Health Information Exchange Activities for LTPAC and Behavioral Health Communities ASPE Sponsored Webinar December 4, 2012 To ask a question during the live webinar – 1) Post a question at any time in the Chat Box 2) Live Q&A will be held at the end of the webinar
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Health Information Exchange Activities for LTPAC and ...campus.ahima.org/audio/2012/RB120412.pdf · Health Information Exchange Activities for LTPAC and Behavioral Health Communities
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The Need for Health Information Exchange • Persons who receive long-term/post-acute care and behavioral
health services are medically fragile, functionally impaired, and/or have serious and complex behavioral health problems.
• These individuals have frequent contact with the health care delivery system, experience frequent transitions and referrals in care, and are among the most costly patients.
• Poor health information exchange is believed to be a factor that
contributes to: readmissions, duplicative testing treatment, adverse medication events, and poor coordination and integration of care. – Improved health information exchange (HIE) on behalf of
persons who receive LTPAC and BH services is anticipated to improve quality and reduce unnecessary health care costs. 5
“The purpose of the Center is to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid, and CHIP… while preserving or enhancing the quality of care furnished.”
- The Affordable Act • Opportunity to “scale up”: The HHS Secretary has the
authority to expand successful models to the national level • Measures of Success focus on:
• Better health care • Better health • Reducing costs through improvement
Innovation Center Portfolio Primary Care Transformation • Comprehensive Primary Care Initiative (CPC) • Multi-Payer Advanced Primary Care Practice (MAPCP)
Demonstration • Federally Qualified Health Center (FQHC) Advanced
Primary Care Practice Demonstration • Independence at Home Demonstration • Graduate Nurse Education Demonstration
Accountable Care Organizations (ACOs) • Medicare Shared Savings Program • Pioneer ACO Model • Advance Payment ACO Model • PGP Transition Demonstration
Bundled Payment for Care Improvement • Model 1: Retrospective Acute Care • Model 2: Retrospective Acute Care Episode & Post Acute • Model 3: Retrospective Post Acute Care • Model 4: Prospective Acute Care
Capacity to Spread Innovation • Partnership for Patients • Community-Based Care Transitions • Million Hearts • Innovation Advisors Program
Health Care Innovation Awards
State Innovation Models Initiative
Initiatives Focused on the Medicaid Population • Medicaid Emergency Psychiatric Demonstration • Medicaid Incentives for Prevention of Chronic Diseases • Strong Start Initiative
Medicare-Medicaid Enrollees • Financial Alignment Initiative • Initiative to Reduce Avoidable Hospitalizations of Nursing
• An ACO promotes seamless coordinated care – Puts the beneficiary and family at the center – Remembers patients over time and place – Attends carefully to care transitions – Manages resources carefully and respectfully – Proactively manages the beneficiary’s care – Evaluates data to improve care and patient outcomes – Innovates around better health, better care and lower
growth in costs through improvement – Invests in team-based care and workforce
Medicare Shared Savings Program (Center for Medicare and CMMI): Facilitates coordination of care and shared savings on behalf of Medicare FFS beneficiaries by creating of participating in ACOs.
Pioneer ACO Model: Organizations including several integrated delivery systems that include LT/PAC and/or BH services, and use health IT to support care coordination.
Advance Payment Model: Physician-based and rural providers that work to coordinate care for Medicare beneficiaries.
Four patient-centered approaches – Focus on bundling payment for episodes of care:
1. Acute care hospital stay only
2. Acute care hospital stay plus post-acute care: episode bundles the inpatient hospital and PAC stay for either 30 or 90 days post-hospital discharge.
3. Post-acute care only: episode begins with the initiation of PAC services within 30 days of hospital discharge and ends after 30 days of PAC service delivery. PAC services are: SNF, HHA, LTCH, IRF. Bundle includes: physician, PAC, lab, DME, and Part B meds.
4. Prospective payment of all services during inpatient stay
GOAL: Drive care redesign by aligning incentives that improve coordination across services and reduce the cost of care.
• This cost $2.6 billion in unnecessary Medicare expenditures. • Initiative supports the goal of reducing avoidable hospitalizations by
20% by end of 2013.
• 09/27 - Announced 7 participating organizations
GOAL: Reduce preventable inpatient hospitalizations among residents of nursing facilities. Providing preventive care and treatment without hospital visits.
