utah health it vision, principles, and priorities: 2015 – … · 2017-08-01 · utah health it...

UTAH HEALTH IT VISION, PRINCIPLES, AND PRIORITIES: 2015 – 2020 - A Statewide Collaborative Statement

[Draft 3, incorporated input from Utah Partnership for Value-based Health Care, 03/13/2015] Our statewide health vision is for Utah to be a place where all people can enjoy the best health possible, where all can live, grow and prosper in healthy and safe communities. Our statewide vision for health IT is for Utah to be a place where the secure and efficient use and exchange of electronic health information will result in improved health status, better health care, lower cost and healthier communities.” In the last decade, we have made significant progress in adoption Electronic Health Records (EHR) and clinical health information exchanges. In the coming decade, we will move forward under following guiding principles:

• Continue to foster statewide collaboration with all partners • Leverage the market and existing HIT infrastructures • Encourage interoperability and portability across care

settings through multi-level or modular advancements • Protect privacy and security in all aspects of IT and its uses • Enhance consumer engagement • Share meaningful health information among learning health

systems to ensure innovation, quality, safety, and value in health care.

• Support health reforms to strengthen health of individuals, families, communities and add value to Utah’s economy.

Our health IT priority is to improve system interoperability and portability to support integration of physical and behavior healthcare and improve population health for all Utahans.

The Priority Framework of Health IT for Population Health and a Statewide Learning Health System in Utah (See next page) describes the relationship of various health IT components, health data uses, and statewide initiatives as follows: • The left pyramid includes core IT applications that were identified

in our statewide IT architecture design for 2009-2014 efforts. • The HIT systems provide information services for multi-level

information uses ranging from care provided in medical home, neighborhood and communities to patient registries, value-based health systems, as well as public transparency reporting (the right pyramid).

• Interoperability and portability are key functions among all IT applications and infrastructure, services, and connections to health data users.

• Health IT must support an integrated collaborative learning health system.

• Health IT must improve efficiency of health promotion and enhance health IT literacy and training.

Partners:

• Utah Digital Health Service Commission (Initiator, 3/5/15) • Utah State Innovative Grant Planning Partners (3/5/15) • Utah Partnership for Value-based Health Care (3/12/15)

To be adopted by: • Utah Department of Health • Utah Health Data Committee • Utah Health Information Network • HealthInsight - Utah • … Open for all organizations in Utah

Priority Framework of Health IT for Population Health and a Statewide Learning Health System in Utah

Public

Transpa- rency

Reporting

Medical Homes,

Neighbor-hood, and

Communities

Registries Patient -

Populations

Value-Based Systems

Consumer App

Public Health Data and

Information Systems

Health Information- Exchange (HIE)

Master Patient Index Electronic Health Records

Privacy and Security

Iona Thraen PhD

Requested $63 million for implementation Awarded $2 million for planning Rewrite of Project Narrative, Budget and

Budget Narrative – due Feb 28, 2015 Submitted Feb 27,2015 30 day review time for approval

R to the fifth power ◦ Right Care at the Right Time for the Right Reason with the

Right Community at the Right Cost

Utah Challenges ◦ Uninsured rate of 11.6% in 2013 ◦ Rising proportion of Behavioral Health diagnoses in

expensive health care environments (7.5% EMS, 12% ED, 6% inpatient)

◦ Mental Health Shortage Designation throughout rural areas ◦ Rating of D by NAMI due to poor infrastructure, information

access, service capacities, recovery support and lack of providers in rural communities

◦ Rising rates of obesity (25%) and diabetes (7.88%) ◦ Growing aging population ◦ Certain cancers above national averages ◦ Pockets of diversity with higher than average health

conditions

$331 million annual uncompensated care $250 million in Ambulatory Care Sensitive

Conditions and inpatient Costs for Behavioral Health Related expenses

Obesity-related adult healthcare expenses expected to reach $2.4 billion by 2018

$49 million in treatment costs for diabetes in 2011

End of life care for pancreatic cancer patients ($14 million)

Strategies for improvement ◦ Healthcare Delivery System Transformation ◦ Payment and Service Delivery Models (volume to value

based) ◦ Regulatory Authority (mandates, incentives, rules) ◦ Health Information Technology ◦ Stakeholder Engagement ◦ Quality Measure Alignment

Changing Environment ◦ Public Health Surveillance moving into the integrated

dashboard using clinical data with claims, survey, surveillance, chart reviews, etc.

