Statewide Provider Directory Project Overview Mar 2017 1 Provider - PowerPoint PPT Presentation

Statewide Provider Directory Project Overview Mar 2017 1

Provider Directory Highlights Directory of accurate, trusted provider data available to vetted healthcare entities (Not consumer-facing) Authoritative data sources that feed the directory are matched, scrubbed, and given a quality score – We are starting with the trusted provider directory related data from Common Credentialing and augmenting with additional data sources Ongoing management of the data is handled by staff (“data stewards”) that ensure data displayed in the provider directory is accurate One-stop Complete Correct data Current data shop for data Provider data 2

Key uses Facilitate care Efficiencies for coordination and health Resource for health Operations information exchange care analysis (HIE) • Access to a trusted, • Find Direct secure • Source of data on single, complete messaging (DSM) where and when source of provider and addresses and other providers practice to practice information provider information support analysis of • Validate data allowing electronic claims and other data clinical data to be sent • Support generation of residing in an health care entity’s own to the correct recipient metrics and data • Find providers for provider directory analysis for quality • Support entities’ referrals and care improvement and coordination related payment efforts need to meet • Meet meaningful use • Support research and requirements for updated/accurate objectives regarding inform policy provider directories transitions of care 3

Provider Directory Users Providers, including care Independent coordinators Physicians Clinics Associations Efficiencies for Operations Local HIEs Hospitals and Care Coordination Health Systems Data resource for analytics CCOs OHA and DHS Payers 4

Provider Directory Services at a glance Data services – Data leveraged from authoritative sources are scrubbed, scored, matched, and maintained Web portal - Query the web portal and export results* Data extracts – Predefined, static extracts of data from the provider directory Custom extracts - customizable extracts of data from the provider directory Integrated provider directory - Integrated access to and from the provider directory via an Application Program Interface (API) or web services *Not expecting data entry component in initial phases 5

Types of providers in the Provider Directory • The term “Provider” is broad • The Provider Directory can contain data on individual practitioners, care coordinators, organizations including facilities, hospitals, and ambulatory surgical centers. • It is NOT required for a Provider to have an National Provider Identifier (NPI) in order to have a record in the Provider Directory • “Who” will be in the Provider Directory is at least initially determined by the data sources the feed the directory and the use cases. For example: – Common Credentialing has 26 different provider types – MMIS has 77 different provider types 6

High Level Provider Directory Data Types  Provider/Organization name  Address (street, billing, practice, mailing)  Contact info (Phone, fax, email(s), website)  Demographics (gender, language, race)  Provider type and specialty  Provider affiliations (clinics, payers) with effective dates  License and certifications (type, dates, renewals)  Identifiers (NPI, Medicaid ID, etc.)  Direct Secure Messaging Address information  Other provider/practice information: Accepting new patients, office hours, ADA accessibility Initial data sources: Common Additional : Public Health, National Plan and Credentialing, MMIS, CareAccord Flat-File Provider Enumeration System (NPPES), Directory, EHR Incentive Programs, Patient- Provider Enrollment, Chain and Ownership Centered Primary Care Home (PCPCH), System (PECOS), All Payer All Claim (APAC), CCO networks HIEs, Other 7

Medicaid Managed Care Rule/ Provider Directory Data Elements Analysis MCD Managed Care Rule Provider Directory Phase Requirement Provider’s name and group affiliation Phase 1 Street address Phase 1 Telephone number Phase 1 Website URL Phase 1 Specialty Phase 1 Accepting new enrollees Phase 2 Cultural and linguistic capabilities TBD Office/Facility accommodations for TBD physical disabilities 8

Timeline • Spring: Convene external subject matter expert workgroup • Fall: CMS Medicaid Funding Approval 2014 • Winter: Release Request for Information (RFI) • Spring: Convene first external advisory group meeting 2015 • Spring: Harris (System Integrator) onboard • Summer: Issue Request for Proposal (RFP) 2016 • Fall: Select vendor (MiHIN) • Winter: Vendor contract finalization • Spring: Vendor onboard 2017 • Spring: Release 1 • Fall: Release 2 2018 • Spring: Release 3 2019 9

Key takeaways • The statewide Provider Directory is a tool for healthcare entities including CCOs, to access valuable provider directory data – It will not be consumer-facing • We are in the contracting process now, vendor (MiHIN) is expected to be onboard Spring 2017 (pending CMS, DAS, DOJ approvals) • The Provider Directory is expected to be operational in 2018 but is contingent on when MiHIN contract is approved • Work still needs to be done to cross-walk all Medicaid managed care rule data requirements to the Provider Directory 10

Questions More information can be found at: www.oregon.gov/oha/OHIT/Pages/Provider-Directory- Advisory.aspx Karen Hale Provider Directory Program Manager Office of Health Information Technology karen.hale@state.or.us 503-602-3252 11