GOAL: Test whether Medicaid Beneficiaries aged 21 to 64 who are experiencing a psychiatric emergency (suicidal or homicidal thoughts or gestures) get more immediate, appropriate care when institutions for mental diseases (IMDs) receive Medicaid reimbursement
Demonstration provides federal matching funds over 3 years
Demonstration pays for inpatient services necessary to stabilize the psychiatric emergency
11 States – Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington, and West Virginia – and the District of Columbia were selected to participate
Innovation Awardees will: • Improve care and lower costs for Medicare, Medicaid, and CHIP
beneficiaries.
• Reach diverse populations in underserved and geographically remote communities
• Rapidly implement the proposed model.
• Develop, train, and deploy workforce in innovative payment and delivery models.
• Status: • 107 Projects Awarded for a three-year period in all 50 states
GOAL: Identify and support a broad range of innovative service delivery and payment models that achieve better care, better health and lower costs in communities across the nation.
Transition of Care: the movement of a patient from one setting of care to another Referral: one provider refers a patient to another, but the referring provider maintains their care of the patient as well
Further Info Explanation of MU Required Data in the C-CDA
• Functional status, including activities of daily living, cognitive and disability status
• Care plan field, including goals and instructions
• Care team including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider
Certification for Other Settings • Nothing prohibits anyone from getting a technology certified to as many
criteria as they wish even if the technology is not designed for or marketed to eligible providers
• Certification ensures that the technology is capable of sharing a C-CDA with other certified technologies and that it can both create and consume information in C-CDA
• ONC Final Rule: HIT: Standards, Implementation Specifications, and Certification Criteria for EHR Technology, 2014 Edition; Revisions to the Permanent Certification Program for HIT
“We encourage EHR technology developers to certify EHR Modules to the transitions of care certification criteria (§ 170.314(b)(1) and (2)) as well as any other certification criteria that may make it more effective and efficient for EPs, EHs, and CAHs to electronically exchange health information with health care providers in other health care settings.”
• Financial Incentives – 2 or 5 % on eligible HCBS provided under the following Medicaid program authorities:
• HCBS under 1915 (c) or (d) or under an 1115 Waiver; • State plan home health; • State plan personal care services; • The Program of All-Inclusive Care for the Elderly (PACE); • Home and community care services defined under Section 1929(a);
and • Self-directed personal assistance services in 1915 (j), • services provided under 1915(i), • private duty nursing authorized under Section 1905 (a)(8) (provided in
home and community-based settings only) • Affordable Care Act, Section 2703, State Option to Provide Health
Homes for Enrollees with Chronic Conditions • Affordable Care Act, Section 2401, 1915(k) - Community First Choice
– No Wrong Door/Single Entry Point system, – Conflict-free case management, and – Core assessment instruments – And data reporting requirements – A User Manual and technical assistance will be
• Wide Range Of Settings • Wide Range Of Service Provider Types And Qualifications • Wide Range of Measurement Sets: No Standardization • Wide Variety Of Diagnostic Categories in LTC • No Standard “Treatment Intervention”, i.e., service definitions
& service delivery models • Personal & social outcomes versus illness or disease outcomes
• Demonstrate personal health records with beneficiaries of CB-LTSS; and
• Curate an electronic Long Term Services and Supports (e-LTSS) standard coordinated through the Office of National Coordinator’s (ONC) Standards and Interoperability Framework.
• States can develop a strategy in their initial operational protocol to integrate health related information through the use of HIT (Health Information Technology).
• This strategy is intended to engage and integrate information from EHRs into a beneficiary’s PHR.
Curate an electronic Long Term Services and Supports (e-LTSS) standard
A health home is an approach to how health care is delivered. A health home is a provider or a team of health care professionals that provide integrated health care. This means that if a person is participating in a health home, that person’s health care, from primary care doctor to dentist to behavioral health professional, all share the same information and coordinate treatment based on that information. Health homes operate under a “whole-person” philosophy – caring not just for an individual’s physical condition, but providing linkages to long-term community care services and supports, social services and family services. The integration of primary care and behavioral health services is critical to achievement of enhanced outcomes. (SAMHSA)
A care manager who knows the member, organizes care, ensures communication with other care providers and assures that the member’s circumstances does not affect his/her progress to better health…
Complex health conditions with complex treatment regimens
Literacy and health literacy issues Homelessness and unreliable food Safety concerns Familial disruption
New York State Health Home Analytical Products ◦ CRG Based Attribution – For Cohort Selection ◦ CRG Based Acuity – For Payment Tiers ◦ Predictive Model – Predicts future negative events
(Inpatient, Nursing Home, Death) using claims and encounters – For Assignment Priority
◦ Ambulatory Connectivity Measure – For Assignment Priority
◦ Provider Loyalty Model – Establishes Patient Connectivity to Existing Care Management, Ambulatory (including BH), ED and Inpatient – For Matching to Appropriate HH and to Guide Outreach activity.
