Community Health Care Association of New York State / Arcadia Solutions

Community Health Care Association of New York State / Arcadia Solutions

Building the New York State Center for Primary Care Informatics: CHCANYS’ Data Warehouse

Today’s Objectives

1. Learn benefits of statewide data and why CHCANYS and many PCAs nationwide are establishing data warehouses.

2. View examples of reports from the Arcadia reporting platform.

3. Learn about the pilot project and what it means for a participant health center.

Agenda

• Statewide Center for Primary Care Informatics Overview

• About Arcadia

• Challenges and Arcadia Perspective

• Pilot Demonstration: Data Aggregation and Reporting Demonstration

Project: Statewide Data Warehouse of Health Center Data

Statewide Primary Care Informatics Benefits

Phase 1 Phase 2

 Practice management (EPM)  Health records (EHR)

 Payer

 Federal (e.g., census, labor)  State (e.g., SPARCS)

Analysis and reporting to support the following:  Quality Improvement -quality measurement

& benchmarking with peers  PCMH

 Health Home  MU

 UDS

Analysis & Reporting to support the following:  Demonstration of VALUE delivered by the

FQHC model - the Triple Aim: higher quality, better outcomes, lower cost

 Advocacy

 Pay-for-Performance (P4P)  Partnerships

 Planning for growth  Fund development

Proposed Scope

About Arcadia: Our Primary Care Associations Clients

Bending The Cost Curve = Opportunity

2009 $2.5 Trillion

1990 $724 Billion

2019 $4.6 Trillion

Source: CMS

Landscape Is Changing Quickly

Sept. 26, 2011

Aug. 30, 2011

• Health Centers are better equipped to thrive under health reform than private physician networks.

• Emerging payment models align with comprehensive primary care.

• Success will require care delivery transformation:

– New technical tools & methods for measuring success.

– Rethinking roles and responsibilities.

• Leaders of our Health Centers should be focused on the cultural challenges of making the leap.

Can you precisely articulate and demonstrate the value of primary care?

• Engages stakeholders to ensure their needs are met.

• Have a consistent understanding on how each component is measured.

• Leverage the primary care value formula:

Own Your Data…Own Your Future

Meaningful Use may not achieve all your organizational goals.

FQHCs will need to demonstrate improved effectiveness, insight, and efficiency throughout the continuum of care. The depth and quality of data will be critical in determining success.

• Meaningful Use of EHR will be the “floor” not the “ceiling.”

• “Recognition” as a Health Home will be a requirement, top-performers will go beyond.

• Competition will be increasingly fierce as the overall system re-evaluates the value assigned to Primary Care.

• How you are paid is how you should pay. This creates more opportunities

Health Home As A Methodology

EHR / Registry / Meaningful Use

Data

Aggregation / Exchange (HIE)

PCHH _Management Performance

SHIFT FOCUS OF

CARE

Demonstration Program Value for Health Centers

• Quality of Document = Quality of Clinical Care Delivered: Get credit for the high quality work your providers are delivering. Ensure clinical care delivered is reflected accurately and reportable from your EHR.

• Increase Transparency: Know where how ALL your patients stand. No need for selective sampling (70 pt manual chart audit).

• Identify Best Practices And Benchmarking: Identify your best performers and bring everyone up to their level.

• Improve Quality: Use the information to identify and prioritize the areas of opportunity. Baseline performance and track progress against your improvement programs. Easily manage your patients by population.

• Easy to Run Reports (UDS, MU, PCHH): Run your reports with the click of a button. Drill down to health center, location, provider and patient levels to understand where you stand. Make course corrections long before the

submission date.

• Improve Reporting Efficiency: Free up analyst time for analysis vs. spending hours, days or even weeks on data collection.

• Drive More Patients To Your Health Center: Demonstrate improved quality and cost effectiveness of CHCs; driving more patients to CHCs. Seize the opportunity provided in 2014 by the health benefits exchange.

• Prepare for Uncertain Future & Assure Sustainability: Empower your providers and staff to address patient center health home, Pay For Performance contracts, Accountable Care Organizations, and develop evidence based guidelines.

Participation in the pilot program will deliver substantial cost savings to the health centers and their providers and serve as the foundation for continued savings through improved healthcare quality and outcomes.

Data Aggregation & Reporting: DRVS Overview

DRVS is a quality measurement and improvement platform that specializes in ambulatory measurement at community health centers. The demonstration outlined in this document represents a typical scenario covering how DRVS is leveraged to support quality

Reporting: DRVS Architectural Overview

• Data from disparate EHR and EPM systems.

• Daily data refresh.

• Data unified in EHR-agnostic Data Warehouse for apples to apples comparison.

• Web-based reporting platform

accessible from any major browser. • User role differentiation and data

blinding.

• Graphical and text based depictions of datasets.

• External data links geographic

Statewide Primary Care Informatics Approach

Our approach to getting our clients to the end state consists of the following activities: Discovery and Strategy Development, Pilot Program, and Implementation Phase 1 and Phase 2.

Discovery & Strategy

Solution roadmap

Assess QD = QC and develop benchmarking

for 6-10 health centers

Pilot Program & Quick Wins

Implementation Phase 1 (EPM/EHR) Implementation (Clinical Outcomes) Business case development

3 Weeks 4-8 Weeks 4-6 Weeks per CHC

Pilot Program Current state assessment Implementation Phase 2 (External Data/Claims) Implementation (External Data)

Pilot Program Approach and Timeline

The initial set of reports will be developed during the first six weeks. After our onsite meeting, we’ll meet weekly to review and validate our results.

Select pilot site

Review workflow Develop preliminary metric analysis Develop metric reports

Present draft reports and solicit feedback

Finalize initial reports

Connect to EHR

Review variability analysis

Analysis

Preparation Measure Continuous

Improvement

Review EHR data Create ability to self-run

reports

Weeks One to Three Week Four Week Five Weeks Six and Onward

Update metric reports

Present draft reports and solicit feedback

Present draft reports and solicit feedback

Expand assessment metrics

QD = QC Data Fidelity Process

Standard metric

definition Agree on standard metric definitions.

Where’s info captured? Structured or unstructured? Variation in definition? Provider variation Root cause analysis Improvement plan

Is smoking cessation captured in one field in the social history template or is it captured in 22 places across 5 templates?

Are results captured in free text fields? Look for impact on patient safety.

Check for standardization of drop down lists (e,g, white, Caucasian, WHTE, W).

Conduct analysis by provider (variations by practice, specialty, location).

If numbers are low, we look for reasons why (e.g., data capture, configuration).

Pilot Health Center Team and Time Commitment

Provider (MD or NP)

– Review of work flows and how providers document care in EHR

Quality Director

– Review current reports and metrics

Technologist/EHR manager

– Help with EHR login and data validation

Health Center Project Lead

– Health Center central point of contact

The Arcadia team will perform the majority of the analysis. However, health center collaboration is critical to the success of the project.

We will need your help with the following: • 30 min onsite preparation call

• 3 hour onsite visit

• Up to three 1-hr data validation review

Summary

• As delivery and payment systems evolve, the most successful organizations

will be those that use data to drive quality improvement and to prove their value (outcomes & costs).

• CHCANYS and its health center members are well positioned.

• Through this effort, you’ll have the data you need to further enhance your

position as heath care leaders.

• Your data becomes even more powerful when you combine your health

center data with external data sources to support planning, negotiation and partnership development (e.g. payers, census, other government data bases, etc).

Next Steps

• Convene governance group.

• Continue to reach out to funding organizations.