T h e MARYLAND HEALTH CARE COMMISSION
Discussion Topics Overview Learning Objectives Electronic Health Records Health Information Exchange Telehealth 2
Overview - Maryland Health Care Commission Advancing value-based care delivery programs; Identifying and addressing challenges regarding health IT implementation and interoperability; Promoting standards-based health IT through educational and outreach activities; Implementing a statewide HIE and harmonizing local area HIE efforts; Diffusing telehealth in long term care (LTC), ambulatory care, and in hospitals; Designating management service organizations (MSOs) that meet select health IT requirements; and Promoting electronic data interchange (EDI) between payors and providers, and certifying electronic health networks 3
Health IT Components Electronic Health Records Health IT Health Information Exchange Telehealth 4
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Value-based purchasing Reduce preventable readmissions Reduce hospital acquired conditions Bundled payments Innovative care delivery models Electronic Health Records Foundation for Health Care Reform Increase health care value The goal Improve quality Reduce Costs Tactics Prerequisite Electronic health records 6
Accelerate Meaningful Use EHRs are considered a critical tool for advancing high quality patient centered care and are essential to practice transformation Achieving efficiencies in clinical practice and in quality requires using EHRs in a meaningful way MU is aligned with the national health care triple aim effort to improve patient care quality and satisfaction, increase population health, and reduce health care costs Maryland Medicaid administers the Medicaid EHR Incentive program in Maryland 7
State Incentives Maryland is the first State to build on the Medicare and Medicaid EHR adoption incentive programs requiring State-regulated payors to provide incentives for the adoption of EHRs State incentives are separate and independent of federal incentives; there are different eligibility and participation requirements for each program Current Legislation 2009 House Bill 706 Electronic Health Records Regulation and Reimbursement (HB 706) requires MHCC to establish regulation to require State-regulated payors (payors) to offer incentives to providers to promote the adoption of EHRs 2011 House Bill 736 Electronic Health Records Incentives for Health Care Providers Regulations (HB 736) further clarifies the incentive program established under HB 706 8
State Incentive Program - Key Provisions Eligibility primary care practices, including family, general, internal medicine, pediatrics, geriatrics, and gynecology Must adopt a certified EHR in order to qualify The six largest private payors required to provide incentives include: Aetna, CareFirst, Cigna, Coventry, Kaiser Permanente, and United Healthcare One time payment per payor per practice Incentive of up to $15,000 based on the practice s panel members, calculated at $25 per member 9
State Incentive Program Progress Over $8.3M to 370 primary care practices since October 2011 Participation has increased by about 14 percent since April 2013 The average number of applications that resulted in payments increased from 33 per month under the previous program to 43 per month under the revised program Source: Data reported by payors for period October 2011 March 2015 10
EHR Adoption Among Office-based Physicians 70% 60% 50% 40% 30% 20% 10% 21.8% 27.9% 18.6% 23.8% 33.9% 33.4% 49.2% 39.6% 58.3% 48.1% 64.3% 54.0% EHR adoption among Maryland office-based physician has increased from 33.4 percent in 2011 (around the time the State incentive program went into effect) to 64.3 percent in 2014 0% 2009 2010 2011 2012 2013 2014 Maryland National Sources: Maryland Data Maryland Board of Physicians National Data 2009-2013 National Center for Health Statistics National Data Centers for Medicare and Medicaid Services EHR Incentive Program data, December 2014 11
EHR Adoption Acute Care Hospitals 100% 90% 80% 77% 81% 89% 89% 89% 85% 96% 94% 100% 76% 97% 70% 60% 72% 59% 50% 44% 40% 30% 28% 20% 10% 9% 12% 16% 0% 2008 2009 2010 2011 2012 2013 2014 Hospitals in Maryland Hospitals Nationally - Certfied EHR Hospitals Nationally - Basic EHR Sources: Maryland Data Maryland Health Care Commission, Health Information Technology, An Assessment of Maryland Hospitals, October 2014. National Data Office of the National Coordinator for Health Information Technology (ONC), ONC Data Brief, Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008-2014, No. 23, April 2015. 12
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HIE Evolving Technology Health care reform is driving evolving electronic HIE strategies Sharing of clinical data among organizations not previously exchanging data More robust clinical data and analytic needs More organizations entering the HIE market Exchange activities expanding geographically, including interstate exchange HIE privacy and security regulations need to keep pace with the changing landscape 14
Health Information Exchange The goal of HIE is to make health related information more accessibl across disparate health systems Benefits Streamlined practice processes: Tasks currently conducted manually requestin results and patient summaries, sending referrals and receiving reports, and sending prescriptions can be completed electronically Better communication: View a more complete patient record electronically, including hospital visits, lab work, medications Improved health outcomes: Up-to-date information on patients, which can result in reduced medical errors and improved quality of care, especially during transitions of care 15
