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State of Michigan HIE Update (without Tina Scott)
1. HIT AND HIE IN THE STATEHIT AND HIE IN THE STATE
OF MICHIGANOF MICHIGAN
Meghan Sifuentes Vanderstelt
HIT Manager
Michigan Department of Community Health
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2. 2
DEPARTMENT OF COMMUNITY HEALTH
2013 STRATEGIC PRIORITIES
MISSION
MDCH will protect, preserve, and promote the health and safety
of the people of Michigan with particular attention to providing for
the needs of vulnerable and under-served populations.
VISION
Improving the experience of care, improving the health of
populations, and reducing per capita costs of health care.
STRATEGIC PRIORITIES
Improve Population Health
Transform the System of Care
Reform the Health Care System
Transform the Department of Community Health
3. THE SIM OPPORTUNITY
(State Innovation Model)
•Collaborating to create meaningful system change in order
to
Improve Care
Improve Health Outcomes
Reduce Costs
•Create a State Healthcare Innovation Plan (SHIP)
• Funding to bring together a broad base of stakeholders to plan
an innovative, multi-payer and multi-sector health care delivery
system transformation
•Testing and implementation funding anticipated
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Center for Medicare and Medicaid Innovation- CMS
4. State Innovation Model (SIM) &
The State Healthcare Innovation Plan
(SHIP)
• Major deliverable – done by September
• SIM Advisory Committee asked to provide input:
• Consider Michigan’s health system, payment models,
performance metrics “as is” and “to be”
• Develop a roadmap for health system transformation
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5. Michigan’s Plan
• Multi-payer, multi-stakeholder, multi-system approach to develop and
test comprehensive system reform
• Invest in a lifetime of good health for people and communities
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6. Innovations being tested
• MiPCT
• Value Partnerships
• Care Bridge
• Health Information Exchange
• Trailblazers
• Community Linkages
• Strengthen Public Health Infrastructure for Improved
Health Outcomes
• Maternal and Child Health Initiatives
• MI Healthcare Workforce Planning Team
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8. The Health Information
Technology Commission
(HITC)
The Health Information Technology Commission is created
within the department to facilitate and promote the design,
implementation, operation, and maintenance of an
interoperable health care information infrastructure in this
state.
HIT Commission Public Act 137-2006
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9. HITC Job Description
• Develop and maintain a strategic plan to guide implementation
of an interoperable health information technology system
• Perform activities within HIT scope as directed by MDCH and
DTMB
• ID strategies to improve ability to monitor health status
• Provide recommendations on policy to achieve HIT adoption
• ID critical issues that affect private/public adoption
• Technical
• Scientific
• Economic
• Governance
• Other
• Increase public’s understanding of HIT
• Promote effective and efficient communication among health
care providers:
• Hospital, physicians, payers, employers, pharmacies, labs, and other
health care entities
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10. 2013 HITC Objectives
Objective: To recommend and advise the Michigan Department of Community Health on Policy
decisions, business and technical needs, and general oversight for the following HIT activities
essential to the State of Michigan HIT and HIE landscape during 2013.
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11. Role of HIT and HIE Stakeholders
• Identify new and emerging best practices
• Provide input for evolving policy framework
• Collaborate and identify potential crossover opportunities
• Coordinate and further advance HIT and HIE in Michigan
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12. Vision beyond HIT and HIE
• Research
• Quality improvement
• Inspire confidence and trust in health IT
• Empower the consumer to be more actively
involved in their health care
• Improve population health
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15. Michigan Medicaid EHRMichigan Medicaid EHR
Incentive Program UpdateIncentive Program Update
June 5, 2013June 5, 2013
Jason Werner, MDCHJason Werner, MDCH
16. Program Summary
This ARRA funded program provides financial
incentives (100% Federal) to eligible
Medicaid professionals and hospitals to
meaningfully use (MU) a certified EHR
technology.
Program administration (90% Federal) is the
responsibility of DCH.
