Connecting Rural Communities to Support Accountable Care: Critical e-health Lessons Learned. Minnesota Rural Health Conference June 29, 2015

Transcription

1 Connecting Rural Communities to Support Accountable Care: Critical e-health Lessons Learned Minnesota Rural Health Conference June 29,

2 Presenters Cassandra Beardsley, Wilderness Health Melissa Larson, Integrity Health Network Anne Schloegel, MN Department of Health 2

3 Overview Status of EHR Adoption and Health information exchange (HIE) in Minnesota Minnesota Accountable Health Model (SIM) E-Health Grant Projects 3

4 Objectives Understand e-health and health information exchange (HIE) activities including the Minnesota Accountable Health Model- SIM Minnesota Learn how rural partnerships and community collaboratives are developing HIE capacity Hear about the lessons learned from two SIM Minnesota e-health grant projects 4

5 Minnesota e-health Initiative A public-private collaboration established in 2004 Legislatively chartered Coordinates and recommends statewide policy on e-health Develops and acts on statewide e- health priorities Reflects the health community s strong commitment to act in a coordinated, systematic and focused way Vision: accelerate the adoption and effective use of Health Information Technology to improve healthcare quality, increase patient safety, reduce healthcare costs, and enable individuals and communities to make the best possible health decisions. 5

6 Funding for EHR and HIE Adoption: : $14.6 million in appropriated by state to support adoption of interoperable EHRs Grants and loans for rural and safety net providers e-health Grants- $8.3 million EHR Loans- $6.3 million (revolving) in $1.15 million $600, $4,000,000 An Important Foundation : $3 million in federal funds to spur HIE Supported connecting community collaboratives to improve care coordination Increased pharmacies capable of e-prescribing 6

7 Minnesota Accountable Health Model: State Innovation Model Initiative (SIM) SIM is a Center for Medicare and Medicaid Innovation initiative to test and implement health care payment and delivery reform ideas Goal: Better quality in health care, improved experience, and lower costs 7

8 Minnesota Accountable Health Model- SIM Five Drivers of Better Health

9 Accountable Care Organizations in Minnesota Medicare Accountable Care Organizations (ACOs) Current estimate: 32,000-48,000 enrollees (4-6 % of Minnesota Medicare beneficiaries) 3 Pioneer ACOs--Allina Health, Fairview, Park Nicollet 4 Medicare Shared Savings Program (MSSP) --Essentia Health, Community Health Network-HealthEast/Entira, Integrity Health Innovations, North Collaborative Care- North Memorial Integrated Health Partnerships (IHPs) or Medicaid ACOs Currently 15 IHPs with ~176,620 enrollees (25 % of ~ 700,000 MA enrollees) 2013: Children s Hospitals and Clinics of Minnesota, CentraCare Health System, Essentia Health, Federally Qualified Health Center Urban Health Network (FUHN), North Memorial Health Care, Northwest Metro Alliance (a partnership between Allina Health and HealthPartners) 2014: Hennepin Healthcare System (Hennepin County Medical Center Hospital and Clinics), Mayo Clinic, Southern Prairie Community Care 2015: Bluestone Physician Services, Winona Health, Lake Region Healthcare, Mankato Clinic, Lakewood Health System, Wilderness Health, Courage Kenny Rehabilitation (Allina)

10 Minnesota SIM e-health Investments e-health Grant Program Development and Implementation e-health Roadmaps local public health behavioral health long-term and post-acute care social services Privacy, Security and Consent Management for electronic Health Information Exchange 10

11 Minnesota Accountable Health Model e-health Grant Program 12 grants awarded ($3.8 million) to Community Collaboratives Community Collaboratives must: Have at least two or more organizations participating or planning to participate in an accountable care organization (ACO) or similar health care finance model Include a partner organization from at least one of the four priority settings: Local public health Long-term and post-acute care Behavioral health Social services 11

12 e-health Grant Projects Development Grants Carlton County Connects (Integrity Health Network) Wilderness Health Disability Community Collaborative (Lutheran Social Service of MN) Fairview Foundation Ebenezer Preferred Integrated Network (Medica Health Plans) White Earth Nation Implementation Grants Federally Qualified Health Center Urban Health Network- FUHN Fergus Falls Community of Practice (Otter Tail County Public Health) NW Minnesota e-health Collaborative (Northwestern Mental Health Center) Southern Prairie Community Care Minnesota Community Healthcare Network (Touchstone Mental Health) Winona Regional Care Consortium (Winona Health)

13 Wilderness Health e-health Development Grant

14 Charter Members Bigfork Valley Hospital, Bigfork Community Memorial Hospital, Cloquet Cook County North Shore Hospital, Grand Marais Cook Hospital, Cook Fairview Range Hospital, Hibbing Lake View, Two Harbors Mercy Hospital, Moose Lake Rainy Lake Medical Center, International Falls St. Luke s, Duluth

15 Goals for Wilderness Possible participation in alternative payment models, such as ACOs and/or bundled payments. Coordination and improvement of patient care Keeping healthcare local and reducing network leakage Exploring shared service opportunities between participating entities to maximize operating efficiencies and reduce costs Need data from providers and payers to see patient outcomes throughout the continuum of care.

