Michigan s Vision for Health Information Technology and Exchange Health information exchange or HIE is the mobilization of health care information electronically across organizations within a region, community or hospital system. In practice the term HIE may also refer to the organization that facilitates the exchange. At its core, secure health information exchange 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. Promoting interoperability through the sharing of vital data, HIE can stimulate better health through reduced mortality, chronic disease and obesity, improved mental health, reduced substance abuse, and reduced health disparities associated with race, ethnicity, income, geography, or insurance. HIE promotes better care that is coordinated across the healthcare community, resulting in fewer hospitalizations and ER visits as well as a reduction in administrative complexity. HIE also lowers healthcare costs by reducing overall expenditures with a healthier population and the reduction in administrative burden, thus reducing premiums. This brief will detail the current and future state of Michigan s Health Information Technology (HIT)/HIE environment and provide informative content to assist your practice in moving into alignment with these efforts. HIT and HIE in Michigan is Driven by the 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 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 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. The Blueprint is structured around the following core components, all of which leverage various HIT/HIE functionality for plan performance. 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. May 2017
Accountable Systems of Care (ASC) and Patient- Centered Medical Homes (PCMH) - Creating PCMH programs with Medicaid Managed Care Organizations will increase care coordination and accountability in the medical neighborhood and encourage integration of behavioral health services, long-term care planning, and community resources. 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. 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 Services (MDHHS) HIT Commission (HITC) and the Michigan Health Information Network (MiHIN ) Shared Services Governance Board, with representation by private health care organizations and the State of Michigan. 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. Statewide HIT will also be vital in population health monitoring and enabling State Innovation Model (SIM) program performance evaluation. 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 the SIM Centers for Medicare and Medicaid Services (CMS) initiative that partners with states to advance multi-payer health care payment and delivery system reform models. Michigan s Blueprint for Health is supported by the CMS SIM initiative. 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. 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 the 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 to Michigan s HIT and HIE landscape. HIT and HIE Efficiency Improvements Achieved MiHIN s goal is to improve Michigan s existing HIE landscape by mitigating the duplicative infrastructure and processes of multiple HIE organizations and other national and third party data providers across the state (health plans, consumer-facing organizations, pharmacies, providers and health systems, and other data suppliers).
Figure 2. MiHIN Shared Services High Level Organization The existing HIE structure in Michigan was not replaced, instead, MiHIN leverages relationships with Michigan s Sub-state HIEs, Qualified Organizations and third party data providers 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 notifications, discharge and transfer alerts, as well as medication information for entire patient populations regardless of hospital affiliation or payer membership. A snapshot of the organizational efficiency achieved by MiHIN shared services can be seen in Figure 2. MiHIN created this statewide ecosystem to create a trusted network, connecting MDHHS, all health plans, HIEs, Pharmacies, appropriate Federal agencies, and other participating organizations. The arrangement allows for maintenance of a statewide master data sharing infrastructure with the ability to convene groups to identify data sharing barriers, reduce provider burdens, engage consumers, and enable population health, as well as aid in the alignment of 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. Healthcare 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 third party healthcare organizations have successfully established a shared infrastructure to support health information sharing across the Michigan healthcare system. Implementing this cooperative HIE infrastructure has certainly presented interoperability and cost challenges, as well as a major shift in the operational workflow of healthcare providers. The successes experienced to date are a testament to the vision of the Michigan Blueprint for Health Innovation, the leadership and commitment of the Governance members, and the collaboration of many third party organizations. All have demonstrated a shared mission to improving the patient care experience as well as improve quality, cost, safety, and efficiency across the care continuum. To learn more about each of the participants, go to: http://new.mihin.org/home-3/our-participants. Secure Data Transfer with Sub-State HIEs and MiHIN Qualified Organizations To have an effective HIE infrastructure in Michigan, area networks, called Sub-state HIEs and MiHIN Qualified Organizations (QO), facilitate the safe transfer of electronic patient information to MiHIN. This is why MiHIN Shared Services is referred to as a network-of-networks model. Figure 3 gives a graphic view of the Sub-state HIEs/MiHIN QOs and other third party participants who supply health information. Providers do not connect directly to MiHIN Shared Services, rather, they connect to a Sub-state HIE or MiHIN QO who then passes data to and from MiHIN.