17. Eligible Professionals:
(Non-hospital based with at least 30% Medicaid volume)
• Physicians/Pediatricians (20%)
• Optometrists
• Dentists
• Certified Nurse Mid-wives
• Nurse Practitioners
• Physician Assistants (PA) practicing in a PA-led FQHC or
Rural Health Clinic
Hospitals:
• Acute care -- at least 10% Medicaid volume
• Children’s hospitals
• Critical access hospitals
Who Is Eligible to Receive the
Medicaid Incentive Payments?
18. Certified EHR
Technology
Office of National Coordinator (ONC)
maintains the list of complete EHRs and EHR
modules that have been tested and
certified.
There are now 6 certifying bodies and over
3,000 certified products.
Certified = Capable of meeting Meaningful
Use (MU).
20. Stage 1 vs. Stage 2
*Regardless of the stage of MU, all providers will complete this
number of CQMs in 2014
Stage I
15 Core
5 of 10 Menu
6 of 44 CQM’s
Total of 26 Objectives
Stage II
17 Core
3 of 6 Menu
*9 of 64 CQM’s
Total of 29 Objectives
Effective 4/20/2012 Effective 1/1/2014
21. Core Objectives Comparison
Core Objective Stage 1 Stage 2
1 CPOE Use CPOE for >30% of
medications
Use CPOE for > 60% of medications,
30% of laboratory and 30% of
radiology
2 e-Rx e-Rx for >40% e-Rx for >50%
3 Demographics Record demographics for >50% Record demographics for >80%
4 Vital Signs Record vital signs for >50% Record vital signs for >80%
5 Smoking Status Record smoking status for >50% Record smoking status for >80%
6 CDS Interventions Implement 1 clinical decision
support rule. Drug/drug and
drug/allergy is separate Core
Objective in Stage 1
Implement 5 clinical decision
support interventions and drug/drug
and drug/allergy
7 Labs Menu Objective in Stage 1;
Incorporate lab results for >40%
Incorporate lab results for >55%
8 Patient List Menu Objective in Stage 1;
Must generate one report
Generate patient list by specific
condition
22. Core Objectives Comparison
Core Objective Stage 1 Stage 2
9 Preventive Measures Menu Objective in Stage 1;
Reminders for follow up care
for >20% of patients ≤ 5 or ≥ 65
years of age
Reminders for follow up
care for >10% of patients
with two or more office
visits in the last 2 years
10 Patient Access Menu Objective in Stage 1;
Provide online access to health
information for >10% within 4
business days of EHR update
Provide online access to
health information for
>50% with >5% actually
accessing
11 Visit Summaries Provide summaries for >50% of
office visits within 3 business
days
Provide summaries for
>50% of office visits within
1 business day
12 Education Resources Menu Objective in Stage 1;
Provide education resources for
>10% of all unique patients
Provide education
resources for >10% of all
unique patients
13 Secure Messages New for Stage 2 More than 5% of patients
send secure messages to
their EP
23. Core Objectives Comparison
Core Objective Stage 1 Stage 2
14 Medication
Reconciliation
Menu Objective in Stage 1;
Medication Reconciliation for
>50% of transitions of care
Medication Reconciliation for
>50% of transitions of care
15 Summary of Care Menu Objective in Stage 1;
Provide documents for >50% of
transitions of care/referrals
Provide documents for >50% of
transitions of care/referrals
with 10% sent electronically.
At least one is sent to a
recipient with a different EHR
vendor or successfully testing
with CMS test EHR
16 Immunizations Menu Objective in Stage 1;
Perform one successful test
transmission of immunization
data
Successful ongoing transmission
of immunization data
17 Security Analysis Conduct or review security
analysis and incorporate in risk
management process
Conduct or review security
analysis and incorporate in risk
management process
24. Stage 2 – EPs must select 3 our of 6
Menu
Menu Objective Stage 1 Stage 2
1 Imaging Results New for Stage 2 More than 20% of imaging
results are accessible through
CEHRT
2 Family History New for Stage 2 Record Family History for >20%
3 Syndromic Surveillance Successful ongoing
transmission of syndromic
surveillance data
Successful ongoing transmission
of syndromic surveillance data
4 Cancer New for Stage 2 Successful ongoing transmission
of cancer case information
5 Specialized Registry New for Stage 2 Successful ongoing transmission
of data to specialized registry
6 Progress Notes New for Stage 2 Enter an electronic progress
note for >30% of unique
patients
25. CQMs in 2014 and Beyond
CQM Changes in 2014
Provider Prior to 2014 2014 and Beyond*
EPs Complete 6 out of 44
•3 Core or 3 Alternate core
•3 Additional CQMs
Complete 9 out of 64
Choose at least 1 measure
from 3 of 6 NQS domains
*Regardless of the stage of MU, all providers will complete this number of CQMs in 2014
26. Auditing
MDCH is responsible for the auditing
function including Meaningful Use (MU)
