PCMH: Learning Session Meeting #1

1. PCMH: LearningSession Meeting #1 American Academy of Pediatrics – Arkansas Chapter October 17, 2014

2. Objectives • Introductions • SHARE Presentation: Justin Villines, MBA and Janis Bartlett • Overview of PCMH project: Dennis Z. Kuo, MD, MHS • Primary Care Trends/General Update: Dennis Z. Kuo, MD, MHS • Upcoming Enrollment Metrics: Dennis Z. Kuo, MD, MHS • Understanding How Data Drives Change: Dennis Z. Kuo, MD, MHS • PCMH Milestones- Cheryl Arnold, MHSA, FACMPE • Care Plans: Jo Lynne Varner • Medical Neighborhood: Dennis Z. Kuo, MD, MHS • Information on Re-enrollment: Dennis Z. Kuo, MD, MHS • Questions?

3. Disclosures • Support provided by Arkansas Medicaid

4. Introductions • Arkansas AAP Leadership • Orrin Davis, MD, FAAP- President • Dennis Kuo, MD, MHS, FAAP – Vice-President • Chad Rodgers, MD, FAAP – Secretary • Chris Schluterman, MD, FAAP - Treasurer • Arkansas AAP staff • Aimee Olinghouse, Executive Director • Kristen Pfeifer, QI specialist

5. Arkansas Academy of Pediatrics Arkansas PCMH October 17, 2014 Jan Bartlett, Policy Director Justin Villines, HIT Policy Integrator Cindy Osment, SHARE Onboarding Arkansas Office of Health Information Technology Connecting to share

6. Presentation agenda • Overview of SHARE • How SHARE can help Clinics • Provider and Vendor Status • Getting started with SHARE • SHARE Demo

7. Share overview

8. What is share? • Statewide health information exchange (HIE) • Established with Act 891 of 2011, governed by HIE Council • Funded with public funds and user fees • Infrastructure for providers, labs, pharmacies, public health, others to share clinical data • Available to any health care entity willing to follow requirements and pay user fees

9. Pathway to Health Data Hospitals Clinics Clinics Hospitals Pharmacies Pharmacies Labs Labs Radiology Centers Radiology Centers Public Health Public Health Medicaid Medicaid Payers Payers

10. 3 ways to share • Secure Messaging • Secure, encrypted email exchange • Virtual Health Record (VHR) • View patient health data in SHARE securely online • No EMR/EHR needed • Clinical In box for qualified medical professionals • Health Information Exchange (HIE) • Integrates with your EMR/EHR system • Send and receive patient health data • View SHARE patient health data online or in EMR/EHR 3 ways to SHARE

11. What data can be shared? HL-7 Messages, CCDs and Unstructured Documents • Clinical Care Summaries • Discharge Summaries • Lab Results • Radiology Reports • Medication Histories • Allergies • CCDs • Problem Lists / Diagnoses • Referrals • Transcribed Documents

12. Benefits of using share Save time • Save money • Improve patient care • Instantly view patient health data from all points of care • Make better-informed care decisions • Easily coordinate care with unaffiliated providers • Reduce administrative costs for gathering health data • Track acute care events for your patients

13. Value of SHARE SHARE seeks to facilitate meeting collection and data reporting goals for local and national health improvement activities • Meaningful Use (MU) • Patient Centered Medical/Health Home (PCMH) • Accountable Care Organizations (ACOs) • Quality Reporting/Monitoring & Measuring Outcomes

14. Transitions of Care SHARE is a tool for facilitating transitions of care: • Care Coordination and PCMH • Alerts transmitted through SHARE between providers and hospitals • Transmission of ED/Inpatient admits and discharge data

15. Stage 1 Stage 2 Meaningful use criteria • Stage 1, Menu Measure 9: Capability to submit electronic data to immunization registries or immunization information systems • Stage 2, Core Objective 15: Provide a summary care record for each transition of care or referral where the recipient receives the summary of care record via exchange • Stage 2, Core Objective 16: Capability to submit electronic data to immunization registries

16. What’s in it for CLINICS?

17. Clinics and Pcmh PCMH practices are required to participate in SHARE: • Obtain patient admission/discharge data from affiliated hospitals • EMR integration is not required until 2015 • OHIT is working with AFMC, AAP, and Qualis to ensure practices are properly connected to SHARE for PCMH compliance

18. SHARE for PCMH Arkansas Medicaid’s PCMH initiative requires providers join SHARE to receive in patient discharge and transfer information. These “event notifications” will alert the practice of ED and hospital admissions, enhancing coordination of care for follow up visits and reducing the cost of care.* *See Arkansas Medicaid PCMH Handbook, 240.000 – Metrics & Accountability for Incentive Payments, Measure J.

