Health Information Technology Oversight Council December 1, 2016 1 - - PowerPoint PPT Presentation

Health Information Technology Oversight Council

December 1, 2016

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Agenda

12:30 pm Welcome, Introductions and HITOC Business 12:50 pm HIE Onboarding Program and HIE Strategic Planning Implications 1:45 pm Break 1:55 pm HIT Governance 3:00 pm HIT Fee Landscape 3:35 pm Public Comment 3:40 pm Closing Remarks

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Goals of HIT-Optimized Health Care

• 1. Sharing Patient

Information Across the Care Team

• Providers have access to

meaningful, timely, relevant and actionable patient information to coordinate and deliver “whole person” care.

• 2. Using Aggregated

Data for System Improvement

• Systems (health systems,

CCOs, health plans) effectively and efficiently collect and use aggregated clinical data for quality improvement, population management and incentivizing health and prevention.

• In turn, policymakers use

aggregated data and metrics to provide transparency into the health and quality of care in the state, and to inform policy development.

• 3. Patient Access to

Their Own Health Information

• Individuals and their

families access their clinical information and use it as a tool to improve their health and engage with their providers.

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Oregon Health Policy Board (OHPB) Update

• SB440 Report to Legislature

– Bill required OHPB to develop a statewide plan for the collection

• f use of healthcare data across OHA, DHS and Division of

Consumer and Business Services (DCBS) – Quality Corp. was contracted to conduct an environmental scan, gap analysis and prepare recommendations – OHPB presented reflections on ten high-priority recommendations as a foundation for further work

• Action Plan for Health: Refresh

– Published in 2010, setting foundation for coordinated care model, expanded coverage, and health equity for Oregonians – OHPB is currently working toward refreshing the plan

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OHPB (cont.)

• Health IT-related recommendations in SB440 report:

– Advance transparency and break down information silos (e.g., across OHA/DHS) – Social determinants of health – develop a data collection framework – Partner across agencies to identify higher-priority programs to maximize impact

• n social determinants of health

– Robust provider directory that is widely available for analysis – Data quality enhancement and validation efforts on high-value data sets – Statewide public / private partnership model for comprehensive HIE – Clinical Quality Metrics Registry – expand beyond Medicaid

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HIE Onboarding Program (HOP) Update

Kristin Bork, Lead Policy Analyst

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Parallel Bodies of Work

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HIE Strategy—HITOC

Governance Model—OHA and OHLC

HIE Onboarding Program Development— HOP-Advisory Group

HIE Onboarding Program (HOP) Goals

• Accelerate HIE and fill gaps for critical Medicaid

providers’ ability to coordinate care through connecting to HIE entities

• Incentivize cross-organizational HIE by supporting

Oregon’s HIE entities that make up its network of networks by funding onboarding for critical Medicaid providers

• Establish and formalize the Oregon HIE network of

networks by ensuring HIE entities in Oregon are able to support HITOC’s HIE objectives and OHA’s Medicaid

• bjectives by setting criteria that entities would need to

meet to be eligible for funding

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Stakeholder Engagement to inform HOP

• OHA has met with a wide array of stakeholders already
• OHA convened the HOP Advisory Group (HOP-AG) to

help with initial program development

• OHA will continue meeting with stakeholders prior to

launch and for the duration of HOP

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Stakeholder Engagement: Completed and Planned

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Area

Completed Planned Behavioral Health

• Assoc. of Community Mental

Health Programs (CMHP)

• Oregon State Hospital
• HOP-AG rep
• Focus Group: CMHPs and

Certified Community Behavioral Health Clinics

• Behavioral Health HIT Scan

Oral Health

• Advantage Dental
• HOP-AG rep
• TBD

Long Term Services and Support

• Leading Age
• Focus Group: Leading Age

members Corrections Health

• Oregon Youth Authority
• Dept. of Corrections
• Assoc. of Counties
• Oregon Sheriffs Assoc.
• Assoc. of Community Corrections

Directors HIE

• rganization

s

• Jefferson HIE
• Regional Health Information

Collaborative

• Advantage Dental Information

Network

• EDIE/PreManage
• TBD

Stakeholder Engagement: Completed and Planned (cont.)