◦ Movement away from report production to interactive visual web based display and dissemination

HIT Planning Retreats - General ◦ Internal UDOH ◦ Cross-Agency (Behavioral Health, Aging, DWS) ◦ Community ◦ Agenda Assessment of our current infrastructure as it relates

to the Federal IT Roadmap HIT Planning Retreats – Application ◦ Behavioral Health Integration ◦ Obesity and Diabetes ◦ Advance Care Planning

Align Utah reporting measures with CMS Meaningful Use ◦ Behavioral Health Integration NQF 0418 Preventive Care and Screening: Screening for

Clinical Depression and Follow up Plan NQF 0105 Anti-depressant medication management; (a)

Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment

NQF 0004 Initiation and treatment of alcohol and other drug dependence treatment: a) initiation, b) engagement

◦ Obesity and Diabetes Reduction NQF 0421 Adult Weight Screening and Follow up NQF 0024 Weight assessment and counseling for Nutrition

and Physical Activity for children and adolescents NQF 0575 Diabetes: HbA1c Control (<8%) NQF 0059 Diabetes: HbA1c Poor Control NQF 0064 Diabetes: LDL Management & Control NQF 0061 Diabetes: Blood Pressure Management

◦ End of Life TBD

UHIN Update HIE User Group March 2 2015

UHIN Overview

• Membership organization • Established in 1993 as a Value Added Network • Moved to Clearinghouse services 2012-UTRANSEND

• 2 Million claims and remittances processed monthly • 3 Million eligibility requests processed monthly • Nationwide network

• Added HIE Services in 2009-cHIE • 2 Million clinical documents processed monthly • 1 Million patients with clinical data

• Added Data Warehouse/Analytics 2011-CareAchieve

cHIEAlerts

• Customized by message, delivery and timing

• Subscription • Through patient file-payer/provider • Updated through ADTs • APCD files for payer

• Transitional Care Management (TCM)

reimbursement

www.mychie.org/files/support/uhin.html

http://www.mychie.org/files/support/uhin.html

cHIEAlerts Use Cases

• Reduce readmissions • Reduce high utilization of the Emergency Room • Ensure Post Partum care • Follow up on acute Asthma events • Intervene on patient with High Risk Behavioral Health • Coordination of Medical and Behavioral Health services

cHIEAlerts Future

• Hospitals use for readmission analysis • Meaningful Use TOC • Attach CCD from cHIE • Medication reconciliation • Home Health use • Coordination of alerts across HIEs

Data Warehouses support analytics

• Using Natural Language Processing (NLP) tools

• Services include: • Data file export • Access to query portal • Reports

Data Warehouse Use Cases

• Assessing Risk • Medicare Advantage

• Diabetic monitoring • Patients at risk • Gaps in services

• Hypertension monitoring • Improve HEDIS Star rating • Readmission reports • Various NQF measures

Data Warehouse Future

• Population Management • Identifying hotspots

• Analyzing Risk • Health Insurance Exchange (HIX)

• Dashboards • Diabetic monitoring • Identifying gaps in care

Questions

Matt Hoffman, MD [email protected]

Merri Rock [email protected]

mailto:[email protected]

mailto:[email protected]

IASIS - Health Choice Bundled Payment Initiative Overview

Overview and Structure Bundled Payment Performance Next Steps Bundled Payment

Capability Overview

John L Oaks Vice President

IASIS Healthcare Utah

1 Overview and Structure Bundled Payment

Performance Next Steps Bundled Payment Capability Overview

Hospitals

Corporate Office

Health Plans Provider Networks

Leading Health Services Organization

• 16 Acute Care Hospitals • 1 Behavioral Health Hospital • 3,778 Licensed Beds • Ancillary Facilities/Access Points in all Markets • 137 Clinics/Physician Sites

• 2 High Performance ACO Networks • 4 Health Plans • ~315,000 Lives in Managed Health Plans/Services • 13,000+ Employees; Medical Staff of nearly 5,300 • $2.5 Billion in Annual Net Revenue



IASIS Health Services Organization Solutions



Health Choice – The IASIS Vehicle For Successful Bundled Payment Initiative

Health Choice capabilities have facilitated successful implementation and management of a bundled payments program

Underwriting and analytics tools: Enable providers to integrate and standardize patient data understand gaps, patient needs, and risk stratification

Provide indicator notifications to both hospitalists and PCPs: Drive discharge planning and post-discharge care coordination

Care coordination and care redesign model: Coordinate care between surgeons, facilities, and PCPs to monitor and helps prevent readmissions and complications

Successfully implemented bundled payments programs at three IASIS facilities in Arizona and Utah

