etools for Health Homes: Overview of NYS DOH OHITT Programs

00111 etools for Health Homes: Overview of NYS DOH OHITT Programs June 16, 2013 Marni Ehrlich TechLeaders Consulting mehrlich@jemsconsult.com 631-757-6363 1

GOAL OF THE NYS CARE MANAGEMENT TRAINING ETOOLS MODULE To provide technology education, training, and ongoing support to care managers who are in transition of their workforce responsibilities in a way that utilizes their existing knowledge, skills and strengths so that individuals with complex needs can improve their health and wellness and realize their full potential. 2

TODAY S WEBINAR OBJECTIVES As a result of today s workshop, HH Providers will: Review of HIT and Incentive Programs available for Health Home Partners Overview -HEAL 22 Program for HH Partners Medicaid Specialist Program Overview of the Medicaid EHR Incentive Support Program. How do HH Partners Meet the Challenges of MU. 3

TECHLEADERS CONSULTING BACKGROUND TLC is NYeC Implementation Agent 10 years Healthcare Experience and Grant Development 25 years IT, Telecom, Software and Internet Experience at : IBM AT&T NSLIJ American Health Information Management Associated Certified Global IT Security Expert Founded first NYS Behavioral Health Informatics Conference Board Member of Suffolk County MHA, Suffolk County United Veterans and Clubhouse of Suffolk TLC has helped more than 200 EPs and over 30 agencies to receive more than $4.0M in EHR Incentive Payments, with more than $8.0M in incentives to follow. TLC has raised over $30M in grant funding of which $20M is for BH providers Parent of Autistic Child 4

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HEAL 22 OBJECTIVE DOH-OHITT established funding (program) to assist Health Home Partners to adopt and implement HIT systems while building the ground work for seamless exchange of health information within and across Health Homes Two Regional Extension Centers contracted to administer the program New York ehealth Collaborative (NYeC) NYCReach These programs have been put in place to provide technical assistance and HIT adoption support to the following provider organizations MH/BH providers participating in Medicaid Health Home DD providers with intent to participate in DISCO, HIV/AIDs and Substance Abuse programs within a Health Home network 6

WHAT ARE THE FUNDING OPTIONS Two Options for funding: Full Service (services provided by (NYeC) or NYeC Agents funding retained to comply with the grant Self Service (services provided by Provider Agency or an agent) to comply with guidelines of the grant Compliance must be completed by October 31, 2013 to receive funding or services Funding for Phase 2 is not contingent on meeting Phase 3. Case Managers, Care coordinator Social Worker, Substance Abuse Counselor, Transitional Housing Coordinator Psychiatrist, Nurse Practitioner, Physician Assistant HH Hospitals ER Clinics

WHO IS AN ELIGIBLE EMPLOYEES (EES) Psychiatrist Licensed Mental Health Counselors (LMHC) Physician Assistant Case Manager / Case Coordinators Physician Licensed Master Social Worker (LMSW) Registered Nurse / Licensed Practical Nurse Psychologist Licensed Marriage and Family Therapists (LMFT) Licensed Psychoanalyst Nurse Practitioner Licensed Clinical Social Worker (LCSW) Credentialed Alcohol and Substance Abuse Counselors (CASAC) 10 EEs per site per program are allowable. 8

HEAL 22 PARTICIPATION REQUIREMENTS AND SELF SERVICE FUNDING Phase 1 Completed Must have signed contract with Health Home (HH) or make commitment to sign HH partner Must attest to Phase 1 of participation with NYeC REC center limited membership, Certain Agreements and information on all Eligible Employees Phase 2 must attest to Go Live Requirements $1750 per EE HIT system must support following capabilities and be upgraded/installed to support MU or BH capabilities after June 1, 2012 Must Go Live by 10/31/2013 Recording of patient demographics Recording and charting changes in patient vital signs Use of Computerized Patient Order Entry for medication orders Implementation of drug-drug and drug-allergy interaction checks Maintenance of up-to-date problem list of current and active diagnoses Generating and transmitting permissible prescriptions electronically Collecting and maintaining active medication and medication allergy lists for patients Documentation of patient smoking status Capable of generating a quality report 9

HEAL 22 PARTICIPATION REQUIREMENTS AND SELF SERVICE FUNDING CONT D Phase 3 Requirements Interoperability and Training Funding $750 Lab ordering (when appropriate) RHIO training Consent Management and HIPPA Security Training PSYKES and PMP enrollment and training RHIO Connectivity

NYS PRESCRIPTION MONITORING PROGRAM (PMP) Effective August 27, 2013 New York State Public Health Law requires most prescribers of controlled substances to consult New York's online Prescription Monitoring Program (PMP) Registry through the Health Commerce System (HCS) Formerly Known as Controlled Substance Information Registry Go to the HCS at: https://commerce.health.state.ny.us Log onto the system with your user ID and password (If you can t remember your password, call the Commerce Account Management Unit at 1-866-529-1890, Option 1, for assistance Get login at http://www.health.ny.gov/professionals/narcotic/docs/hcs_licensed_profession als.pdf