19. SHARE for PCMH When a Patient whose providers are connected to SHARE is admitted to or discharged from the hospital: Participating SHARE providers receive an instant notification of the patient’s hospital status in the EMR inbox or SHARE’s VHR inbox. This allows timely follow up and care management.

20. SHARE SECURE mESSAGING • System with expanded features • Cloud-based • Web-based user interface • Functions like traditional email • Facilitates HISP services • Provides notifications to 3rd party email systems • Alerts when a message is successfully or unsuccessfully processed /sent

21. Immunizations reporting Automate Immunizations Reporting through SHARE: • SHARE has built an interface with ADH • Send immunizations data directly to ADH through SHARE • Simplify workflow by reducing duplicate data entry • ImmunizationsRegistry is “Live” • ELR andSyndromic Surveillance are “Live” • No additional cost to SHARE participants

22. Participation update

23. 287 Who shares? Health care sites participate, including 27 hospitals with (15) Live and 260 practices in 99+ cities. *As October 16, 2014

24. HOSPITALS PRACTICES Connected Participants Now Include • NARMC • AR Children’s Hospital • UAMS • JRMC • Ashley County • McGehee Hospital • BradleyCounty • White River Health System • Ark Methodist Medical Center • Stone County Medical Center • Conway Regional • Conway Regional Rehab Hospital • Howard Memorial • Magnolia Regional Med. Center • Saline Memorial Hospital • Family Medicine Clinic • Family Doctors Clinic • Claude Parrish CHC • Main Street Medical • Marshall Family Practice • Ronald Reese, M.D. • Newton County Family Practice • Andrew Coble – General & Specialty Surgeon • Internal Medicine Diagnostics, Inc. • UAMS Regional Center – Pine Bluff; Fort Smith • Boston Mountain Rural Health Center (7 sites) • East Ark Health Center (5 sites) • Jefferson Comprehensive Care (6 sites) • Lee County Cooperative Clinic (4 sites) • Willow Street Health • NEA Baptist (37 sites) • Fonticiella Medical Center

25. HOSPITALS PRACTICES Connecting Participants • North Metro Medical Center • Chicot Memorial • Izard County • Pinnacle Point Hospital • UAMS Regional Centers (4 sites) • ARcare (23 sites) • Apache Drive Children’s Clinic • Conway / Greenbrier Children’s Clinic • Conway OB/GYN • Cornerstone Clinic for Women • Little Rock Pediatric Clinic • The Pediatric Clinic, NLR • Ozark Internal Medicine and Pediatrics • Pocahontas Medical Clinic • The Children’s Clinic of Jonesboro • Sager Creek Pediatrics • MANA • North Central Arkansas Medical Associates • Community Physical Group • The Breast Center • Paragould Pediatrics Plus many more…

26. Behavioral Health PRACTICES Behavioral Health PRACTICES • AR Psychiatric Clinic PA • Behavior Management Systems Inc. Center For Individual &Family Community Service Inc • Cooper Clinic – Ozark • Dayspring Behavioral Health • Ascent Children's Health Services Youth Home Inc. • Outpatient Clinic Southwest AR Counseling Arkansas • Behavioral Healthcare Counseling Services Of Eastern AR - Forrest City • Family Psychological Center Health Resources of AR Hometown Behavioral Health Services Hope Behavioral • Healthcare Jerry Blaylock MD Connected Participants • Families Inc. Counseling Services Corporate Office • Baptist Health Behavioral Service Community • Counseling Services Inc Cornerstone Community Counseling • Delta Counseling Associates • Centers For Youth And Families • Life Strategies Counseling Inc (Little Rock) • Life Strategies Counseling Inc (Osceola) • Life Strategies Counseling Inc (Paragould) • Life Strategies Counseling Inc (Piggott) • Life Strategies Counseling Inc (Trumann) • Life Strategies Counseling Inc(Jonesboro) • Life Strategies Counseling Inc • Perspectives Behavioral Health Ma Corp • Counseling & Education Center Inc. • Psychiatric Associates of AR PLLC • Mid-South Health Systems • Plus many more…

27. More than 893,596 patients participate in SHARE

28. Help for Providers

29. statewide agreements SHARE is helping the provider community by: Negotiating statewide contracts with EHR vendors THAT: • Reduce or waive one-time vendor interface fees to connect to SHARE • Shorten the implementation timeline