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Area

Completed Planned Supported Housing

• Housing with Services
• HOP-AG Rep
• Additional as other models

emerge Social Services

• Central City Concern
• HOP-AG Rep
• Outside In

Individual Providers

• Focus group

CCOs

• November HITAG
• January Open HITAG

Coordinated Health Partnerships (CHP)

• CHP Council and internal

workgroup

• Gorge Health Council
• Continue on CHP Council and

internal workgroup Standing OHA Groups

• October HCOP
• November HITAG
• Ongoing communication with

relevant groups

Stakeholder Engagement: Completed and Planned (cont.)

• Government to government: tribal liaison transition

precluded HOP-AG participation, engagement work continues

• Additional contacts needed?

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HOP Advisory Group (HOP-AG)

• Meet in late 2016/early 2017 – may reconvene as

needed

• Advisory only—no consensus requirement
• Share deliverables with internal/external stakeholders
• Use output to inform HOP plan
• May help OHA develop a staged HOP approach
• Input may be relevant for the HIE Strategic Plan

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HOP-Advisory Group: Participants

Name/Title Organization

Maili Boynay, IT Director Legacy Bud Garrison, Dir. of Clinical Informatics OHSU Brandon Gatke, CIO Cascadia Behavioral Health Mark Hetz, CIO Asante Ryan Freeman, Data Analyst Capitol Dental Care Sonney Sapra, CIO Tuality Healthcare Gina Seufert, VP Physician & Clinic Services Tillamook Adventist Kim Whitley, VP/COO IHN CCO Andy Zechnich, CMIO Providence Michael Heidenreich, HIE Coordinator PacificSource Jeremy Wood, CIO Central City Concern David Caress, Director of Quality Management Central City Concern Howard Klink, Executive Director Housing with Services

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HOP-AG: HOP Framework

• Draft HOP Framework

– Fundamental Principles – HIE Onboarding Program Objectives/Goals – HIE Entity Criteria – HIE Minimum Services/Data Expectations – Measures of Success – Priority Provider Types and Phasing – Approach to Statewide Network of Networks – Risks and Mitigations – Assumptions

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HITOC Input on HIE Onboarding Program

• Review/discuss framework handout
• Thoughts on how we should best leverage HIE

Onboarding funding: – If we are successful with HOP – and bring Medicaid providers onboard HIEs in Oregon - what will change in the next 3-5 years?

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HIE Onboarding Program Tentative Schedule

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HOP-AG: Themes

• HIE Onboarding must support HIE that has meaningful

value for participants

• Prioritization

– Balance expansion (harder providers) and enhancement (traditional/easier providers) – Incentives for challenges such as new data types, new EHRs, geographic location, etc.

• Data

– Varied minimum data sets, depending on org type, provider type, use case, etc.

• Other Challenges

– How do organizations determine what the options are and what the costs/benefits of joining an HIE are? – Lack of information about landscape

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HIE Onboarding Program (HOP) and HIE Strategic Planning Implications

Sean Carey, Lead Policy Analyst

• 1. Sharing Patient

Information Across the Care Team

• 2. Using Aggregated

Data for System Improvement

• 3. Patient Access to

Their Own Health Information

Larger Issues/ Opportunities from HOP Stakeholder Engagement

Some identified needs / opportunities fall outside the scope of HOP, have larger strategic implications, or could serve to complement and support HOP

– Exchange is multi-faceted, complex and involves many different entities and usages

• Varied minimum data sets, depending on org type, provider type, use case,

etc.

– To be successful, HIE onboarding may require additional enablers and supports:

• EHR upgrades, vendor requirements, high-speed internet access
• Support for providers’ EHR costs

– Implications for governance and HIT Commons:

• Coordination of learning and cross-organizational assistance
• Sharing best practices in HIE
• Large health systems and organizations could support resources for
• nboarding providers—training, etc.

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Strategic planning process and progress

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Step in the process Status Timeframe Goals (confirm) Completed December 2015 Aims/objectives Completed December 2015 State’s role In process Summer 2016 Prioritizing objectives and

• utcomes

Drafted Fall 2016 Assess environment:

• Identify current state
• Identify changing policies, etc.

