The Role of Technology in California s Dual Eligibles Coordinated Care Demonstration

Transcription

1 The Role of Technology in California s Dual Eligibles Coordinated Care Demonstration Following the passage of SB 208 (Steinberg, 2010) and the receipt of federal planning funds to develop new models of coordinated care under the Accountable Care Act s Dual Eligible Integration Pilot Projects, the state has been moving full speed ahead with developing a plan to care for the more than 1.1 million dual eligible individuals in California. California was one of 15 states to receive a $1 million design contract through the Center for Medicare and Medicaid Innovation in April 2011 in order to develop service delivery and payment models that integrate care for dual eligibles. The California Department of Health Care Services (DHCS) is in the process of site-selection and aims to have multiple demonstration sites operational by the end of The dual eligibles are those persons eligible for both Medicare and Medi-Cal. 70 percent (770,042) are 65 or older, and 30 percent are adults with disabilities. They are the most chronically ill and costliest of all Medicaid beneficiaries -- representing 15 percent of Medicaid enrollees and nearly 40 percent of the program s spending. The majority of dual eligible costs pay for long-term services and supports not covered by Medicare. In California, 54% of duals have a cardiovascular disease, 52% have a psychiatric illness, 28% have a disease of the central nervous system, and 22% have diabetes. i In January, 2012 DHCS released a Request for Solutions (RFS) outlining project site selection criteria. AgeTech California successfully advocated for the inclusion of specific provisions regarding ecare technology utilization which required all applicants - health plans and county health systems - to describe how they propose to include such technologies in models of care. RFS technology provisions include: "Technology: Coordinated care will increasingly depend on the effective use of ecare technology, such as telehealth-enabled critical and specialist care, home technologies (i.e. daily health vitals monitoring, medication optimization, care consultations), remote monitoring of activities of daily living, and safety technologies. Demonstration sites are encouraged to include such technologies in their models I Street, Suite 100 Sacramento, CA (916) (916) FAX agetechca.org

2 The Applicant must: quality care, including efforts of providers in meaningful use health information Demonstration for beneficiaries at very high-risk monitoring, care management technologies, protocol interoperability standards (if Twenty-two (22) applicants submitted Request for Solutions to the Department from 10 counties. Attached is a summary of the technology portion of these applications. These responses indicate an emerging trend for plans to support provider utilization of ecare and HIT technologies to reduce institutionalization, improve care coordination, and reduce the costs to serve dual eligible in these systems.

3 Dual Eligible Request for Solutions Summary Chart of Technology Responses Page 3 of 7 Alameda Contra Costa Los Angeles Alameda Alliance for Health Anthem Blue Cross Contra Costa Health L.A. Care Health Net Migrating to EHR Longitudinal patient record, EMR, Medication Adherence and Compliance Dispensing System, Hospital Admission Feeds and Monitoring, Telehealth, IBM Watson Pilot Migrating to EHR Helping providers purchase/implement HIT (disease and immunization registries, e prescribing, EHR). Awarding HIT grants to community clinics (projects include: eprescribing, chronic disease management, HIE systems). HITEC LA (federally designated grantee) assisting providers to achieve meaningful use of a certified EHR by April Provider portal on web site for providers (view benefits, patient plans etc.), members can also access information through portal, committed to helping providers achieve meaningful use (working with safety net providers and others to assess readiness for EMR and will provide support for this transition), will promote e prescribing and tracking of chronic disease through registries. Care transition intervention (Coleman Model) Focusing on technology and in home support to reduce nursing home admissions, will utilize (in addition to 7.11 technologies): In Home Biometric Devices and Monitoring, Medication Adherence and compliance dispensing system, remote EMR Access for Clinicians, Electronic Pen for Mobile EMR Syncing Care transition intervention (Coleman Model) Piloted econsults to replace paper communication with a Health Insurance Portability Act secure application for sharing clinical information Meeting with electronic monitoring vendors, have goal to use technology for frail at home with awareness of needed research and privacy concerns, provide selected beneficiaries cell phones with chronic conditions. In the future, will add: electronic scales, programmed medication bottles, medical alert monitoring system, and possibly in home monitoring (all for duals). Also leveraging government programs such as LifeLine. Contracting with CPN Network to pursue meaningful use, FQHCs implementing EHR system, providers planning on implementing electronic communication tools to communicate with PCPs, discussing national level combination of Next Gen and EPIC systems. Currently using PQV as HIE to publish info. Exploring use of HIE product associated with EMR (this will involve clinic based biometric lab devices connect seamlessly to EHR through Bluetooth capabilities) Leading development of HIE exchange (founded Health e LA), supported other efforts for HIE, provides financial supoprt for CA's HIE planning effort Using technology to transmit data between DHCS and HealthNet and CMS and Health Net. Conducting all electronic transaction in 5150 compliant format, demonstrating connectivity via file exchange with disease management and other exchanges, access and post information on secure web sites, provide online, real time data transfers, remain in real time contact with other IDCT members for case management.

