CRISP Data Reporting to Support Marylands Total Cost of Care Model - - PowerPoint PPT Presentation

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CRISP Data Reporting to Support Marylands Total Cost of Care Model - - PowerPoint PPT Presentation

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CRISP Data Reporting to Support Marylands Total Cost of Care Model January 9, 2019 7160 Columbia Gateway Drive, Suite. 230 Columbia, MD 21046 877.952.7477 | info@crisphealth.org www.crisphealth.org About CRISP Regional Health Information

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7160 Columbia Gateway Drive, Suite. 230 Columbia, MD 21046 877.952.7477 | info@crisphealth.org www.crisphealth.org

CRISP Data Reporting to Support Maryland’s Total Cost

  • f Care Model

January 9, 2019

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About CRISP

Regional Health Information Exchange (HIE) serving Maryland, West Virginia, and the District

  • f Columbia.

Vision: To advance health and wellness by deploying health information technology solutions adopted through cooperation and collaboration

  • 1. Begin with a manageable scope and remain

incremental.

  • 2. Create opportunities to cooperate even while

participating healthcare organizations still compete in other ways.

  • 3. Affirm that competition and market-mechanisms

spur innovation and improvement.

  • 4. Promote and enable consumers’ control over

their own health information.

  • 5. Use best practices and standards.
  • 6. Serve our region’s entire healthcare community.

Guiding Principles

http://userguide.crisphealth.org/

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CRISP Core Services

  • 1. POINT OF CARE: Clinical Query Portal & In-context Information
  • Search for your patients’ prior hospital records (e.g., labs, radiology reports, etc.)
  • Monitor the prescribing and dispensing of PDMP drugs
  • Determine other members of your patient’s care team
  • Be alerted to important conditions or treatment information
  • 2. CARE COORDINATION: Encounter Notification Service (ENS)
  • Be notified when your patient is hospitalized in any regional hospital
  • Receive special notification about ED visits that are potential readmissions
  • Know when your MCO member is in the ED
  • 3. POPULATION HEALTH: CRISP Reporting Services (CRS)
  • Use Case Mix data and Medicare claims data to:
  • Identify patients who could benefit from services
  • Measure performance of initiatives for QI and program reporting
  • Coordinate with peers on behalf of patients who see multiple providers
  • 4. PUBLIC HEALTH SUPPORT:
  • Deploying services in partnership with Maryland Department of Health
  • Pursuing projects with the District of Columbia Department of Health Care Finance
  • Supporting West Virginia priorities through the WVHIN
  • 5. PROGRAM ADMINISTRATION:
  • Making policy discussions more transparent and informed
  • Supporting Care Redesign Programs
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Point of Care

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Point of Care: Unified Landing Page (ULP)

  • Main point of access

for CRISP applications

  • Search page allows

multiple patients to be selected for specific apps

  • Primary users include

ambulatory practices, care coordinators, and payers

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  • View of critical patient

data including care alerts, care teams, and prior visits with customizable widgets

  • Data returned through

CRISP’s FHIR-enabled API gateway and is made available directly in EHRs as well

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Point of Care: Patient Snapshot

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Point of Care: InContext Data Delivery

  • View of critical

patient data, pulled from multiple repositories and embedded in the end user’s EHR

  • Integrations can
  • ccur in EHR native

app stores or through API queries

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Care Alert: a short description of critical information for patient care generated by CRISP participants within their EHR.

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Point of Care: Care Alerts

“Mrs. Franklin’s pain medications are managed entirely by Dr. Dolor. Securely text him prior to prescribing any controlled substances.” “Mr. Stevens has CHF exacerbations that typically and rapidly respond to 40 mg IV furosemide in the ED with close follow up the next day in the office. Call/text Dr. FIRST at 111-333-4444 if you are considering admission.” “This patient has a MOLST. Please note: DNR, DNI, no feeding tube, no antibiotics.”

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Care Coordination

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Care Coordination: Encounter Notification Service

  • Solves a basic problem

for organizations responsible for a patient's health – where is my patient? When did my patient access care?

  • Real-time or batch alerts to
  • rganizations and providers

based on known treatment and care management relationships

  • Notifications can be delivered via

a secure folder, the ULP , EHRs, or databases

  • Organization/patient

relationships are displayed at the point of care through ULP or In- Context

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Care Coordination: Care Programs

  • Patient panels submitted manually or automatically in

ADT feeds can include care program data such as care teams, contact information, and program enrollment

  • Program metadata, without PHI, can be submitted to

CRISP to show services available to all patients enrolled in that program, ACO, or payer plan ➢ Information can include services offered, 24hr support numbers, regions served, and other similar information

  • CRISP matches patients to panels to a program directory

in real-time to display comprehensive information

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Population Health

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Population Health: CRISP Reporting Services (CRS)

  • Dashboards from

administrative data to support high-needs patient identification, care coordination, and progress reporting

  • Primary data sets are hospital

casemix and Medicare claims and claim line feed (CCLF)

