NYeC Monthly Association Call Kick-Off

Valerie Grey

Executive Director

October 12, 2018

AgendaTime Topic

9:30 - 9:40am Welcome, Introductions & Purpose

9:40 - 10:15am NYeC and SHIN-NY: Review & Updates• General SHIN-NY Progress Update• Roadmap Strategies• Other Updates

10:15 - 10:45am Association Roundtable (to include report-outs, updates, and other issues to raise)• Behavioral Health • Clinics• Health Plans• Home Care• Hospice• Hospitals• Nursing Homes• Providers

10:45 - 11:00am Action Items & Next Steps

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Welcome, Introductions & Purpose

• Background: o Importance of a continuous statewide feedback loop became apparent during the development

of the SHIN-NY 2020 Roadmapo NYeC is currently forming six Advisory Groups: Provider, Health Plan, CBO/VBC, Consumers,

Technology & Innovation, and Quality Measuremento NYeC establishing ongoing, regular contact with our association partners via a monthly call

• Purpose:o To help advise us on the intersection of patient care, transformation, and workflow with HIE and

HIT, and how that can be harnessed to transform the healthcare system and improve health outcomes and provider experience

• Focus: o Updates, hot topic developments, challenges and opportunities for collective advocacyo Advisory Group Updates once they are fully operational o Associations should use this space to raise HIT/HIE issues and concerns to NYeC

Monthly Association Call Kick-Off

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NYeC and SHIN-NY: Review & Updates

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Roles and Responsibilities

QEsDOH• Exercise overall authority for

the SHIN-NY (funding,regulation, laws, policy guidance, QE certificationrequirements, etc.)

• Serve as a partner with theprivate sector

• Utilize state levers topromote SHIN-NY

NYeC• Provide thought leadership

and statewide management to advance, align, integrate, and advocate

• Facilitate and propose policy, technical standards, functionality, business operations, and innovation

• Oversee delivery of QE core services through performance-based contracts

• Connect QEs statewide and meet performance goals

• Partner with DOH and NYeC to provide thought leadership

• Deliver core SHIN-NY services

• Meet performance goals and comply with State requirements

• Directly support healthcare reform initiatives, care models, and innovation

• If desired, offer enhanced services for additional fees

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SHIN-NY Governance

Department of Health

Board may formally propose statewide policy guidance to DOH. DOH may accept or reject

proposed statewide policy guidance at its

sole discretion.

NYeC Board

STATEWIDE COLLABORATION PROCESS

• Facilitates a transparent and robust governance process to prioritize and drive consensus on policy development, implementation approaches, and operation support services.

• Provides a functional structure to convene stakeholders and coordinate the implementation and operation of New York’s health information infrastructure.

• Provides support (thought leadership, project management, staff, tools and other resources) to streamline, coordinate and document activities.

*VBC: Value-based care

Business Operations Committee (BOC)

Planning & Operations

Technical

Implementation

Provider Advisory Group

Consumer Advisory Group

Health Plan Advisory Group

SHIN-NY 2020 Roadmap additional groups to inform & provide feedback to NYeC staff & Board

Special teams as neededPolicy Committee

Committees may develop and approve recommendations on policies, technical standards and SHIN-NY services. Recommendations may be submitted

for approval to the Board.

VBC* & CBO Workgroup

Technology Advisory Group

Quality Measurement Workgroup

Monthly Association Calls

Strong Foundation

• Performance-Based Contracts

• Ambitious targets for participation, consent, data quality*

• Enhanced Security

Value Based Care

• Additional data & services & participants

• Enhanced functionality & integration

• Policy changes including consent

Innovation

• Leverage market developments

• Discrete data via FHIR

• Patient engagement

Efficiency

• New QE payment methodology

• Standardization, shared services, mergers

• Wire once ability

Advocacy

• Federal and State funding, policy, legislation

• EHR vendors

• Feedback via 6 new advisory groups

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SHIN-NY: Current StatisticsAs of September 30, 2018

Metrics 2020 Goal

QE Average

(of 8 QEs)

Low (of 8 QEs)

High(of 8 QEs)

Participating hospitals 100% 100% 98% 100%

Participating skilled D&TCs, FQHCs, nursing facilities, home care, hospice 70% 78% 60% 93%

Participating physicians 70% 68% 52% 91%

Unique patient consent for at least one provider 85% 85% 54% 111%~

New data format and fields for hospitals 100% 32% 0% 83%

New data format and fields for other regulated entities (ORE)** 70% 15% 0% 34%

New data format and fields for physicians 70% 19% 0% 43%

~QE consent rates may exceed 100% if the consent rate exceeds their market share of participants

SHIN-NY Performance Based Contracting (PBC)

