Community Coordination of Care-Beyond Meaningful Use

1. Community Coordination of Care-Beyond Meaningful Use Kim R. Pemble Executive Director WHIE Alison Lopez, RN, ED Case Manager

3. Meaningful Use Blumenthal: 2013 meaningful use to ramp up HIE, decision support “… an exchange that consciously ignores economic relationships, geographic relationships and political jurisdictions.” “We want information to follow patients,” Blumenthal said.

4. 21,859 Patients and 134,868 Encounters ‘4 to 10’ = 20,227 Patients and 106,376 Encounters Impact to Public Health, Policy, Care Delivery based on near real time data.

6. Wisconsin Health Information Exchange • WHIE is non profit organization 501(c)(3) • Key stakeholders • Milwaukee Health Care Partnership • Department of Health Services • Humana and Business Health Care Group • Patients • Advisory Board – 22 seats • Technical Service Provider for WISHIN

7. Active Use Cases • ED Linking Clinical Summary View • Fourteen EDs and One Community Health Center • Public Health Disease Surveillance – 24 WI Counties, 44 hospitals, numerous clinics • Care/Case Management (Clinical Settings) • Auto Print History Summary • Provider and Care/Case Manager Messaging • Patient Consent

8. WISCONSIN HEALTH INFORMATION EXCHANGE AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION V2011 02 09 PATIENT INFORMATION Patient Name _________________________________ Patient Birth Date (mo/day/year) ___________________ Patient Address ________________________________ City _________________________ State ____ Zip ____________ TO WHOM THE INFORMATION MAY BE DISCLOSED This Authorization is for disclosures to The National Institute for Medical Informatics (NIMI). NIMI is a not-for-profit company managing the Wisconsin Health Information Exchange (WHIE). WHIE is a local effort in Milwaukee, which electronically shares personal health information for improving patient safety. This sharing also is intended to aid in improving the quality and efficiency of care. A list of participating organizations (WHIE Participants) is attached as part of this Authorization. NIMI is acting on behalf of the WHIE Participants to obtain this Authorization. This form authorizes NIMI and the WHIE Participants to receive, disclose, and re-disclose as permitted by law, your personal health information via electronic transfer or other reasonably secure means of transfer. WHAT INFORMATION IS AUTHORIZED FOR DISCLOSURE By signing this Authorization, I authorize for disclosure any of my existing and future medical records. Medical records include: 1. demographic, insurance, and financial information; 2. medication and allergy information; 3. complaints and diagnoses, procedures, care plans and advance directives; 4. laboratory, radiology and other tests performed and their results; and 5. discharge summaries, progress notes, and consultation notes DISCLOSURE AND RE-DISCLOSURE SUBJECT TO APPLICABLE LAW, BY SIGNING THIS AUTHORIZATION, I PERMIT THE DISCLOSURE AND RE-DISCLOSURE OF PERSONAL HEALTH INFORMATION DESCRIBED ABOVE, AS WELL AS PERSONAL HEALTH INFORMATION AND HEALTH CARE RECORDS RELATED TO MY HIV TEST RESULTS OR DIAGNOSIS, TREATMENT OR DIAGNOSIS OF MENTAL HEALTH, DEVELOPMENTAL DISABILITIES, SICKLE CELL ANEMIA, AND/OR ALCOHOL AND DRUG ABUSE FOR THE PURPOSES DESCRIBED IN THE SECTION BELOW. PURPOSE OR NEED FOR DISCLOSURE I authorize the disclosure of this information for direct health care treatment purposes. The information may also be disclosed as permitted by law for purposes related to public health, quality improvement, medical care case management, insurance eligibility, and/or research approved by an Institutional Review Board. Medicaid claims data will be specifically excluded from disclosures of health information used for research purposes. PATIENT RIGHTS WITH RESPECT TO THIS AUTHORIZATION 1. Right to Inspect or Copy Information to be Disclosed. I understand that I have a right to inspect and copy the records or information I have authorized for disclosure. I understand that there may be a reasonable fee for this request. This request will be made by contacting the clinic or hospital making the disclosure. 2. Right to Receive Copy of This Authorization. I understand that if I sign this permission form, I will be provided with a copy of this form. 3. Right to Refuse to Sign Authorization. I understand that I am under no obligation to sign this form. I understand that health care facilities may not condition providing care to me on signing this permission form. 4. Right to Revoke this Authorization. I understand that I have the right to revoke this permission. I understand that my revocation will be effective on and after the date it is received. I understand that revocation does not apply to any disclosures of personal health information made before the date and time of revocation. I may revoke this permission by contacting in writing the clinic or hospital that asked me to sign this Authorization. I may also revoke this permission by contacting in writing any other of my healthcare providers that participate in the WHIE. 5. HIV Test Results. I understand that my HIV test results may be disclosed without authorization to individuals or organizations that have the right to access these results under State and/or federal law. A list of those organizations is available by contacting the clinic or hospital that asked you to sign this permission form. 6. Re-Disclosure Notice. I understand that the information I authorize to be disclosed may be re-disclosed by the recipient of the records if permitted by law. The recipient of re-disclosed information may be controlled by different laws. EXPIRATION DATE This Authorization is valid until revoked by me or expires three years following the date I sign this Authorization. Signature: ______________________________________ Date: ____________________Print Name: ___________________________________ If signed by someone other than the patient, indicate relationship and authority for signature: _____________________________________ ___________________________________________ Relationship (e.g. parent, spouse) Authority (e.g. guardian, health care agent, parent)

9. DATA COLLECTED IN SEGREGATED DATA STRUCTURES Patient Registers For Care -- Triggers WHIE 44 hospitals (9 delivery networks), 1 community health center, Medicaid and 1 MCO populating the WHIE Establish “care relationship” through admission record

10. Information About Today… Today Reapplying data to a different question 07/04/2009

11. ER Utilization Management

12. “HOSPITAL REFERRALS.—A State shall include in the State plan amendment a requirement for hospitals that are participating providers under the State plan or a waiver of such plan to establish procedures for referring any eligible individuals with chronic conditions who seek or need treatment in a hospital emergency department to designated providers” (i.e., designated Health Homes). Sec. 2703 (d) PPACA on ED Management

13. iCare ER Utilization Experience

14. iCare ER Cost Experience

15. iCare identifies members who have a need to obtain a physical exam and specific health indicator metrics at their ER visit iCare alerts ER providers of the need for PE and HI actions to protect ongoing eligibility and insurance benefit coverage iCare ensures that current PE and HI information is posted to avoid duplication of services Effect on iCare CORE Members CORE Notice: “This patient is a BadgerCare Plus CORE member who requires a physical examination to maintain BadgerCare Plus CORE eligibility. As part of your examination, please record height, weight, and blood pressure. This is a Medicaid requirement for this patient to maintain their eligibility.”

16. iCare identifies members who have a history of high ER utilization iCare configures for ER providers an avenue for them to address clinically inappropriate utilization iCare Care Coordinators educate members regarding PCP/MedHM use. iCare encourages members to make appropriate care access decisions OVER TIME Effect on iCare SSI Members SSI Notice: “This patient has used the ER 4 or more times in the last 12 months. If the reason for this visit is not an emergency, refer to an urgent care center or PCP. Call iCare for transportation at 414-223-4847. See case management module for Care Coordinator contact information.”

17. iCare Change Metrics

18. Re-admission Prevention

19. “Beginning on January 1, 2015, a qualified health plan may contract with— (A) a hospital with greater than 50 beds only if such Hospital — … (ii) implements a mechanism to ensure that each patient receives a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional …” PPACA, Sec. 1311(h)(1) PPACA on Post-Discharge Services

20. Access to Post-Discharge Plans

21. iCare Post-Discharge Patterns

22. Post-Discharge Measures

23. Use Cases In Development • Engaging other Community Health Centers (CHC) • Sixteenth Street CHC • Milwaukee Health Services CHC • Westside Healthcare Association CHC • Ongoing Care Relationships • Care Managers and Primary Provider • eCommunity Care Plans

24. “Preliminary questionnaire results indicate that the information provided by the ED Linking Project has an impact on clinical care. Additional data collection is planned to further delineate the effects of specific types of information.” Dr. Jonathan Rubin Work up or treatment of the patient altered? N=420

25. Study Results: Evaluation Impact on MD Ordering Lab Orders Med Orders Imaging Orders 52% decreased 59% decreased 61% decreased 8% increased 9% increased 8% increased 25 % no change 16% no change 19% no change 15% no response 14% no response 14% no response

26. Study Results Impact on Efficiency Time to Disposition Decision Time Spent Seeking Information 40% decreased 41% decreased 3% increased 0% increased 55% no change 53% no change 4% no response 4% no response N=420

27. Payer Feedback More importantly, partnerships such as ours help improve the health of the community as a whole addressing key problems facing our health care system: fragmentation of medical history, waste accrued through repetitive testing and an inability to provide a community-wide solution to care coordination. Not only do providers and patients benefit, but payers realize a positive ROI. Dr. Albert Tzeel, MD, MHSA, National Medical Director Humana One

28. Health Care Community “Integration Engine” EMS/First Responders Hospitals, IDNs Data Registries Imaging Regional and State HIE Clinical Labs PHR People PCP Payers/MCOs NHIN and other Networks Portal PublicHealth Pharmacies, PBM Specialist