4 Dual Eligible Request for Solutions Summary Chart of Technology Responses Page 4 of 7 Los Angles Orange Riverside CalOptima Inland Empire Health management, participate in tests of other monitoring Worked with local medical associations and hospitals to establish Inland Empire EHR Resource Center, develops tools to meet provider needs (online secure services), annual visits also posted on server. data, incorporating Care Access and Monitoring forms management system), revamping plans e portal management, participates in tests of other monitoring individuals. Hope to expand these systems. Uses demonstration. Recipient of mhealth grant that uses remote scale monitoring for patients with congestive heart failure, piloted electronic pillbox from MedMiner through OneCare Medication Therapy Management. s to use similar technology for duals and is involved in hospital and county telehealth initiatives. Will identify IHSS recipients with greatest healthcare needs at highest risk of entering nursing home. Will then conduct intensive health analysis (potentially with Health Risk Assessment once member joins the plan). Then would integrate findings in Care to share with member and ICT members. individuals. Hope to expand these systems. Use demonstration. Sets policies and standards for data exchange within county and state, offers software tools to aggregate ineroperability between systems and HIE, monitors state and federal progress, participates in HIT demonstrations projects. IEHP is part of Inland Empire HIE (supported by 29 partner hospitals, physician groups, medical groups and IPAs).

5 Dual Eligible Request for Solutions Summary Chart of Technology Responses Page 5 of 7 Sacramento San Diego Care 1st Community Health Group Health Net data, incorporating Care Access and Monitoring forms management system), revamping plans e portal Developed Provider Web Portal Dashboard for all PCPs that have assigned members. Utilizes NCQA Certified Software to identify members with gaps in program. Portal is also available for IPAs and FQHC to track HEDIS gap services. Promotes use of EMR/EHR systems. Interacts with contracted IPAs to exchange service information. Views medical management roles as primary in ensuring high level of care. Developed and uses automated customized care management systems to track clinical and quality of care. Provide web based access for on line look up for immunizations. Working with San Diego Medical Association to enhance electronic connectivity and meaningful use. Committed to partnering with other providers and IPAs on Health Initiative for duals integration. Provider portal on web site informs providers (view benefits, patient plans etc.), members can also access information through portal, committed to helping provider achieve meaningful use (working with safety net providers and others to assess readiness for EMR and will provide support for this transition), will promote e prescribing and tracking of chronic disease through registries. Uses home health technology to monitor high risk members (provides objective data for case managers). Uses Vital Sign Measurements; Health Surveys; Appointment Reminders to meet the needs of this population. Uses Care Enhance Clinical Management Software for an integrated approach to member centered case management. Offers medication therapy management through pharmacy department. Developed comprehensive Medication Adherence Program to ensure compliance for chronic patients. Intends to use care technology for high risk beneficiaries (including timely transmission and remote interpretation of patient data). Exploring the feasibility of utilizing telehealth services through contract with community health center. Meeting with electronic monitoring vendors, have goal to use technology for frail at home with awareness of needed research and privacy concerns, provide selected beneficiaries cell phones with chronic conditions. In the future, will add: electronic scales, programmed medication bottles, medical alert monitoring system, and possibly in home monitoring (all for duals). Also leveraging government programs such as LifeLine. Uses state of the art tools for data exchange for web portal. Makes sure web portal is functional on all web browsers. Working closely with provider network to meet information exchange advances. Will collaborate with plan providers to research FDA approved tele medecine options in full compliance with interoperability standards. Will examine quality and costs of Medicare and Medicaid services and consider integrating technology for IHSS recipients and other home based LTSS. Using technology to transmit data between DHCS and HealthNet and CMS and Health Net. Conducting all electronic transaction in 5150 compliant format, demonstrating connectivity via file exchange with disease management and other exchanges, access and post information on secure web sites, provide online, real time data transfers, remain in real time contact with other IDCT members for case management.

