Health Current: Roadmap Practice Transformation using Information & Data
Melissa A. Kotrys, MPH Chief Executive Officer July 2017 2
Arizona Health-e Connection is now Health Current. Powering the future of healthcare with more complete information. 3
4 Health Current Celebrates 10 Years! 2005 Governor s Executive Order 2006 Arizona Health-e Connection Roadmap published 2007 Arizona Health-e Connection (AzHeC) founded 2010 Regional Extension Center (REC) grant awarded 2011 & 2012 HIT and HIE legislation passed 2013-2014 Merged statewide HIE into AzHeC 2014 Arizona s Health IT Roadmap 2.0 published 2015 Transforming Clinical Practice Initiative (TCPi) grant awarded to AzHeC (in collab with Mercy Care) 2016 AzHeC initiates integrated physical & behavioral HIE strategy 2017 10 year anniversary, launch of new strategic business plan & rebrand as Health Current
5 10+ Years of HIE Progression in Arizona 2007 2010 Two regional HIEs developed S. Az HIE (SAHIE) and Az Medical Info Exchange (AMIE) 2010-2014 Two regional HIEs (AMIE & SAHIE) merged to form statewide HIE Health Info Network of Az (HINAz) 2014 2015 Arizona s Health-e Connection (AzHeC) and HINAz formally affiliate and operate as single entity 2016 AzHeC & HINAz formally merge; AzHeC to handle all communitywide HIT and HIE activity 2017 AzHeC rebrands as Health Current & rolls out 3 year strategic business plan
Health Information Exchange 6
7 HIE Services Data Exchange - Push/pull or query/response functionality Portal - Secure online access to patient summary view Alerts - ADT alerts and other clinical results notifications in human & machine readable formats Direct Secure Email - Secure email for clinical information exchange; DirectTrust certified and HIPAA compliant Clinical Summary - The delivery of a continuity of care document (CCD) based on an electronic request
Participation Growth as of June 2017 8
9 HIE Participants (as of June 12, 2017) Current participants include 340 entities: 120 Community Provider Organizations 71 Behavioral Health Organizations 29 Hospitals & Health Systems (95% of inpatient discharges) 21 FQHCs & Community Health Centers 54 Long-Term & Post-Acute Care Organizations 17 State & Local Government Organizations 12 Health Plans 14 Accountable Care Organizations 2 Reference Labs & Imaging Centers Hospitals, FQHCs and RHCs participating in the Medicaid EHR Incentive Program with AHCCCS (Arizona Medicaid) are eligible to receive financial incentives for HIE participation. Note: An HIE Participant is an organization that has signed a Participation Agreement. These organizations are either already connected to the HIE or in the process of connecting.
Hospital Participants: Inpatient Discharges & ED Visits 10 100% 94% 94% 94% 95% 90% Percent of Arizona's Total Volume 80% 70% 60% 50% 40% 30% 20% 13% 13% 53% 54% 54% 48% 49% 49% 56% 53% 10% 0% 2011 YE 2012 YE 2013 YE 2014 YE 2015 YE 2016 YE 2017 YTD Inpatient Discharges ED Visits
11 FQHCs, RHCs, Community & Behavioral Health Providers 140 120 120 100 Number of Participants 80 60 40 80 67 71 20-19 21 21 14 9 5 6 6 1 1-2 - 2-2 - 2011 YE 2012 YE 2013 YE 2014 YE 2015 YE 2016 YE 2017 YTD FQHCs & RHCs Community Providers Behavioral Health Providers
12 Accomplishments to Date 90% of hospital admissions with data flowing (soon 94%) 7.0M+ patients with clinical data 50,000+ Alerts monthly Integrating physical & behavioral health information statewide Successful grant programs REC and Practice Innovation Institute Interstate connectivity Patient Centered Data Home Groundswell of interest 300+ Participants
The Patient Rights Process 13
Health Current Participants Data Providers & Data Types (updated monthly) 14 https://healthcurrent.org/the-network/the-network-participants/data-providers-data-types/
HIE Statistics (May 2017) 15
HIE Statistics (May 2017) 16
HIE Statistics (May 2017) 17