30. Basic Pricing for practices

31. How to join share

32. Online or by phone Register online at SHAREarkansas.com OR Call 501.410.1999

33. Thank you! Questions? Now the DEMO!

34. Patient-Centered Medical HomeOverview .

35. Arkansas Medicaid PCMH • PCMH: “team-based care delivery model led by PCPs who comprehensively manage patients’ health needs with an emphasis on health care value” • Goals • Encourage population health management (all children, regardless of whether they are coming in or not) • Align financial incentives with good preventive care • Supports primary care physicians as key partners

36. Terms • Practice transformation: “adoption, implementation, and maintenance of approaches, activities, capabilities and tools” to encourage team-based care and population management • It’s all about the population management • And being proactive with patient care • Care coordination: “ongoing work of engaging beneficiaries and organizing their care needs across providers and care settings” • This is particularly valuable for children with disabilities and special health care needs – i.e. the high resource utilizers

37. Pediatric Practices • 47 practices enrolled • Arkansas AAP is assisting 15 practices • Monthly webinars • Weekly contacts • Listserv • Personal discussions • Review of reports

38. Activities Completion of activity and timing of reporting Continue to innovate Evolve your proce-sses Month 12 Commit to PCMH Month 0-3 Start your journey Month 6 Month 16-18 Activity Month 24 • 1 • Identify office lead(s) for both care coordination and practice transformation1 • 2 • Assess operations of practice and opportunities to improve (internal to PCMH) • 3 • Develop strategy to implement care coordination and practice transformation improvements • 4 • Identify top 10% of high-priority patients (including BH clients)2 • 5 • Identify and address medical neighborhood barriers to coordinated care (including BH professionals and facilities) • 6 • Provide 24/7 access to care • 7 • Document approach to expanding access to same-day appointments • 8 • Complete a short survey related to patients’ ability to receive timely care, appointments, and information from specialists (including BH specialists) • 9 • Document approach to contacting patients who have not received preventive care • 10 • Document investment in healthcare technology or tools that support practice transformation • 11 • Join SHARE to get inpatient discharge information from hospitals • 12 • Incorporate e-prescribing into practice workflows3 • 13 • Integrate EHR into practice workflows 1 - At enrollment; 2 - Three months after the start of each performance period; 3 - At 18 months

39. Well? • HOW’S IT GOING????

40. Bodenheimer, Ann Fam Med 2014

41. Best practices for transformation • Culture of QI – develop formalized team process and dedicate time • Family-centered care – recruit and utilize parent partners to motivate and visualize • Team-based care – play to everyone’s strengths, collaborate • Care coordination –develop care plans, dedicate time and staff, collaborate to develop patient-centered goals McAllister et al. Ann Fam Med 2013

42. Successes • Looking more closely at/tracking specific information (like 24/7 access) helped to provide consistency within offices. • Tracking patients better to see when they need WCCs, PFTs, etc. • Hired additional nursing positions/PCMH Care Coordinators. • Monitoring PFSH components filled out by MD on first visit with new patients. • Adding EMR software. • Better chart documentation by the physicians. • Opening of walk-in clinic model allowing immediate access

43. Challenges • Lag in data • Time (webinars & care plans and audits, oh my! ;) • Inconsistencies with what qualifies as meeting metrics (often based on subjective judgment of reporting form answers) • Not having resources to track down patients/get them scheduled • Some [consultants] more helpful than others • Medicaid enhanced payment set to expire at the end of 2015 (unless reauthorized)

44. National trends in primary care • Reminder: ACA – test innovative payment methods • Projects that focus on children with medical complexity • High value proposition • Co-management • Payments may be increasingly tied to adoption of EHR, data, and care plans

45. What’s ahead in 2015? • Enroll by 11/17/14 • Practices may pool with any number of PCMHs to form a shared savings entity • Statewide pool also an option • Beneficiary level data available • Cost data: Q4 2014 • Metric data: Q1 2015

46. What’s ahead in 2015? • Shared savings – likely to be determined by Q2 2015 • Possible changes in targets • Process metrics may all rise a little • Shared savings – a few will rise • ADHD, Asthma, adolescent wellness visits • Considering demonstration of extracting data from EHR

47. Also- • Enrollment/Re-enrollment opportunity available here today and at the Pediatric Forum held at ACH tomorrow October 18th 2014 • Please see Kristen for more details.

48. Questions? • .

49. Understanding How Data Drives Change: Dennis Z. Kuo, MD, MHS

50. Data • Objective measure of performance • Patient • Physician • Practice (or care team) • Sources • Payer • EMR • Manual review of chart • Measure patient experience