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HI E Data: Value Proposition for Payers and Providers
Session #21, March 6, 2018 Laura McCrary, Executive Director, KHIN Tara Orear, Senior Ambulatory Systems Analyst, Newman Regional Health Dirk Rittenhouse, Director at Anthem
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HI E Data: Value Proposition for Payers and Providers Session #21, - - PowerPoint PPT Presentation
HI E Data: Value Proposition for Payers and Providers Session #21, - - PowerPoint PPT Presentation
HI E Data: Value Proposition for Payers and Providers Session #21, March 6, 2018 Laura McCrary, Executive Director, KHIN Tara Orear, Senior Ambulatory Systems Analyst, Newman Regional Health Dirk Rittenhouse, Director at Anthem 1 Conflict of
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Tara Orear, Senior Ambulatory Systems Analyst, Newman Regional Health
Has no real or apparent conflicts of interest to report.
Conflict of I nterest
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Dirk Rittenhouse, Director at Anthem
Has no real or apparent conflicts of interest to report.
Conflict of I nterest
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Agenda
- Introduction to KHIN
- Introduction to Newman Regional Health Medical Partners
- Introduction to Anthem/Amerigroup
- Overview of KHIN Data Analytics Products
- Overview of Data & Analytics for Providers-Provider Perspective
- Overview of Data & Analytics for Payers-Payer Perspective
- Challenges & Findings
- Conclusion & Questions
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Learning Objectives
- Describe how KHIN is aggregating data for business intelligence
and analytic purposes.
- Detail how providers are using KHIN data for Value Based Payment
Models, MIPS reporting and Improved Patient Outcomes.
- Detail how payers are using KHIN data for HEDIS reporting and
- ther use cases.
- Discuss future opportunities to use HIE data.
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Kansas Health I nform ation Netw ork: Overview
- 501c3 Not for Profit-2010
- Over 25 million patients available for query through connections with
- ther exchanges
- 9,900 providers
- 5.2 million unique patients in KHIN
- 1,000+ healthcare organizations in production with CCDs and HL7v2
- 120,000 HL7 messages daily
- 9,000 CCDs daily
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New m an Regional Health: Overview
- 25 bed inpatient CAH:
– Rehab Unit, OT/PT/ST, OB with Level 2 nursery, ER (6 physicians), Hospitalists (2 physicians, 3 APRNs, 1 RN), ICU, Cath Lab, Breast Center
- Outpatient services:
– Lab, Radiology, OT/PT/ST, infusions, Pain Clinic, Wound Care, Cardiopulmonary and Sleep Lab, Express Care, Occupational Health
- Provider Based Outpatient Clinics:
– 24 providers: Orthopedics, Cardiology, Pediatrics, Family Medicine and General Surgery
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Ambulatory Center
KHIN Analytics Process: Fragmented Clinical Data
Office Visit Hospital Stay Specialist Referral Post-Acute Care
High-cost patients see 10+ providers annually with data spread across care settings Unified, Normalized Clinical Data Ready for Analytics
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Successful Integrations With EMRs
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Products and Services 2018
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CONNECT
HEALTH INFORMATION EXCHANGE WEB-BASED PHYSICIAN PORTAL LONGITUDINAL PATIENT RECORD BI-DIRECTIONAL IN EHR SECURE CLINICAL MESSAGING/DIRECT STATE LEVEL INTERFACES SUCH AS: IMMUNIZATIONS SYNDROMIC SURVEILLANCE REPORTABLE DISEASES CANCER REGISTRY (AND OTHERS)
ENGAGE
ONC CERTIFIED PERSONAL HEALTH RECORD VIEW, DOWNLOAD & TRANSMIT PATIENT EDUCATION SECURE MESSAGING PATIENT ELECTRONIC ACCESS CERTIFIED IMMUNIZATION RECORD
ANALYZE
ANALYTICS DASHBOARDS INCLUDE: HIGH RISK QUALITY METRICS READMISSIONS DISEASE REGISTRIES POPULATION HEALTH CONTROLLED SUBSTANCES* DATA EXTRACTS ALERTS
TRANSFORM
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Provider Utilization of KHI N Data
- Data Sharing
– XDS.B Direct Messaging (CCD) – HL7: demographics, admissions, discharges, transfers, progress notes, diagnosis, procedures, lab results, medications
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Provider Utilization of KHI N Data
- Clinical Impact
– Increased Continuity of Care
- Medication reconciliation
- Immunization records
- Problem List
- Lab Data
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Provider Utilization of KHI N Data
- Patient Impact
– More complete history
- Patient information is imported directly to EHR
– Transition of Care simplified
- Less “re-telling” of history, data at the provider’s fingertips
Higher Patient Satisfaction Scores!!!
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Provider Utilization of KHI N Data
- Financial Impact
– Payer Incentive Program
- + $230,000 in reimbursement for 2017
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Payer Utilization of KHI N Data
Anthem Use Cases:
- Quality Measures and Care Gaps
- Risk Adjustment Programs
- Care Management – Notification, Care Coordination, Re-
Admission Risk , Medication Reconciliation
- Pay for Performance
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Payer Utilization of KHI N Data
Benefits:
- Reduce Medical Records Requests
- Improve Quality Scores – HEDIS/STARS
- More Accurate Member Health Profile
- Analytic Capabilities – Value Based, Population Health,
Predictive Analytics
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Payer Utilization of KHI N Data
Clinical Data is Incremental and Additive:
- Incremental to Existing Data: Diagnosis, Procedures,
Medications, Lab
- Additive to Existing Data: Allergies, Vitals (Ht., Wt., BP, BMI)
Smoking Status, Immunizations, Race, Ethnicity, Medication Orders, Medical Reports (H&P, Imaging, Discharge Summary, Progress Notes, etc.)
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Payer Utilization of KHI N Data
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Conclusions:
- 1. Data Derived from Health Information Exchanges can be utilized
for a variety of purposes as allowed under HIPAA and respective Participation Agreements.
- 2. Combining the HL7 v.2 and CCD/CCDA data together produces
the richest and most robust data set.
- 3. Normalizing and de-duplicating the data is a complex task.
- 4. Move from a focus on interoperability to data quality and quantity.
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