Practice Innovation Institute (Pi Institute) Key Facts 18 Potential of up to $14.6 million from CMS over four years (2015-2019) Collaboration of Health Current, Mercy Care Plan & Mercy Maricopa Integrated Care One-on-one consulting valued at $50K+ per practice Assistance in integrating physical & behavioral health care Engagement and practice transformation for 2,500 Arizona Clinicians Connection to the statewide HIE, including pop health & data analytics to enhance communications and care coordination Collaboration with QIN-QIO and professional medical associations to advance practice transformation
Transforming Clinical Practice Initiative (TCPI) Goals 1 Support more than 140,000 clinicians in their practice transformation work 2 Improve health outcomes for millions of Medicare, Medicaid and CHIP beneficiaries and other patients 3 Reduce unnecessary hospitalizations for 5 million patients 4 Generate $1 to $4 billion in savings to the federal government and commercial payers efficient care delivery by reducing 5 Sustain unnecessary testing and procedures 6 7 19 Transition 75% of practices completing the program to participate in Alternative Payment Models Build the evidence base on practice transformation so that effective solutions can be scaled 19
What are the 5 phases of TCPI? Set Aims Use Data to Drive Care Achieve Progress on Aims Achieve Benchmark Status Thrive as a Business via Pay for Value Approaches 20
21 Patient Centered Data Home (PCDH) Patient Centered Data Home (PCDH) is a concept of Strategic HIE Collaborative (SHIEC). 1 Non- Home HIE 2 ADT to PCDH HIE 3 Acknowledgement of Clinical Data 4 Home HIE 5 Query/Response Hospital (Non-Home) Care Team Home Care Team 3 Alert Add l Data 5
PCDH Regions: Current + Potential Expansions Western Heartland Central 2016 SHIEC All rights reserved, proprietary and confidential not for further redistribution.
PCDH Regions: National Connectivity Northwest Region Western Heartland Northeast Region Southeast Region Regional Gateway Connections Central 2016 SHIEC All rights reserved, proprietary and confidential not for further redistribution.
24 24 Statewide HIE Integration Plan (SHIP) 2016 2018 Accelerated connectivity of integrated HIE strategy supported by all 3 Regional Behavioral Health Authorities (RBHAs) - Mercy Maricopa - Cenpatico Integrated Care - Health Choice Integrated Care 2-year plan to connect 100 high priority behavioral health providers by summer 2018 - Behavioral health providers - Behavioral health hospitals Current status - Statewide crisis portal go-live in late July 2017 - Portal implementations 41 organizations - Alerts & Direct secure email 23 organizations - Inbound data feeds 5 organizations (expect 25+ by end of year)
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26 26 Opioid Epidemic Solutions: HIE/PMP Integration HIE integration with Arizona s Prescription Monitoring Program required by SB 1283 BEGINNING THE LATER OF OCTOBER 1, 2017 OR SIXTY DAYS AFTER THE STATEWIDE HEALTH INFORMATION EXCHANGE HAS INTEGRATED THE CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM DATA INTO THE EXCHANGE HIE/PMP integration go-live scheduled for early August Impact on Opioid Epidemic Providers using HIE Portal will be able to access all controlled substance prescriptions from PMP database along with all medical history available through HIE Aligns with integrated physical and behavioral health information exchange - In emergency, providers able to break the glass and access patient s Part 2 substance abuse data - In other instances, can access Part 2 substance abuse data with patient consent
27 Strategic Business Plan: 2017-2019 4 Pillars of Success Sustainability Data Integration Data Acquisition Data Quality Value-Added Services Core HIE Foundation
28 Strategic Business Plan: 2017-2019 4 Pillars of Success Sustainability Data Integration Data Acquisition Data Quality Value-Added Services Core HIE Foundation
29 Data Integration We help our partners realize their highest potential to transform care What It Means Make sure the HIE is usable and integrated into participants workflows Map out needs, expectations, priorities and timelines to integrate Understand & address barriers to successful and efficient HIE use Overall, maximize HIE value to participants
30 Strategic Business Plan : 2017-2019 4 Pillars of Success Sustainability Data Integration Data Acquisition Data Quality Value-Added Services Core HIE Foundation