Ongoing Ongoing Define/refine strategies:

• Technology
• Governance/Finance
• Policy, legal, education, etc.
• Pilots/initiatives

End of 2016/2017 Roadmap/Final Plan Initial draft roadmap 2017

OHA’s HIT Priorities (a short list)

Past

• Physical health: EHR Adoption and Meaningful Use payments
• Basic common exchange: Direct secure messaging

Current

• Support for care coordination (CCOs, PCPCHs, local HIE)
• Hospital event notifications
• Core infrastructure components (Provider directory, e.g.)
• Initiatives/pilots/grants:
• Telehealth, OpenNotes, end of life/ePOLST
• Behavioral health consent, opiate prescribing/PDMP

Future

• Support for value based payment and population management
• CCOs/payers, PCPCHs, CHPs, new HIT entities
• New opportunities for funding and evolution of governance
• HIE onboarding funding
• Advancing care coordination
• Interoperability and query
• Connecting care team: behavioral health, dental, long term

care, social services, corrections, etc.

• Expanding notifications to other transitions of care
• Support for consumer access/mobile health

Current Approach and Activities

Oregon Approach Current/planned activities Private and public HIEs provide services to some entities

• Regional HIEs
• Private efforts – population mgmt., care

coordination tools, interfaces, hosted EHRs

• Some leverage vendor driven solutions and/or

national efforts State provides enabling or connecting statewide services

• Direct secure messaging flat file directory
• Statewide provider directory (planned)
• Hospital event notifications/EDIE

State provides common services to fill gaps and provide high-value

• CareAccord
• Common credentialing program (planned)
• Clinical Quality Metrics Registry (planned)

State provides clarity around strategic direction

• Certified HIT and recognized standards
• Statewide Direct secure messaging
• Clarity on state role allows investments locally

High Level HITOC Work Plan

2016 2017

Policy Topics

• Interoperability
• Behavioral Health Information Sharing
• Other Policy Board or HITOC-identified Topics
• Chartered Committee Policy Work
• Identifying new priorities for 2017-

2019 biennium

Strategic Planning

• Rely on Existing

Business Plan Framework

• Update HIT strategic plan
• Release of next strategic plan

Oversight

• Oregon HIT Program (e.g. Provider Directory, Common Credentialing, HIE Onboarding

Program)

HIT Environment

• Define scope of

environmental scan

• Behavioral Health scan
• LTSS scan

Reporting

• Define format and

scope of HITOC Reporting to Board

• Report to OHPB

and Legislature

• OHPB report due Winter 2016-

2017

• Second Report to Legislature on

OR HIT Program released Summer 2017

Federal Policy

• Federal Law/Policy Considerations (e.g. MACRA, ONC initiatives, privacy and security

requirements (42 CFR part 2, etc.))

Oregon HIT Roadmap (dates are estimated)

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2016 2017 2018 2019 - 2021 Landscape Ongoing landscape assessment to understand environment, refine strategies and measure progress to goals Strategic Planning and Policy Strategic Plan updated Rolling 3-Year Update HITOC: Ongoing oversight, strategic planning and reporting work (see HITOC work plan) Governance and Financing HIT Utility/ HIT Commons Concept Design/ Launch Transition programs as appropriate EDIE Utility (live – 2015) Utility Pilot Ends/ Transition HIE Onboarding Program (funding) Design Implement/ Launch Phase 1 Launch Phase 2 Funding ends 2021 Medicaid EHR Incentive Program (MEHRIP) Last year for enrollment Funding ends 2021 Technology and Services Common Credentialing Procurement Implementation Live CareAccord (live – 2012) Business plan updated CQMR Procurement Implementation Live for CCO/ MEHRIP Expand to P4P PreManage (OHA Medicaid Subscription) Live Ends/ transitions Oregon Medicaid Meaningful Use TA Program (OMMUTAP) Live Ends Provider Directory Procurement Implementation Live Flat File for DSM (live – 2015) Transition to PD Initiatives/ Pilots Telehealth, OpenNotes Behavioral health info sharing Ongoing pilots and initiatives to support goals and objectives

