Health Current:

Roadmap – Practice Transformation using Information & Data

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Melissa A. Kotrys, MPHChief Executive OfficerJuly 2017

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Arizona Health-e Connection is now Health Current.Powering the future of healthcare with more complete information.

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2005 Governor’s Executive Order2006 Arizona Health-e Connection Roadmap published2007 Arizona Health-e Connection (AzHeC) founded2010 Regional Extension Center (REC) grant awarded2011 & 2012 HIT and HIE legislation passed2013 - 2014 Merged statewide HIE into AzHeC2014 Arizona’s Health IT Roadmap 2.0 published2015 Transforming Clinical Practice Initiative (TCPi) grant

awarded to AzHeC (in collab with Mercy Care)2016 AzHeC initiates integrated physical & behavioral HIE strategy2017 10 year anniversary, launch of new strategic business plan &

rebrand as Health Current

Health Current Celebrates 10 Years!

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10+ Years of HIE Progression in Arizona

2007 – 2010Two regional HIEs developed – S. Az HIE (SAHIE) and Az Medical Info

Exchange (AMIE)

2010 -2014Two regional HIEs (AMIE & SAHIE)

merged to form statewide HIE –

Health Info Network of Az

(HINAz)

2014 – 2015Arizona’s Health-e

Connection (AzHeC) and

HINAz formally affiliate and

operate as single entity

2016 AzHeC & HINAz formally merge;

AzHeC to handle all community-wide HIT and HIE activity

2017AzHeC rebrands as Health Current & rolls out 3 year strategic business

plan

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Health Information Exchange

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HIE Services

• Data Exchange- Push/pull or query/response functionality

• Portal- Secure online access to patient summary view

• Alerts- ADT alerts and other clinical results notifications in human & machine readable formats

• Direct Secure Email- Secure email for clinical information exchange; DirectTrust certified and HIPAA compliant

• Clinical Summary- The delivery of a continuity of care document (CCD) based on an electronic request

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Participation Growth – as of June 2017

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HIE Participants(as of June 12, 2017)

Current participants include 340 entities:• 120 Community Provider Organizations• 71 Behavioral Health Organizations• 29 Hospitals & Health Systems (95% of inpatient discharges)• 21 FQHCs & Community Health Centers• 54 Long-Term & Post-Acute Care Organizations• 17 State & Local Government Organizations• 12 Health Plans• 14 Accountable Care Organizations• 2 Reference Labs & Imaging Centers

Hospitals, FQHCs and RHCs participating in the Medicaid EHR Incentive Program with AHCCCS (Arizona Medicaid) are eligible to receive financial incentives for HIE participation.

Note: An HIE Participant is an organization that has signed a Participation Agreement. These organizations are either already connected to the HIE or in the process of connecting.

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Hospital Participants: Inpatient Discharges & ED Visits

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 YE 2012 YE 2013 YE 2014 YE 2015 YE 2016 YE 2017 YTD

13%

53% 54% 54% 56%

94% 94%

13%

48% 49% 49%53%

94% 95%Pe

rcen

t of A

rizo

na's

Tot

al V

olum

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Inpatient Discharges ED Visits

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FQHCs, RHCs, Community & Behavioral Health Providers

1 2 2 2

14 21 21

1 5 6 6

19

80

120

- - - -

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67 71

-

20

40

60

80

100

120

140

2011 YE 2012 YE 2013 YE 2014 YE 2015 YE 2016 YE 2017 YTD

Num

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of P

artic

ipan

ts

FQHCs & RHCs Community Providers Behavioral Health Providers

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Accomplishments to Date

• 90% of hospital admissions with data flowing (soon 94%)

• 7.0M+ patients with clinical data

• 50,000+ Alerts monthly

• Integrating physical & behavioral health information statewide

• Successful grant programs – REC and Practice Innovation Institute

• Interstate connectivity – Patient Centered Data Home™

• Groundswell of interest – 300+ Participants

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The Patient Rights Process

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Health Current Participants Data Providers & Data Types (updated monthly)

https://healthcurrent.org/the-network/the-network-participants/data-providers-data-types/