31 Data Acquisition Data Sources Continue adding new data sources: Remaining acute care hospitals (18 = 6% of statewide discharges) Remaining behavioral health hospitals (14) Physical health practices Behavioral health practices Long term post-acute care organizations First responders Correctional health providers Claims data to fill encounter data gaps Medicaid claims Medicare claims Commercial claims Medication fill history PDMP Commercial sources Social services agencies VA & IHS Advanced directives Other HIEs
32 Data Acquisition Data Elements Capture missing data (varies by Participant): Diagnosis & chief complaint Discharge destination Electronic images Encounter based data Immunizations Insurance & guarantor Lab & radiology results Medications Patient attributions PCP designation Social determinants Transcribed reports & electronic documents Treatments & procedures Vital signs & BMI Determinants
33 Strategic Business Plan: 2017-2019 4 Pillars of Success Sustainability Data Integration Data Acquisition Data Quality Value-Added Services Core HIE Foundation
34 Data Quality Data Normalization The process of making data less variable by: - Grouping similar values into a common value set (e.g. payer names, gender, religion, ethnicity, practice specialties, etc.) - Utilizing common data formats for variable format elements (e.g. name and address formats) Data Standardization The process of utilizing accepted data coding standards to make data more meaningful, comprehensive and actionable - Examples: CPT, ICD-9, ICD-10, RxNorm, LOINC, NDC, SNOMED CT, DICOM
35 Strategic Business Plan: 2017-2019 4 Pillars of Success Sustainability Data Integration Data Acquisition Data Quality Value-Added Services Core HIE Foundation
36 Value-Added Services New Services to be Considered Population Health Management Health Care Analytics Community Care Plans Medication Fill History Electronic Image Sharing Community Referral Management Community Scheduling Advanced Directives, Power of Attorney & POLST Consent Management & Identity Proofing Personal Health Record Advanced Reporting Bundled Payment Support Secure Test Messaging+
37 Health Current & Value-Based Purchasing The Four Pillars Data Integration - Utilization of integrated HIE data to improve outcomes Data Acquisition - More data = more complete patient record = better care coordination and improved outcomes Data Quality - Discrete data in a format to analyze Value-Added Services - Additional HIE services can be tailored to the needs of the community to support value-based purchasing
38 Health Current & Value-Based Purchasing HIE Services Data Exchange - More data into the HIE & your EHR = more complete record Portal - Easy access to patient summary on new patients as initial step Alerts - Real-time care coordination & follow-up can avoid readmissions, provide appropriate follow-up care, etc. Direct Secure Email - Mechanism to support alerts and other information transfer Clinical Patient Summary - Triggered patient summary response gets new information in clinicians hands when it is needed
39 Next Steps for YOU! 1. Contact Health Current to ensure you are connected soon! - Contact Beth Scully beth.scully@healthcurrent.org or 602-688-7216 2. Encourage other providers to participate more value received as more patient information available; statewide participation is key - Provide contacts to Health Current 3. Get engaged & involved provide input for future services and opportunities or participate on councils or workgroups - Send us your ideas or set-up a time to meet - Volunteer for a council or workgroup 4. Stay informed get regular updates about new opportunities - Make sure you receive Health Current Updates subscribe at www.healthcurrent.org
40 Closing Remarks Sustainability Active Participation + Strategic Partnerships + Value-Added Services + Data Integrity = Sustainability & Value Data Integration Data Acquisition Data Quality Value-Added Services Core HIE Foundation
42 Health Current Melissa A. Kotrys, MPH Chief Executive Officer melissa.kotrys@healthcurrent.org www.healthcurrent.org 602-688-7200 Follow Us: