ACMHA: The College for Behavioral Health Leadership

June 8, 2011

Patricia MacTaggartPatricia.mactaggart@gwumc.edu

HEALTH INFORMATION TECHNOLOGYHEALTH INFORMATION TECHNOLOGY INFRASTRUCTURE FOR THE INFRASTRUCTURE FOR THE

TRANSFORMATION OF HEALTH CARE & TRANSFORMATION OF HEALTH CARE & HEALTH CARE DELIVERYHEALTH CARE DELIVERY

AGENDAAGENDASURVIVAL:

•TRANSFORMATION OF HEALTH CARE DELIVERY•TRANSFORMATION OF HEALTH CARE ADMINISTRATION•TRANSFORMATION OF YOU = e-EVERYTHING

SUCCESS: BETTER HEALTH, BETTER CARE, LOWER COSTS

•HEALTH IT IS THE “VEHICLE”•INTEROPERABILITY & CONNECTIVITY THE “HIGHWAY”•QUALITY & PATIENT SAFETY IS THE “DESTINATION”

STANDARDIZATION: SAVES LIMITED RESOURCES•AIU & MU•HIEs & HIEs•MITA

SURVIVAL: TRANSFORMATION OF HEALTH CARE DELIVERYSURVIVAL: TRANSFORMATION OF HEALTH CARE DELIVERYFocus on Where “Going” – Not Where “From”Focus on Where “Going” – Not Where “From”

• Accountable Care Plans

• Integration:– Physical and Behavioral Health– Integration Public-Private: Premium Based Subsidies– Integration Medicare-Medicaid: Standardized Assessment,

Extensive Data Analysis & Sharing, Financial Incentives for Quality

• Reimbursement Reform

Triple Aim: Better Care, Better Health, Lower Costs

SURVIVAL: TRANSFORMATION OF HEALTH CARE DELIVERY SURVIVAL: TRANSFORMATION OF HEALTH CARE DELIVERY Opportunities for ProvidersOpportunities for Providers

• Community-Based Care Transitions Program– Competitive Pilot: 5-year to manage care transitions for

highest-cost enrollees with multiple chronic conditions (Sec. 3026, 2011-15)

• Bundling Payment Pilot Program • Acute, inpatient hospital services, physician services,

outpatient hospital services, and post-acute care services for an episode of care (Sec. 3023, 2013-18) (Medicare & Medicaid)

• Medicaid Safety Net Global Payment Demo & 1% FMAP increase for states that eliminate cost-sharing for preventive services (Sec. 4106, starts 2013)*

SURVIVAL: TRANSFORMATION OF HEALTH CARE SURVIVAL: TRANSFORMATION OF HEALTH CARE ADMINISTRATIONADMINISTRATION

• Patient Centric: Consumer Engagement & Education

• Administrative Simplification:– No More Paper– e-Signature– Standardization: • Public/Private• Across State Agencies• State to National

SURVIVAL: TRANSFORMATION OF YOUSURVIVAL: TRANSFORMATION OF YOU e-Everything e-Everything

• EHR: Electronic Health Record (across health organizations)

• EMR: Electronic Medical Record (within health organization)

• HIE: Health Information Exchange (across providers, purchasers, regulators) & Health Insurance Exchange

(health benefit exchange)

• HIT: Health Information Technology (EHRs, HIEs, Registries, Tele-health)

• e-PHR: Electronic Personal Health Record

SURVIVAL: TRANSFORMATION OF YOUSURVIVAL: TRANSFORMATION OF YOU e-Everything e-Everything

• 4010 TO 5010: Updating the Book (1/1/12)

• ICD-9 to ICD-10: Whole New Book

(10/1/13)

• Privacy & Security Requirements: “Breaches”

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SUCCESS: HEALTH IT IS THE VEHICLE

Interoperability and Connectivity are the Highway

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MEANINGFUL USE OF HEALTH IT MEANINGFUL USE OF HEALTH IT Gets Us Where We Want to GoGets Us Where We Want to Go

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Research Institute

Beacon Community

IntegratedDelivery System

Community Practice

Health Information Exchange

Health CenterNetwork

FederalAgenciesState

Public Health

AggregationAnalysisDissemination

State Agencies

Adapted from ONC Diagram

SUCCESS = ACTIONABLE INFORMATION SUCCESS = ACTIONABLE INFORMATION Get the Data Once and Use it for Care, Oversight, Policy Get the Data Once and Use it for Care, Oversight, Policy

Development Across Public/Private & State Agencies Development Across Public/Private & State Agencies

MEASURE SUCCESSMEASURE SUCCESS Data on Performance

• CHIPRA Quality Measures for Children,• MU Measures,• ACA Quality Measures for Adults,• HCBS Measures for Waivers,• PQRI Measures • MCOs: External Reviews & Quality

Improvement• ACO Measurement

MEANINGFUL USE STAGE ONE MEANINGFUL USE STAGE ONE EPEP Core Measures (15)Core Measures (15)

Medications• CPOE *• Drug Interaction Checks *• e-Prescribing• Active Medication List *• Medication Allergy List

Management of Care•Maintain Problem List *•Record Vital Signs *•Record Smoking Status *•Record Demographics *•Clinical Decision Support *•E-Exchange of Clinical *

Quality Measures * Patient Centric Engagement•Electronic Copy of Health Information *•Clinical Summaries *•Protect Electronic Health Information *

EH Core Measures (14)

MU STAGE 1 QUALITY MEASUREMENTMU STAGE 1 QUALITY MEASUREMENTCore – Alternative – Menu Core – Alternative – Menu

EP• 3 Core Clinical:

– Hypertension– Smoking

Assessment/Intervention– Adult Weight

Screening/Follow Up• 3 Alternative Clinical:

– Children Weight Assessment & Counseling **

– Child Immunization Status **– 50+ Influenza Immunization

• 3 Additional Clinical:– Select from 38 Options

** Overlap CHIPRA National 4 Total

EH - 15• VTE Prophylaxis within 24 hrs• Intensive Care Unit VTE prophylaxis• VTE discharge instructions• Incidence of potentially preventable VTE • Anticoagulation overlap therapy• Platelet therapy on unfractionated heparin • Thrombolytic therapy for patients arriving

within 2 hours of symptom onset• Ischemic stroke: Discharge on Anti thrombotics‐• Ischemic stroke: Anticoagulation for Arterial

Fibrillation/flutter• Ischemic or hemorrhagic stroke: Antithrombotic

Therapy by day 2• Ischemic stroke: Discharged on Statin

Medication• Ischemic or hemorrhagic stroke: Stroke

Education• Ischemic or hemorrhagic stroke: Rehabilitation

Assessment • Admission decision time to ED departure for

admitted patients• Median time from ED arrival to ED departure

for admitted patients

MU STAGE 1 EP CORE MEASUREMENT MU STAGE 1 EP CORE MEASUREMENT SSpecifications Examplepecifications Example

Record DemographicsDenominator: No unique patients seen by the EP during the EHR reporting period. Record all of the following demographics: (A) Preferred language (B) Gender (C) Race (D) Ethnicity (E) Date of birth

Numerator: Number of patients in denominator who have all demographic elements (or a specific exclusion if the patient declined to provide elements or if recording an element is contrary to state law) recorded as structured data.

Requirement: The resulting percentage (Numerator ÷ Denominator) must be more than 50 percent for EP to meet this measure.

MEANINGFUL USE MEANINGFUL USE EP EP Menu Measures (5 of 10)Menu Measures (5 of 10)

Medications•Drug Formulary Checks *•Medication Reconciliation *

Management of Care•Clinical Lab Test Results *•Patient Lists *•Transition of Care Summary *

Patient Centric Engagement•Patient Reminders•Patient Electronic Access•Patient-specific Education Resources *

Public Health•Immunization Registries Data Submission *•Syndromic Surveillance Data Submission *

EH: 5 of 10: 1 must be from PH Advanced Directives & Lab Results

STANDARDIZATIONSTANDARDIZATIONSaves Limited ResourcesSaves Limited Resources

• ONC = lead for standards and certification of EHR

• CMS = lead for Medicaid/Medicare Incentive Program

• Incentives to Standardize: Meaningful Use: – EMR = $0– Certified EHR = Maximum of $63,500 (Medicaid) & $43,000 (Medicare)

“One Offs” are Not GoodWhen it comes to data sources & IT infrastructure, not so unique

STANDARDIZATION CURRENT EFFORTSSTANDARDIZATION CURRENT EFFORTSAIU and Meaningful UseAIU and Meaningful Use

• State Activities for 2011-2012: – States Providing Provider Directories, Secure

Messaging (Step 1) and HIEs– State Strategic/Operational Plans– State Medicaid HIT Plans– State HIT to Support MU

• Provider Activities for 2011-2012: Follow the Money– Adopt, Implement, Upgrade of certified EHRs for

Medicaid (AIU) – Medicare/Medicaid Meaningful Use: EPs & EHs– Quality Reporting: Stage 1

CORE SUPPORT MEDICAID PROVIDING CORE SUPPORT MEDICAID PROVIDING MEDICAID/MEDICARE PROVIDERS FOR MUMEDICAID/MEDICARE PROVIDERS FOR MU

• entralized Provider Registry/Directory: – through a secure web-interface.– individual and entity identity management – specific levels of security, including authentication and

access controls and necessary firewalls

• Secure Messaging: – “on ramp” for meaningful use – technical functionality of a secure web service– direct messaging or email attachments using Direct standards– role based access and management, message and data

validation, privacy and security (encryption and signed data user agreement-DURSA), monitoring and auditing

TRANSITION OF CARE SUMMARYTRANSITION OF CARE SUMMARYCritical for Community IntegrationCritical for Community Integration

• Vocabulary of Transition of Care

• “Scope”• Time Line• Performance Standards

HIEs & HIEsHIEs & HIEsHEALTH INSURANCE EXCHANGESHEALTH INSURANCE EXCHANGES

•Single Integrate Pathway •Easy for Individuals to Explore Health Coverage Options•Individuals can Quickly and Accurately Enroll into Coverage

•Common systems and High Levels of Integration: No “Gap” in Coverage

•100% FFP for IT Infrastructure

Medicaid138% FPL

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Basic Health Plan139% to 200%

Tax Subsidy138% to 400%

MITAMITAMEDICAID ELIGIBILITY & SYSTEMS TO SUPPORT DISABILITIESMEDICAID ELIGIBILITY & SYSTEMS TO SUPPORT DISABILITIES

Single Doorway = Computer Screen

Uniform Assessments

Simple, Secure, Scalable& Standards Based

New Focus – New Funding

KNOCKING ON THE DOOR TO GET INKNOCKING ON THE DOOR TO GET INHIT for Behavioral HealthHIT for Behavioral Health

• Behavioral Health Information Technology Act of 2011 (S 539) – Sen. Sheldon Whitehouse (D-R.I.)– Expand Medicare & Medicaid Meaningful Use Incentive

Payment Eligibility to Behavioral Health, Mental Health and Substance Misuse Treatment Professionals and Facilities.

– Eligible Providers would include Licensed Psychologists and Clinical Social Workers;

– Eligible Hospitals would include Psychiatric Hospitals

“Traction” Hard to get in Environment of “Cuts”

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MOVING FORWARDMOVING FORWARDHHS Strategic Plan HHS Strategic Plan

2010-20152010-2015