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HIE Statistics (May 2017)

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HIE Statistics (May 2017)

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HIE Statistics (May 2017)

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Practice Innovation Institute (Pi Institute)Key Facts

Potential of up to $14.6 million from CMS over four years (2015-2019)

One-on-one consulting valued at $50K+ per practice

Engagement and practice transformation for 2,500 Arizona Clinicians

Collaboration with QIN-QIO and professional medical associations to advance practice transformation

Assistance in integrating physical & behavioral health care

Connection to the statewide HIE, including pop health & data analytics to enhance communications and care coordination

Collaboration of Health Current, Mercy Care Plan & Mercy Maricopa Integrated Care

19Transforming Clinical Practice Initiative (TCPI) Goals

Support more than 140,000 clinicians in their practice transformation work

Improve health outcomes for millions of Medicare, Medicaid and CHIP beneficiaries and other patients

Reduce unnecessary hospitalizations for 5 million patients Generate $1 to $4 billion in savings to the federal government and commercial payersSustain efficient care delivery by reducing unnecessary testing and procedures

Transition 75% of practices completing the program to participate in Alternative Payment Models

Build the evidence base on practice transformation so that effective solutions can be scaled

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What are the 5 phases of TCPI?

Set Aims Use Data to Drive Care

Achieve Progress on

Aims

Achieve Benchmark

Status

Thrive as a Business via

Pay for Value

Approaches

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Patient Centered Data Home™ (PCDH)Patient Centered Data Home™ (PCDH) is a concept of Strategic HIE Collaborative (SHIEC).

Hospital(Non-Home)Care Team

HomeCare Team

Non-HomeHIE

HomeHIE

1 Acknowledgement of Clinical Data

3

5Query/Response

4

3

Add

’l D

ata

5

2ADT to PCDH

HIE

Ale

rt

©2016 SHIEC– All rights reserved, proprietary and confidential not for further redistribution.

Western

Central

Heartland

PCDH Regions: Current + Potential Expansions

©2016 SHIEC– All rights reserved, proprietary and confidential not for further redistribution.

PCDH Regions:National Connectivity

Northeast Region

Southeast Region

Western

Central

Heartland

Northwest Region

Regional Gateway Connections

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Statewide HIE Integration Plan (SHIP)2016 – 2018• Accelerated connectivity of integrated HIE strategy supported by all 3 Regional

Behavioral Health Authorities (RBHAs) - Mercy Maricopa- Cenpatico Integrated Care- Health Choice Integrated Care

• 2-year plan to connect 100 high priority behavioral health providers by summer 2018- Behavioral health providers- Behavioral health hospitals

• Current status- Statewide crisis portal go-live in late July 2017- Portal implementations – 41 organizations- Alerts & Direct secure email – 23 organizations- Inbound data feeds – 5 organizations (expect 25+ by end of year)

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Opioid Epidemic Solutions: HIE/PMP Integration

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HIE integration with Arizona’s Prescription Monitoring Program required by SB 1283“BEGINNING THE LATER OF OCTOBER 1, 2017 OR SIXTY DAYS AFTER THE STATEWIDE HEALTH INFORMATION EXCHANGE HAS INTEGRATED THE CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM DATA INTO THE EXCHANGE…”

HIE/PMP integration “go-live” scheduled for early August

Impact on Opioid Epidemic• Providers using HIE Portal will be able to access all controlled substance prescriptions from

PMP database along with all medical history available through HIE• Aligns with integrated physical and behavioral health information exchange

- In emergency, providers able to break the glass and access patient’s Part 2 substance abuse data- In other instances, can access Part 2 substance abuse data with patient consent

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Sustainability

Core HIE Foundation

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Strategic Business Plan: 2017-20194 Pillars of Success

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Sustainability

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Strategic Business Plan: 2017-20194 Pillars of Success

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Data IntegrationWe help our partners realize their highest potential to transform care

