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Delaware Department of Health and Social

Services

Division of Medicaid & Medical Assistance

Information Systems Unit Mary E. Marinari,

Senior Administrator Mary.marinari@state.de.us

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Delaware Statistics

§ Total Population – 952,065 § Second smallest State - 1,982 square miles. 96 miles long and at

most 35 miles wide. § Delaware was the first state to ratify the U.S. Constitution on

December 7, 1787. § Medicaid population - Total 251,038 - 208,596 in managed care

•  Managed care since 1996 including adult expansion population and more recently dual eligibles with LTCSS – developmentally delayed excluded.

§ Seven hospitals including a children’s hospital and a major hospital system with a Level 1 Trauma Center serving Philadelphia and Baltimore.

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Delaware Medicaid Health Information Technology (HIT) Landscape

§ State Innovation Model (SIM) Grant: Delaware Center for Health Innovation

§ Delaware Health Information Network (DHIN): Delaware’s Health Information Exchange (HIE)

§ Electronic Health Records (EHR) Incentive Payment Program

§ Data Warehouse and Decision Support System § Delaware Medicaid Enterprise Systems (DMES) MMIS

replacement project went live January 1, 2017

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EHR Incentive Payment Program

§  Eligible Medicaid Providers and Hospitals apply for an incentive payment §  $21,250 in Year 1 Adopt, Implement, Upgrade phase §  $8,500 in Years 2-6 for Meaningful Use (MU) reporting

§  Over $40 million in incentive payments made to more than 2,000 providers and hospitals. §  722 unique Medicaid providers have been paid an incentive payment. §  Over 1,000 Medicare providers have been paid an incentive payment in Delaware. §  All 7 Delaware hospitals have participated in the Medicaid program. §  EHR adoption in Delaware creates the opportunity for doctors to join the DHIN for access

to the Community Health Record and individual patient level clinical information. §  Most providers who have received a Medicaid EHR Incentive Payment also participate on

the MCO provider panels.

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DHIN Core Services – Participation Rates

Data Senders

§  100% of Hospitals – all DE acute care hospitals + 3 Maryland border hospitals

§  100% of Laboratories – all commercial labs + Public Health

§  95% of Imaging Centers – all hospital based imaging centers + majority of free standing

§  DHIN exchanges hospital and emergency department discharge info with Maryland’s CRISP and Washington D.C’s DC HIE; agreement with southern New Jersey’s NJSHINE

§  77% of Pharmacies §  12% of Ambulatory Practices send the

Continuity of Care Document (CCD) §  9% of Urgent Care and Walk-In Facilities

Data Users and Receivers

§  98% of Delaware Providers + providers in border States

§  100% of Federally Qualified Health Centers §  100% of School Based Clinics §  83% of Urgent Care & Walk-In Facilities §  100% of Skilled Nursing Facilities §  90% of Assisted Living Facilities §  50% of Hospice Facilities §  47% of Behavioral Health Providers §  State Agencies: epidemiologists, immunization

registry; cancer registry; Department of Corrections

§  Medicaid Managed Care MCOs – daily hospital and ED ADT messages from Event Notifications Services (ENS).

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Growth in Services & Capabilities

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End-of-LifeOrdersRegistryHealthCareClaimsDatabase

FraudDetecGonPHRPaGentPortal

DirectSecureMessagingAnalyGcs/ReporGngSvcSpecimenLocaGonforResearch

CommonProviderScorecardBulkclinicaldatatransfersbypaGentcohort

EventNoGficaGonCareSummaryExchangeInterstateHIE-to-HIEExchangeConsulGngServices

MedicaGonHistoryImageSharing

ImmunizaGonRegistryUpgradeandQuery

PublicHealthElectronicLabReporGng

PublicHealthElectronicLabReporGng

ElectronicResultsDelivery

EHRIntegraGonsCommunityHealthRecord

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Growth in Adoption of Newer Services (as of Jun 2017)

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Status of DHIN-EMR Interfaces (as of Jun 2017)

