Michigan Quality Improvement Network HCCN Grant - A Clinical - - PowerPoint PPT Presentation

January 14, 2020

Michigan Quality Improvement Network

HCCN Grant - A Clinical Perspective

2020 Great Plains Health Data Network Summit & Strategic Planning Rushmore Plaza Civic Center Rapid City, South Dakota

Overview

• 1. Michigan Primary Care Association
• 2. Challenges and Barriers Of member Health

Centers

• 3. Health Center Clinical Leadership and Staff

Engagement

• 4. Michigan Quality Improvement Network-

HCCN Grant Highlights

• 5. PCA-HCCN-CIN Collaboration
• 6. Lessons Learnt and Successes/Outcomes

MPCA History

• 1978 - Organization formed as the Michigan

Association of Rural Health Care (MARHC),

• Networking organization of health centers and

stakeholders interested in fostering primary care in rural underserved communities across the state.

• Realization that urban communities also had great

health care needs, the association broadened its scope

• 1981- to better reflect this broadened scope,

MARHC changed its name to Michigan Primary Care Association (MPCA).

45 Health Centers across MI

provide care for more than

700,000* residents

at over 270 delivery sites across Michigan

*UDS 2018

Michigan Health Centers

Health Center Challenges

 Health Information Technology/ EHR Challenges  Inability to Integrate Clinical, Financial and Operational Data  Lack of Process and Workflow Standardization  Regulatory and Reporting Requirements  Reimbursement and Payment issues  Provider Burnout  Primary Care Workforce Shortages  Emerging Health Care Issues

MPCA Strategic Goals

1. Delivery System Transformation 2. Importance of Data & Analytics 3. Payment Reform

Potential Solutions

Process Technology People

Workflow Efficiencies, Waste Reduction, PDSA. Care Teams, Patient Outreach & Engagement, Provider Satisfaction. EHR Optimization, Interoperability, Data and Analytics Tool.

Health Center Collaboration Path

• Started with MPCA Clinical Quality Committee - 2010
• Formation of MQIN (HCCN) – December 2012

➢Round 1 (2012-2016) – focus on EHR Implementation, Meaningful Use, Quality Improvement-PCMH- 22 Participating Health Centers ➢Round 2(2016-2019) – focus on Population Health Management, HIE, Data Quality and Reporting – 38 Participating Health Centers ➢Round 3 (2019-2022) – focus on Provider and Patient Experience enhancement, Interoperability, HIT Optimization, Data Integration – 40 Participating Health Centers

Collaboration Path, Cont.

• Value Based Care Readiness

➢ PCMH Recognition (33/40 MQIN Members) ➢ CMS Demonstration Projects (MiPCT 1/2012, MiCare Team 7/2016, SIM 8/2016) ➢ Health Center Readiness Assessment (Curis Consulting 2017)

• Integrated Data System selection

➢ May 2016 – Committee Startup ➢ March 2017 – Contract Complete with Azara ➢ December 2017 – 11 Health Centers live ➢ December 2018 – 22 Health Centers live ➢ Today – 29 Health Centers live - 3 more before end of 2020

Health Center Leadership and Staff Engagement

• Support & Successes
• Dedicated Clinical Quality Staff: CMO, Nurse Care Consultant, Associate

Director of Operational Excellence, with PCMH CCE providing PCMH T/TA

• Clinical Networks and Listservs: Monthly QI news letter, QI Directors

Network, CMO Network, Nurse Care Managers Network, Clinicians Listserv etc.,

• Outside Consultants: MQIN provided nationally renowned expert consultant

services- Candice Chitty (PCMH), CURIS (VBC), Coleman Associates (Clinical Process Improvement) etc.,

• Provider Trainings: Maximizing the Use of EHR, ICD, Clinical Conferences
• CHC Benchmarking: UDS, HealthyPeople 2020 benchmarking of Health

Centers shared annually

• Best Practices Identification: Identification of Health Center

best/promising practices and facilitation of sharing between peers

• MQIN specific clinical Quality Measure benchmarking with Azara every

quarter

HRSA’s Health Center Controlled Networks (HCCNs) are networks controlled and acting on behalf of health centers as defined and funded under Section 330(e)(1)(C) of the Public Health Service Act and must consist

• f

at least 10 Health Center

• rganizations.

