PRACTITIONER DATABASE PROJECT

Advisory Committee Meeting

HealtheConnections Health Planning (CNYHSA)

Monday, February 24, 201414th Floor Conference Room, Corning Tower

Empire State Plaza, Albany, NY 12237

Agenda Understanding the Possibilities

potential uses of CAQH provider database (UPD)potential for streamlined physician credentialing

Understanding Vendor Capabilities Data Work Group Recommendations System Development Issues Next Meeting

Uses and Potential Uses of CAQHUniversal Provider Datasource (UDP)

Welcome CAQH Christine Stroup, Credentialing Sales Manager Sorin Davis, UDP Managing Director

CAQH (Council for Affordable Quality Health Care) was established in 1999 to promote administrative simplification, common HIE operating rules, etc.

The CAQH Universal Provider Datasource (UDP) is used to support credentialing processes across the nation including those of the NYS Medicaid program, major insurers, hospital systems and provider organizations such as IPAs.

Council for Affordable Quality Healthcare CAQH Universal Provider Datasource (UPD)

Demographics, Licenses and Other Identifiers (including NPI)

Education, Training and Specialties Practice Details – Sites of Service, Days and

Hours, Contact Information Billing Contact Information Hospital Affiliations Malpractice Liability Insurance Work History and References Disclosure Questions Images of Supporting Documents

MassachusettsCredentialing Verification System

Welcome Lori Burgiel, Executive Director, Health Care Administrative Services (HCAS)

HCAS was established by Mass Association of Health Plans as a non-profit entity to operate the program.

Program uses Aperture Credentialing as its CVO (Credentialing Verification Organization), partners with CAQH for data submission, serves non-public payors.

Other Examples Credentialing Systems

Washington State (Complex Structure, Uses Aperture as CVO, partners with CAQH)

Arkansas (State is its own CVO) Common Credentialing Application Forms (19

States) Florida, North Carolina, Colorado, Illinois, Maine Minnesota, Oklahoma, Maryland, West Virginia

Health Care Exchange Directories (Colorado) All Payer Databases (Most States)

Other Examples

Consumer Oriented Physician Profile Systems Many states have these systems. Most are modeled

after New York State’s System. Most do Virginia is one of few states that post a downloadable

file Most states do not allow for data downloading. North

Carolina, for example, has a profile system, but it is not part of state’s workforce analysis system which relies on licensure and survey data, much like NYS at the present

Self grown database with Quality Measures (Maine)

Potential for StreamliningPhysician Credentialing in NYS

Keith ServisActing Deputy Executive DirectorOffice of Primary Care and Health System Management

Understanding Vendor Capabilities Data Validation

Mark Biddle (Enclarity, a LexisNexis Company) Josh Schoeller, VP, Chief Solutions Architect

Master Data Management Services Joe Kelly (Treo Solutions)

Other Services Special Datasets (eg. SK&A, Health Market

Science) Taxonomies Unique Applications (e.g. ZocDoc)

Data Work Group RecommendationsShould have certain desired capabilities

be searchable, queryable, and able to produce simple tables and tabulations.

be downloaded and readily incorporated into user projects

have geographic and other algorithmic fields that support data analysis and file linking

have strong internal validation and/or error correction capabilities

able to incorporate or receive user input (e.g. updates and feedback on the status of practitioners)

Data Work Group Recommendations Build on/relate to Other Initiatives

Should leverage state acquisition/investment in internal/external sources and systemsPhysician Profile RedesignInnovation Plan/Primary Care DevelopmentAll Payer DatabaseMedicaid Information System RFPNYeC/HIT/Info ExchangeHealth Benefit ExchangeMay need to improve existing management information systems, especially those related to licensure

Data Work Group Recommendations Meet Needs of Multiple Stakeholders

NYSDOH Offices (Primary Care, Health Insurance, Quality and Patient Safety, Public Health Practice, Information Technology Transformation)

NYSED Office of the Professions, Board of Regents, and professional boards

Center for Health Workforce Studies Regional health planning agencies

and quality improvement collaboratives

Economic development councils, county & regional planning agencies and development organizations

County health departments Rural Health Networks/NYSARH

RHIOs/NYeC/HI-TECH/SHIN-NY Entities with IT expertise Area Health Education Centers Health Advocates and disease

associations (e.g. Cancer Society, Arthritis Foundation)