How Eligible Members are Being Identified and Assigned
◦ Comprehensive care management An individualized patient centered care plan based on a comprehensive health risk assessment – must meet
physical, mental health, chemical dependency and social service needs. ◦ Care coordination and health promotion
One care manager will ensure that the care plan is followed by coordinating and arranging for the provision of services, supporting adherence to treatment recommendations, and monitoring and evaluating the enrollee’s needs. The health home provider will promote evidence based wellness and prevention by linking patient enrollees with resources for smoking cessation, diabetes, asthma, hypertension, self-help recovery resources, and other services based on need and patient preference.
◦ Comprehensive transitional care Prevention of avoidable readmissions to inpatient facilities and oversight of proper and timely follow-up care.
◦ Patient and family support Individualized care plan must be shared with patient enrollee and family members or other caregivers.
Patient and family preferences are considered. ◦ Referral to community and social support services
Provider will identify and coordinate community and social supports ◦ Use of health information technology (HIT) when feasible
Health home providers will be encouraged to utilize RHIOs or a qualified entity to access patient data and to develop partnerships that maximize the use of HIT across providers. Health home provider applicants must submit a plan with their application for achieving compliance with the final health home HIT requirements within 18 months of program implementation
• NYS has developed a strong state HIE infrastructure with the SHIN-NY and local RHIOs. Most development has been focused on hospital and physicians. Very little funding has been available for behavioral health providers aside from HEAL 17.
• RHIOs use different platforms and have different consenting processes for HIE access.
• MU incentives apply to a limited number of providers.
• In 18 months from the date of the SPA, Health Homes need to meet HIT Health Home standards:
– Health home providers will be encouraged to utilize RHIOs or a qualified entity to access patient data and to develop partnerships that maximize the use of HIT across providers. Health home provider applicants must submit a plan with their application for achieving compliance with the final health home HIT requirements within 18 months of program implementation
Brookdale Senior Living owns / operates 647 senior living communities in 36 states A successful Transitions of Care program was implemented in select skilled nursing
centers CMS Innovations Grant awarded for 3 years (July 2012-July 2015)
Partnerships in the Grant • Brookdale Senior Living • University of North Texas Health Sciences Center (UNTHSC) • Florida Atlantic University (FAU) • Loopback Analytics • University of South Florida (USF) • American Association of Colleges of Nursing (AACN) • Florida Medical Quality Assurance Inc. ( FMQAI)
Goals • Improve the quality of care for the resident, NOT prevent hospitalization when warranted.
• 1 out of 4 resident admitted to a nursing home will be readmitted to the hospital within 30days
• INTERACT can result in a more rapid transfer for residents who need acute care. • Implement INTERACT in 67 Brookdale communities over 3 years that provide Skilled Nursing,
Assisted Living, Independent Living and Home Health services and demonstrate success metrics
• Increase care coordination across continuum • Integrate care cost data • Create strong collaborative relationships/partnerships with hospital systems
• Reporting, Analysis and Tracking tools support Quality Improvement and Root Cause Analysis
• Monthly Summaries produced can be entered on the AE website for trend graphing http://www.NHQualityCampaign.org
• Admission logs from Acute Care Hospitals • Transfer logs for Acute Care Transfers • Communication Tool logs and graphs • Transfer Related process logs and graphs • Admissions by Day of Week graph template • Admissions by Hospital graph template ● Transfers by Doctor graph
template • Transfers by Time of Day graph template ● Transfers by Outcome graph
template • Transfers by Primary Reason for Transfer graph template
• All Audiences Information Exchange Activities for LTPAC and BH Communities – December 4 | 12:30–1:45 p.m. ET
• Providers and Affiliated Organizations Implementing HIE in the BH Community
– December 4 | 2:30–3:45 p.m. ET Implementing HIE in the LTPAC Community – December 12 | 1–2:15 p.m. ET
• State and HIE Organizations Implementing HIE in the BH Community – December 5 | 12 Noon–1:15 p.m. ET Implementing HIE in the LTPAC Community – December 14 | 11:30–12:45 p.m. ET
To Register: https://www.ahimastore.org/ProductList.aspx?CategoryID=1324