PMP CONT D

PMP CONT D: ENTER PATIENT NAME

PMP CONT D PRACTITIONER ATTESTATION PAGE

PMP CONT D PATIENT REPORT

PMP CONT D PATIENT REPORT

PMP CONT D COMING SOON NEW FUNCTIONALITIES More Data at least six months of data of all controlled substance prescriptions dispensed for a patient More Current Data pharmacies will be required to submit information more frequently Ability to view the names of the practitioners who wrote a controlled substance prescription and the names of the pharmacies where the prescription was filled Ability to obtain multiple patient reports for a single practitioner Ability for a practitioner to assign a designee to obtain a record on behalf of a practitioner Ability for a practitioner to view additional reports relating to their searches, searches done by their designees done on their behalf Ability for a practitioner to view the controlled substance prescriptions dispensed under their DEA number Ability for pharmacists and their designees to access the Practitioner Monitoring Program

NYS AVAILABLE TOOLS PSYCKES 18

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MEDICAID SPECIALIST PROGRAM OPTIONS Two Options for funding: Full Service (services provided by (NYeC) or NYeC Agents funding retained to comply with the grant Self Service (services provided by Provider Agency or an agent) to comply with guidelines of grant Funds Provider Agency up to $2,250.00 per EP for implementation services 20

WHO IS ELIGIBLE FOR Medicaid Physicians Dentists Certified Nurse-Midwives Nurse Practitioners Physician Assistants who are practicing in FQHCs or RHCs led by a physician assistant Must have 30% of encounters with Medicaid Patients or 30% of Groups Encounters 20% for Pediatricians 21

MEDICAID SPECIALIST SELF SERVICE PROGRAM Compliance Requirements Must meet the CMS Medicaid patient volume thresholds Could not have received any REC funds for adoption or implementation support from another REC Grant/program. Participating providers could not have been listed on a Schedule A for any previous REC program Providers will be paid for Completing AIU providing they sign their Medicaid Specialists PPA agreement prior to Reporting AIU to CMS Providers who completed and reported A/I/U prior to signing the Medicaid Specialists program PPAs still can qualify for M3 payments. (Agents would qualify for M1 and M3 payments in this scenario). Self Service (services provided by Provider Agency or an agent) to comply with guidelines of grant 22

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WHO IS ELIGIBLE PROFESSIONAL (EP) Medicaid Physicians Dentists Certified Nurse-Midwives Nurse Practitioners Physician Assistants who are practicing in FQHCs or RHCs led by a physician assistant Medicare Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Medicine Doctor of Podiatric Medicine Doctor of Optometry Chiropractor 24

WHAT S IT WORTH TO YOU $$$ FOR EACH EP 70,000 60,000 63,750 Incentive Payment for 6 EPs Medicaid Incentive ($) 50,000 40,000 30,000 20,000 10,000 0 39,000 21,250 15,000 Medicare Medicaid Total Incentive 1st Year Incentive Total Medicaid Incentive payment Medicaid Incentive Payment First Year $ $382,500 $127,500 Plus saving no Medicare Penalties for Non compliance that represents 1.5% for MU and 2% for not eprescribing Yearly Medicare Billings grows up to 5% by 2019 25

All Practitioners (at least 30% Medicaid/needy) Year 1 $21,250 Year 2 $8,500 Year 3 $8,500 Year 4 $8,500 Year 5 $8,500 Year 6 $8,500 Total $63,750 Note: program participation years do not need to be continuous

SAMPLE REMITTANCE

MEDICAID EHR INCENTIVE PROGRAM Provides incentive payments to Adopt, Implement and Upgrade (AIU) EHR Technology a Certified EHR Systems. Requires that agency makes financial commitment to purchasing system. Eligible Professionals must: Be one of the eligible practitioner types Be actively enrolled in Medicaid as a fee-for-service provider in good standing Note this does not require you accept Medicaid in any other practice location. Meet minimum patient volume criteria (Medicaid/needy) 30% Medicaid for entire group Not be hospital-based (>90% of Medicaid encounters in the inpatient and emergency department settings) Adopt, implement or upgrade to an ONC-certified EHR system in participation year 1 Register using the CMS Medicare & Medicaid EHR Incentive Program Registration and Attestation System Will have 50% of encounters at location(s) with EHR technology 28

STAGE 1 MEANINGFUL USE CRITERIA Core Set Menu Set Meaningful Use Objectives 15 Core Objectives 5 of 10 Menu Set Objectives Clinical Quality Measures 3 core measure, or 3 alternate core measures 3 of 38 Menu Set Measures There are many exceptions for Behavioral Health Providers 29