OHPB – SB440 report

• Health IT-related recommendations:

– Advance transparency and break down information silos (e.g., across OHA/DHS) – Social determinants of health – develop a data collection framework – Partner across agencies to identify higher-priority programs to maximize impact

• n social determinants of health

– Robust provider directory that is widely available for analysis – Data quality enhancement and validation efforts on high-value data sets – Statewide public / private partnership model for comprehensive HIE – Clinical Quality Metrics Registry – expand beyond Medicaid

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OHPB Refresh: Action Plan for Health

• OHA is collecting information on opportunities, complexities and

vision for the next 5 years for OHPB review

• OHPB retreat in mid-January to review recommendations and begin

to prioritize and map out overall vision

• HITOC’s work on strategic plan components key to this effort;

– Staff will share the draft HIT components for OHPB consideration with HITOC members in mid-December to review

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Break

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Oregon HIT

Public Private Partnership Model

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Context

• Oregon commitment to coordinated care
• Long history of transformation vision to coordinate care across

care settings

• Accelerated by Affordable Care Act
• Momentum of Coordinated Care Organizations
• Alignment of performance metrics, performance reporting and

alternative payment methodologies

• Need for economies of collaboration, limited state funds to

finance shared infrastructure.

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Experience

• Oregon HIT strategy development in 2013
• Create IT infrastructure support for healthcare

transformation

• Patient and family
• Providers
• Coordinated Care stakeholders
• Policy makers
• Envisioned "Commons" approach to community wide

access to essential information

• "Democratization" of essential information
• Governance structure to reflect interests of common good 31

Experience (cont)

• Other states have achieved successful public / private partnerships:
• WA state has One HealthPort as its “state designated entity" with community
• versight
• Kansas Health Information Network
• Michigan Health Information Shared Services (MiHIN)
• EDIE "experiment" demonstrated several principles of successful

“Commons" or utility approach

• All affected parties able to participate
• Financial model that fairly proportions financial participation with ability to pay
• Governance structure reflects interested stakeholders beyond funders
• Common infrastructure agreements, e.g., standard data submission, technical

assistance, common contracts, collaborative learning, oversight discipline

• Single Fiscal Agent

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Experience (cont)

• Evolution of collaboration
• One Health Port single sign on: voluntary, informal,

standardization

• EDIE / PreManage: formal state/private "co-sponsorship"

with common governance structure

• State financial support for Medicaid share of infrastructure, and support for

high priority Medicaid users of PreManage (CCOs, behavioral health teams)

• Private financial support/sponsorship for primary care clinics
• Standard vendor contracts, data use agreements, research and analytic

support, and decision making policies

• Prescription Drug Monitoring Program – HIT Gateway
• Coordinated legislative strategy
• Coordinated technology solutions (e.g., Gateway)
• Potential for shared funding for infrastructure and operations that leverages

federal, state and private funding

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Principles for “Commons” Governance

• Everyone "in" with commitment of proportionate resources

(financial or other)

• Clear scope in service to the critical few, common good initiatives
• Clear economies of scale
• Clear performance expectations
• Clear stakeholder /sponsor governance inclusion & selection
• Clear dispute resolution, adherence to decisions
• Regulatory and legislative support for decisions
• Clear exit plan / consequences
• Clear roles / RACI defined

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HIT Commons Governance: Roles

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Coordinate and Convene

Standardize and Offer

Centralize and Provide

Example - EDIE Utility

Relatively Light

Agreements and Principles

Charter Data sharing agreement Data stewardship Shared legal oversight

Coordinate

Best practices/ learning collaboratives Knowledge sharing Data reporting/ analytics

Standardize

PreManage

Centralize

EDIE Subsidies for critical access hospitals

Organization formality

State/OHLC co-sponsors OHLC serves as external fiscal agent

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HIT Commons/ Utility Options

Light Robust

Agreements and Principles

Principles of participation; Data use agreements Data governance

Coordinate

Promote initiatives (e.g. Open Notes); Communication/education; Reporting on data showing ROI/value

