Overview Tom Simmer, MD, Senior VP and Chief Medical Officer Blue Cross Blue Shield of Michigan ...

Statewide Daily Notification Service for Admissions,

Discharges and Transfers

BCBSM, MIHIN, MSMS

June 14, 2013PGIP Quarterly Meeting

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OverviewTom Simmer, MD, Senior VP and Chief Medical OfficerBlue Cross Blue Shield of Michigan

Enabling Statewide ADT ServicesTim Pletcher, Executive DirectorMichigan Health Information Network

2013 TimeframesRick Wilkening, MIHIN/BCBSM

PO PreparationJoe Neller, Integrated Physician AdvocacyMichigan State Medical Society

Questions

Today’s Agenda

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Overview

Statewide Daily ADT Notification Service

Tom Simmer, MD, Senior VP and Chief Medical OfficerBlue Cross Blue Shield of Michigan

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Produce comprehensive daily census reports on admissions and ER visits◦ Improve care transitions◦ Improve efficiency◦ Avoid unnecessary services

Streamline utilization management obligations to payers

Platform to develop additional HIE reporting capabilities◦ Medication Reconciliation◦ Lab values

Purpose of the Statewide ADT Notification Service

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Why a “Statewide” Service?

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20000

40000

60000

80000

100000

120000

140000

0

20

40

60

80

100

120

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160

Hospital Count and Admissions

Admissions

Hospital Count

PGIP POs

Adm

issi

ons

Sca

le

Hos

pita

l Cou

nt S

cale

Every PO has patients in numerous hospitals

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Why a “Statewide” System?

62%15%

7%

16%

Primary hospital system

Secondary hospital systems

Admissions are distributed across many hospitals, even for a highly integrated system.

All other hospital systems

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Hospitals should be able to communicate ADT information once, regardless of the number of recipients.

Hospitals should be able to send the information through the electronic channel of its choice, as long as it connects to the appropriate clinical process for managing transitions.

Practitioners should be able to receive the information in the manner they choose to support their clinical processes.

Report information should meet standard expectations related to common data definitions, fields etc.

Principles of the Statewide Service

Enabling

Statewide ADT Services

Copyright 2013 - Michigan Health Information Network 8

Tim Pletcher, Executive DirectorMichigan Health Information Network

Agenda

1. Make sure everyone understands statewide HIE model

2. Review of the Statewide Use Cases

3. Ensure legal protections in place that protect everyone and conform with HIPAA and the new HITECH rules

4. Discuss statewide ADT Use Case

5. Deep dive into ADT & Patient Provider Attribution

6. Current plans around the business model

7. Value proposition to become early adopters


Establishing Statewide Shared Services


State o

f Mich

igan

In

ternal

ExternalSTATEWIDESHARED SERVICES

MDCH Data Hub(formally SOM HIE)

MiHIN & the Qualified Data Sharing Organizations

Transparency via HIT

Commission Monitoring

Shared Governance via

MiHIN BOD

Federal

MDCH Data Hub

Medicaid

MSSS

State LABS

Doctors & Community Providers

HIEs(Qualified sub-state

HIEs)

Basic Data Flow

Data Warehouse


State-wide Shared Services

DIRECTHISP

Virtual Qualified

Organizations

Health Plans (more coming)

MiHIN Statewide Use Cases

12Copyright 2013 - Michigan Health Information Network

Push Alerts & Notification

Pull/Query Care Summaries

Health Provider Directory

Public Health Reporting

PILOTS

PRODUCTION

PRE-PRODUCTION

PRE-PRODUCTION

ORGANIZATION AGREEMENT(QDSOA or VQDSOA)

Basic Connection Terms

Basic BAA Terms

Minimal Operational SLA

Contracting & Payment

Definitions

Termination

Cyber Liability Insurance

Data Sharing Agreement

Use Case #1

Use Case #2

Use Case #3

Legal Infrastructure for Data Sharing


State-wide ADT Use Case

• Phase One: ADT Pilots & BCBSM Feeds

• Phase Two: All Patient ADT Service

• Phase Three: Convert Syndromics


The ADT Use Case

• Every hospital in the State of Michigan is already creating ADT messages

• 85 hospitals voluntarily send a variation of an ADT message to the state of Michigan to support syndromic surveillance

• A hospital can send an ADT message with no impact on internal workflow & typically no new technology

• Currently there are lots of point to point interfaces, but no statewide effort until now


Point-to-Point Doesn’t Scale


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5000

10000

15000

20000

25000

Clinics

Interfaces

Insurance Companies

Physicians

Specialty Providers

Hospitals & Clinics

Patients & Families

Lab tests &XRAYs

Medications

Public Health

N*(N-1)/2Insurance Companies

Physicians

Specialty Providers

Hospitals & Clinics

Patients & Families

Lab tests &XRAYs

Medications

Public Health

ADT Notification Service

• Statewide, all-payer, all-patient Transitions of Care (TOC) Notification Service

• For each organization responsible for the patient’s care, the message is routed based on preferences defined in MiHIN’s Health Provider Directory

• Enable the exchange of ADT messages to the patient’s relevant providers and health care organizations

• Receives HL7 Admission, Discharge, Transfer (ADT) and uses the patient’s information to match against patient attribution lists maintained by physician organizations, care coordinators, and payers participating in the service