Health Center Controlled Network (HCCN)

Governance MQIN Leadership Committee

Operate under structure and by-laws of MPCA

Leadership representatives:

• Executive Officer
• Financial Officer
• Operations Officer
• Medical Officer
• Information Systems/Technology
• Quality Improvement
• Transformation Leader

The primary function of the Michigan Quality Improvement Network Leadership Committee is to provide guidance to the Network to support systems and processes that provide optimal

• rganizational results in clinical outcomes, operations, financial sustainability and patient

satisfaction

MQIN Leadership Committee Leadership 2019 Chair – Velma Hendershott 2019 Vice-chair – Dan McKinnon 2019 Meeting Dates February 12, 2019 Teleconference May 14, 2019 Teleconference August 4, 2019 (MPCA Annual Conference) In-person with teleconference option November 19, 2019 Teleconference

HCCN Spread

HCCN Grant 1.0 : MQIN Implementation Date: August 1, 2012 End of Funding Cycle: July 31, 2015 Membership: 22 Health Centers Grant Amount: $750,000 Grant Focus Areas:

1. EHR Adoption and Implementation 2. Meaningful Use 3. Quality Improvement: PCMH, HealthyPeople 2020

HCCN Grant 2.0 : MQIN Implementation Date: August 1, 2016 End of Funding Cycle: July 31, 2019 Membership: 39 Health Centers Grant Amount: $1.125 Million per year

• 1. Health IT Implementation and Meaningful

Use

• 2. Data Quality and Reporting
• 3. Health Information Exchange (HIE) and

Population Health Management

• 4. Quality Improvement

1.Health IT Implementation & Meaningful Use

Certified EHR Implementation and Optimization: Support the adoption, use, and optimization of certified EHRs. Advance Meaningful Use Assist with meeting Stages 1, 2, and 3 Meaningful Use requirements. Response/TA Strategies: EHR/EDR User Groups- 3 EHR and 2 EDR user groups Virtual CHC- Group discounts and vendor negotiations MU assistance- Staff expertise and strategic partnerships (M- CEITA, Medicaid EHR Incentive program office), HIPAA training and Security Risk Assessment help.

MQIN CHC's Achieving MU/Promoting Interoperability

91% 95% 68%

2015= 22 CHC 2016= 38 CHC 2017= 38 CHC

Column1

CHCs that Attested

20 36 26

48% 46% 40%

2015= 22 CHC 2016= 38 CHC 2017= 38 CHC

Column1

EP’s achieving PI

226 368 293 2 3 6 2 6

EHR Challenges

• Non performing or under performing EHRs
• Variety (11) of EHRs being used across Michigan
• Promoting Interoperability reporting issues
• Mergers and Acquisitions of EHR companies
• Health Centers in the middle of transitioning EHR systems
• 2 Health Centers have transitioned in 2018 to a new EHR
• 5 will have to move off SuccessEHS in 2019 due to SuccessEHS end of

life.

EHR Support

• Continued engagement and discussions with EHR vendors
• Financial incentives offered for adopting tools and templates for

EHR optimization, such as:

• PRAPARE tool
• OSIS NextGen EHR toolkits
• Offered a no cost Security Risk Assessment (SRA)
• using HIPAAOne tool hosted by MetaStar.
• EHR trainings and resources
• Nextgen Optimization training at MPCA
• SuccessEHS Optimization and transition training remote and at MPCA
• Assistance with EHR system transitions
• Virtual CHC hosting and technical support
• Hosting of EHR/EDR user groups

• 2. Quality Improvement

Clinical Quality Improvement Support use of health IT to enhance performance on clinical quality measures Operational Quality Improvement Support use of health IT to support health center operational excellence. Advance PCMH Status Assist health centers in using health IT to advance their respective PCMH recognition and implementation efforts. Response and TA Strategies: CMO Network, Clinician Network, QI Directors Network, Lean and PCMH certified staff- personalized TA Trainings and educations on a regular basis Strategic partnership (GLPTN, Consultants)

2016 2017 2018 2019 86.84% 76.92% 67.50% 86.84%

Percent of MQIN Members with PCMH Recognition

Goal

2016 n=37 2017 n=39 2018 n=38 2019 n=38 PCMH Nationally: 70% of Health Centers

25 33 33 30

Healthy People 2020 UDS 2018

4 8 6 10 7 3

Meeting < 4 Goals Meeting 4 Goals Meeting 5 Goals Meeting 6 Goals Meeting 7 Goals Meeting 8 Goals

Number of MQIN Members Meeting HP2020 Goals

11% 21% 8% 18% 26% 16%

N=38

2018 Clinical Quality Assessment

Health Information Technology (HIT) & Promoting Interoperability/Meaningful Use 33

Patient Portal Access to Patients

N=34

21 27 2016 (n=32) 2018 (n=34)

Patients receive summary within 48 hours of visit

8 10 EDRs EHRs

Total Number

• f EHR’s &

EDR’s

N=34

62 % 79 % (97 %)

2018 Clinical Quality Assessment

Telehealth

7 11 2016 (n=32) 2018 (n=34)

Active telehealth services Telehealth services integrated in EHR

N=11

5

3 9 2 Specialties Psychiatry Primary Care

Telehealth Services

(check all that apply) N=11

22 % 26 % (45% )

2018 Clinical Quality Assessment

Social Determinants of Health

14 30 2016 (n=32) 2018 (n=34)

SDOH Tracking

N=34

9 7 5 9 Other Home grown tool SIM SDOH PRAPARE

SDOH tool integrated in EHR

N=30

14 24 2016 (n=32) 2018 (n=34)

SDOH Tool

N=30

44 % 88 % 44 % 71 %

2018 Clinical Quality Assessment

Health Information Exchange (HIE)

16 26

2016 (n= 32) 2018 (n=34)

Connected to an HIE & able to share data electronically

6 10 13 10 22 7 8 19 Other Lab/Xrays results VIPR Referrals State Registries Direct Messaging ACRS ADTs ADT

HIE Services

(check that all apply) N=26

50 % 76 %

2018 Clinical Quality Assessment

Quality Improvement 32

PCMH Recognition

N=34

26

Transformation team that meets regularly

N=34

2 16 2 4 3 26 No Recognition BCBS CARF AAAHC Joint Commission NCQA

Accrediting Agency

(check all that apply) N=34

(76% ) (94%)

2018 Clinical Quality Assessment

Care Management 24

Designated Care Coordinator/Man ager

N=34

Using IT tools such as; registries & dashboards

N=34

24

6 19 22 22 Other Patient & Family Education Transitions of Care Assessment & Care Plan Development

Care Coordinator/Manage r Tasks/Duties

(check all that apply) N=24

(71 %) (71% )

2018 Clinical Quality Assessment

Data Quality & Reporting

20 9 12 25 2016 (n=32) 2018 (n=34)

Full Universe UDS Reporting

32

HEDIS Measure Tracking

N=34

17 2 5 22 Other Wellcentive i2i Azara

Reporting/Analytical tool for data extraction

(check all that apply) N=34

63 % 37 % 26 % 74 %

(94 %)

• 3. Health Information Exchange &

Population Health Management

Health Information Exchange Support secure health information exchange among unaffiliated providers or entities. Population Health Management Support population health management activities leveraging health information across different care settings. Responses and TA Strategies: MQIN representation on MiHIN board Extensive partnerships with sub-state HIEs (Ex; GLHC) Needs assessment interviews with Health Centers

HIE Connection Status

50% 69% 76% 87%

2016 2017 2018 2019

N=38

18 26 29 33

HIE Connection Challenges

• Complicated technical requirements to navigate the

connection process

• Limited staff resources at Health Centers
• Data security and privacy concerns and fear of violating

regulations such as HIPAA and 42 CFR Part 2

• Multiple HIE vendors in Michigan and choosing the right HIE

partner

HIE Connection Successes

• Supporting the Health Centers in navigating through

the selection process to move the connection needle up

• MPCA signed the agreement to become a Data Sharing

Organization (DSO)

• Using Azara connection to receive ADT messages
• Participation in PPQC (Physician-Payer Quality

Collaborative) Use Cases

• MQIN staff on the board of MiHIN the network of

networks and designated state entity

• Partnerships with almost all of the Sub-state HIE in

Michigan

• 4. Data Quality and Reporting

Data Quality Provide strategies to enhance data validity for reporting, aggregation, and analysis. Health Center and Site Level Data Reports Support enhanced data reporting at the health center site and clinical team levels. Health Data Integration Support the integration of health data across all service types provided by the health center. Responses and TA Strategies: Data driven staff with ability for data aggregation and analysis. Exploration and purchase of analytical tool that best serves the data needs of the Health Centers and MQIN

Integrated Data System Successes

• A very robust tool selection process acclaimed nationally, adopted by
• ther HCCNs and PCAs
• Successful transition from BridgeIT to Azara
• 32 Health Centers have signed the contract to date
• 25 Health Centers have implemented the tool and are live on the tool
• Smooth and easy UDS 2018 reporting by the Health Centers with an

ability to look at incremental data

• Specialized Registries such as Opioid and Colorectal Cancer developed
• Risk Score Implementation
• Transition of Care Implementation
• Care Gaps Report for value based contract
• MQIN instrumental in forming the National Azara User Group
• Population Health Management capacity building- Health Centers now

have ability to drill down to patient level, provider level and disease conditions specific data for better management of high risk individuals and disease prevention activities