HIE Considerations HIE can help get the right data to the right place at the right time To be effective, HIE needs to support and be integrated into workflows not compete with them HIE needs to be adopted by all health care providers to achieve maximum benefits HIE query portal is accessible through the Internet; providers do not need to have an EHR to access the system 16
The Development of the Statewide HIE Planning and legislative authority Two multi-stakeholder groups worked independently to identify best implementation strategy (May 2008 - Feb. 2009) Legislative authority to designate a statewide HIE in May 2009 - House Bill 706, Electronic Health Records Regulation and Reimbursement The Chesapeake Regional Information Systems for our Patients (CRISP) was competitively selected in August 2009 CRISP is a not-for-profit collaborative effort among the Johns Hopkins Health System, MedStar Health, University of Maryland Medical System, Erickson Retirement Communities, and Erickson Foundation, and more than two dozen major stakeholders across the state 17
Maryland s State-Designated HIE The Chesapeake Regional Information System for our Patients (CRISP) All 47 acute care hospitals and two specialty hospitals are connected and provide admission, discharge, and transfer information Around 40 hospitals submit clinical data (e.g., labs, radiology, clinical documents) to the HIE infrastructure Two national laboratory and three radiology centers are connected and provide laboratory and radiology reports CRISP Services Query Portal: Gives providers access to prior hospital and medication records Direct Secure Messaging: Enables referrals and other care coordination Encounter Notification Service: Notifies providers in real time about patient visits to the hospital Prescription Drug Monitoring Program: Monitor the prescribing and dispensing of drugs that contain controlled dangerous substances 18
HIE Privacy and Security Legislative Authority 2011 law requires the MHCC to adopt regulations for the privacy and security of PHI exchanged through an HIE Regulations The HIE Policy Board, a staff advisory group, consisting of various stakeholders proposed policies for privacy and security Policies became the framework for the draft HIE regulations Final regulations, COMAR 10.25.18, adopted by MHCC went into effect in March 2014 19
Regulation Section Summaries Key Areas Health care consumer rights concerning information accessed, used, or disclosed through an HIE Access, use, or disclosure of sensitive health information Requirements for accessing, using, or disclosing PHI through an HIE Auditing requirements Remedial actions to be taken by an HIE Notice of breach or violation Registration and enforcement 20
Requirements under the Existing Regulations The regulations require HIEs that operate in Maryland to register with MHCC and renew their registration annually Information collected as part of registration: Technical capabilities from HIEs Service areas and types of participating organizations Authentication and audit policies and procedures Consumer educational materials Audited financial statements National accreditation if achieved; however, not required 21
Registered HIEs 22
Now inhale deeply, Mrs. Saunders 23
Telehealth A Statewide Perspective Fragmented adoption Acute care hospitals roughly 46 percent Physicians about 10 percent Minimal use About 50 providers submitted roughly 78 telemedicine claims to State-regulated payors from October 2012 June 2013 24
Key Challenges to Telehealth Expansion Little incentive for practices to move away from the traditional fee-forservice (volume-based) business model Limited government reimbursement Medicare: About 60 evaluation and management services within certain rural areas of the State Medicaid: Restricted to two pilot programs Lack of widespread awareness about how to incorporate the effective use of telehealth into existing practice workflows Technology adoption, integration and capability 25
Telehealth Adoption Nationally: American Telemedicine Association estimates roughly 200 telehealth networks in the U.S.; connectivity to over 3,500 sites Roughly 28 percent of Maryland physicians that are using telehealth are primary care physicians, 10 percent are behavioral health, and approximately 62 percent other specialties Maryland health care organizations: Two emerging value-based reimbursement models in Maryland Retail health clinics: Included in pharmacies and supermarkets beginning to develop telemedicine programs 26
Reimbursement About 19 states have laws that require payors to compensate for telemedicine care Roughly 44 states have some method of telemedicine reimbursement for Medicaid 27
2014 Telemedicine Task Force Activities Develop recommendations to address telemedicine adoption challenges Identify strategies to deploy a statewide phased approach to diffuse telemedicine technology in innovative care delivery models Identify appropriate use cases that could be regionally deployed in the State Finalize the technical architecture of a telemedicine registry Propose solutions to key policy challenges for reducing barriers to adoption and meaningful use of telemedicine 28
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Telehealth Grants Round One Awards made in October 2014 Goal: Improve transitions of care between a comprehensive care facility (CCF) and a general acute care hospital using telehealth technology Required: Use of telehealth, an EHR, and services of the State- Designated HIE, CRISP Assess the impact of using telehealth on hospital emergency room visits, admissions, and readmissions A dollar-for-dollar match contribution to the grant funds 30
