Session: 236 MACRA Preparation in Underserved Populations ...€¦ · •Addressing MACRA...
Transcript of Session: 236 MACRA Preparation in Underserved Populations ...€¦ · •Addressing MACRA...
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Session: 236
MACRA Preparation in Underserved Populationswith Data-Centric HIE
February 23, 2017 12:00 p.m.Dominic Mack, MD, MBA
Director , National Center for Primary Care
Associate Professor, Morehouse School of
Medicine
Executive Medical Director, GA-HITEC
Gary Palgon
VP Healthcare & Life Sciences Solutions
Liaison Technologies
@GaryPalgon
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Presenting Your Presenters!
Dominic Mack, MD, MBA
Director , National Center for Primary Care
Associate Professor, Morehouse School of Medicine
Executive Medical Director, GA-HITEC
Gary Palgon
VP Healthcare & Life Sciences Solutions
Liaison Technologies
@GaryPalgon
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Conflict of Interest Disclosure
• Dr. Dominic Mack, Co-Director of the National Center for Primary Care and an Associate Professor at Morehouse School of Medicine
• Gary Palgon, VP Healthcare & Life Sciences Solutions, Liaison Technologies
Has no real or apparent conflicts of interest to report.
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Agenda
• Understanding MACRA requirements among rural and underserved geographies
• Addressing MACRA Challenges
• Taking a Data-Centric Approach to an HIE / HIT to accelerate MACRA
• Engaging HIT / HIE Tools for MACRA Readiness and Strategies
• Q&A
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Learning Objectives
• Explain MACRA requirements and potential challenges for rural and urban health
providers in medically underserved communities.
• Prepare to meet MACRA requirements in medically underserved communities by
providing technology, technical support and education to network providers and
health information exchanges serving these communities.
• Demonstrate how a cloud-based, data-centric approach to HIE creation and data
sharing can accelerate MACRA preparation and ease the transition for the rural
and urban networks in medically underserved communities
• Assess current MACRA readiness and identify strategies and tactics to kick start
preparation
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Keys To Realizing Value of Health IT
http://www.himss.org/ValueSuite
• Cloud-based solution enables low-cost point of entry for participants and access to at-risk populations
• Security of patient information is baseline requirement
• Compliance to Meaningful Use helps funding and provides provider credibility
• Geographical-based coverage enhances longitudinal patient record
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Polling Question 1:
Medically underserved communities:
a) Are always poor and in inner city areas
b) Have access to same advanced HIT as all other communities
c) Can be rural or urban and may have advanced technology
d) Don't differ from other populations except they have fewer medical facilities in their communities
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National Center for Primary Care Research – Training – Resource Center
Morehouse School of Medicine
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•MACRA / Meaningful Use Assistance•EHR vendor selection
•CMS and MAPIR registration and attestation
EHR Implementation
Resource & Support
•Boots on the Ground
•Distance Learning / Web-based training
•Barrier mitigation / Risk Assessment
Outreach, Education &
Training
•Service Area HIE with State HIE
•Lab Interface
•HIE outreach and education
HIT Infrastructure
•Workflow Assessment/GAP Analysis
•PCMH, ACOs
•Improve clinical outcomes
Practice Management
•EHR adoption, Vendor utilization, Population Health
Research
HIT Center
EMR Implementation
Resource & Support
Cloud-based Technical Solutions
Practice Management
Outreach, Education &
Training
GA-HITEC Supports Georgia Providers & Hospitals
56 Hospitals> 4,000 Providers
~$100M Incentive Payouts
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• GAHC• GAHITEC
• TCPI
• TCC- HIT Policy
• PCMH
Community Health
Education & Training
Practice Based Research
Health Information Technology
Quality Improvement
Primary Care
National Center for Primary Care (Morehouse School of Medicine):
Providing tools to strengthen the Primary Care System for
sustainability toward Health Equity.
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2013 Medicare Per Capita spending
Source: Medicare Geographic Variation Public Use File (GV PUF) from the Centers for Medicare & Medicaid Services (CMS), February 2015.
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An estimated 3.7 million nonelderly adults fall into the coverage gap, most of whom reside in the South.
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Understanding MACRA requirements among rural and underserved
geographies
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Why Move to Value?