Hospitals, Health Centers, and other providers of health care

Provider and Insurer Associations Foundations which support health

related projects Consultants and private sources of

Information Schools of Public Health, Medical

Schools, and other institutions involved in provider training and research

Consumers

Workforce Development

Planners/Policy Makers

FoundationsFunders

Education/Training

Licensure

Data Work Group Recommendations Other Recommendations

Should incorporate/reflect national standards for provider directories but not be inhibited by them

Should use Profile or other system to collect data that cannot be gathered from other sources

Should have indices or other mechanisms to permit user to understand the relationship between practice locations, corporate structures, hospital systems, IPAs, ACOs, and managed care networks

Should have robust validation, standardization, and error correction processes

Data Work Group Recommendations Desired Data Elements Should Include:

name degree and type of licensure key identifying information

(NPIN, License Number) associated practice group(s) practice location(s) specialization & sub-

specialization professional education,

advanced training, & certifications

nature of professional activity

PCMH status FT/PT status and clinical work

hours/FTE time devoted to patient care birth date or age staff appointments at hospitals willingness to accept new

patients and/or Medicaid patients (or % of practice allocated to Medicaid patients)

practice volume & productivity geographic identifiers analytical algorithms/classifiers

Data Work Group RecommendationsSources Reviewed

New York State: DOH Profile, Center for Health Workforce Studies Registration Survey, NYSED Licensure Files, Medicaid Managed Care Directory, Medicaid Provider Enrollment Data

Federal: National Plan and Provider Enumeration System (NPI), Medicare Enrollment Files and PECOS, National Provider Data Bank, DEAA, TRICARE (Dept of Defense)

Association: CAQH, AMA Profile, Medical Society of the State of NY (MSSNY), Federation of State Medical Boards (FSMB), American Board of Medical Specialties (ABMS)

Commercial: SK&A, Treo Solutions, Maximus, ZocDoc, Health Market Science, FolioMed, Medical Marketing Services (AMA License), MEDICAlistings, Medical Mailing Services and similar services (USAData, Physicians Lists, DoctorListPro)

System Development IssuesContinued Discussion

How should it be related or connected to other data systems and functions

Where should the system be housed or operated

how should it be supported? how can data be shared with the widest range

of users? should different classes of users or privilege

levels be established are legal and regulatory changes needed

Potential Systems and Functions Licensure/Registration Workforce Surveys DOH Physician Profile All Payer Database Medicaid Information Systems Insurers/Payors/Managed Care Networks NYeC/HIT/Info Exchange Health Benefit Exchange Private Vendor Systems Credentialing Processes Other

Potential Hosting Options creation of a state sponsored system such as SPARCS used for

hospital discharge data. Such a system could be run by NYSDOH which oversees the provision and quality of health care, NYSED which is responsible for licensing or joint venture of both departments

component of an existing or yet to be developed system such as the All Payer Database, an HIE structure, or a statewide credentialing system

creation of a statewide collaborative that involves governmental and non-governmental entities such as the New York eHealth Collaborative (NYeC) which coordinates the joint activities of NYSDOH and regional health information organizations (RHIOs)

use of an existing independent non-profit entity with workforce expertise such as the Center for Heath Workforce Studies (CHWS)

contract with a proprietary entity that specializes in practitioner databases and provider directories

Potential Financing Options

licensing and registration fees assessments and user fees state and federal budget appropriations Medicaid waivers, or use of funds

related to implementation of the Accountable Care Act and NYS Health Care Reform.

Demonstration program funded by Federal, State, and Foundation Sources

Next Steps Finalize/accept recommendations related to:

Data elements and sources that should be included Broad information system requirements and principles Strategy that should be used to develop, implement, and

operate the system on a long term basis where should the system be housed how should it be supported how should it be related or connected to other data systems should different classes of users or privilege levels be

established are legal and regulatory changes needed

review project final report that will outline preferred strategy for plan implementation

Project Objective:Develop Plan for a database that:

covers physicians, physicians’ assistants, midwives, and nurse practitioners (100,000-120,000 individuals)

integrates information from multiple sources provides accurate, validated, geographically-based

information on number of practitioners, associated practice group(s) and office locations; specialization and sub-specialization; professional education and advanced training; age, major professional activities, and other practice characteristics

meets the needs of a wide range of users

How to reach usHealtheConnections Health Planning

(CNYHSA)109 South Warren Street, State Tower Building Suite 500Syracuse, NY 13202(315) 472-8099

Sara Wall Bollinger, Executive Director swbollinger@healtheconnections.org

Terry Richmond, Deputy Director/Senior Associategmrichmond@healtheconnections.org