6 Dual Eligible Request for Solutions Summary Chart of Technology Responses Page 6 of 7 San Diego San Mateo Santa Clara Health of San Mateo Anthem Blue Cross data, incorporating Care Access and Monitoring forms management system), revamping plans e portal management, participates in tests of other monitoring Took on a major claims systems conversion in 2011 utilizing technology to improve quality of care. Many providers in process of converting to EHRs and meeting meaningful use standards. Currently developing new program to assist smaller provider offices in meeting meaningful use. Utilizing Data Mark for DEDP to integrate data elements from the health plan, the county ASS and BHRS. Medical claims will be data cross matched with functional scores from IHSS, UAT values from MSSP, and LOCUS scores from BHRS. Will result in a single data source. Longitudinal patient record, EMR, Medication Adherence and Compliance Dispensing System, Hospital Admission Feeds and Monitoring, Telehealth, IBM Watson Pilot individuals. Hope to expand these systems. Use demonstration. In year 1 of DEDP, focus will be on refining infrastructure for model of care and defining staff roles. Begun intensive data integration from AAS and BHRS, merging data with HPSM's. Year 2 will have greater focus on technologies to support project goals. Will conduct analysis and select technology that supports goals. Already developed sophisticated data analytics unit. Focusing on technology and in home support to reduce nursing home admissions, will utilize (in addition to 7.11 technologies): In Home Biometric Devices and Monitoring, Medication Adherence and compliance dispensing system, remote EMR Access for Clinicians, Electronic Pen for Mobile EMR Syncing N/A Currently using PQV as HIE to publish info. Exploring use of HIE product associated with EMR (this will involve clinic based biometric lab devices connect seamlessly to HER through Bluetooth capabilities)

7 Dual Eligible Request for Solutions Summary Chart of Technology Responses Page 7 of 7 Santa Clara San Bernardino Santa Clara Family Health Inland Empire Health Implementing web based provider portal and will implement member portal with Individual Care. Worked with local medical associations and hospitals to establish Inland Empire EHR Resource Center, develops tools to meet provider needs (online secure services), annual visits also posted on server. date, incorporating Care Access and Monitoring forms management system), Revamping plans e portal management, participates in tests of other monitoring Utilizes a risk assessment methodology for SPD population using health information provided by member, medical utilization data and prescription utilization data. Will take this model but change it from telephonic use to face to face health risk assessments for consumers at risk of institutionalization. Started conversations with Phillips Home monitoring and will continue conversations. Will identify IHSS recipients at highest risk of entering nursing home. Will then conduct intensive health analysis (potentially with Health Risk Assessment once member joins the plan). Then integrate findings in Care to share with member and ICT members. individuals. Hope to expand these systems. Uses demonstration Web based portal has ability to send and receive data (HIPAA compliant). IEHP is part of Inland Empire HIE (supported by 29 partner hospitals, physician groups, medical groups and IPAs). i Background: The 2010 Medi Cal Waiver and the Future of Seniors & People with Disabilities in the Medi Cal Program. Joint Oversight Hearing of the California Senate & Assembly Health Committees, December 7, 2011.