HI E Data: Value Proposition for Payers and Providers Session #21, - PowerPoint PPT Presentation

HI E Data: Value Proposition for Payers and Providers Session #21, March 6, 2018 Laura McCrary, Executive Director, KHIN Tara Orear, Senior Ambulatory Systems Analyst, Newman Regional Health Dirk Rittenhouse, Director at Anthem 1

Conflict of I nterest Laura McCrary, Ed.D. Executive Director of KHIN Has no real or apparent conflicts of interest to report. 2

Conflict of I nterest Tara Orear, Senior Ambulatory Systems Analyst, Newman Regional Health Has no real or apparent conflicts of interest to report. 3

Conflict of I nterest Dirk Rittenhouse, Director at Anthem Has no real or apparent conflicts of interest to report. 4

Agenda  Introduction to KHIN  Introduction to Newman Regional Health Medical Partners  Introduction to Anthem/Amerigroup  Overview of KHIN Data Analytics Products  Overview of Data & Analytics for Providers-Provider Perspective  Overview of Data & Analytics for Payers-Payer Perspective  Challenges & Findings  Conclusion & Questions 5

Learning Objectives  Describe how KHIN is aggregating data for business intelligence and analytic purposes.  Detail how providers are using KHIN data for Value Based Payment Models, MIPS reporting and Improved Patient Outcomes.  Detail how payers are using KHIN data for HEDIS reporting and other use cases.  Discuss future opportunities to use HIE data. 6

Kansas Health I nform ation Netw ork: Overview  501c3 Not for Profit-2010  Over 25 million patients available for query through connections with other exchanges  9,900 providers  5.2 million unique patients in KHIN  1,000+ healthcare organizations in production with CCDs and HL7v2  120,000 HL7 messages daily  9,000 CCDs daily 7

New m an Regional Health: Overview • 25 bed inpatient CAH: – Rehab Unit, OT/PT/ST, OB with Level 2 nursery, ER (6 physicians), Hospitalists (2 physicians, 3 APRNs, 1 RN), ICU, Cath Lab, Breast Center • Outpatient services: – Lab, Radiology, OT/PT/ST, infusions, Pain Clinic, Wound Care, Cardiopulmonary and Sleep Lab, Express Care, Occupational Health • Provider Based Outpatient Clinics: – 24 providers: Orthopedics, Cardiology, Pediatrics, Family Medicine and General Surgery 8

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KHIN Analytics Process: Fragmented Clinical Data High-cost patients see 10+ providers Unified, Normalized Clinical annually with data spread across care settings Data Ready for Analytics Office Specialist Ambulatory Hospital Post-Acute Visit Referral Stay Care Center

Successful Integrations With EMRs 12

Products and Services 2018 ENGAGE ANALYZE CONNECT ONC CERTIFIED PERSONAL HEALTH INFORMATION ANALYTICS DASHBOARDS HEALTH RECORD EXCHANGE INCLUDE: HIGH RISK VIEW, DOWNLOAD & TRANSMIT WEB-BASED PHYSICIAN PORTAL QUALITY METRICS READMISSIONS PATIENT EDUCATION LONGITUDINAL PATIENT DISEASE REGISTRIES RECORD POPULATION HEALTH SECURE MESSAGING BI-DIRECTIONAL IN EHR CONTROLLED SUBSTANCES* PATIENT ELECTRONIC ACCESS SECURE CLINICAL DATA EXTRACTS MESSAGING/DIRECT CERTIFIED IMMUNIZATION RECORD ALERTS STATE LEVEL INTERFACES SUCH AS: IMMUNIZATIONS SYNDROMIC SURVEILLANCE TRANSFORM REPORTABLE DISEASES CANCER REGISTRY (AND OTHERS) 8 13

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Provider Utilization of KHI N Data • Data Sharing – XDS.B Direct Messaging (CCD) – HL7: demographics, admissions, discharges, transfers, progress notes, diagnosis, procedures, lab results, medications 16

Provider Utilization of KHI N Data • Clinical Impact – Increased Continuity of Care • Medication reconciliation • Immunization records • Problem List • Lab Data 17

Provider Utilization of KHI N Data • Patient Impact – More complete history • Patient information is imported directly to EHR – Transition of Care simplified • Less “re-telling” of history, data at the provider’s fingertips Higher Patient Satisfaction Scores!!! 18

Provider Utilization of KHI N Data • Financial Impact – Payer Incentive Program • + $230,000 in reimbursement for 2017 19

Payer Utilization of KHI N Data Anthem Use Cases: • Quality Measures and Care Gaps • Risk Adjustment Programs • Care Management – Notification, Care Coordination, Re- Admission Risk , Medication Reconciliation • Pay for Performance 20

Payer Utilization of KHI N Data Benefits: • Reduce Medical Records Requests • Improve Quality Scores – HEDIS/STARS • More Accurate Member Health Profile • Analytic Capabilities – Value Based, Population Health, Predictive Analytics 21

Payer Utilization of KHI N Data Clinical Data is Incremental and Additive: • Incremental to Existing Data : Diagnosis, Procedures, Medications, Lab • Additive to Existing Data: Allergies, Vitals (Ht., Wt., BP, BMI) Smoking Status, Immunizations, Race, Ethnicity, Medication Orders, Medical Reports (H&P, Imaging, Discharge Summary, Progress Notes, etc.) 22

Payer Utilization of KHI N Data 23

Conclusions: 1. Data Derived from Health Information Exchanges can be utilized for a variety of purposes as allowed under HIPAA and respective Participation Agreements. 2. Combining the HL7 v.2 and CCD/CCDA data together produces the richest and most robust data set. 3. Normalizing and de-duplicating the data is a complex task. 4. Move from a focus on interoperability to data quality and quantity. 24

Questions Laura McCrary, EdD LMcCrary@khinonline.org Tara Orear torear@newmanrh.org Dirk Rittenhouse Dirk.Rittenhouse@anthem.com 25