Performance Based

Contracting

Core Allocation

Dedicated Funding

High Gap Closure Pool

Interoperability & Innovation

Pool

Performance Payments

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Ambitious Statewide Goals Used in Performance-Based Contracting

• Adoption:o 100% participation by hospitalso 70% participation by other provider typeso 100% full data contribution by hospitalso 70% full data contribution by other provider types

• Consent:o 85% of patients provide consent to at least one provider

• SHIN-NY Utilization • Enterprise Availability• Customer Satisfaction

• All QEs and NYeC must obtain HITRUST certification

Performance payments 2018 - 2020

Pay-for-reporting for 2018 while work done on measures

Performance payments start for these metrics in 2019 and 2020

Share of overall funding allocated to performance

will increase over time

Gateway Vendor

Hub Connections

eConsent

Healthix

eConsent

NYCIGSubsidy to temporarily reduce or eliminate provider connection fees charged by QEs

HGC QEs

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High Gap Closure Program Focused on Participation & Consent Downstate

• The Data Exchange Incentive Program (DEIP) provides up to $13,000 financial incentive payment to eligible providers to help offset costs related to connecting to their QE and the SHIN-NY

• DEIP 2-year extension was approved

• DEIP eligibility being expanded to EMS and Pharmacyo EMS target – Fall 2018o Pharmacy target – Late 2018

• NYeC is working with NYS and stakeholders on defining the data that would be required as a condition of DEIP funding

• Potential expansion to include labs as eligible participants

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Data Exchange Incentive Program – Good News!

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Supporting Value Based Care

Up to 3 enhanced functionality projects, examples include:• Medication fills

• Quality measurement reporting

• Standardized data formats

• Medical claims (via APD)

• eMOLST

• Registries

• Social determinants of health

Up to 3 additional data & services projects, examples include:

• Single sign-on for Health Commerce System (I-STOP, others)

• Smarter, actionable alerts

• MACRA/MIPS compliance

• Care plan exchange

• Additional EHR integration

• Patient-centered data home

• Basic alerts available to those with treating relationships without written consent

• Incorporation of SHIN-NY consent with other forms

• Exploration of opt-out

• Data governance

• Others

Screening for Clinical Depression and Follow-Up (CDF): Non-HEDIS

Controlling High Blood Pressure (CBP): HEDIS

Comprehensive Diabetes Care (CDC): HEDIS

Viral Load Suppression (VLS): Non-HEDIS

Prenatal and Post Partum Care* (PPC): HEDIS

Childhood Immunization Status (CIS): HEDIS

Lead Screening in Children (LSC): HEDIS

• 25 DSRIP Performing Provider Systems (PPSs) selected projects and each project has performance metrics, 7 of which are measures are obtained via medical record data

• QEs will examine their data and help supplement medical record information obtained by NYS DSRIP medical record review contractors

• Example: When HealtheConnections assisted earlier this year, the additional information reduced HbA1C poor control from 61.4% to 36.4% (lower rate is better)

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SHIN-NY Helping PPSs!QEs Assisting with DSRIP Medical Record Review

• 4 QEs* will to support regional oversight and management committees (ROMCs), NYS PCMH practices and health plans with data contribution and data quality

• Goal is to develop the capability to support quality measurement and transformation activities:

o Calculating quality measures for NYS PCMH practices to use for ongoing monitoring and quality improvement

o Delivery of data to health plans to use in measurement of NYS PCMH practices

• A critical activity for all pilot participants will be to share detailed documentation:

o Will be used to inform consensus building and SHIN-NY quality measurement governance, including standardization

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SHIN-NY Helping ROMCs with NYS PCMH!QE Quality Measurement Pilots

* HEALTHeLINK, HealtheConnections, Hixny, Healthix/Bronx RHIO

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I-STOP EHR Integration Pilot

• Prescribers must consult I-STOP when writing prescriptions for certain controlled substances

• I-STOP is a stand alone system that is not connected to EHRs or SHIN-NY

• Clinician workflow improves if integrated with HER

• NYeC, working in partnership with DOH’s various divisions, issued an RFA for a QE pilot to work with a health system to integrate I-STOP with their EHR

• Rochester RHIO’s proposal with Rochester Regional was selected

• Goal will be to test current NYS I-STOP specs to integrate Rochester’s EPIC EHR with I-STOP and see if the specs are scalable

• Also exploring use of FHIR standards for future integration

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Social Determinants of Health

• NYeC presented a poster on SHIN-NY opportunities for Social Determinants of Health at the DOH Summit

• NYeC is funding a Rochester RHIO pilot that will do a deep-dive legal analysis for sharing of social determinants of health data

