How To Improve Health Care In Missouri

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Paul Porter
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1 SHOW ME THE DATA: THE MISSOURI JOURNEY California Primary Care Association Quality and Technology Conference San Ramon, California February 19, 2015 Own Your Data. Own Your Future. (shamelessly stolen from Arcadia Solutions we think) Reform Ready High-performing health centers can be competitive in any environment. Changes in health care delivery, financing and organization are inevitable. Data and the ability to manage it and leverage it are essential. We can own our future. 1

(shamelessly stolen from Arcadia Solutions we think) Reform Ready High-performing health centers can be competitive in

2 Owning Our Future Missouri Quality Improvement Network Missouri Health Plus MO Community Health Access Center for Health Care Quality Policy FQHCs MPCA MO School of Dentistry and Oral Health MO Health Professional Placement Services Advocacy Network Health Benefits Consortium MO Community Health Foundation Vision for Health Information Technology All health centers should have an EMR Integration with state and local systems Collaborative reporting Centralized data warehousing Ability to respond to external data requests Develop IT capacity Health Information Exchange (HIE) In the Beginning 2007 Missouri General Assembly appropriation to create a data warehouse for FQHCs MPCA HIT Steering Committee formed Data warehouse started modeled on PECS, HL7 EMR purchases subsidized Applied (unsuccessfully) for HCCN funding 2

Integration with state and local systems Collaborative reporting Centralized data warehousing Ability to respond to external data requests Develop IT capacity Health Information Exchange (HIE) In the

3 Health Center Controlled Network EHR acquisition accomplished; homegrown data warehouse stalled out 2010 ARRA HITECH Award and Congressional Mandate Established Missouri Quality Improvement Network (MOQuIN) Transformed HIT Steering Committee into MOQuIN Operating Board Elected to outsource data warehouse and reporting application, connected health centers to DRVS MOQuIN Bring Clinical, Quality, and HIT together Accurate, reliable and timely clinical quality measures reporting Organized statewide quality improvement program Accomplishment of meaningful use and related measures so member FQHCs will receive full benefit of meaningful use HIT incentives. All MPCA members are in MOQuIN. Additional Investment 2012 ACA HCCN grant Mapping Expansion and Data Validation Connecting 5 new start FQHCs Health Centers learning how to use DRVS in daily operations MPCA practice coaches use DRVS to monitor health center performance and plan interventions Develop HEDIS measures 3

and HIT together Accurate, reliable and timely clinical quality measures reporting Organized statewide quality improvement program Accomplishment of meaningful use and related measures so member

4 Lessons Learned A single EHR platform would have been so much easier and less expensive Communication gaps between clinical, HIT, and finance required additional effort from MPCA to keep all informed FQHC leadership is essential and needs cultivation Lessons Learned EHR customization complicated data mapping Reluctant EHR vendors and other networks complicated data mapping Difficult to quantify value beyond EHR investment in fee-for-service reimbursement reality Walk the talk: MPCA activities moved from silo approach to integrated via MOQuIN If Only We Had Known EHR came before DRVS (insufficient planning) DRVS came before financial incentive to use (IPA) Poor data quality and inconsistent data policies (document v self-report eye exams) Lack of discipline in EHR use (multiple data tables, multiple data entry points, descriptors open to any user to change) Workflow deficiencies and inefficiencies Communication gaps Nurse knew there was a checkbox for a follow-up service, but didn t know she was supposed to check it 4

value beyond EHR investment in fee-for-service reimbursement reality Walk the talk: MPCA activities moved from silo approach to integrated via MOQuIN If Only We Had Known EHR came before DRVS

5 Members First Clinical Quality Measures Benchmarking Visit Planning Alerts Meaningful Use Patient Centered Medical Home Provider and Team Performance Maintenance and Enhancement Member subscription fees maintenance Other People s Money - enhancement Grants measure development, staff Contracts measure development, staff Partners St. Louis Integrated Health Network Initial federated local health information exchange failed HRSA approved re-direction of HCCN funds to connect additional members and develop additional measures Non-member subscribing to DRVS (large urban county health department) Strategy - DRVS connection to statewide HIE Community Referral Coordinator support (imminent) 5

