acmha: the college for behavioral health leadership june 8, 2011 patricia mactaggart...
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ACMHA: The College for Behavioral Health Leadership
June 8, 2011
Patricia [email protected]
HEALTH INFORMATION TECHNOLOGYHEALTH INFORMATION TECHNOLOGY INFRASTRUCTURE FOR THE INFRASTRUCTURE FOR THE
TRANSFORMATION OF HEALTH CARE & TRANSFORMATION OF HEALTH CARE & HEALTH CARE DELIVERYHEALTH CARE DELIVERY
AGENDAAGENDASURVIVAL:
•TRANSFORMATION OF HEALTH CARE DELIVERY•TRANSFORMATION OF HEALTH CARE ADMINISTRATION•TRANSFORMATION OF YOU = e-EVERYTHING
SUCCESS: BETTER HEALTH, BETTER CARE, LOWER COSTS
•HEALTH IT IS THE “VEHICLE”•INTEROPERABILITY & CONNECTIVITY THE “HIGHWAY”•QUALITY & PATIENT SAFETY IS THE “DESTINATION”
STANDARDIZATION: SAVES LIMITED RESOURCES•AIU & MU•HIEs & HIEs•MITA
SURVIVAL: TRANSFORMATION OF HEALTH CARE DELIVERYSURVIVAL: TRANSFORMATION OF HEALTH CARE DELIVERYFocus on Where “Going” – Not Where “From”Focus on Where “Going” – Not Where “From”
• Accountable Care Plans
• Integration:– Physical and Behavioral Health– Integration Public-Private: Premium Based Subsidies– Integration Medicare-Medicaid: Standardized Assessment,
Extensive Data Analysis & Sharing, Financial Incentives for Quality
• Reimbursement Reform
Triple Aim: Better Care, Better Health, Lower Costs
SURVIVAL: TRANSFORMATION OF HEALTH CARE DELIVERY SURVIVAL: TRANSFORMATION OF HEALTH CARE DELIVERY Opportunities for ProvidersOpportunities for Providers
• Community-Based Care Transitions Program– Competitive Pilot: 5-year to manage care transitions for
highest-cost enrollees with multiple chronic conditions (Sec. 3026, 2011-15)
• Bundling Payment Pilot Program • Acute, inpatient hospital services, physician services,
outpatient hospital services, and post-acute care services for an episode of care (Sec. 3023, 2013-18) (Medicare & Medicaid)
• Medicaid Safety Net Global Payment Demo & 1% FMAP increase for states that eliminate cost-sharing for preventive services (Sec. 4106, starts 2013)*
SURVIVAL: TRANSFORMATION OF HEALTH CARE SURVIVAL: TRANSFORMATION OF HEALTH CARE ADMINISTRATIONADMINISTRATION
• Patient Centric: Consumer Engagement & Education
• Administrative Simplification:– No More Paper– e-Signature– Standardization: • Public/Private• Across State Agencies• State to National
SURVIVAL: TRANSFORMATION OF YOUSURVIVAL: TRANSFORMATION OF YOU e-Everything e-Everything
• EHR: Electronic Health Record (across health organizations)
• EMR: Electronic Medical Record (within health organization)
• HIE: Health Information Exchange (across providers, purchasers, regulators) & Health Insurance Exchange
(health benefit exchange)
• HIT: Health Information Technology (EHRs, HIEs, Registries, Tele-health)
• e-PHR: Electronic Personal Health Record
SURVIVAL: TRANSFORMATION OF YOUSURVIVAL: TRANSFORMATION OF YOU e-Everything e-Everything
• 4010 TO 5010: Updating the Book (1/1/12)
• ICD-9 to ICD-10: Whole New Book
(10/1/13)
• Privacy & Security Requirements: “Breaches”
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SUCCESS: HEALTH IT IS THE VEHICLE
Interoperability and Connectivity are the Highway
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MEANINGFUL USE OF HEALTH IT MEANINGFUL USE OF HEALTH IT Gets Us Where We Want to GoGets Us Where We Want to Go
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Research Institute
Beacon Community
IntegratedDelivery System
Community Practice
Health Information Exchange
Health CenterNetwork
FederalAgenciesState
Public Health
AggregationAnalysisDissemination
State Agencies
Adapted from ONC Diagram
SUCCESS = ACTIONABLE INFORMATION SUCCESS = ACTIONABLE INFORMATION Get the Data Once and Use it for Care, Oversight, Policy Get the Data Once and Use it for Care, Oversight, Policy
Development Across Public/Private & State Agencies Development Across Public/Private & State Agencies
MEASURE SUCCESSMEASURE SUCCESS Data on Performance
• CHIPRA Quality Measures for Children,• MU Measures,• ACA Quality Measures for Adults,• HCBS Measures for Waivers,• PQRI Measures • MCOs: External Reviews & Quality
Improvement• ACO Measurement
MEANINGFUL USE STAGE ONE MEANINGFUL USE STAGE ONE EPEP Core Measures (15)Core Measures (15)
Medications• CPOE *• Drug Interaction Checks *• e-Prescribing• Active Medication List *• Medication Allergy List
Management of Care•Maintain Problem List *•Record Vital Signs *•Record Smoking Status *•Record Demographics *•Clinical Decision Support *•E-Exchange of Clinical *
Quality Measures * Patient Centric Engagement•Electronic Copy of Health Information *•Clinical Summaries *•Protect Electronic Health Information *
EH Core Measures (14)
MU STAGE 1 QUALITY MEASUREMENTMU STAGE 1 QUALITY MEASUREMENTCore – Alternative – Menu Core – Alternative – Menu
EP• 3 Core Clinical:
– Hypertension– Smoking
Assessment/Intervention– Adult Weight
Screening/Follow Up• 3 Alternative Clinical:
– Children Weight Assessment & Counseling **
– Child Immunization Status **– 50+ Influenza Immunization
• 3 Additional Clinical:– Select from 38 Options
** Overlap CHIPRA National 4 Total
EH - 15• VTE Prophylaxis within 24 hrs• Intensive Care Unit VTE prophylaxis• VTE discharge instructions• Incidence of potentially preventable VTE • Anticoagulation overlap therapy• Platelet therapy on unfractionated heparin • Thrombolytic therapy for patients arriving
within 2 hours of symptom onset• Ischemic stroke: Discharge on Anti thrombotics‐• Ischemic stroke: Anticoagulation for Arterial
Fibrillation/flutter• Ischemic or hemorrhagic stroke: Antithrombotic
Therapy by day 2• Ischemic stroke: Discharged on Statin
Medication• Ischemic or hemorrhagic stroke: Stroke
Education• Ischemic or hemorrhagic stroke: Rehabilitation
Assessment • Admission decision time to ED departure for
admitted patients• Median time from ED arrival to ED departure
for admitted patients
MU STAGE 1 EP CORE MEASUREMENT MU STAGE 1 EP CORE MEASUREMENT SSpecifications Examplepecifications Example
Record DemographicsDenominator: No unique patients seen by the EP during the EHR reporting period. Record all of the following demographics: (A) Preferred language (B) Gender (C) Race (D) Ethnicity (E) Date of birth
Numerator: Number of patients in denominator who have all demographic elements (or a specific exclusion if the patient declined to provide elements or if recording an element is contrary to state law) recorded as structured data.
