Michael Scandrett, Halleland Habicht Dave Carlson, Touchstone Mental Health June 16, 2015

Transcription

1 Using HIE to Move to Accountable Health: Mission Hennepin Project Michael Scandrett, Halleland Habicht Dave Carlson, Touchstone Mental Health June 16, 2015

2 State Health Care Reform Strategy Triple Aim Improved Health Outcomes Patient Engagement and Satisfaction Affordable Costs Coordination/Integration of Services Medical, behavioral/mental health, long-term care services and supports, social services, and public health Health Information Technology (HIT) for care coordination and population health management Provider Payment Incentives Performance-based payment, gain-sharing, risk-sharing tied to Triple Aim outcomes 2

3 MCHN: GOALS Join forces to achieve shared goals that would be difficult to achieve individually Educate health plans, providers, IHPs/ACOs, policymakers and government officials about service and payment models to integrate BH into service delivery Increase visibility of MCHN and its individual members Define and promote Behavioral Health Home models and BH payment methods that reward wellness and recovery and seek beneficial contracts Open and build relationships with potential partners 3

4 e-health Grant Goal: To support the secure exchange of medical or health-related information between organizations participating in, or preparing to participate in, accountable care models so that it occurs in a more seamless/real time way across settings, for the purpose of more effectively identifying opportunities for improvement and coordination, to improve health care. 4

5 Mission Hennepin Community Collaborative Minnesota Community Health Network (MCHN) Hennepin Health Hennepin County HSPHD Metropolitan Health Plan NorthPoint Health & Wellness Center HCMC 5

6 Minnesota Community Healthcare Network (MCHN) Canvas Health Touchstone Mental Health RESOURCE, Inc., MCHN: Transform the lives of people with mental illness by forming regional alliances to create and continuously improve comprehensive treatment and integrated care models that promote wellness and recovery Guild Incorporated Mental Health Resources, Inc. 6

7 Unmet e-health Needs Behavioral health care is challenged by fragmentation and poor coordination MCHN members and other community providers have limited ability to exchange health information with Hennepin Health and HCMC and other hospitals and providers MCHN members do not have the capacity to identify when and where their patients obtain physical health services MCHN members do not have the ability to analyze data to understand when and how their organization s interventions add value, improve outcomes and lead to reductions in total cost of care 7

8 Target Population High-risk population of people who are low-income, diverse, and vulnerable with co-occurring medical, behavioral health, and social complexity Initial target population for the SIM grant project is people enrolled in the Hennepin Health or HCMC Integrated Health Partnership demonstration projects or who are served by HCMC and its primary care and specialty clinics After the initial model is established and tested, it will be expanded to include other populations and create connectivity with other providers, such as FQHCs 8

9 Benefits of Enhanced HIT/HIE The ability to see all of the services, providers and drugs that are used by a client The ability to securely communicate, share health information, and coordinate services with other providers serving a client The ability to analyze utilization data to identify clients who need additional outreach, services and care coordination in order to reduce costly ER and hospital use The ability to track and actively manage quality and costs on an ongoing, real-time basis to improve quality and reduce costs The ability to participate successfully in new care delivery and payment models 9

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11 Example of How Data is Used to Improve Quality and Reduce Costs IHP Contract and data agreements allow access to data IHP receives DHS or health plan utilization data, care management data and data analytics IHP uses data and data analytics to identify high-risk patients Care Teams deploy services & coordinate care Providers & care teams communicate, share information and coordinate through access to Continuity of Care Documents MCHN and IHP track quality and costs to achieve goals for QI and reduction in Total Cost of Care 11

12 Mission Hennepin e-health Grant Project Goals Establish the collaborative Implement Health Information Exchange system Establish systems to coordinate patient care Improve use of data and HIT Lay the foundation for performance-based contracting Design and document the model for expansion and replication 12

13 Establish the collaborative MCHN governance structure established - a new nonprofit corporation was formed A collaborative project oversight structure was established between MCHN and the Hennepin System MCHN members and staff meet regularly to work together on e-health grant activities A Marketing Communications Team was established to develop a coordinated communications plan 13