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Enabling Interoperability, Innovations & Wiring Once

Cross QE data sharing to support analytics

BronxCombining commercial claims with QE clinical data for quality measures and more

HEALTHe-LINKMultiple Wegmans pharmacy sites cross QE borders with one HealtheConnections connection

Healthe-Connections

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Advocacy

• Academic studies• Consistent messaging• Consumer education• New Advisory Groups• Strong advocacy with

Executive and Legislature

Aggressive collective work with EHR vendors on issues including:

• CCD/C-CDA, certified EHRs, prioritization of QE participants, responsiveness to development of gateways and inconsistent pricing, and charging for HIE connections

• Participate and influence federal discussionso Val Grey was appointed by Senator

Schumer to serve on Federal HIT Advisory Committee (HITAC)

• Collaborate with other states and regional HIEs

• Promote statewide standards

Value, Policy & Funding EHR Vendors Interoperability & Standards

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NYeC Federal Work

NYeC provided extensive comments on proposed National HIE Network (TEFCA), New MU

Rules (PI), and others

• Traditional non-Meaningful Use provider types are vital and need supporto Phase-in future interoperability requirements over time, moving initially from incentives to a firm requirement

• Incentivize health plan participationo Consider providing extra points on Medicare Advantage star ratings to health plans participating in health information

exchange networks

• Support better medication management for patients through medication fill datao Explore all federal levers, including Part D and other, to ensure HIEs and participating providers have timely access to

medication fill data for their patients

• Recognize mature HIEs ensure that information is not blockedo Active participation in HIEs, as designated by the Medicaid agency in each state, should serve as evidence that

information blocking is not occurring, especially since TEFCA will take time

• Consider requiring hospitals to share admission, discharge and transfer (ADT) data with other providerso New York hospitals already do this and this data has proven very valuable to care teams

• Do more to modernize data sharing under Part 2o This is needed to truly address the opioid crisis and actually integrate physical and behavioral health

• Continue to set minimum set of information for exchange

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NYeC Feedback On CMS Promoting Interoperability RFIs

• Interest in sharing best practices for how to leverage the SHIN-NY to increase awareness and support providers generally

• Initiated discussion regarding the value SHIN-NY offers to providers and the contribution of each core service

• Discussion of need to prioritize value-based care support mechanisms such as medication fill data, social determinants, I-STOP integration, and quality measurement

• Recognition that patient engagement remains challenging but there are opportunities worth exploring such as open APIs and EHRs in iPhones/mobile devices

NYeC Provider Advisory GroupKick-Off Meeting Highlights

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NYeC EHR Vendor Advocacy Strategy 2018-2019

Understand vendor support of NYS data exchange EHR Vendor Assessment

• Assessment criteria will demonstrate how EHRs’ functionality and other characteristics align with NYS data exchange needs

• Leverage Salesforce aggregate reports to populate assessment for hospitals, articled facilities, and physician practices and identify vendors to assess

Understand common challenges related to HIE Stakeholder Engagement

• QE survey to collect information and affirm assessment criteria

• Association and NYeC’s Provider Advisory Group discussions to assess criteria on behalf of providers

• Use qualitative data to further refine strategies and advocacy opportunities

Identify workable, interoperable solutions for providers across all sectorsEHR Vendor Engagement

• Drive vendor compliance with DEIP and SHIN-NY Connections Initiative (SCI) requirements to entitle providers to incentive funds and support Participation and Contribution goals

• Educate vendors and their customers on the SHIN-NY

• Coordinate with vendors to understand feasibility, pricing variation, challenges, etc.

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Association Roundtable

• We want to encourage dialogue, and ensure a meaningful feedback loop

• Each month, we will dedicate a significant portion of this call to association sharing

• This is an opportunity for you to discuss HIT/HIE related updates impacting your members, and opportunities for us to support shared goals and address related needs throughout the provider and plan communities

Let’s Hear From You!

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• Behavioral Health o MHANYSo NYS Council for Community Behavioral Healthcare

• Clinicso CHCANYS

• Health Planso Coalition of NYS PHPso HPAo NYS Conference of BC and BS Plans

• Home Careo HCAo NYSHCP

• Hospiceo HPCANYS

• Hospitalso GNYHA

o HANYS

o Iroquois

• Nursing Homes

o Leading Age NY

o NYSHFA

• Providers

o ACP

o MSSNY

o NPA

o NYSAFP

Let’s Hear From You!Association Updates, Concerns and Issues to Raise

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Action Items & Next Steps

Upcoming Association Calls

November 910am

December 1410am

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40 Worth Street, 5th Floor New York, New York 1001380 South Swan Street, 29th Floor Albany, New York 12210