What It Means

• Make sure the HIE is usable and integrated into participants’ workflows• Map out needs, expectations, priorities and timelines to integrate• Understand & address barriers to successful and efficient HIE use• Overall, maximize HIE value to participants

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Sustainability

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Strategic Business Plan : 2017-2019 4 Pillars of Success

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Data AcquisitionData Sources

Continue adding new data sources:• Remaining acute care hospitals (18 = 6% of statewide discharges)• Remaining behavioral health hospitals (14)• Physical health practices• Behavioral health practices• Long term post-acute care organizations• First responders• Correctional health providers• Claims data to fill encounter data gaps

• Medicaid claims• Medicare claims• Commercial claims

• Medication fill history• PDMP• Commercial sources

• Social services agencies• VA & IHS• Advanced directives • Other HIEs

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Data Acquisition Data Elements

Capture missing data (varies by Participant):• Diagnosis & chief complaint• Discharge destination• Electronic images• Encounter based data• Immunizations• Insurance & guarantor• Lab & radiology results• Medications• Patient attributions • PCP designation• Social determinants• Transcribed reports & electronic documents• Treatments & procedures• Vital signs & BMI

Determinants

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Sustainability

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Strategic Business Plan: 2017-20194 Pillars of Success

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Data QualityData NormalizationThe process of making data less variable by:

- Grouping similar values into a common value set (e.g. payer names, gender, religion, ethnicity, practice specialties, etc.)

- Utilizing common data formats for variable format elements (e.g. name and address formats)

Data StandardizationThe process of utilizing accepted data coding standards to make data more meaningful, comprehensive and actionable

- Examples: CPT, ICD-9, ICD-10, RxNorm, LOINC, NDC, SNOMED CT, DICOM

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Sustainability

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Strategic Business Plan: 2017-20194 Pillars of Success

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Value-Added ServicesNew Services to be Considered

• Population Health Management

• Health Care Analytics

• Community Care Plans

• Medication Fill History

• Electronic Image Sharing

• Community Referral Management

• Community Scheduling

• Advanced Directives, Power of Attorney & POLST

• Consent Management & Identity Proofing

• Personal Health Record

• Advanced Reporting

• Bundled Payment Support

• Secure Test Messaging+

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Health Current & Value-Based PurchasingThe Four Pillars• Data Integration

- Utilization of integrated HIE data to improve outcomes• Data Acquisition

- More data = more complete patient record = better care coordination and improved outcomes

• Data Quality- Discrete data in a format to analyze

• Value-Added Services- Additional HIE services can be tailored to the needs of the community to

support value-based purchasing

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Health Current & Value-Based PurchasingHIE Services• Data Exchange

- More data into the HIE & your EHR = more complete record• Portal

- Easy access to patient summary on new patients as initial step• Alerts

- Real-time care coordination & follow-up can avoid readmissions, provide appropriate follow-up care, etc.

• Direct Secure Email- Mechanism to support alerts and other information transfer

• Clinical Patient Summary- Triggered patient summary response gets new information in clinicians’ hands when it

is needed

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Next Steps for YOU!

1. Contact Health Current to ensure you are connected soon!

- Contact Beth Scully – beth.scully@healthcurrent.org or 602-688-7216

2. Encourage other providers to participate – more value received as more patient information available; statewide participation is key

- Provide contacts to Health Current

3. Get engaged & involved – provide input for future services and opportunities or participate on councils or workgroups

- Send us your ideas or set-up a time to meet

- Volunteer for a council or workgroup

4. Stay informed – get regular updates about new opportunities

- Make sure you receive Health Current Updates – subscribe at www.healthcurrent.org

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Closing Remarks

Sustainability

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Active Participation+

Strategic Partnerships+

Value-Added Services+

Data Integrity =

Sustainability & Value

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Health Current

Melissa A. Kotrys, MPHChief Executive Officermelissa.kotrys@healthcurrent.org

www.healthcurrent.org602-688-7200Follow Us: