A Regional Community Asset to Facilitate Collaboration & Innovation
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A Regional Community Asset to Facilitate Collaboration & Innovation The Population Health Forum October 19th, 2016 Why HIE? 2 Greater Philadelphia Area Healthcare Drivers for Change... • 60+ Hospitals; 5 Medical Schools • Top five MSA for utilization / cost - Significant physician • Overall average quality despite Centers of employment Excellence • Specialist: Primary Care ratio is 4:1 • Average satisfaction by consumers - Disparity in reimbursement, • Gaps in Care/Challenges in ToCs resources, technology, staffing - PAVE Study 2009/10 - HCIF • Minimal technology integration • Care Coordination/Shared Savings Models: - Many silos PCMH, ACO, Value Based Networks, - No HIE/HIO Clinically Integrated Networks, Bundle • Shift toward Pay for Performance models/Episode Based Payments, Narrow • Federal Programs including Networks. Meaningful Use and now • Private Exchanges – Many Individual Health MACRA/MIPS, and CPC+ IT Investments in play increasing costs. • Large Federal Grant $$ Trending to • Readmission Challenges in the Market much less – Resulting in Financial • No Dominant Health System Sustainability Challenges (next slide) 3 Patients See Care From Multiple Providers No Dominate Health System Abington Health Albert Einstein Health Network Albert Einstein Health Network ARIA Health Abington 5% Health CHE 7% ARIA Health UPHS 4% CHOP 16% CHS Southeastern Crozer-Keystone Pennsylvania’s 580,000 CHE Doylestown MLHS 10% Eastern Regional Inpatient 11% Admissions by Grand View Health system CHOP Holy Redeemer TJUH 5% FY2011-2012 8% Kensington CHS Prepared by DVHC 6% NPHS Tenet of HAP. Prime Healthcare 5% Crozer- Keystone St. Lukes Quakertown Temple 6% 8% Temple Doylestown Tenet 2% TJUH St. Lukes Quakertown NPHS Grand View 1% 1% 2% Eastern Regional MLHS Prime Healthcare Holy Redeemer 0% Kensington UPHS 2% 0% 2% 4 What is HealthShare Exchange of Southeastern Pennsylvania, Inc.? HSX is a non-profit health information exchange (HIE) organization serving the greater Philadelphia Region. • The HSX Mission is to provide secure access to health information that enables preventive and cost effective care; improves the quality of care; and facilitates the transitions of care. • The HSX Vision is to build a trusted community of healthcare stakeholders collaborating to deliver better healthcare to patients. 5 Who are we? • A non-profit – 501(c)(3) – Member Owned Entity. • Corporation formed in May 2012. • Board and Governance formed in January 2013. • Staff of 13 FTEs, technology vendors, consultants, several college interns and incredible volunteerism from our members. • Geography Focus - City of Philadelphia and surrounding counties: Bucks, Montgomery, Chester, Delaware and Philadelphia counties. • Plans to expand coverage as current members and participants become connected. 6 • 37 Acute Care Hospital Members • 3 Health Plans • 5 Behavioral Health Organizations • 2 Long-Term Care Organizations • 1 Accountable Care Organization • 1 Clinically Integrated Network • 1 Other Risk Bearing Entity • 64 Ambulatory Practice Participants (including Federally Qualified Health Centers) 7 Financial Sustainability • Hospital Members – Account for 1/3 of HSX Subscription Fees (Annual) • Admissions Volume – (includes employed providers) • Health Plan Members – Account for 2/3 of HSX Subscription Fees (Annual) • Per Member Per Month • Community Based Providers • No Fee for Direct Messaging Participation • Fee for ENS (Current – One-time Administrative Fee - Based on # of providers) • Clinical Data Repository (Future – Annual Subscription Fee) • Safety Net Providers • No fee for FQHCs & City of Philadelphia Clinics participating with HSX and our services • Other Fee Models exist for urgent care, long-term care, etc. • HSX leverages grant funding, when available 8 A Legal Framework Now in Place The Signing Event – A Success ! September 14th – HealthShare Exchange Day in City of Philadelphia! 9 HSX Services Roadmap Direct Secure Messaging – Live since January 2014- Free for Ambulatory Providers! - Health Information Service Provider (HISP) deployment continues - Discharge Information use case adoption scaled across HSX membership – Automated Care Team Finder (ACTF) - Provider Directory Grows - Active Ambulatory Practice Participant Recruitment Encounter Notification Services – Live since April 2015 - Health Partners Plans Pilot for Encounter Notification Service (ENS) - Hospital Data Feed Implementation continues to support use case - ENS scales across the membership Clinical Activity History Use Case - Live since July 2015 - Paoli Hospital, Doylestown Hospital and IBC early adopters - Roll out to other emergency departments - Add other health plans- 2016 Clinical Data Repository – Currently populating –Live in Q3 2016 - HSX receives additional data feeds from members (e.g. CCDs, Labs, Radiology Reports, Transcribed Documents) - Query Portal Implementation begins 10 Motion Story DV HIMSS Conference Atlantic City 2014 11 Services 12 HSX Use Cases & Services Value Realization for Members/Participants Enhanced Discharge Information Service - Automated Care Team Finder (ACTF): - Leverages payer information to identify a patient’s PCP and routes members’ discharge CCDs to these identified PCPs using Direct Secure Messaging - Participating payers today are Independence Blue Cross, AmeriHealthCaritas & Health Partners Plans CCD/A Checks Member Status With Payer returns PCP Participating Plan information ADT CCD CCD/A Patient Discharged PCP or Care Team Receives from Hospital or ED Discharge info CCD/A via 13 Direct Secure Message Example Discharge Document 14 Automated Care Team Finder (ACTF) - Total Successful CCD Deliveries by Participating Health System/Hospital 1600 1400 31 92 1200 35 97 163 141 1000 Einstein Healthcare Network 18 164 30 138 Lower Bucks Hospital 800 159 Crozer Keystone Health System Roxborough Memorial Hospital 12 237 91 209 600 19 Doylestown Hospital Aria Health 183 350 842 400 36 41 125 43 78 579 530 3016 200 133 292 288 275 207 121 0 15 ACTF – Total Successful CCD Deliveries By Receiving Organization – September 2016 [PERCENTAGE] (175 CCDs) [PERCENTAGE] (140 Hospital Owned CCDs) Independent FQHC [PERCENTAGE] (1054 CCDs) 16 HSX Services Value Realization for Members/Participants Use Case: Clinical Activity History (CAH): - “Push” from participating payers for clinical history (CCD) for patient presenting to different care settings (e.g. emergency department, urgent care, ambulatory practice) Checks Member Status Payer Sends Clinical With Participating Plan Activity History from Claims Data as a CCD/A or PDF Patient Admitted to Hospital or ED ADT Clinical Activity History Clinical Activity History Hospital or ED Receives Payer Clinical Activity History 17 Clinical Activity History Use Case Available Information Provides Value Data available on the following: • Patient Demographics • Inpatient Admissions • Patient's PCP • Immunizations • Past 6 Months • Lab Results • Rx Detailed Drug List • Alerts by Condition - Gaps in • Past Year Care • ED Visits • Past 2 Years • Disease Conditions • Primary Procedures • Outpatient Procedures • Office Visits • Specialists Seen • Imaging • Past 4 Years Clinical Activity History Total Documents Delivered by Organization 900 792 800 777 740 716 711 687 700 646 597 600 560 573 607 594 586 586 480 551 500 534 537 400 426 420 363 300 322 329 200 100 0 Main Line Health - Paoli Hospital Doylestown Hospital 19 HSX Services Value Realization for Members/Participants Encounter Notification Service (ENS): - By subscription, requested patient emergency and inpatient admits and discharges are sent to participants (real-time or as a summary list) - Breadth of notifications dependent on ADT feeds HSX members provide (33 hospitals as of September 2016) PCP or Care Team Subscribes to Patients or Members ADT List of Admits/Discharges HSX Member Subscribing PCP or Care Hospital/Health System Team Receives List of Admits for Subscribed Patients or Members 20 Encounter Notification Alerts Data to Participants Notifications deliver the following information related to patient encounters on a subscription basis: *Data provided in notifications can vary by hospital source. HSX has developed an ENS Data Matrix that shows what subscribers can expect to receive in notifications from the hospitals that currently participate in the service. 21 ENS Patient Subscriptions & Notifications 2,750,000 Patient Subscriptions 2,484,756 2,481,061 2,387,780 2,277,704 2,250,000 1,913,093 1,811,234 1,703,329 1,750,000 1,490,373 1,280,434 1,332,979 1,198,617 1,110,856 1,250,000 750,000 250,000 October November December January February March 2016 April 2016 May 2016 June 2016 July 2016 August September 2015 2015 2015 2016 2016 2016 2016 Notifications 140,000 122,369 110,874 120,000 93,232 100,000 87,443 84,764 87,444 83,966 80,000 60,478 65,470 62,882 60,000 44,450 43,987 Jefferson – 40,000 IBC- Panel Go Live 20,000 Crozer-Keystone Primary Increase Care Practices - Live - October November December January February March 2016 April 2016 May 2016 June 2016 July 2016 August September 2015 2015 2015 2016 2016 2016 2016 22 HSX Services Value Realization for Members/Participants Clinical Data Repository (CDR): • A central repository, hosted by HSX, that contains clinical data provided by its Participants • Provides access, using designated role- based controls, to view a patient’s longitudinal health record, based on data sources contributing across the region • Access granted through a portal or integration with an electronic health record • Complementary