hitmpresentation06262013

©2013THEADVISORYBOARDCOMPANY
Leading the Transition to Value-Based
Health Care Delivery and Payment Models
Health Information, Technology & Measurement
Work Stream
June 26, 2013

Road Map
2
3
4
5
1
2
Review Themes from Previous Meeting (6/5/13)
(8:40-8:50)
Update on Major HITM Initiatives
(8:50-9:25)
Identify Priority Technologies and Functions for Payment Reform
(9:25-9:45)
Initial Identification of Barriers and Gaps
(9:45-10:00)
Welcome, Introductions & Agenda Review (8:30-
8:40)

3
•#1: Share detailed information on several key
technologies
•#2: Identify high priority technologies that promote
payment reform and improved care
•#3: Initial discussion of barriers to accelerate
adoption of priority technology
Meeting Objectives
HITM Work Stream Meeting #3: June 26th

4
Cross-Pollination
Updates from other work streams
Work Stream Highlights
Clinical and Payment
Innovation
• Payment Reform Summit June 19th: Subject matter
expert presented on the different payment models that
emerged under health care reform
Community Health
Initiatives
• Identified and discussed the breadth of community
based health related programs in Rhode Island
Workforce and Practice
Transformation
• Built on original inventory taken in 2010 task force
and identified additional achievements and gaps that
appeared in Rhode Island since 2010
Policy and Regulatory
Issues
• Introduced work stream goals; will regularly meet in
July & August to discuss solutions proposed by other
work streams
Population Focused • Identify critical delivery pieces that populations with
complex health needs require
•Identify attempts made to integrate care for special
populations

Road Map
2
3
4
5
1
5
Review Themes from Previous Meeting 6/5/13
(8:40-8:50)
(8:50-9:25)
(9:25-9:45)
(9:45-10:00)
Welcome, Introductions & Agenda Review
(8:30-8:40)

6
Before we begin…
Established Meeting Ground Rules
1. Use and abide by an agenda
2. Good facilitation
3. Advanced distribution of presentation materials or meeting topics so members can come
prepared to participate
4. No side conversations
5. Talk about the problem, not the person
6. Be engaged and present during the meeting
7. Keep discussion on topic
8. Connection with relevant work streams – highlight efforts of other work streams
9. Share knowledge of documented work completed by other organizations
10. Operate on a consensus model that includes solutions everyone can “live with,” not
necessarily “the ideal”

7
Areas to focus on:
3. High-quality, low cost care needs timely
data
• “A system needs feedback to improve”
• Risk models and high-quality, linked claims
and clinical data
• Alignment of payers, providers, and insurers in
approaching and understanding cost
implications
4. Technology and measurement in
practices: “Doctors are not business
professionals”
• Training, education are key
• Specialization (outsourcing) of analytic tasks
for small groups
5. Learn from current work
• CurrentCare
• CSI/Beacon
Areas to focus on:
1. Emphasize person-centered system
• Information should follow the patient
• Direct flow of information from hospital to PCP
(via CurrentCare)
• CurrentCare assist with patient registration
(only give basic information once)
• Allow patients to see their own info in
CurrentCare
2. Clear expectations for performance
standards
• Define “high quality care”
• Define and harmonize measures
• Neutral party to ID “best practices”
Lessons learned from RIQI October Strategic Session
HITM-related Highlights of the RIQI Strategic
Sessions

Map of Meeting Topics & Project Requirements
Health Information, Technology, and Measurement (HITM)
Date Major Agenda Item Map
June 5 HITM Possibilities & Inventory 1, 2, 3,
6
June 26 In-depth analysis of existing
HITM projects; define “priority”
initiatives
1, 2, 3,
6, 7
July 10 What barriers exist to adopting
and accelerating spread of
priority HITM projects?
1, 2, 3,
4, 6
July 24 Develop recommendations for
accelerating adoption of priority
initiatives
1, 2, 3,
4, 5, 7
Aug 7 Refine recommendations and
identify costs, implications
All
Aug 21 Finalize plan All
CMMI and SHIP Requirements
1 Accelerate adoption of HITM among providers
2 Ensure that HITM activities will reach hard-to-access
providers
3 Coordinate Plan with all statewide HITM initiatives
4 Consider the impact of this Plan on MMIS, including
planning and implementation timelines
5 Cost allocation plan or methodology for any planned IT
system solutions/builds
6 Review and identify IT resources (including EHR)
across providers that can support testing of multi-payer
and payment reform model
7 Develop reporting mechanisms for outcomes
8 Develop approaches to ensure accountability across
stakeholders
8

Road Map
2
3
4
5
1
9
(8:40-8:50)
(8:50-9:25)
(9:25-9:45)
(9:45-10:00)
(8:30-8:40)

©2013 THE ADVISORY BOARD COMPANY • 25644A
10
Innovations and Projects in Rhode Island
Major Health Information, Technology and
Measurement Initiatives
Health Information Exchange (CurrentCare)
All Payer Claims Database (APCD)
Unified Health Infrastructure Project (UHIP)
Trailblazers Action Plan

Structure: State Designated Entity: The Rhode Island Quality Institute will
oversee and operate
11
Services Provided :
– Clinical viewer (web based portal for query)
– Alerts and notifications
– Subscription to notifications
– Home health monitoring
– Direct Adoption
Update on Major HITMS Initiatives:
RI’s Health Information Exchange Infrastructure (Currentcare):
!

