Georgia Department of Community Health

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October 29th, 2015

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Agenda

Introduction

Business Drivers

Pilot Use Case

Pilot Timeline and Process

Ecosystem

Defining Success

Resources/References

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Introduction: Pilot Team

Name Role

Laura Ellis Project Director

Bonnie Young Project Manager

Waiver Program Directors SME

Program Integrity Managers SME

Waiver Program IT Specialists SME

Irina Connelly Georgia Tech Research Institute (GTRI) Technical Support

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MissionThe Georgia Department of Community Health

We will provide Georgians with access to affordable, quality health care through

effective planning, purchasing and oversight.

We are dedicated to A Healthy Georgia

Georgia Department of Community Health (www.dch.georgia.gov)

Pilot Introduction: Business Drivers

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Georgia Business Drivers:Development of Health Information Technology (HIT) standards that:

• Support program monitoring and improvement of all waivers

• Support cross-waiver program information sharing

• Help bridge the gap between clinical and non-clinical data

• Support incremental adoption by members of the ecosystem

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Support cross-waiver program information sharing

Entities in Long Term Services and Support Transitions:• Waiver programs, hospice care, nursing homes, hospitals, rehab

facilities, etc.

Lack of information sharing leads to…– Uncertainty in service eligibility– Delay in receiving eligible services– Lost productivity and time impact on case managers– Miscommunication between LTSS stakeholders

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Use Case: Support cross-waiver program information sharing

Transitioning between LTSS services:Pilot Focus –

Beneficiary moving between CCSP and ICWP waivers

• Information currently flows within each waiver.

• Information flowing across waiver groups are not currently supported.

• Identifying and documenting the information and process needs across waiver groups will illuminate common/overlapping as well as distinct data components.

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Overview of 2 Waiver Programs

- Community Care Waiver Program (CCSP)

- Independent Care Waiver Program (ICWP)

CCSP ICWP

Population Size 8,866 1,375

Age Range Any 21-64

Impairment Eligibility Functional impairment caused by physical limitations (including Alzheimer’s and dementia)

Severe physical impairment and/or Traumatic Brain Injury

Service Eligibility Determination

Care Coordinators involved in eligibility determination subject to validation by External Quality Review Organization

External Quality Review Organization involved in eligibility determination

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Waiver Program Services

Services CCSP (Any) ICWP (21-64)

Team-based Care (i.e., jointly developed Plan of Care)

Case Management

Adult Day Health

Alternate Living Services (24-hour personal/nursing supervision)

Behavior Management Services

Counseling Services

Emergency Response System

Home-delivered Meals

Home-delivered Services (skilled nursing/therapy)

Home Environment Modification

Personal Support Services (e.g. personal care tasks and ADL)

Respite Care

Skilled Nursing Services

Specialized Medical Equipment and Supplies

Consumer Directed Care Option for Personal Support Services

Financial Support Services

Vehicle Adaptation

• Both waivers serve different populations with some overlap

• Similar services provided by both

• Similar data needs

Comparison between CCSP and ICWP

Georgia’s Round 1 pilot focusIdentifying data requirements (i.e., identify overlapping and

distinct data)

Georgia Waiver Programs (www.dch.georgia.gov/waivers)

Georgia Pilot Timeline – Tier I

Oct Nov Dec Jan ’16 Feb March April (round 1 complete)

Kick-off & Pilot plan

finalization

Participant Identification/Recruitment

- conduct outreach activities

- prepare materials for pilot participants

Conduct Pilot- identify and validate data

items via stakeholder interviews, focus group, town halls

- identify and validate potential vocabulary standards for coded data items

- solicit input for additional data items not in use today

- capture qualitative feedback

Results AnalysisBased on input received

- summarize findings on common data items and associated domains

- summarize findings on unique data items and associated domains

- identify potential candidate standards applicable to data items

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Round I Pilot Details

GOAL 1: Develop a data profile for CCSP and ICWP – begin with Service Plans

- Inputs (i.e., data collection)- Outputs (i.e., data sharing)- Data Format (semantics/syntax)- Identify Standards (i.e., data, forms, etc.) - Business Process Flows- Actors (i.e., internal and external)

GOAL 2: Identify existing ecosystem problems HIT can help solve- Improve timely access to critical information- Reduce redundancy and burden of manual data input- Identify current barriers to eLTSS implementation

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How do you define success

Deliverables: 1. Identified and documented data that exists in both programs2. Gap analysis3. Identified and documented essential service plan data to

share

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Resources/References

For more information:

Georgia Department of Community Health, Division of Health IThttps://dch.georgia.gov/health-information-technology

Georgia Department of Community Health, Waiver Programshttps://dch.georgia.gov/waivers

Georgia Tech Research Institutehttp://www.gtri.gatech.edu/icl