16 Data Integration Platform All hospitals on separate EHRs Most on Meditech, one on CPSI Clinics using eclinicalworks Other regional providers using GE Centricity and Epic Varying levels of CPOE implemented IT Needs Assessment February Developed RFP and sent to vendors March July 2014 Vendor demos, assessment process Fall 2014 Contracting discussions with selected vendor

17 Vendor Requirements Ability to interface with multiple EHR systems Patient Outreach Tools Ability to push alerts and reporting to physicians native EHR Strong patient matching process Demonstrated ability to identify high-cost patients, conditions and procedures Quality monitoring

18 Development Plan Goal Develop a work plan for exchanging Continuity of Care Documents (CCD) between Wilderness Health Members. Identified 4 deliverables needed for development.

19 Identify Resources at Each Facility Staff and Training Necessary Data Interfaces Not every facility had in-house IT support

20 Determine Implementation Schedule Identify outreach and education plans Interview staff and IT consultants Vendor contracting requirements

21 Gap Analysis Identify patient matching process Identify payer data feed process Identify workflows, policies and procedures needed

22 Legal Documents Complete Data Sharing Agreements with Members and other stakeholders Complete Data Sharing Agreements with payers Identify privacy, security and patient consent requirements HIE requirements?

23 How we started Used Stratis Health as Project Manager Wilderness BOD identified IT subcommittee members (22, so far) Kick-off meeting in person/on phone Weekly project meetings via webinar Working documents on SharePoint site HIE assessments with each participating site Demonstration of the vendor tool

24 Use Case Development Identify who, what, where, when and how Used the Integrated Health Partnership (IHP) monthly reports as basis Worked through how we d receive and distribute the information as needed Identified future deliverables for how we d like to distribute the information

25 What we learned Legal documents take a long time to develop Needed to develop and approve a data sharing agreement between Wilderness and each Member Needed to develop a Privacy and Security Workplan and do a risk assessment of Wilderness Health These will both evolve as we start sharing more information with additional payers and add bi-directional data. Developed a privacy and security subcommittee with SMEs to review workplan.

26 What we learned Vendor contracts take a really long time Check and double-check references Understand the billing arrangements Use your legal counsel to review the contract Not everyone has been given the same project overview and/or comes into the project at the start Be prepared to follow-up on the project goals and initiatives many times Distance is a barrier occasional face-to-face meetings are best Your project will be competing with many others for resources

27 Carlton County Connects Melissa Larson, MBA Integrity Health Network, LLC Minnesota Rural Health Conference, June 30, 2015

28 Minnesota Health Care Reform Strategy Triple Aim Greater Transparency Improve clinical outcomes (individual and population) Improve patient experience Promote efficient use of resources (cost effectiveness) Coordination/Integration of Services Medical, social services, behavior health, long term care, and public health Health Information Technology Emerging Payment Models Performance-based payments, risk sharing tied to Triple Aim objectives

29 Minnesota e-health Initiative The Minnesota e-health Initiative is a publicprivate collaborative whose vision is to accelerate the adoption and use of health information technology (HIT) in order to improve health care quality, increase patient safety, reduce health care costs and improve public health. Minnesota has been a leader in pursuing bold e-health policies and applying statutory mandates and governmental funding to accelerate the adoption of HIT, electronic health records, and health data standards.

30 Carlton County Connects Grant Partners Arrowhead Health Alliance Integrity Health Network, LLC Augustana Mercy Care Carlton County Public Health and Human Services Community Memorial Hospital of Cloquet & Sunnyside Nursing Home Cromwell Medical Clinic Gateway Family Health Clinic Human Development Center Mercy Hospital Min-No-Aya-Win Medical Clinic of Fond du Lac Human Services Raiter Clinic, Ltd. Villa Court

31 Carlton County Connects e-health Project Goals Establish the community collaborative Implement a Health Information Exchange system Establish systems to coordinate patient care Improve the use of data Lay the foundation for performance-based contracting Develop the Minnesota Accountable Health model Design the model for expansion

32 Minnesota State Improvement Model Development Grant Entered into an agreement with Stratis Health for grant facilitation Partners identified a need to securely communicate, share health information, and coordinate services with other community providers serving a patient/client Partners explored their overall current capabilities, identify limitations of current systems, and developed an understanding of what is needed to advance health information exchange in the community. Partners gained a strong understanding of the needs and capabilities of their individual organizations

33 Carlton County Connects MN SIM Development Grant Deliverables Initial Readiness Assessment Needs Assessment Functional Requirements and Priorities Understanding Connect (Query-Based) vs. Direct (One-Way) communication GAP Analysis Use Case Supporting Documentation for Implementation Grant Application

34 Carlton County Connect General e-health Challenges No single state-certified HIE How many HIEs are enough? Building a system that can be replicated to future partners is difficult Sharing data alone doesn t create coordinated care Difficult to envision/plan for the future until an HIE vendor is chosen

35 Carlton County Connects Lessons Learned Define key roles and responsibilities early in the project Budget Project administrator vs grant facilitator Develop human capital to sustain project for long term Time! MDH deliverables Meaningful communication with grant partners Vendor selection Money! Sustainable model Don t be afraid to modify original (perceived) plan

36 Carlton County Connects Lessons Learned, con t Identify and reach the correct audience Perceived usefulness Perceived ease of use Recognize the importance of relationships Learn/utilize the expertise of those organizations further down the HIE path Innovators vs early adopters Identify your organizational culture and available resources

37 Carlton County Connects Contact Information Melissa Larson, MBA Chief Operations Officer Integrity Health Network, LLC