Atlantic General Hospital Partnership with Berlin Nursing and Rehabilitation Center (Berlin) Goal: Reduce both general acute care hospital costs and transportation costs associated with hospital admissions and readmissions from Berlin Hospital physicians will provide remote care to Berlin residents using telehealth technology Requested $30,000 in grant funding and intends to provide a matching contribution of $87,922 31
Dimensions Healthcare System Partnership with Sanctuary of Holy Cross Goal: Improve transitions of care for residents at Sanctuary of Holy Cross through virtual consultations and remote monitoring for residents with pneumonia and heart failure Application includes services of Zane Networks, LLC, a State- Designated management service organization Requested $30,000 in grant funding and intends to provide a matching contribution of $32,000 32
University of Maryland Upper Chesapeake Health Partnership with the Bel Air facility of Lorien Health Systems (Lorien Health Systems) Goal: Reduce avoidable hospital utilization originating from Lorien Health Systems using telehealth technology, extending emergency medical management expertise to Lorien Health Systems 24/7 Real-time data on residents vital signs will be transmitted between Upper Chesapeake Health and Lorien Health Systems Requested $27,888 in grant funding and intends to provide a matching contribution of $27,888 33
Telehealth Grants Round Two Awards were made in April 2015 Goal: Use telehealth technology to improve overall health of population being served, improve patient experience, and provide best possible care while lowering costs Required Up to $30,000 in grant funds available per grantee Use an electronic health record and services of the State-Designated, CRISP Provide a 2:1 financial match contribution to grant funds 34
Crisfield Clinic Family practice clinic in Somerset County will deploy telehealth in two county schools to address asthma, diabetes, childhood obesity, and behavioral health issues 24/7 care will be provided via remote patient monitoring; virtual consultations will be provided via school-based telemedicine carts issued under another grant Goal: improve clinical data indicators, reduce lost school days, reduce emergency department visits, and improve patient s perception of health Requested $30,000 in grant funding and intends to provide a matching contribution of $92,983 35
Lorien Health Systems Skilled nursing facility and residential service agency in Howard County will deploy telehealth to address hospital PQI diagnoses, including uncontrolled diabetes, chronic heart failure, and hypertension Remote patient monitoring and videoconferencing will be provided at home post discharge from the skilled nursing facility Goal: improve clinical data indicators and reduce readmissions and admissions to an acute care hospital Requested $30,000 in grant funding and intends to provide a matching contribution of $63,220 36
Union Hospital of Cecil County Acute care hospital in Cecil County will deploy telehealth to address hospital PQI conditions, including diabetes, chronic obstructive pulmonary disease, hypertension, heart failure, angina, and asthma Remote patient monitoring and health education will be provided to patients at home after discharge from the hospital to improve community and population health Goal: improve clinical data indicators and reduce readmission rates Requested $30,000 in grant funding and intends to provide a matching contribution of $60,000 37
Next Steps Accelerate the implementation of health IT statewide where electronic patient information is available at the point of care delivery for all Marylanders and the data is used to influence knowledge-based decision making by providers and consumers Develop an achievable number of innovative health information exchange use cases in collaboration with stakeholders that improve population health, improve care delivery, and decrease health care costs Integrate leading ambulatory practice EHR systems; expand analytics and reporting; and, connect additional provider types based on value-specific HIE use cases 38
Next Steps (Continued) Work with ambulatory practices to adopt and meaningfully use EHRs by leveraging the State-regulated payor incentive program, and building awareness of the federal incentives and penalties Foster statewide growth of telehealth through use case pilots where lessons learned provide the foundation for broader diffusion of the use case Continue to create sound policy to ensure the privacy and security of electronic health information that aligns with federal initiatives, policy, and regulations and allows for use case innovation, yet minimizes intrusion risks 39
Want more information? Visit the Maryland Health Care Commission s website for more information mhcc.maryland.gov 40
Melanie Cavaliere Maryland Health Care Commission 410-764-3282 Melanie.cavaliere@maryland.gov Jenny McDaniel UnitedHealthcare 301-371-3609 jenny_mcdaniel@uhc.com 41
Appendix
Learning Objectives Be familiar with the telehealth landscape in Maryland Identify the work of the Maryland Telemedicine Task Force (task force) in expanding opportunities for telehealth adoption Understand how telehealth is being used to improve access to care Recognize the benefits of electronic health information exchange 43