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Polling Question 2:
MACRA has four major components. Which of the following are correct?
a) Quality
b) Improvement Activities
c) Advancing Care Information
d) Cost / Resource
e) All of the above
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QualityImprovement
Activities
Advancing Care
Information Cost
The MIPS composite performance score will factor in
performance in 4 weighted performance categories on a 1-100
point scale
60% 15% 25% 0%Begins in 2018
MACRA: Quality Payment Program
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MIP: Advancing Care Information Objectives and Measures
Objective Measure (Bold = Required Base Score Measures)
Protect Patient Heath Information Security Risk Analysis
Electronic Prescribing ePrescribing
Patient Electronic AccessProvide Patient Access
Patient-Specific Education
Coordination of Care Through Patient
Engagement
View, Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Health Information Exchange
Send a Summary of Care Record
Accept/Request Summary of Care
Clinical Information Reconciliation
Public Health and Clinical Data Registry
Reporting
Immunization Registry Reporting
Syndromic Surveillance Reporting (Optional)
Electronic Case Reporting (Optional)
Public Health Registry Reporting (Optional)
Clinical Data Registry Reporting (Optional)
ACI Has Greater Emphasis on HIT / HIE Utilization
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Addressing MACRA Challenges in underserved communities
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Rural and Underserved Communities
Slow / Low EHR
adoption
Lack of reliable
broadband
Health Information Exchange
Meeting demands of aging
population
HIT / HIE Challenges Facing Rural and Underserved Communities
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Electronic Data Exchange between Rural Hospitals and Community Physicians is Limited
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• Value for providers
• Smaller practices and disparate systems
• Vendor interoperability and support
• Privacy Concerns
• Financial Sustainability
– NeHC- average profitable HIE has invested 7.1 million in grants and product development
Source: National eHealth Collaborative (NeHC), “Following the NeHC HIE Roadmap: Four Routes to Success”, December 2012
HIT Challenges in Georgia & Southeast
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Taking a Data-Centric Approach to an HIE to accelerate MACRA
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Health Information Exchange vs Interoperability
Health Information Exchange
The ability of 2 or more systems
to exchange health information
Health Information
Interoperability
The ability of those systems to use the
Information that has been exchanged
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Allows HIEs to exchange data across boundaries
Bridges gaps in patient care
Community Health Network
Patient Centered Data Home
Sends alerts to connected providers when patients
seeks medical care outside of their “home”
Potential for centralized patient consent
Models for Health Interoperability
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A direct node on the
Georgia health information
network is known as a
Qualified Entity
The Big Picture
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NCP
C
Georgia Health Connect Ecosystem
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• Medicaid/GA Department of Community Health (DCH)
• GA Department of Public Health (DPH)
• GA Division of Families and Children Services (DFCS)
• GA Department of Juvenile Justice (DJJ)
• GA Department of Behavioral Health & Developmental Disabilities (DBHDD)
• Amerigroup
• PeachState
• WellCare
• Emory Healthcare (Cerner)
• Grady Health System (Epic)
• Children’s Healthcare of Atlanta (Epic)
• Gwinnett Medical Center (Relay)
• Georgia Health Connect (GaHC) (Liasion)
• HealtheConnection (Cerner) -
• GRAChIE/Chatham HealthLink (Cerner)
• Georgia Partnership for Telehealth (GPT)
• South Carolina Health Information Exchange
• East Tennessee Health Information Network
• Alabama’s One Health Record®
• Texas (HIETexas)
• Veterans Health Administration
State Agencies
CMO
Hospitals
NationalExchange
Regional HIEs
Specialty Connection
41 Providers
connected;
over 29,000 patients
registered
Broad Interoperability
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Sustainable Partnerships
Liaison Technologies is a global data management and integration
company. It provides innovative solutions to integrate, transform,
harmonize, manage and secure critical business data on-premise or in
the cloud. Headquartered in Atlanta, Liaison has offices in the
Netherlands, Finland, Sweden and the United Kingdom. For more
information, visit www.liaison.com.
Quest is the world’s leading provider of diagnostic testing, information
and services that patients and doctors need to make better healthcare
decisions. Our services range from routine blood tests — such as total
cholesterol, Pap testing and white blood cell count — to complex, gene-
based and molecular testing.
GAHITEC is the ONC designated Regional Extension Center for the
state of Georgia. GAHITEC provides technical support to over 4000
providers and 56 critical access and rural hospitals to meet meaningful
use. Also serves as the Georgia CMS/DCH REC program for specialist;
currently working with CHOA, Georgia CSBs, and community
providers.
DrFirst pioneers software solutions and services that provide real-time
access to patient data, improve communication and collaboration at the
point of care and across the patient’s circle of caregivers, and enhance
the doctor’s clinical view of the patient to help drive better health
outcomes.
