There are more than 9,000 billing codes for individual procedures and units of care. But there is not a single billing code for patient adherence or improvement, or for helping patients stay well. Clayton M. Christensen, The Innovator's Prescription: A Disruptive Solution for Health Care
Building Proficiencies How to talk to individuals we serve about the data we have and how it will be used How to use data for care planning How to develop interventions around cohorts of individuals with common conditions How to turn data into actionable information Using clinical care guidelines and protocols
Building the New Models Pilot Sites across the state are building the new service delivery models: Integrated Care for Dual Eligibles BH system managing whole continuum of BH services including Mild/Moderate Health Homes for individuals with chronic conditions HIE pilots Admissions/Discharge/Transfer protocols Integrated Substance Use Disorder Services What are you building????
Creating Efficiencies TSG led Reciprocity and Efficiencies Subgroup of 490 Workgroup. (Thanks Ginny Reed!) Developed draft policy focused on sharing/reciprocity within and across regions in areas of: Provider network applications Provider quality/monitoring results Training Records Contracting
Not everything that can be counted counts, and not everything that counts can be counted Albert Einstein, Physicist
Thank You! Laura Vredeveld Director - The Standards Group laurav@tbdsolutions.com