12
RI’s Health Information Exchange Infrastructure (Currentcare):
• Rhode Islanders enrolled (opt in): 300,000
• Data submitters:
–9 Hospitals sending ADT feeds (83%)
–6 Hospital Laboratories (58%), 2 large clinical laboratories
–20 Medical practices are sending clinical summaries (CCDs) from their EHRs
–2 Community mental health centers (including 42 CFR Part 2)
–4 Large chain pharmacies sending dispensed medications
• Data users via Clinical viewer:
–104 Practices using viewer
–1 Emergency Department
–12 Long term care sites
–32 Community mental health centers
• Adoption of Direct messaging: 125 sites
• Receiving hospital notifications:72 sites
• Sharing Behavioral Health Records
Status:

13
RI’s All Payer Claims Database (APCD):
Goals:
– Create a comprehensive data system that allows tracking an individual
across insurance carriers and time
– Allow for robust reporting and analysis including calculation of risk
scores
Structure: APCD is a partnership initiative administered by an interagency
workgroup which includes:
Department of Health (DOH)
Executive Office of Health and Human Services (EOHHS)
Office of Health Insurance Commissioner (OHIC)
Health Benefits Exchange (HBE)

14
Status:
• Conduct RFI followed by RFP to select Analytic Vendor: TBD
– Responsible for receiving data extract from Aggregator; data checks and
validation; enhancing and organizing data; calculating risk scores
– Producing identified reports
• Conduct RFI followed by RFP to select Hosting Vendor: TBD
– Responsible for providing data extracts for research and internal state
users
– Acts as State’s repository for data
• Development and Implementation: (runs until Dec 31, 2014)

15
Status:
• Regulations will be promulgated shortly; include strong privacy protections and
data review boards
• Hired Project Management Vendor: Freedman Healthcare
• Hired Encrypted Unique Identifier Vendor (“Lockbox”): HMS
– Responsible for creating Unique ID, attaching to payer’s eligibility files, and
returning data to payers
• Hired Data Aggregator: Onpoint Health Data
– Responsible for preliminary intake/collection; data structure and format
checks; creating person-level extract
– Convenes Data Submission Workgroup (payers) to clarify process

Structure: UHIP is a interagency initiative between
– Health Benefits Exchange (HBE)
– Executive Office of Health and Human Services (EOHHS)
– Department of Human Services (DHS)
– Office of Health Insurance Commissioner (OHIC)
16
Unified Health Infrastructure Project (UHIP):
Goal:
– Create a single technical platform that will support the Health Benefits Exchange,
Medicaid eligibility, and other state human service program eligibility

17
Unified Health Infrastructure Project (UHIP):
Status:
• Technical Vendor Chosen: Deloitte
• Numerous stakeholder sessions held to validate business requirements
• Development will be phased: initial deployment for October 1, 2013 will include
Health Benefits Exchange and Medicaid eligibility for expansion population and
will include basic functionality
• Outreach and communication about health benefits exchange and Medicaid
expansion will begin over summer (mass media and targeted approaches)
• Metrics and evaluation plan under development: hope to eventually include
quality measures to assist individuals when purchasing insurance and choosing
providers.

18
Trailblazers Action Plan:
• Identify, harmonize, and define use of measures:
– Local/National
–Quality/Payment Reform
–Public/Private Reporting
• Create a statewide quality measurement system:
– Collects once and used by many (payers, federal gov’t, state gov’t
etc)
– Electronically generated (and aligns with Meaningful Use)
– Individual or aggregate
– Governance
– Feedback systems
• Authoritative shared provider directory: needed by HIE, HBE, APCD,
Licensure, Medicaid, etc
• Link de-identified datasets: claims with clinical (APCD with HIE)

Road Map
2
3
4
5
1
19
(8:40-8:50)
(8:50-9:25)
Identify Priority Technologies and Functions for
Payment Reform
(9:25-9:45)
(9:45-10:00)
(8:30-8:40)

20
Identifying Priority HITM
Which technologies, measurements, and functions are priority?
Which are must-haves? Nice-to-haves?
• Build on – but don’t be limited to – past and current projects
• Consider options that drive both payment reform and quality
• Emphasize initiatives that we can achieve in the medium-term
(within 5 years)
If the goal of HealthyRI is to design a model that ensures
80% of the state's total population moves to value-based
payment and delivery models within 5 years…

21
1.
Identifying Priority HITM
Suggestions: Priority Functions, Technologies & Measurements
Healthy Rhode Island
1. Interoperable technology
a) Streamline patient and provider portals
b) Single sign-on for EHR, HIE
2. Improved communication among and within user
groups – patients, providers, payers, state
3. Timely claims and clinical (EHR) data
4. Comprehensive provider directory
5. Harmonized measures (alignment of
measurement types and definitions)
6. Predictive modeling and actuarial data
7. Unblinded and public provider data for quality
measurement
8. Linked claims and clinical data
Guidelines for
Narrowing
Which are priority?
Which are must haves?
What will drive both
payment reform and
higher-quality care?
What can we achieve in
the medium-term (within
5 years)?

Road Map
2
3
4
5
1
22
(8:40-8:50)
(8:50-9:25)
(9:25-9:45)
(9:45-10:00)
(8:30-8:40)

23
Healthy Rhode Island
#2 Evolving
environment
#1 Legal
Barriers
Ease of
interoperability
Identifying Initial Gaps and Barriers
#3 Current Care’s
Opt-in Provision
Link Clinical
and Claims Data
Patient
Engagement; HIE

hitmpresentation06262013

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