  • Different levels of patient data

available for hospitals based

  • n HSCRC payment

requirements and Total Cost

  • f Care Model participation
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  • Web address: www.reports.crisphealth.org
  • Hospitals and organizations have a CRS Point of Contact (POC)

that can credential users for reports (PHI and/or nonPHI)

  • Contact CRISP Support for assistance:
  • support@crisphealth.org
  • 1(877) 952 7477

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CRS: Getting Access

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HSCRC Casemix Reports

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  • Maryland Hospital Acquired Conditions (MHAC)
  • Potentially Avoidable Utilization (PAU)
  • Quality Based Reimbursement (QBR)
  • Readmissions
  • Market Shift
  • Demographic Adjustment
  • Transfers

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HSCRC Regulatory Reports

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Executive Dashboard and Detailed Executive Dashboard

  • Provides a high-level view

into hospital utilization, compared to the previous year

  • Can view trends across time
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Casemix: Care Coordination Program Enrollment

  • Tracks overtime how well

hospitals assign patients with Care Plans, Care Alerts, Care Managers and PCPs

  • Subsequent tabs provide detail
  • n current month of data
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  • Provides hospitals with cross

hospital data for patients with utilization

  • Summary provides utilization

and charges information for specific selection criteria

  • Detail is usually leveraged to

generate patient lists based on a set of definitions

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Casemix: PaTH

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Casemix: Panels for Practices

Panel 1 Panel 2 Panel 3 Panel 3 Panel 4 Panel 5 Panel 6 Panel 7

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Casemix: Pre/Post

  • Upload patient panel with enrollment date in program
  • Compare patient utilization and charges before and after
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Casemix: Pre/Post

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Medicare Analytics Data Engine (MADE)

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MADE: Data Source and Access

Medicare Claim and Claim Line Feed (CCLF) Data

  • Receive monthly from CMS
  • Contains only Medicare Fee-

for-Service beneficiaries

  • Data processed and hosted by

hMetrix on behalf of CRISP

  • MADE application updated

monthly

  • Hospitals receive data for

patients with a hospital or ED visit in the past 36 months

Credentialed access for PHI and non-PHI users

  • Non-PHI users have access to 20

summary/aggregate reports

▪ No roster functionality ▪ No patient-level data

  • Hospital POC can credential

hospital users

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Goals of MADE

  • Provide insight into where providers may focus Care Redesign and

care coordination programs for maximum impact

  • Specialized reports for MDPCP and ECIP
  • Monitor population-level trends over a series of utilization and

payment metrics

  • Facilitate providers’ use of patient- and population-level data to

improve care coordination for rising and high needs patients

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MADE Capabilities MADE provides reports across four modules:

  • Population

▪ Patient- and population-level details for your attributed populations

  • Episode

▪ Acute and post-acute care utilization for 90-day episodes of care following a hospitalization

  • Pharmacy

▪ Reports categorized by utilization, volume, cost, high-risk medications, utilization by top therapeutic categories and many more

  • Monitoring

▪ High-level trend reports to track population changes over time

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Common Use Cases for MADE Reports Executive/Population Health Manager

  • Overall program and population

monitoring

Financial

  • Identify the opportunity to

streamline patient care at the population-level

Clinical

  • Access to patient-level claims to

assist in care management and patient tracking

Population Episodes Pharmacy Monitoring

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Use Case: Executive Monitoring

Key Utilization Metrics Report

  • “30,000ft Perspective” on population and

roster utilization metrics over 36 months

SNF Utilization Report

  • Identifies high-quality SNFs to further

develop provider network

Acute & Post-Acute Care Management

  • Provides overall readmission rates and

discharge patterns for episodes initiated in a given hospital

Population Analytics

  • Population-level reports across a defined

roster

  • High-level utilization and trends

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Use Case: Financial Tracking

Opportunity Summary Report

  • Identifies potential savings opportunities by

streamlining discharge patterns out of the hospital

Post Acute Variance Explorer (PAVE) Report

  • Identifies discharge patterns by physicians and

clusters them to determine savings

  • pportunities

Episode Benchmarks

  • Compares hospital performance relative to

aggregate target prices using CMMI BPCI guidelines

Pharmacy Reports

  • Compare brand/generic substitution and

medication synchronization

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Use Case: Clinical Intervention

Population Navigator (PHI)

  • Create and manage patient

rosters

  • Identify patients according to

pre-defined measures

  • View detailed patient care history

visually through the Patient Timeline

Population Analytics

  • Population-level reports across a

defined roster

  • High-level utilization and trends

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MPA Monitoring and Sandbox

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Resources

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Training materials, recorded webinars, and patient education flyers can be found at: https://crisphealth.org/resources/ For general questions, please reach out to CRISP Customer Care Team: support@crisphealth.org | 877-952-7477

Megan Priolo, DrPH, MHS Senior Director of Reporting & Analytics | CRISP Office: 443-430-2999 Email: megan.priolo@crisphealth.org