CORE METRICS Threshold Exclusions Improving quality, safety, efficiency and reducing health disparities Percentage of unique patients seen with at least one medication in their medication list and having at least one medication order entered using CPOE (>30%). 30% EP who writes <100 prescriptions Drug-drug and drug-allergy interaction checks enabled for entire reporting period. YES Percentage of permissible prescriptions written that are transmitted electronically using certified EHR technology (>40%). 40% EP who writes <100 prescriptions Percentage of unique patients seen who have demographics recorded as structured data (>50%). 50% Percentage of unique patients seen who have at least one entry, or indication that no problems are known, in the problem list (>80%). 80% Percentage of unique patients seen who have at least one entry, or indication that no medication currently prescribed, in medication list (>80%). 80% Percentage of unique patients seen who have at least one entry, or indication of no known medication allergies, in the medication allergy list (>80%). 80% Percentage of unique patients seen, age 2 and over, who have height, weight and blood pressure recorded as structured data (>50%). 50% Percentage of unique patients seen, age 13 and over, who have smoking status recorded as structured data (>50%). 50% At least 1 clinical decision support rule implemented during entire reporting period. Ambulatory clinical quality measures for entire reporting period reported to CMS or the States (2011 via attestation, 2012 electronically). YES Engage patients and families in their health care Percentage of patients requesting an electronic copy of their health information (Including diagnostic test results, problem list, medication lists, medication allergies) who are provided it within 3 business days (>50%). 50% Percentage of all office visits for which patients are provided clinical summaries within 3 business days (>50%). 50% Improve Care Coordination Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information. YES YES If all three vital signs of height, weight and blood pressure have no relevance's to scope of practice No Minimum Values are required and EPs are not penalized for reporting zero values for CQMs in Stage 1 Ensure adequate privacy and security protections for personal health information Have conducted or reviewed a security risk analysis per 45 CFR 164.308 (a)(1) and implemented security updates as necessary and corrected identified security deficiencies. YES 30

SECURITY ASSESSMENT 31

WHY ARE THESE PROGRAMS IMPORTANT TO CARE MANAGERS HITECH Enables Integrated Care Coordination Mandates electronic exchange of Patient Health Record Provides funding Educates patients about online access to their health information Enables CMs to be added to existing consent documents of referring providers in Health Home 32

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SUMMARY OF ALL PROGRAMS HEAL 22 Self Service SS, CM, RN, LPN, Eligible Providers Psychologists Medicaid Specialist Program Self Service Psychiatrist, MD, NPs, Medicaid EMR Incentive Psychiatrist, MD, NPs Amount Paid EPIC per EP $2,500 $2,250 $ 63,750 ($21,250 Year 1) Requirements Implement a HIT that meets minimal functional requirements. Connect to RHIO, HH Partner, PMP Training, Psyckes Training AIU, and Implement MU Certified EMR, MU Stage 1 AIU and MU through Stage 3 34

EXAMPLE OF TOTAL FUNDING EXAMPLE No of EE/EPs Heal 22 Funding Medicaid EMR Incentive Medicaid Specialist Funding Funding Total Funding 6 $ 2,250 $63,750 $ 396,000 10 $ 2,500 $ 25,000 $ 421,000 35

RECOMMENDED NYEC BH EHR SYSTEMS Accumedic Computer Systems, Inc. AccuMed EMR Cerner Corporation Anasazi Complete EHR Askesis Development Group PsychConsult Provider Version 7.1 DocuTrac, Inc QuicDoc 6.2.2 Echo Consulting Services, Inc. Clinicians Desktop/Revenue Manager eclinicalworks eclinicalworks Comprehensive EHR/PM V9 Foothold Technology AWARDS HInext LLC TREAT Information Management Associates, Inc. IMA Desktop JAG Products, LLC ClinicTracker MindLinc-Duke (and Accumedic EPM) MindLinc Duke Netsmart Technologies, Inc. TIER Version 7 Netsmart Technologies, Inc. myavatar Netsmart Technologies, Inc. myevolv (formerly EvolvCS from Defran Systems, Inc.) NextGen Healthcare Nextgen Ambulatory EHR Patagonia Health Inc. Patagonia Health EHR v3.0 TenEleven Group Inc. ecr - electronic Clinical Record Vitera Healthcare Solutions, LLC Vitera Intergy Meaningful Use Edition Lavender & Wyatt Systems, Inc (LWSI) Essentia V.6 37

Doctor A Doctor B STATE HEALTH INFORMATION NETWORK OF NY (SHIN-NY) EMR EMR Health Information Exchange(HIE) Health Information Exchange(HIE) Patient visits Doctor A who records information in an EMR. The information gets stored in a HIE/RHIO. While at the office, Doctor A says that you need to see a different doctor Doctor B. Since they are both connected Doctor A can securely send information directly to Doctor B With a patients consent Doctor B can securely query or ask the HIEs for all the clinical information he needs to care for the patient Doctor has a better picture of the patient health S L I D E 38

QUESTIONS? 39

NEXT STEPS Please share your feedback via the webinar survey Log on to the NYS Care Management Training Initiative website to review additional resources at www.healthhometraining.com Feel Free to Contact me with your questions