MCO/Registry Data Exchange Initiative A Collaboration Between Every Child By Two & The American...
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Transcript of MCO/Registry Data Exchange Initiative A Collaboration Between Every Child By Two & The American...
MCO/Registry Data Exchange Initiative
A Collaboration Between Every Child By Two & The AmericanImmunization Registry Association
July 2002 ECBT Hosted Health Plan Executives
Aetna Incorporated AMERIGROUP AvMed Health Plan Blue Cross Blue Shield Chartered Health Plan CIGNA Corporation Geisenger Health Plan
July 2002 ECBT Hosted Health Plan Executives Health Partners Incorporated Health Right Health Net Independence Blue Cross Kaiser Permanente Mid-Atlantic Permanente PHP TennCare United Healthcare University of Pittsburgh Medical Center WellPoint Health Networks
Benefits of Data Exchange Increased coverage rates Disease prevention Decreased missed days of employment
by parents who must care for ill children
Cost savings by eliminating necessity for manual record pulls
Cost savings by eliminating duplicative immunizations
Increase in data completeness and quality
Benefits of Data Exchange Public relations value for benefits
managers who can compare services offered by various MCOs
Broader impact on preventive services Improved quality ratings for
managed care Consistent data reporting for providers Increased provider and member
overall satisfaction
Benefits of Data Exchange Increased provider satisfaction by
eliminating chart reviews by managed care
Promotion of quality care by providing current recommendations and adding new vaccines
Move toward electronic CIS Increased quality of care by utilizing “real
time” information (current immunization status, recommendations, etc)
Benefits of Data Exchange
Assists families when moving by providing access to children’s records
Potential for long-term access to immunization information -alleviates need for record archiving by providers
Shows that health plans care about their participants - GOOD PR Value
Potential Challenges Addressing privacy and confidentiality
regulations Ensuring legality of disclosing immunization
data to public health from managed care Ensuring legality of disclosing immunization
data from public health to managed care Participation of Providers Requirements – should providers be required
to submit data? This does not always prove to be effective in increasing registry data because there are few ways to enforce.
Potential Challenges Incentives – there are many examples
of managed care organizations providing incentives to providers that exhibit high immunization rates, can there be incentives for providing data to the registry?
Important to ensure that usage of registry is simple & user friendly – ability to look up reports, attain batch data
Potential Challenges
Registry functionality Information technology financial investment
by health plans must be modest Provider and health plan have varying
technological capacity to access registry Data quality issues Financing registries/sustainability Standardization of performance measures Must be Internet based
MCO/Registry Data Exchange Advisory Committee Therese Hoyle, Michigan Dept. of Comm.
Health Marcina Robertson, Intermountain Health
Care Dennis Michaud, Mass DOH/CIRSET Chair Dr. Allan Lieberthal, Kaiser Permanente, CA Kim Salisbury-Keith, Rhode Island DOH Reid Kiser, Natl. Cmte for Quality Assurance Debbie Mccune Davis, Arizona Partnership
for Imm.
MCO/Registry Data Exchange Advisory Committee James Resnick, Health Resources Services
Assoc. Julie Jones, Centers for Medicare & Medicaid Linda Murphy, Centers for Medicare &Medicaid Jennifer Zavolinsky, American Assoc. of Health
Plans Angela Salazar, CDC/NIP Janet Kelly, CDC/NIP Aurora Oliva, American Imm. Registry Assoc. Amy Pisani, Every Child By Two
Goals of the Advisory Group To identify key issues and
resources to facilitate data exchange between MCOs and registries
To create a “how-to” manual to guide and articulate the challenges & successes of data exchange
Advisory Group Activities Spent time discussing issues &
initiatives The Vendor Recruitment Model California’s SIIS Conference Workgroups Partnership for Prevention – Insights from
registries/MCOs Examples of data exchange partnerships HIPAA ramifications Medicaid/Commercial health plan variations
Products Survey of current registry data sharing
activities Data exchange guide for registry offices Business template to be developed by
registry staff MCO marketing card Available electronically/limited #
printed
Registry MCO/Data Exchange Survey Results CDC/NIP 2002 annual report data
showed that 41% of grantees provided data to health plans to assist in HEDIS Data did not delineate whether
electronic, paper, or by MCO staff designated to download
Registry MCO/Data Exchange Survey Results
Our Survey sent to all 64 of 317 grantees
38 registries returned survey 14 of the 38 are electronically
exchanging data
Survey Results - Reasons for Not Exchanging Data Nine due to technical reasons
Registry system being upgraded System relatively new, staff focused on
deployment to providers and health depts. Not HL7 compliant
Eight due to legal or policy issues State laws or local interpretation of HIPAA not
favorable to exchange Consent-based registry policies act as a
barrier
Survey Results- Reasons for Not Exchanging Data Six due to other issues
Desire to focus on enrolling private providers
Awaiting higher data saturation to make it worthwhile to health plans
Lack of staff resources Lack of marketing skills
Anecdotal Findings Several of Arizona’s commercial
and Medicaid plans used registry as primary source of information to conduct HEDIS assessments. Costly record reviews conducted only when information not found in registry
Key Findings - Arizona Review of imm. coverage levels for four
health plans from 1998 (when registry was launched) and 2001 showed avg. increase of 8 percentage points for 4:3:1 series
One of largest AZ health plans used reg. to raise adolescent levels
Levels rose by 18 and 22 points for MMR & Hep B in just three years time
How to Guide Outline Health Plan Attributes and Needs
Quality performance measures Registries benefits to health plans Health plan benefits to registries
Increased immunization rates Increased data completeness/quality
How to Guide Outline Health plan benefits to registries
Increased Medicaid enrollment in registry
Promote the awareness and use of registries by providers
Provide funding to registry Educate members and providers about
importance of immunizations and registries
How to Guide Outline Getting started
Evaluate registry’s resources and assets How much time/staff can registry office
allocate Does your registry have enough imm. records
to make it worthwhile for health plans
Making it Happen How to identify health plan contacts Identify health plan structure
How to Guide Outline Determine the requirements
Check with your legal department and agency staff
What laws/rules in your state/county influence data exchange
HIPAA Interpretations
Special Cmte. On Aging hearing “HIPAA Medical Privacy and Transaction Rules: Overkill or Overdue?”
Status from federal agencies on implementation & impact of policies on providers and consumers
HIPAA Interpretations Richard Campanelli, director of
HHS Office of Civil Rights Testimony dispelling much
misinterpretation www.ecbt.org/news sept/october Majority of registries are not “covered
entities” – therefore not governed by HIPAA
HIPAA Interpretations While registries not covered
entities, most users of registries (health plans) are
Rule allows covered entities to “disclose to a public health authority authorized by law to collect…”
HIPAA’s Good Intentions Jarad Adair – Director of CMS’
Office of HIPAA Standards reported that there are 400 different formats used to submit insurance claims…HIPAAA requires that there be just one.
HIPAA – Arm Yourself with Pro- Data Sharing Examples
“resources should be devoted to proper and vigorous implementation (of the rule), and not to using misunderstanding and mishap to build public opposition to the law.” Health Privacy Project’s Director-
Janlori Goldman
How to Guide Outline
Issues to Consider HIPAA – clear examples of pro data
sharing interpretations included NY State Immunization Information
System explanation MOU’s from various states
How to Guide Outline Making it Happen – Cont.
Meet with immunization department staff to discuss how this initiative fits in with strategic plans/goals of entire department
Create specific marketing plans Individualize for staff models, network
models, Medicaid, commercial plans
Specific Marketing Plans Sept, 2003 JAMA reported that quality
of care for commercial MCOs was significantly higher than that of Medicaid MCOs
# of Complete Childhood Imm. Series Commercial MCOs 64% , Medicaid 49%
# of Adolescent MMR Shots Commercial MCOs 52%, Medicaid 43%
$ Make a Good Sales Pitch $ “Think like a business person, not a health
care professional” – Dr. Allan Lieberthal Use sales techniques Deal with health plan decision makers Highlight cost savings on manual record
pulls, decreased duplicative imms, data collection
Highlight public relations/sales benefits Improved data quality and consistency