14 Selected a vendor to complete HIE readiness and Privacy & Security assessment for each of the MCHN organizations MCHN members implementing changes and improvements to prepare for HIE and care coordination Brought together the IT staff MCHN organizations to review the Use Case and to discuss next steps in implementing HIE Identified the functional HIE requirements for MCHN to consider in its HIE vendor selection process Have begun process to select a vendor for establishing HIE connectivity 14

15 Establish systems to coordinate patient care MCHN developed a Use Case and collected other information on the target population, services needed, and care coordination strategies MCHN has identified the array of services and care coordination activities needed to serve the target population, some of which are currently covered and adequately reimbursed under Minnesota health care programs and/or managed care plan policies, others are not. MCHN is developing the products and pricing for valuebased BH payment arrangements with IHPs and health plans. 15

16 Improve use of data and HIT HIE systems will be used to coordinate, communicate and share information with other providers and agencies serving a patient, but also to develop a data repository and data analytics for population health management. Data Repository and Analytics - not covered by SIM grant, but one of the functional requirements requested of the HIE vendor. Other funding has been secured for these costs MCHN, like a number of other HIT-HIE projects, has encountered challenges, barriers and delays in identifying qualified vendors with adequate technology. 16

17 Lay the foundation for performance-based contracting Acquiring the tools that are needed to enable MCHN members to improve their value and services and assess the risks and opportunities of risk- and performance-based arrangements Developing payment methods including bundled payments, pay-for-performance, or gain sharing methods that reward improvements in outcomes and reduction of total cost of care. Negotiations underway for development of value-based payment arrangements to be effective

18 Design and document the model for expansion and replication Design and document the HIE connectivity, collaboration and care coordination model so that it can be expanded to include other provider partners, such as FQHCs, and replicated in other geographic settings locally and nationally. 18

19 Touchstone Mental Health One of five community behavioral health organizations who make up MCHN Dave Carlson, Technology Services Manager at Touchstone 19

20 Touchstone Mental Health s Experience HIE projects are not just IT projects even though they are highly technical. They rely heavily on leadership (75% leadership, 25% IT) to guide process changes, create systems, and be involved in the overall change management A governance structure and care coordination model are key components to achieving the overall implementation, bolstered by consistent data and forms 20

21 Touchstone Mental Health s Experience Just like all of us, the HIE market is rapidly changing and adopting new technology, which means it is not simply an established product. Expect a long road even after your initial implementation The primary focus for HIE is currently the CCD (Continuity of Care Document) and understanding it is fundamental to understanding vendors and HIE overall 21

22 Touchstone Mental Health s Experience Understanding Connect (Query-Based) versus Direct (One-Way) is one of the most important first steps; fundamentally you need to understand both because they are not exclusive and they both impact your project differently The various vendors are all focused on exchanging structured data first and foremost; when handling unstructured data such as treatment plans, care plans, or assessments additional vendor support may be required 22

23 Touchstone Mental Health s Experience EHR vendors all have their own way of facilitating exchange; advanced integration or automation may require additional vendor support even if the EHR is Meaningful Use certified Having HIE connectivity will only allow you to browse the information limited to the networks you subscribe to and the partners you can get on board, at least for now 23

24 Challenges No current state-certified HIE service providers provide connectivity with metro area hospitals No incentive for the hospitals to agree to connect or pay, for connections to independent and community providers, who are using other HIE vendors Query protocol is not widely being used in Minnesota; potentially limiting MCHN members that believe this type of information exchange would be useful to support the care coordination model 24

25 Challenges, continued Building a system that can be replicable to other future partners is difficult the solution to connect with one partner may not work for another In planning for an environment where care is shared, and coordinated among different organizations, it s important for everyone to understand who will have primary responsibility for a patient s care Shared treatment plans alone do not create a clinical paradigm shift sharing data does not automatically equal coordinated care 25

26 Next Steps Vendor Selection The vendor selection process, while traditionally part of the middle of a project, may be something you want to start sooner Vendors have use cases and can tell you what they are good at even without an RFP which may help you learn how to develop the RFP by knowing what questions to answer I believe that after selection things should get easier because we will have gone from conceptual systems to concrete systems; this remains to be proven as we have not made our choice yet 26

27 Questions? 27