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Advantages Realized by Georgia Health Connect
• Interoperability with GAHIN
• Interoperability with partners
• Lab orders and results
• Clinical Record (CCD)
• Claims Data
• Medication Reconciliation
• Transitions of Care
• Neutrality, Flexibility, Agility
• Secure Exchange of Information
• Decrease Cost for Sustainability
• Aggregating the Data
• Coordination of Care
• Reduce Errors & Redundancy
• Improve Quality of Care
• System built to serve independents
Helping independent Hospitals & PracticesExchange of Health Data
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Solution Approach
EXCHANGE
TRANSFORM
HARNESS
Information Exchange
• Lab/Radiology orders and results
• Clinical Documents – medical
summary, discharge summary,
operative note, consultation note,
procedure note and others
Community Patient Record
• Analytics ready repository
• Patient matching
• Format reconciliation
Analytics, Registries, Quality
Reporting, and Patient
Engagement
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What Georgia Health Connect Has To Offer
Feature DescriptionPatient Data Repository and Community Patient Record
HIE Platform services that promote the integration of participants into a common integration network. Includes the following:- Data Normalization,- Patient Data Repository,- Security, Access and Authorization,- Messaging Interfaces,- Community Patient Record web application that allows the user to view patient record including encounters, medications, allergies, procedures, problems, observations, and other documents.
Integration with Georgia Health Information Network (GaHIN)
Configure IHE PIX and XDS.b profiles in HDM and integrate with GaHIN as producer and consumer of the data according to GaHIN specification.
Practice/Hospital onboarding Connectivity between GaHC and practices/hospitals and implement the Consolidated-Clinical Document Architecture (C-CDA) interface between HDM and practices/hospitals EHR. ** (May require vendor interface – extra fees not included)
Performance Quality Dashboard Harmonization of data from HIE platform and integration and syndication to analytics platform. Prepackaged dashboard that help providers monitor summary quality measure reports on the provider’s patient population and participate in different initiatives.
Electronic Lab and Radiology Orders and Results
Electronic lab and radiology orders and results provided as option
Direct Messaging Service Direct Messaging will be implemented by GaHIN.
Georg
ia H
ealth C
onnect
Colla
bora
tion P
ackage
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What Georgia Health Connect Has To Offer(Cont’d)
Medication Reconciliation Medication history solution to improve medication reconciliation workflows for hospitals, long-term care facilities and other acute care environments.
Syndromic Surveillance Reporting Routing and Connectivity
Provides tools & services necessary to route syndromic surveillance reporting from one EHR database to Georgia public health through GaHINgateway. This is just routing only and excludes any EHR vendor interface fees.
Public Health Gateway-eLabRouting and Connectivity
Provides tools & services necessary to route lab or radiology results from one EHR database to Georgia public health through GaHIN gateway. This is just routing and excludes any EHR vendor interface fees.
Bidirectional Immunization (GRITS) Routing and Connectivity
Provides tools & services necessary to route immunization information to/from one EHR database to/from Georgia Immunization Registry via GaHIN. This provides connectivity and mapping required for the practice’s EHR. Excludes any EHR vendor interface fees.
eHealth Exchange Service Provides tools & services necessary to share patient information with other HIEs across state lines using eHealth Exchange Service (Nationwide Network).
Georg
ia H
ealth C
onnect
Colla
bora
tion P
LU
S
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Meets unique needs
of providers who
want an HIE that:
• Enables collaboration with other providers in spite of geographic differences;
• Fits a rural provider’s more limited budget
• Improves patient care and satisfaction through access to a longitudinal record
• Adds value to existing EHR systems by providing access to data and analytical tools previously unavailable
• Supports clinical decision-making and population health management initiatives
STEPS: Satisfaction
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Provides access
to complete
overview of
patient’s medical
history:
• Better informs clinical decisions for improved patient outcomes
• Ensures care continuity as patients move from primary to acute to post-acute care
• Uploads information from other sources such as statewide immunization databases or lab results directly into EHR for clinician’s easy access
• Creates complete longitudinal record, regardless of geographic location of providers
STEPS: Treatment/Clinical
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STEPS: Electronic Secure Data
HIE leverages GA-HITEC’s
existing members, which use
HIT regional extension
center to adopt and optimize
EHR technology.
Features ensuring
HIE data is secure
include:
• Cloud-based platform integrates, aggregates and translates information into standard format in a central repository – eliminates need for IT expertise
• Analytics provide insight, benchmarks and data previously unavailable to individual providers to support clinical and business decisions
• Different service levels allow providers to choose services that best fit needs
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STEPS: Patient Engagement & Population Management
Access to patient’s
longitudinal
medical record
through the HIE
enables provider to:
• Seek health equity through better access for rural and underserved communities
• Follow-up to ensure patients comply with instructions for optimum outcomes
• Identify and avoid potential negative medication interactions
• Evaluate patients for recurrence of conditions treated by other providers
• Obtain information from all practices and hospitals connected to state-wide HIE and Medicare and State immunization data
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STEPS: Savings
Because value-based
care focuses on
controlling costs and
improving outcomes,
GaHC HIE saves in
these ways:
• Access to patient’s longitudinal medical record reduces duplicate tests and therapies
• Improved ability to produce mandated quality and cost reports - access to harmonized data from all sources enables automation of reports
• Dashboards that monitor care at high-levels with ability to drill down to detailed information enable identification of clinical and financial outliers, speeding response to potential risks
• Credible, holistic data available for developing best practices for quality outcomes
• Lower cost for technology
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Engaging HIT / HIE Tools for MACRA Readiness and Strategies
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Polling Question 3:
MACRA is a federal law that encourages the use of Health Information Exchanges in rural and underserved communities.