Integrated Data System Support

• So far $ 950,000 dollars (approx.) worth of financial support provided to the

Health Centers for the tool implementation

• Data aggregation and benchmarking of clinical quality measures
• Identification of Health Center best/promising practices and facilitation of

sharing between peers

• Help with creation of PCMH, Meaningful Use dashboards among many others
• Offered Modules such as Pre visit planning (PVP), Operations and Financial

measures

• MQIN staff (6.3 FTE),including Data Manager providing Care Management

support to the Health Centers with data and quality needs

• Monthly user group to educate and train the Health Center staff
• Hosting and facilitation of the IDS Steering Committee consisting of Health

Center staff

HCCN Grant 3.0 : MQIN Implementation Date: August 1, 2019 End of Funding Cycle: July 31, 2022 Membership: 40 Health Centers Grant Amount (Expected): $1,250 Million annually

HCCN 3.0 Grant Purpose

• The purpose of this funding opportunity is to support health

centers to leverage health IT to increase their participation in value-based care.

• HCCNs will accomplish this purpose by supporting health

centers to: ❖Enhance the patient and provider experience, ❖Advance interoperability, and ❖Use data to enhance value.

Shift from Volume to Value Based Care

d

Volume Based

Payment: Fee-for-Service Providers reimbursed for number of interventions performed (e.g., lab tests, x-rays, procedures, etc.) Incentives: Order/perform as many interventions as possible to maximize reimbursement Focus: Individual patient episode Role of Provider: Siloed approach based on specialty-driven interactions Payment: Outcomes based Providers reimbursed on health outcomes (i.e., was patient readmitted within 30 days? Did patient condition improve following intervention?) Incentives: Keep patients healthy and reduce unnecessary interventions Focus: Outcomes across continuum of care Role of Provider: Team-based across care continuum

Value Based

Shift from Volume to Value Based Care

CIN Formation

• Initial Discussions – 2011 (Did not result in any action)
• Network Formation Steering Committee

(with Starling Advisors) – May 13, 2014

• MOU for 33 Health Centers Early 2015
• MCHN capitalized and incorporated – May 1, 2o15
• CEO Hired – October 2016
• First Contract – October 1, 2017
• Second Contract – January 1, 2019

PCA / HCCN / CIN Alignment

• Common Areas of Focus

➢ Clinical Quality Measures - Diabetes, Hypertension ➢ Health Information Exchange and Interoperability Initiatives

• HCCN developed

➢ Care Managers Network ➢ Social Determinants of Health / Risk Scores ➢ Enhance Pt. / Provider Experience

• Member Representation

➢ Board of Managers ➢ Committees

Financial Success

• Meridian Focused Opportunity Initiative (New $)

➢ 2017-18 – $1,980,000 (25 Health Centers) ➢ 2019 – $194,892 (4 Health Centers)

• Molina Quality Project – Hypertension

➢ 2019 YTD - $432,667

• Meridian Quality Bonus Program (HEDIS)

➢ 2018 - $1,313,389 (25 Health Centers)

• Meridian Shared Savings (Total Cost of Care)

➢ 2018 - Current settlement trend approximately $200,000 ➢ 2019 - Current positive trend approximately $1,000,000

Lessons Learned

• Flexibility required as each Health Center is different
• Need for patient outreach and engagement
• Automated data sharing-single Integrated Data System
• Audit health plan data
• Sustainability (Balance costs / need for resources)
• Accountability (performance / participation)
• Payment based upon group performance
• Focus on a defined set of HEDIS Measures to move the needle
• Meet annually with health centers executive teams to review

performance, to set goals for improved performance and show the resulting impact on the health centers payments.

Current Structure

PCA (1978) HCCN (2012) CIN (2015)

Health Centers

45 CHCs 40 CHCs 32 CHCs

Outcome

Shared Leadership

Shared Strategic Vision Shared Staff

Michigan Community Health Network

Measuring Success

• Develop tools and processes to measure

the Return on Investment (ROI) and what success really looks like.

Questions?

Contact

Faiyaz Syed fsyed@mpca.net 517-827-0887

Our mission is to promote, support and develop comprehensive, accessible and affordable community-based primary health care services to everyone in Michigan.