Figure 3. MiHIN Shared Services is a network-of-networks Each Sub-state HIE and MiHIN QO has their own business model for data collection and specific service offerings. Every provider in the state has at least one choice for a sub-state HIE, and there are several areas with multiple choices. When a provider is faced with multiple choices in Substate HIEs/MiHIN QOs, keeping up with the differing business models and their requirements can be daunting. The Michigan Center for Effective IT Adoption (M-CEITA), a nonprofit run by Altarum was created to help accelerate the adoption and implementation of HIT. M-CEITA provides objective guiding principles to assist providers in determining the best-fit HIE connection(s) and has been helping providers navigate the complexities inherent to multiple HIEs/MiHIN QOs and their differing business model requirements. Guiding Principals When making an HIE vendor selection, it is important for providers to research their regional offerings. Some of Michigan s HIE s operate only in specific areas of the State, but others, such as Great Lakes Health Connect, are now operating across our entire state, linking healthcare organizations from deep in the Upper Peninsula to Detroit and everywhere in between. Another helpful selection strategy is for providers and health systems to talk to their top ten referring offices to see which HIE vendor they each use. There can be linkages and strength between providers in your geographic area to consider. Lastly, not all HIE s offer the same level of technical implementation expertise and training. Therefore, providers should make sure the one they select can meet their individual needs and that of their IT and other support staff. Current Sub-state HIEs and MiHIN QOs Figure 4 contains a list of the current Sub-state HIEs and MiHIN QOs. Below we have spotlighted Great Lakes Health Connect (GLHC), one of the nation s largest providers of HIE. To learn more about the great work of each of the Sub-state HIEs/QOs, go to: www.mihin.org/exchanges. Sub-state HIE spotlight: Great Lakes Health Connect (GLHC) was formed when the former Michigan Health Connect and Great Lakes Health Information Exchange merged. GLHC is one of the nation s largest providers of HIE, helping hospitals, physicians, and other medical professionals (including rural hospitals, Federally Qualified Health Centers, and free clinics) quickly and securely share the health records of their members.
Current Exchanges ANTS (Administrative Network Technology Solutions, Inc.) Great Lakes Health Connect Health Information Exchange Henry Ford Health System Huron Valley Physicians Association Ingenium Jackson Community Medical Record MHIN (Michigan Health Information Network) National ehealth Exchange (Healtheway) Northern Physicians Organization PatientPing Southeast Michigan Health Information Exchange Upper Peninsula Health Information Exchange Exchanges in other states Figure 4. Current Sub-state HIEs and MiHIN QOs (as of June 2017) GLHC, though large and far reaching, differs from the heavily IT focused MiHIN Shared Services in that they work directly with providers, and their focus is services and solutions to strengthen and support providers in the creation of care-connected communities. Together, GLHC and MiHIN Shared Services, as well as other Substate HIE efforts, created the comprehensive, leading edge HIE needed to best serve the healthcare needs of Michiganders. What Happens when Michiganders Receive Care Outof-State? MiHIN is actively working with many out-of-state HIE organizations to develop secure, interstate information exchange. The initial focus is on those states to which Michiganders most typically travel, such as California, Nevada, Arizona, the southeastern states, and states making up the Great Lakes regional area. The Forward Momentum of HIT and HIE in Michigan Figure 5 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). Beginning in the fall of 2016, MDHHS began work with community partners and stakeholders to further develop and test the Blueprint model in the following 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. Along with the Blueprint expansion, the forward momentum of HIT and HIE in Michigan will focus on improving public health, provider engagement, and coordination of physical and behavioral patient healthcare. To facilitate this, electronic exchange will expand, as will sharing of health information resources. With the technical infrastructure for health information sharing built, the Michigan HIT Commission has begun exploring how the network can be better leveraged to support critical statewide healthcare efforts. Three topics of particular focus by the Commission are: 1. Using health information sharing to improve the management of prescription drugs 2. Using health information sharing to advance business integration and strategic alignment within MDHHS 3. Using 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 needed legislation, such as statewide adoption and use of the Electronic Prescribing Controlled Substance program (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 and outcomes, and enforcement. www.mipcc.org 517-908-8241
Figure 5. Statewide Shared Services Practically Applied through Valuable Use Cases and Scenarios Another practical example would be the successful partnership between MiHIN and the Department of Technology and Budget Management (DTMB), which would allow for the submission of collective statewide HIE data, via MiHIN Shared Services, to the MDHHS Data Hub in support of meaningful use reporting requirements. As shown earlier in Figure 3, MiHIN Shared Services is a network-of-networks through which all the state systems are connected to 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 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, to 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 will also be connected to the MDHHS Data Hub. www.mipcc.org 517-908-8241
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 With the technical infrastructure for health information sharing built, the Michigan HIT Commission has begun exploring how the network can be better leveraged to support critical statewide health care efforts. Measuring Success An important take-away as you consider the current forward movement of HIT and HIE in Michigan is the accumulated successes to date. While the list is extensive, below are some noteworthy statistics: 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 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 improve secure HIE functionalities, facilitating 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. Under the policy guidance of the HITC and evidenced by the innovation of MiHIN, Michigan continues to be on the leading edge of HIE and HIT adoption. Source List: Value Partnerships-BCBS of MI 2017 PGIP Fact Sheet: Health Information Exchange Initiative Michigan Health IT Commission 2016 Annual Report Michigan Health IT Commission 2007-2008 Report to Michigan Legislature MiHIN.org Frequently Asked Questions (FAQs) 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 MiHIN.org/Exchanges/great-lakes-health-connect gl-hc.org www.mipcc.org 517-908-8241