Louis Integrated Health Network Initial federated local health information exchange failed HRSA approved re-direction of HCCN funds to connect additional members and develop

6 Partners St. Louis Regional Health Commission Clinical Quality Measures for Gateway to Better Health CMS demonstration Performance trending Missouri Department of Health and Senior Services Chronic Disease Collaborative contract Training and Technical Assistance Measures development and reporting Partners MO HealthNet Tobacco Cessation grant Tobacco Measures Reporting and subscription subsidy Primaris (Missouri Medicare QIO) contract Cardiac Learning and Action Network Meaningful Use REC Learning and Action Network MO HealthNet Primary Care Health Home Administrative fee from pmpm payments Developed 17 (now 20) clinical quality measures Report to MO HealthNet on behalf of FQHC and non-fqhc Primary Care Health Homes Practice coaching for PCMH recognition and performance improvement MOSBIRT contract to provide demographics and screening data 6

Collaborative contract Training and Technical Assistance Measures development and reporting Partners MO HealthNet Tobacco Cessation grant Tobacco Measures Reporting and subscription subsidy Primaris

7 Claims Data Piloting MO HealthNet claims data mining with another vendor Suggested by MO HealthNet Director for Primary Care Health Homes 4 FQHCs in Transforming Pain Management in Missouri FQHC Medical Homes project Pain medication prescribing Quality Indicators Access to Medicaid Total Medical Expense data IPA Strategy Threat of losing state funding, uncertainty of federal funding, anticipating fewer grant opportunities Rumblings about the future of cost-based reimbursement Strength in numbers, MOQuIN/DRVS foundation Opted for a separate for-profit business entity Negotiate managed care plan contracts Hold members accountable to each other MPCA and Strong together Leverage non-profit and for-profit advantages Reconcile divergent association and business drivers New dynamics with overlapping members Data/measure transparency Data use and sharing policies 7

anticipating fewer grant opportunities Rumblings about the future of cost-based reimbursement Strength in numbers, MOQuIN/DRVS foundation Opted for a separate for-profit business entity Negotiate

8 MOQuIN/DRVS and Evidence of clinical integration to enable collective negotiation Monitoring of common clinical performance measures in standards and contracts - holding members accountable on a level playing field Patient registries support population health management MOQuIN/DRVS and DRVS Visit Planner alerts to care gaps; alerts can be tailored for health plan performance incentives Ability to use external patient lists to monitor performance by individual payer (MO HealthNet, Managed Care Plans, others?) overcomes inconsistencies in health center payer data entry Supports distribution of incentives earned based on clinical performance Building service contract as needs are identified Next Steps for MOQuIN/ Additional data elements (social determinants), data analytics and predictive modeling capacity Claims data in DRVS; clinical data to health plans Operational and financial measures in DRVS Allocation of meeting time to Evolving governance and operational structure to meet client demands Function as Care Coordination Council for 8

Ability to use external patient lists to monitor performance by individual payer (MO HealthNet, Managed Care Plans, others?

9 Future MOQuIN Opportunities MOQuIN/DRVS is in demand Missouri Health Connection (statewide HIE) DRVS as data supplier Health centers access through web-based viewer Asthma in Chronic Disease Collaborative CDC $ for new DRVS measures Included in 2 CMMI grant applications Included in three university grant applications Own Your Data. Own Your Future High-performing health centers can be competitive in any environment. Changes in health care delivery, financing and organization are inevitable. Data and the ability to manage it and leverage it are essential. We can own our future. Questions? 9

university grant applications Own Your Data. Own Your Future High-performing health centers can be competitive in any environment.

10 Contact Information Susan Wilson Chief Operations Officer Missouri Primary Care Association 3325 Emerald Lane Jefferson City, MO (573)

Patient Centered Health Home and Data Analytics. Amanda Stangis, Director of Programs, CPCA Andrew Principe, VP Strategy, Arcadia Solutions

Patient Centered Health Home and Data Analytics Amanda Stangis, Director of Programs, CPCA Andrew Principe, VP Strategy, Arcadia Solutions Agenda What is a Health Home? What is the connection between Health