Overall gain share improvement of 124% from 2013 to 2014

Redesigned care model--proven care coordination model applied to bundled payment approach

Developed scalable care model, which includes education on continuum of care—initial consult through post-discharge coordination – establishes patient and hospital expectations

Created pricing model that can be deployed for additional services

Developed communication and data sharing approach to manage episodic care including real-time monitoring

Bundled Payment Initiative Accomplishments

Health Choice Competencies



IASIS Bundled Payment Value Proposition

VALUE TO BUNDLED PAYMENTS PARTNERS

2 Experienced health services team manages relationships, communications, and contracts with Centers for Medicare and Medicaid Services (CMS) and physician partners to ensure regulatory compliance

1 Model ensures member’s care is appropriately managed throughout episode to minimize complications, re-admissions, and unnecessary utilization of services

3 Leverage MedAssets predictive modeling tools and Care Radius platform to evaluate progress, make program adjustments, and integrate care management throughout course of treatment

4 Robust financial performance and partner gain share reimbursement model facilitates real time analysis of episode of care reimbursement

CORE STRENGTHS

Financial & Performance

Accountability

Episode Care Model

Analytics / Risk Stratification

Compliance & Communications



Sample Bundled Payment Physician Placemat – Initial Education



Hospital Payment Reconciliation Tables • Average gain share for positive and negative NPRA-rated episodes remained relatively constant from 2013 to

2014 • At Salt Lake Regional Medical Center, the percentage of episodes with positive NPRA ratings increased from

63% in 2013 to 75% in 2014 – led to an increased average gain share of $1,257 per episode • Gain share performance improvement driven by leveraged Health Choice capabilities that limited

complications, re-admissions, and other unnecessary utilization Care coordination (including post-discharge) Analysis and analytics Improved communication between hospital, physicians, and other ancillary providers

2013 2014

**Only includes concluded episodes from 2014 (as of October 2014) *NPRA = Net Payment Reconciliation Amount

Number of Episodes

Total Gain share Payment

Average Gain share Payment

Number of Episodes**

Total Gain share Payment

Average Gain share Payment

Positive NPRA* 110 $575,432 $5,231 54 $284,721 $5,273

Negative NPRA 65 ($615,032) ($9,462) 18 ($210,475) ($11,693)

Grand Total 175 ($39,599) ($226) 72 $74,246 $1,031



High-Level Implementation Plan

Physician Engagement Foster strong relationships with community providers and provide tools to successfully manage patient treatment throughout each episode of care

Care Redesign Development 20+ years experience managing patient care under risk contracts deployed to establish model for bundled payment initiative success. Care Redesign Models reviewed and approved by CMS

Payor Contract Submission Utilize formal proposal experience to evaluate and pursue appropriate bundled payment initiatives that include both gain sharing and quality monitoring

Communication Plan Development Develop and deploy communications strategy with physicians and payor (In this case CMS)

Care Team Assignment Care team must engage patients and manage care through entire bundled payment period to 1) ensure high quality outcomes, 2) avoid unnecessary emergency room use and readmissions, and 3) ensure proper utilization of sub-acute care

Ancillary Provider Engagement Access existing relationships with ancillary providers (e.g. skilled nursing facilities, IP Rehab, Home Health) to maximize cooperation and support in episode management (with or without incentives)



Bundled Payments Program Administration Costs

Program Management

CMS communications

Physician communications

Predictive analytics

Reporting

Risk stratification

Regulatory compliance

Care Management

Care redesign

Care plans

Care coordination

Discharge management

Medical / health homes

Population health

Network Management

Physician engagement

Ancillary provider engagement

Provider profiles / benchmarks

Outlier identification

Comprehensive evaluations

Physician education

Key Bundled Payment Program Components

MSO costs on a per episode basis to be scaled based upon annual volume & maturity



Standard Bundled Payments Implementation Timeline

Develop Communication

Plan

Build Physician

Relationships

Reach Contractual Agreement with

CMS

Build Interdisciplinary

Care Team

Identify and Engage Ancillary

Providers

Adapt Care Plans

Customize Analytics and

Reporting Suite

Complete Financial Tracking

Build-Out

Establish Data Loads and Sharing

Channels

Identify Performance Benchmarks

Publish Compliance

Plan

Days 1 - 30 Days 61 - 90 Days 31 - 60

Health Choice’s core competencies and experience resulted in successful implementation of a Bundled Payment Program with CMS

utah health it vision, principles, and priorities: 2015 – … · 2017-08-01 · utah health it...

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