Requirement: The resulting percentage (Numerator ÷ Denominator) must be more than 50 percent for EP to meet this measure.
MEANINGFUL USE MEANINGFUL USE EP EP Menu Measures (5 of 10)Menu Measures (5 of 10)
Medications•Drug Formulary Checks *•Medication Reconciliation *
Management of Care•Clinical Lab Test Results *•Patient Lists *•Transition of Care Summary *
Patient Centric Engagement•Patient Reminders•Patient Electronic Access•Patient-specific Education Resources *
Public Health•Immunization Registries Data Submission *•Syndromic Surveillance Data Submission *
EH: 5 of 10: 1 must be from PH Advanced Directives & Lab Results
STANDARDIZATIONSTANDARDIZATIONSaves Limited ResourcesSaves Limited Resources
• ONC = lead for standards and certification of EHR
• CMS = lead for Medicaid/Medicare Incentive Program
• Incentives to Standardize: Meaningful Use: – EMR = $0– Certified EHR = Maximum of $63,500 (Medicaid) & $43,000 (Medicare)
“One Offs” are Not GoodWhen it comes to data sources & IT infrastructure, not so unique
STANDARDIZATION CURRENT EFFORTSSTANDARDIZATION CURRENT EFFORTSAIU and Meaningful UseAIU and Meaningful Use
• State Activities for 2011-2012: – States Providing Provider Directories, Secure
Messaging (Step 1) and HIEs– State Strategic/Operational Plans– State Medicaid HIT Plans– State HIT to Support MU
• Provider Activities for 2011-2012: Follow the Money– Adopt, Implement, Upgrade of certified EHRs for
Medicaid (AIU) – Medicare/Medicaid Meaningful Use: EPs & EHs– Quality Reporting: Stage 1
CORE SUPPORT MEDICAID PROVIDING CORE SUPPORT MEDICAID PROVIDING MEDICAID/MEDICARE PROVIDERS FOR MUMEDICAID/MEDICARE PROVIDERS FOR MU
• entralized Provider Registry/Directory: – through a secure web-interface.– individual and entity identity management – specific levels of security, including authentication and
access controls and necessary firewalls
• Secure Messaging: – “on ramp” for meaningful use – technical functionality of a secure web service– direct messaging or email attachments using Direct standards– role based access and management, message and data
validation, privacy and security (encryption and signed data user agreement-DURSA), monitoring and auditing
TRANSITION OF CARE SUMMARYTRANSITION OF CARE SUMMARYCritical for Community IntegrationCritical for Community Integration
• Vocabulary of Transition of Care
• “Scope”• Time Line• Performance Standards
HIEs & HIEsHIEs & HIEsHEALTH INSURANCE EXCHANGESHEALTH INSURANCE EXCHANGES
•Single Integrate Pathway •Easy for Individuals to Explore Health Coverage Options•Individuals can Quickly and Accurately Enroll into Coverage
•Common systems and High Levels of Integration: No “Gap” in Coverage
•100% FFP for IT Infrastructure
Medicaid138% FPL
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Basic Health Plan139% to 200%
Tax Subsidy138% to 400%
MITAMITAMEDICAID ELIGIBILITY & SYSTEMS TO SUPPORT DISABILITIESMEDICAID ELIGIBILITY & SYSTEMS TO SUPPORT DISABILITIES
Single Doorway = Computer Screen
Uniform Assessments
Simple, Secure, Scalable& Standards Based
New Focus – New Funding
KNOCKING ON THE DOOR TO GET INKNOCKING ON THE DOOR TO GET INHIT for Behavioral HealthHIT for Behavioral Health
• Behavioral Health Information Technology Act of 2011 (S 539) – Sen. Sheldon Whitehouse (D-R.I.)– Expand Medicare & Medicaid Meaningful Use Incentive
Payment Eligibility to Behavioral Health, Mental Health and Substance Misuse Treatment Professionals and Facilities.
– Eligible Providers would include Licensed Psychologists and Clinical Social Workers;
– Eligible Hospitals would include Psychiatric Hospitals
“Traction” Hard to get in Environment of “Cuts”
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MOVING FORWARDMOVING FORWARDHHS Strategic Plan HHS Strategic Plan
2010-20152010-2015