To help with the audit function related to
MU Public Health testing, MDCH has created
a MU repository
27. What is this MU Repository?
Tool used by the Michigan Department of
Community Health (MDCH) to track providers
in the State of Michigan that wish to meet
electronic public health reporting meaningful
use requirements.
28. Medicare?
CMS is running a similar program for
Medicare providers.
Professionals can only claim one incentive
program (either Medicaid or Medicare).
Very similar eligibility criteria.
10,991 Medicare providers have registered
with 8,121 having received a payment.
29. Incentive Payment for
Eligible Professionals
First Calendar Year in which the EP receives an Incentive Payment
Calendar
Year
CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016
2011 $21,250
2012 $8,500 $21,250
2013 $8,500 $8,500 $21,250
2014 $8,500 $8,500 $8,500 $21,250
2015 $8,500 $8,500 $8,500 $8,500 $21,250
2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250
2017 $8,500 $8,500 $8,500 $8,500 $8,500
2018 $8,500 $8,500 $8,500 $8,500
2019 $8,500 $8,500 $8,500
2020 $8,500 $8,500
2021 $8,500
Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
30. Incentive Payment for
Eligible Hospitals
Payments are formula driven and will vary
per hospital.
Most hospitals will receive between $1-$3
million.
Payments are made over 3 years at a 50%,
40%, 10% ratio.
MDCH will utilize cost report data in
deriving the incentive amount.
31. Registrations/Payments
As of 5/29/2013
Registered
Paid
Under
AIU
Paid
Under
MU
Total
Payments
Dollars Paid
(In Millions)
EP 3,756 2,516 431 2,947 $55.6
EH 117 93 50 143 $108.6
Totals 3,873 2,609 481 3,090 $164.2
32. What the rest of 2013 holds?
Launching Stage II of MU
Getting Registration System Ready
Getting Public Health Registries Ready
Getting MU Repository Ready (MSSS, Cancer,
CDR)
Increasing MU Adoption Rates
Electronic Clinical Quality Reporting
HIT and HIE related projects in DCH DCH strategic priorities State Innovation Model Trailblazers and work related to SIM Role of HITC in relation to HIT and HIE in MI Purpose 2013 goals Stakeholder involvement Coordination of all groups and how HIT and HIE foundational to combined endeavors Triple aim and intrinsic role of HIT and HIE
General overview of the DCH Strategic Priorities: Improve Population Health: Integrate services for physical health and mental health and increase coordination among care providers. Current Projects: Strengthen Public Health Infrastructure for Improved Health Outcomes, Maternal and Child Health initiatives, Community Linkages, etc…. Transform the system of care: Support the person centered medical homes and preserve the safety net. Bring the patient into their care by allowing more data available to them. Develop opportunities for persons with mental illness and substance abuse issues to receive early intervention services to prevent incarceration. Current Projects: MiPCT, Care Bridge, Health Information Exchange, etc… Reform the Health Care System: Improve fraud identification and prevention to reduce waste and increase accountability. Focus on quality and outcomes for fee for service and managed care rather than quantity. Develop a standardized method to provide services consistently through the state to improve the quality of care Current Projects: Trailblazers, Medicaid Data Hub, Data Warehouse, etc. Transform the Department of Community Health: Reinvent MDCH by creating an organizational structure that is effective, efficient, interactive, customer focused, and value driven. Establish standards and procedures to enhance customer experience. Ensure IT systems are unified, usable and meet future business needs. Current Projects: Dual Integration, Workforce Transformation, HIE efforts, SIM etc..