Alerts & Notification

Qualified Sub-state HIE

or VQO

Qualified Sub-state HIE

or VQO


Copyright 2013 - Michigan Health Information Network

Patient to Provider Attribution

Delivery Preference

Lookup

1) Patient goes to the hospital, hospital sends a registration message

2) MiHIN checks Patient Attribution Lists and identifies three providers

3) Using the HPD, MiHIN identifies a Delivery Preference for each provider

4) Notification is routed to the providers based on their preference

Primary Care

Specialist

Care Coordinator

Alerts & Notification

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Animation

Patient Attribution List

• Physician organizations can provide patient lists in Excel or another MiHIN-provided format• “Active” means patient seen within 2 years• Regular updates required• Coordination via MiPCT / CareBridge & sub-state HIE’s

• Health plans can deliver standard X12 834 enrollment files to populate MiHIN Plan-Provider tables

• Work with QO’s, MHA, and hospitals to utilize ADT messages for hospitals seeking to subscribe to patients discharged in previous 30 days


Health Provider Directory• Trusted source of secure routing

information for providers and HIEs• Statewide Provider Lookup (PLU):

• Direct addresses• HIE / IHE routing info (OIDs)• Referrals and required info• Notification and delivery

• Uniquely holds complete inter-HIE and provider-provider routing info

• Not a phone book!


HPD

Direct Address Book

Directory Services

Provider Relationship Management

Routing Preferences

Two Data Delivery Options

1. Receive ADT’s via your Qualified Sub-state HIE

a. Sub-state HIE processes message and delivers it how you want (as their vendor solution allows)

b. Sub-state HIE sends you a “raw” data feed

c. Some sub-states have begun using DIRECT

2. Via Care Bridge VQO & MiPCT

a. Contract with Care Bridge for care coordination support

b. Utilize the MiPCT-funded application


Phase 1: MiPCT Member Lists via CTC PartnershipTIMING (TARGET): July/August

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Transitional Care Management Medicare Fees Jan 2013

CODE Non-Facility Facility Locality

99495 $120.39 $99.38 Detroit

99496 $169.65 $145.70 Detroit


9949-• Communication (direct contact,

telephone, electronic) with the patient and/or caregiver within 2 business days of discharge

• Medical decision making of at least moderate complexity during the service period

• Face-to-face visit, within 14 calendar days of discharge

99496 - • Communication (direct contact,

telephone, electronic) with the patient and/or caregiver within 2 business days of discharge

• Medical decision making of high complexity during the service period

• Face-to-face visit, within 7 calendar days of discharge

Health Plan- Pricing Model


Participation Fee

• PMPM• Core Services• Offset by HIE incentives to providers

Ala Carte

• ADT (read-only, full feed)• MTM (fill status, CMR notice, query)• Labs (per result, per source)• Query / Audit (per trx, per service)

Custom Engagement

• Services• DIRECT feeds• Unique query or data standardization

Reduced by HIE specific incentives paid to providers

PO Actions to Get Ready:1. Figure out where your digital identity is going to be: Where &

how will you receive electronic clinical communications? MiPCT? QO Sub-state? Other? Multiple?

2. Get in the Health Provider Directory: How will your clinical preference for data routing be expressed state-wide?

3. Generate your patient attribution lists: For which active patients do you want to be notified for

ADTs? For other TOC events?

4. Create a plan for the workflow implications: Where is this work going to land and how will the activities be processed?


More information about MiHIN

Questions?www.mihin.org


Tim Pletcher [email protected]

Copyright 2013 Michigan Health Information Network 27


PGIP Quarterly

Rick Wilkening, MIHIN/BCBSM

MiPCT Member List / ADT Distribution

28Copyright 2013 Michigan Health Information Network

• Opportunity (option not a requirement) for MiPCT POs and practices

• Allows for direct member list distribution (with ADT alerts where possible) to care managers and practices.

• Aims to reduce the administrative burden on POs and to allow them to focus their efforts on supporting the provision of team-based care within their practices

• No fee to PO for participating (covered in the MiPCT administrative budget)

• POs that participate would continue to receive their member list and other products from the MDC as well as any future MDC reports

ADT Notification Service Onboarding

29Copyright 2013 Michigan Health Information Network

DMCUMHS

BeaumontTrinityUPHIE

Initial Target Hospital Systems Initial Recipients

CareBridge (VQO)MiPCT (via CareBridge)MedNetOne (via MHC)

UPHIE (QO)

Beacon (QO)Ingenium (QO)

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PO Preparation

Statewide Daily ADT Notification Service

Joe Neller, Integrated Physician AdvocacyMichigan State Medical Society

Statewide ADT Notification MSMS and MHA convened ADT Workgroup

◦ Representation from Trinity Health, Henry Ford Health System, Ascension Health, Metro Health, Spectrum Health, Huron Valley Physician Association and United Health.

Standard Data Elements◦ 108 discrete data elements possible in ADT

“spec”◦ 45 identified by physicians for clinical care

Health Information Exchange Next Steps for Statewide ADT Notification

◦ Physician/Care Team/Patient Attribution Health Provider Directory

◦ Workflow and clinical processes redesign Other Use Cases

◦ Continuity of Care Documents (CCD)◦ Medication reconciliation◦ Query Functions

Physician Organization connections to HIEs

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Questions?

Overview Tom Simmer, MD, Senior VP and Chief Medical Officer Blue Cross Blue Shield of Michigan ...

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