• f Commons

Learning collaboratives; Supporting pilots (e.g., funding); Significant evaluation

Standardize

Implementation guides; Value add tools/services (e.g., PreManage) Technical assistance; Endorse/certify technology solutions

Centralize

Provide funding and subsidies (e.g., HIE Onboarding); Provide light-weight services (e.g., PDMP Gateway) Vendor management/ procurement; Provide significant centralized services

Organization formality

Sponsors with external fiscal agent Stand-alone legal entity (e.g., non-profit); Formal public/private partnership 37

Next Steps

• Further develop/refine Commons concept
• Conduct sensing sessions among stakeholders
• Learn from other states’ experience
• Initiate interim governance advisory group to develop business plan

proposal including:

• Confirming business case
• Assessing alternative models and governance structures
• Develop proposed governance including:
• Scope
• Principles
• Initiative selection criteria
• Structure / membership
• Financing plan
• Implementation plan
• Review formal Commons proposal with stakeholders for agreement
• HITOC, OHLC, CCOs, etc.

HIT Fee Landscape

Susan Otter, OHA Melissa Isavoran, OHA

• 1. Sharing Patient

Information Across the Care Team

• 2. Using Aggregated

Data for System Improvement

• 3. Patient Access to

Their Own Health Information

HITOC’s Role in Fee Oversight

• State programs must have legislation enabling them to set fees, and

require legislative approval of fee structures and amounts

• Fees are developed at the program level with active, public

stakeholder engagement

• HITOC is uniquely positioned to:

– review fees in development across HIT programs – provide input as to the broader impact of specific program fees,

• for example, opportunities for alignment or efficiency

HIT Fee Landscape*

Program Stakeholders Affected by Fees Oversight Fee Implementation Date Common Credentialing Credentialing organizations (e.g., Hospitals, Health plans, CCOs, IPAs, ASCs) and Credentialed practitioners Common Credentialing Advisory Group Late 2017 – 2018 Provider Directory Users (non-Medicaid) Provider Directory Advisory Group 2019-2020 Care Accord TBD OHA leadership, HITOC 2018+ EDIE Hospitals, Health Plans, OHA for CCOs EDIE Utility 2014/2015 PreManage Health plans, CCOs, HIEs, Other users (clinics are typically sponsored) EDIE Utility 2015 PDMP Gateway Practitioners and Prescribers PDMP Advisory Commission 2017

Mandatory OHA-sponsored Program offered by private service

*Does not reflect broader fee landscape such as licensing, regulatory, and other optional fees such as access to state datasets, etc.

Common Credentialing Update

Melissa Isavoran

Background on Common Credentialing

The Oregon Common Credentialing Program:

• A mandated, fee-based program that will centralize the

collection and verification of practitioner information:

– A centralized web-based electronic Solution – Practitioner/designee submit information and attest every 120 days – The collection and verification of credentialing information – Credentialing organization retrieve practitioner credentialing information

• Established by Senate Bill 604 (2013), with an extension

via Senate Bill 594 (2015); requires six months’ notice

• Includes leveraging Health Care Regulatory Board Data

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Legislation sponsored by Senators Alan Bates and Elizabeth Steiner-Hayward and supported by the Oregon Medical Association, the Oregon Association of Hospitals and Health Systems, Regence, and more.

Common Credentialing Vendor Selection

• Competitive procurement process resulted in selection Xerox

partnered with Medversant to carry out system/program:

– Xerox is primary teammate for overall services (includes Help Desk)

– Medversant is responsible for CC Solution and verification services

• Vendor contracts to be finalized in January 2017
• Ensuring accountability via:

– Monitoring the integrated project schedule – Daily standups and weekly meetings on – Establishing and Monitoring Service Level Agreements (System

• perational metrics with penalties and rewards)
• Coordinating stakeholder participation via plans for:

– User Acceptance Testing – Early adoption for a two month period – Change management for users – Online training materials – Advisory Group status updates and feedback

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Implementation Approach

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Fee Structure Principles

Stakeholders agreed to the following principles:

Original Fee Principles Fees should be:

• Balanced considering benefits and resources
• Efficient and economical to administer
• Transparent and justifiable in development
• Stable and produce predictable income to support costs

Additional Fee Principles

• Tiered fee structure based on credentialing organization (CO) health

care practitioner panel sizes

• Leverage other funding sources where possible

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Fee Development Update

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Fee Structure Credentialing Organizations One-Time Setup Fee Tiered fee based on practitioner panel size Annual Subscription Fee Expedited Credentialing Fee Flat fee per expedite request/per practitioner Health Care Practitioners Initial Application Fee Flat fee (one-time)

Agreed fee structure...