a) True
b) False
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Healthcare Data Pool Silos
Provider Clinical Data
Claims Data Life Sciences Data
Patient-Generated Data
Clinical and Translational
SciencePayers Life SciencesProvider
Organizations
Shared Contextual Data
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Data Challenges• Integration is difficult
– With many different partners
– Point to point connections
– Using different protocols and formats
– Homegrown and proprietary systems
– Multiple consumers of data with different needs / demands
• Standardization is challenging
– There is no “standard” – When you've seen one, you've seen one
– Many “generational” versions of so-called “standards” to maintain
– Many different terminologies to determine data context
– Capturing the necessary data in EHRs and other systems
• Overall very expensive to integrate, aggregate and harmonize
– High vendor interface fees
– Cost of hardware, software and staff to manage data
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Different Types of Cloud-based Solutions
Source: NIST SP 500-292 - NIST Cloud Computing Reference Architecture
SaaS
Consumer
IaaS
ConsumerPaaS
Consumer
Software-as-a-Service
Platform-as-a-Service
Infrastructure-as-a-
Service
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Cloud: Delivering faster time to value
• Reduced ‘time to results’ by eliminating need to stand-up operations
• Pay-as-you go, eliminates CAPEX
• Accelerated access to new capabilities via shared platform investment
• Tailored solution AND benefits of multi-tenant platform
• Robust compliance: SOC 2, HIPAA, PCI DSS, Title 21 CFR Part 11
• Support for data standards - HL7, CDISC, OMOP, FHIR, IHE, and SMART platforms
75% of customers report that service availability improved after moving to the cloud1
94% of businesses say their security has improved since adopting cloud applications1
1 CloudTweaks, 2015
dPaaS
INC
RE
AS
ING
US
ER
SE
LF
-SE
RV
ICE
AN
D C
ON
TR
OL
INTEGRATION
DATA MANAGEMENT
DATA ANALYTICS & BUSINESS INTELLIGENCE
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Technical Requirements – 100k feet
• Streamlined data sharing between ambulatory, acute care, and post-acute care settings. Provider web portal to view aggregated longitudinal patient data
• Connection to a variety of data sources such as EHRs, administrative and billing systems with support for patient and provider matching
• Patient data repository with real-time access through IHE XDS.b document registry and repository profiles
• Support all messaging standards HL7 v2 and v3, ASC X12 HIPAA-adopted, HL7 CDA, UN/EDIFACT, and many others
• Secure transfer and storage of data
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HIE as a Service
State HIE
Clinical Data
Viewer
Reporting and
Analytics
Clinical Data
Financial DataProvider
Organizations
Source: Georgia Health Connect © 2016
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Data Subscribers
Georgia Health Connect
Ambulatory
Acute
Inte
gra
tion
Pla
tfo
rm
Health Data Management Platform
Big Data Repository
Patient and
Provider Index
Services
Healthcare
Terminology
Services
Map / Transform / Format
Inte
gra
tion
Pla
tfo
rm
Patient
Health Data
Model
Target
Data
Model
Lab and Radiology
Data feed Data feed
Labs
Radiology
& Imaging
Community
Patient Record
Portal
AnalyticalSystems
GAHIN & Other HIEs
PHR ApplicationsPHR Applications
EHR Applications
Source: Georgia Health Connect and Liaison Technologies © 2016
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Benefits Were Realized for the Value of Health IT
http://www.himss.org/ValueSuite
• Better access in rural & urban underserved populations
• Affordable technology for smaller practices
• Cloud-based integrative platform for quality reporting
• Improve patient safety, error reduction & clinic outcomes
• Improved provider/patient engagement and satisfaction
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Questions
Dominic Mack, MD, MBA
Director, National Center for Primary Care
Associate Professor, Morehouse School of Medicine
Executive Medical Director, GA-HITEC / GaHC
404.756.5740
Gary Palgon
VP Healthcare & Life Sciences Solutions
Liaison Technologies
770.442.4922