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ADS Advanced MD AllMeds Allscripts (Incl Eclipsys) Amazing Charts Aprima Arete Athena Bizmatics/Prognosis Cerner e Clinical Works (eCW) Epic Eye MD GE Healthcare (Centricity)

GEMMS Glenwood/Glace Greenway Health Fusion InfoQuest McKesson Practice Partners Med Plus - Care 360 MicroMD NextGen Office Practicum (Connexin Software) SequelMed STI Computer Services Waiting Room Solutions

Elekta PCC

iKnowMed PhysiciansXpress

Varian

76%ofDHINEMRPrac2ces

3%ofDHINEMR

Prac2ces

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Utilization of Community Health Record by State Agencies (Data “pull”)

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Highestusersare:•  DOC•  Epidemiology•  CancerRegistry

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State Innovation Model

§  Delaware aspires to be one of the five healthiest states in the nation, to be in the top 10% of states in health care quality and patient experience; and to reduce health care costs by six% by 2019.

§  Measure Delaware’s performance on core dimensions of CDC’s Healthy People 2020 goals.

§  Improve Population Health through “Healthy Neighborhoods.” §  Prioritize integrated care, including behavioral health, for high-risk individuals – the top

5-15% consuming 50% of the costs - and more effective diagnosis and treatment for all. §  All Delaware payers to have at least one Pay for Value (P4V) and one Total Cost of Care

(TCC) payment model for PCPs. §  Common Provider Scorecard: Medicaid and commercial MCOs contractually required to

participate in SIM and new delivery and payment models. Payers submit measures to DHIN for the scorecard.

§  http://www.choosehealthde.com/Providers/Common-Scorecard#common-scorecard-webinars

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Common Scorecard

§ Support for primary care practice transformation and care coordination – single integrated scorecard across all payers.

§ Aligns with measures that will be tied to payment under payers’ value

§ Health technology challenges: Practice service locations not indicated on claims or encounter data for “practice level” reporting. A few scorecard measures are custom; most are nationally recognized standards.

§ Version 2.1 of scorecard produced. Provider enrollment is open.

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Common Scorecard Measures

Quality of Care §  Diabetes: HbA1c control 2

§  Diabetes: Medical attention for nephropathy

§  Medication adherence in diabetes

§  Medication adherence in high blood pressure: RASA

§  Adherence to statin therapy for individuals with cardiovascular disease

§  Medication management for people with asthma

§  High risk medications in the elderly

§  Colorectal cancer screening

§  Cervical cancer screening

§  Breast cancer screening

§  BMI assessment

§  Screening and follow-up for clinical depression

§  Avoidance of antibiotic treatment in adults with 13 acute bronchitis

§  Appropriate treatment for children with URI

§  Childhood immunization status

§  Developmental screening in the first three years of life

§  Fluoride varnish application for pediatric patients

§  HPV vaccination for female adolescents

§  Adolescent well-care visits

§  Well child care: 0-15 months

§  Well child care: 3-6 years

Utilization

§  Follow-up within 7 days after hospital discharge 4

§  Plan all-cause readmissions

§  Inpatient utilization

§  Emergency department utilization

Total Cost of Care §  Total cost of care per patient

http://www.choosehealthde.com/Providers/Common-Scorecard#common-scorecard-measure-chart

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Vision for HIT from Mark Jacobs, DHIN CIO

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What’s next for Delaware HIT Landscape?

§ DHIN is the first HIE to achieve HITRUST certification § Delaware Health Care Claims Database (HCCD) Initiative – developing

governance and technical specifications in support of a health claims database.

§ Governor Carney signed House Joint Resolution 7 on September 7, 2017 to establish a Delaware Health Care Spending Benchmark. §  Delaware continues to make progress in the adoption of value-based

payment reform strategies, and has made investments in transitioning to value-based payment models. Delaware is supporting changes in policy and legislation to help reduce the cost of health care in the state. The Health Care Spending Benchmark will position Delaware to move toward innovative payment reform strategies, address issues in access to care, and quality improvement.

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