Other revenue assumptions:

• State contribution (OHA and grant funds) to support

implementation and some state staffing costs

• Provider Directory contribution for access to information

• Model to include 11 fee

tiers based on distributed panel size ranges

• Tiered fees set to achieve

fair discounts as tier panel size increases to account for economies of scale

CO Fee Structure Tier Development

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Tier Practitioner Panel # of COs Tier 0 ≤ 5 51 Tier 1 6-25 64 Tier 2 26-100 84 Tier 3 101-250 52 Tier 4 251-500 25 Tier 5 501-1,000 19 Tier 6 1,001-2,500 23 Tier 7 2,501-5,000 10 Tier 8 5,001-10,000 6 Tier 9 10,001-15,000 1 Tier 10 > 15,000 4 Total 339 Developed based on CO survey results related to practitioner panel sizes

OCCP Revenue Coverage Estimates

• Planning and Implementation

– Includes credentialing vendor, Harris Corporation, quality assurance vendor, and OHA staffing and overhead costs – Planning period includes all costs prior to implementation start – Implementation period is 15 months total and begins at credentialing vendor start date and (10 months system implementation, two months

early adoption, three months warranty period)

• Annual ongoing budget

– Includes credentialing vendor, Harris Corporation, and OHA staffing and overhead costs – 12 months operations and maintenance costs

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Note: Final contract negotiations are underway and will determine future revenue needs.

Communicating Program Benefits

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Practitioner Benefits

• Centralized solution to enter credentialing information
• Automated one-time initial application; updates thereafter
• Minimized recredentialing process and less reverification
• Reduced overall workflow; especially if have numerous COs
• Increased revenue possibilities due to quicker credentialing

Credentialing Organization Benefits

• Centralized solution of verified credentialing information
• Automated notifications for changes to Practitioner records
• Minimized application mailing and processing
• Reduced overall workflow and 3rd party verification costs
• Increased revenue possibilities due to quicker credentialing

Fee Development – Next Steps

• Determine actual Provider Directory contribution
• Obtain actual OCCP vendor costs via contract negotiations
• Engage the Oregon Medical Association, the Oregon

Association of Hospitals and Health Systems, and the Oregon Health Leadership Council on actual fees

• Finalize fee structure at a public CCAG meeting
• Incorporate final fee structure into administrative rule
• Legislative session ensues…

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Adoption Plan

Targeting Marketing and Outreach:

 Communicate programmatic details to mandated users  Participate in health care forums to inform users

Health Care Regulatory Board Participation:

 Ensure the leveraging of data from the Oregon Medical

Board, the Board of Nursing, and the Board of Dentistry

 Engage other boards as possible

Early Adoption:

 Solicit for Early Adopters  Begin early adoption 2 months prior to system “go live”

Change Management:

 Solicit for volunteer Change Leaders  Develop a change management plan

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 Finalizing OCCP fees and associated policy (e.g., rules)  Activating the adoption plan  Revising and finalizing programmatic rules  Focusing on quality assurance by obtaining stakeholder

input, ensuring vendor accountability, and aligning with national credentialing standards and HIT policy

 Continuing stakeholder engagement along the way:

• Common Credentialing Advisory Group
• Subject matter experts
• Professional associations
• General outreach efforts

Activities Moving Forward

“Go live” Early 2018

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Questions?

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More information can be found at: www.oregon.gov/oha/OHIT/occp Send questions, comments, or volunteer interests to: credentialing@state.or.us

Public Comment

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Next Meeting

Next Meeting: February 2nd, 2017 Location: Lincoln Building, Portland

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