Value and Importance of the SIM planning grant and how incorporates with DCH Strategic Priorities 6 states with testing grants, 3 with pre-testing assistance, 16 with planning grants The outcome of the work of the next 5 months will be a comprehensive, state-wide State Healthcare Innovation Plan (SHIP) and a testing plan, which will be used to apply for CMMI support for testing. (The graphic is from the CMMI page describing the funding opportunity – original color.)
1. Provide a Vision Statement for health system transformation. 2. Describe population demographic including Medicaid and CHIP populations. 3. Describe population health status and issues or barriers that need to be addressed. 4. Describe health system models “current as is” and “future to be” States, including the level of integration of behavioral health, substance abuse, developmental disabilities, elder care, community health, and home and community-based support services. 5. Report on opportunities or challenges to adoption of Health Information Exchanges (HIE) and meaningful use of electronic health record technologies by various provider categories, and potential strategies and approaches to improve use and deployment of HIT. 6. Describe delivery system payment methods both “current as is” and “future to be” payment methods. 7. Describe health care delivery system performance “current as is” and “future to be” performance measures. 8. Describe the current health care cost performance trends and factors affecting cost trends (including commercial insurance premiums, Medicaid and CHIP information, Medicare information, etc. ). 9. Describe the current quality performance by key indicators (for each payer type) and factors affecting quality performance. 10. Describe population health status measures, social/economic determinants impacting health status, high risk communities, and current health status outcomes and the other factors impacting population health. 11. Describe specific special needs populations (for each payer type) and factors impacting care, health, and cost. Health System Design and Performance Goals 12. Describe delivery system cost quality and population health performance targets that will be the focus of delivery system transformation. 13. State goals for improving care, population health and reducing health care cost. 14. Describe delivery system models and approaches including how public health care entities, such as publicly-supported university hospitals and faculty practices will transition to value-based business and clinical models. 15. Describe proposed payment and service delivery models.
key building blocks
Number of DCH initiatives that will contribute to SIM goals and overall DCH strategic goals for transforming health.
Alignment of DCH priorities with SIM goals and how Trailblazers will focus on the data, infrastructure, and quality measures to support the SIM efforts. Trailblazers: Alignment of health IT and care transformation activities at the state, local, and national levels Focus is to develop an infrastructure for electronic, streamlined state-level quality measurement, reporting, and feedback This infrastructure will allow for data-driven quality improvement, delivery system transformation, and value-based payment of health care services.
Founded in 2006 by the MI Legislature the 12 gubernatorial appointed members represent a variety of areas within health care system with an emphasis on IT. Includes a representative from DCH and DTMB (Nick Lyon and David Behen).
HITC job and relationship with DCH executive office: offers recommendations to be carried out by the Department on HIE and HIT related iniatives. Offers a venue for difficult and often complex HIT and HIE issues to be vetted and an opportunity for colloboration. Commission focus/oversight was related to ARRA funded groups: MihiN, MCEITA, EHR Incentive Program, Beacon and others but as the ARRA HITECH era draws to a close, what’s next? Continued oversight over
Established in early 2013, graphic overview of the Commission’s main objectives and strategic priorities relative to their four main assigned tasks of: -develop and maintain strategic plan -increase public awareness -ID critical issues -Adopt/create policies and measures to encourage the adoption of HIT Each color section of the plan directly relates to Public Act 137 which established the Commission and outlined the Commission’s main functions and goals.
CONSIDER ROLE OF EXTERNAL HIT AND HIE GROUPS…. HOW DO THEY FIT INTO THE ROADMAP? IMPORTANCE OF THEIR PARTICIPATION IN SEEING THE GOAL. Who doe we see as stakeholders? Stakeholders includes all involved within the HIT and HIE community. Includes all present that have an interest in HIE in Michigan and are committed to seeing this crucial and foundational project through across the State.
Improvements in technology, the accessibility of data, and the work of HIT and HIE in MI is foundational and intrinsic to meeting the goals of transforming MDCH and transforming the system of care. Which all fits into the Triple Aim of improving the experience of care, improving population health, and reducing per capita costs.
The process has already begun for certifying 2014 versions of EHR’s.