Practitioner Database Project Advisory Committee Meeting

1. Practitioner Database ProjectAdvisory Committee Meeting HealtheConnections Health Planning (CNYHSA) Monday, March 24, 2014 Conference Room 1331, Corning Tower Empire State Plaza, Albany, NY 12237

2. System Development Issues • How should it be related or connected to other data systems and functions? • How should data be obtained or collected? • Where should the system be housed or operated? • How should it be supported? • How can data be shared with the widest range of users? Should different classes of users or privilege levels be established? • Are legal and regulatory changes needed? • What should the next steps be?

3. Page 5 Build on/relate to Other Initiatives Should leverage state acquisition/investment in internal/external sources and systems • Licensure/Registration • Physician Profile Redesign/Workforce Surveys • All Payer Database • Medicaid Information Systems • NYeC/HIT/Info Exchange • Health Benefit Exchange • Credentialing (??) Will need to improve existing management information systems, especially those related to licensure

4. Education/Training Licensure Foundations Funders Planners/Policy Makers Workforce Development Consumers

5. Page 2 Meet Needs of Multiple Stakeholders • Consumers of health care • NYSDOH (Primary Care, Health Insurance, Benefit Exchange, Quality and Patient Safety, Public Health Practice, Technology Transformation) • NYSED Office of the Professions, Board of Regents, and professional boards • Center for Health Workforce Studies • Regional health planning agencies and quality improvement collaboratives • Economic development councils, county & regional planning agencies and development organizations • County health departments • Rural Health Networks/NYSARH • RHIOs/NYeC/HI-TECH/SHIN-NY • Entities with IT expertise • Area Health Education Centers • Health Advocates and disease associations (e.g. Cancer Society, Arthritis Foundation) • Hospitals, Health Centers, and other providers of health care • Provider and Insurer Associations • Foundations which support health related projects • Consultants and private sources of Information • Schools of Public Health, Medical Schools, and other institutions involved in provider training and research

6. Page 3, Appendix Data Elements Should Include: • name • degree and type of licensure • key identifying information (NPIN, License Number) • associated practice group(s) • practice location(s) • specialization & sub-specialization • professional education, advanced training, & certifications • nature of professional activity • PCMH status • FT/PT status and clinical work hours/FTE • time devoted to patient care • birth date or age • staff appointments at hospitals • willingness to accept new patients and/or Medicaid patients (or % of practice allocated to Medicaid patients) • practice volume & productivity • geographic identifiers • analytical algorithms/classifiers

7. Page 4 How Should the data be Collected or Obtained: Sources Primary Sources (Items in Red currently in use): • NYSED Licensure/Registration files • Specialty/Training Information (FMSB, ABMS, or alternative) • NYSDOH Physician Profile System (Mechanism to collect data which cannot be obtained elsewhere) • National Provider Data Bank • CAQH UPD (Credentialing related data source) • Proprietary Sources (e.g. SK&A, Health Market Science) • National Plan and Provider Enumeration System (NPI) • Indices which show relationships between practitioners, service locations, practice and corporate structures, hospitals, IPAs, etc. • Other: All Payer Database, Medicaid Information Systems

8. Page 4 Data Source Relationships Data Validation/ MDM Services CAQH UPD (Credentialing related data source) • Redesigned NYSDOH • Physician Profile System • NYSED Licensure/Registration files • Specialty/Training Information (FMSB, ABMS, or alternative) • Self Reported Data items • National Provider Data Bank Proprietary Sources (e.g. SK&A, Health Market Science, Other) Other: All Payer Database, Medicaid Information Systems, National Plan and Provider Enumeration System (NPI) Credential Verification Process NYSDOH Physician Profile Mechanism to collect data which cannot be obtained elsewhere (e.g. workforce survey items)

9. Page 4 How Should the data be Collected or Obtained: Services • Master Data Management (MDM) services • Data governance/intake/integration • Master indexing/coding • Remediation/enhancement • Data storage/warehousing/analytics • Robust data validation, and error collection mechanisms • Validated sources vs. validation services • Improvements to existing management information systems especially those related to licensure

10. Page 6 Potential Hosting Options • creation of a state sponsored system such as SPARCS used for hospital discharge data. Such a system could be run by NYSDOH which oversees the provision and quality of health care, NYSED which is responsible for licensing or joint venture of both departments • component of an existing or yet to be developed system such as the All Payer Database, an HIE structure such as NYeC, NYS Health Insurance Marketplace, or a statewide credentialing system • creation of a new statewide collaborative that involves governmental and non-governmental stakeholders • use of an existing independent non-profit entity with workforce expertise such as the Center for Heath Workforce Studies (CHWS) or a University-based Health Informatics Center • contract with a proprietary entity that specializes in practitioner databases and provider directories • A combination of one or more of the above approaches

11. Page 6 Potential Financing Sources • Reallocation of resources currently used to collect, acquire, and analyze provider data • Assessments and user fees (e.g. for credentialing) • Funds related to implementation of the Accountable Care Act and NYS Health Care Reform. • State and federal budget appropriations • Medicaid • Demonstration program funds from Federal, State, and/or foundation sources • Licensing and registration fees

12. Financing Example: Credentialing • Research suggests that physicians have an average of 12 credentialed relationships and in the future will need to be re-credentialed every three years. • There are approximately 90,000 active physicians in New York State • If one third need to be re-credentialed each year, a charge of $30 per verified credentialed data set, for example, could raise as much as $10 million per year.

13. Implementation StrategyPotential Next Steps - Discussion • Promote Plan/Expand Stakeholder Buy-in • Formalize Process/Structure for Implementation • Create Leadership Team • Establish Implementation Workgroups to address issues such as • governance • user access • information products, services, and database functions • system design • project financing • RFP for master data management and other services

14. Pages 7-8 Other Recommendations • Should insure that data can be accessed and used by people who have different skill sets and interests • May be necessary to limit access to some data items by establishing different classes of users or data products. Responsibility for making determination should be given to an advisory committee rather than defined precisely in law or regulation. • Legal and regulatory changes will be needed to implement the database. • Consider inclusion of other practitioners (dental, nursing, mental heath)

15. How to reach us HealtheConnections Health Planning (CNYHSA) 109 South Warren Street, State Tower Building Suite 500 Syracuse, NY 13202 (315) 472-8099 Sara Wall Bollinger, Executive Director swbollinger@healtheconnections.org Terry Richmond, Deputy Director/Senior Associate gmrichmond@healtheconnections.org