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TRANSCRIPT
TEFT (Testing Experience Functional Tools)
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HCBS Conference 2016
Presentation by-
Julie Reed and Danielle Culp
Our Mission
Improving health care access and
outcomes for the people we serve
while demonstrating sound
stewardship of financial resources
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Objectives
• Explain how CO has developed a systemic
approach to person-centered information
sharing through effective community
engagement strategies.
• Provide ways in which Continuous Quality
Improvement efforts have been used to
further develop TEFT in CO.
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Department Strategic Framework
Enhance Quality of Life and
Experience
Improve Health
Long Range Goals
Reduce Cost
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More details specific to LTSS Delivery:
Colorado Community Living Advisory Group
Colorado's Community Living Plan
Strategic Policy Initiatives
Delivery Systems
Innovation
Tools of Transformation
Partnerships to Improve
Population Health
Operational Excellence
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Outcome Domains
• ER Visits
• Hospitalizations
• Imaging
• Choice and Control
• Satisfaction
• Social Isolation
• ADLs
• Self-Efficacy
• Behavior
• A1c Levels
• Depression
• BMI
Clinical Functional
Utilization Quality of
Life
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The Department’s definition of a person-centered
approach is one that respects and values individual
preferences, strengths, and contributions. The goal of
the Department’s person-and family-centered approach is
to incorporate the value of person-centeredness into
everything we do. This will ultimately improve the client
experience by enabling a ll Department employees to
understand the perspectives and experiences of the
people we serve.
Person and Family- Centered Approach
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EoC-
Experience of Care Survey
FASI –
Functional Assessment
Standardized Items
PHR –
Personal
Health
Record
e-LTSS –
Records
S&I Framework
Colorado TEFT Grant
WHY this matters with
TEFT?
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(EoC)
(FASI)
(PHR)
e-LTSS
•When we understand how our actions impact the people we serve, we are
more committed to and engaged in our work.
•When we work with clients and family members to fully understand their
perspectives and experiences, we make better policy and program
decisions.
•When we are person-and family-centered in our work, we engage clients in
their health and health care
LTSS Puzzle: The Status Quo
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(90/10 MMIS
Funded)
(90/10 HIT MU
Funded & HIE
Maximization)
Acronyms
EPSDT: Early and Periodic Screening, Diagnosis & Treatment
RCCO: Regional Care Collaborative Organization
BIDM: Business Intelligence & Data Management System
HIE: Health Information Exchange
CCB: Community Centered Board
SEP: Single Entry Point
PBMS: Pharmacy Benefits Management System
UM: Utilization Management
TPL: Third Party Liability
MMIS: Medicaid Management Information System
CBMS: Colorado Benefits Management System PCMP: Primary Care Medical Provider
*APCD: All Payers Claims Database
*DORA: Colorado Department of Regulatory Agencies
*DPHE: Colorado Department of Public Health & Environment
*DHS: Colorado Department of Human Services
*CDE: Colorado Department of Education
CORHIO: Colorado Regional Health Information Organization
QHN: Quality Health Network
LTSS: Long-Term Services and Supports
PHR: Personal Health Record
TEFT: Testing Experience & Functional Assessment Tools
SIM: State Innovation Model Testing Grant
HER: Electronic Health Record
PEAK: Program & Eligibility Application Kit
Data Feed Data
Feed
Key
State Systems
Eligibility Determinations
Case Management Tool
O v e r v i e w o f M e d i c a i d S y s t e m s
BIDM
Provider
Portal
BIDM
Population Management Tool
Risk Scores/Quality Measurements
Predictive Analytics/Modeling
Data Exchanges with Multiple State Systems
EHR
Clinical
Quality
Hub
(SIM Grant)
Client PHR (FY 2015-16
Budget)
Client
Mobile
App
PEAK &
Client
Eligibility
Portal
CBMS
interChange
Provider
Portal &
Client Portal
Data
Exchanges
with Other
Vendors &
State
Systems*
PBMS &
Interfaces
to vendors
(UM, TPL)
HIE thru
CORHIO/QHN
interChange
Vital Tool for
Care
Coordinators
RCCO & PCMP Client Reports
RCCO & PCMP Query Ability
High Utilizers/High Risk Info
Quality/Incentive Reporting
Single-Sign-On between Portals (90/10 MMIS &
FY 2015-16 Budget)
Single-Sign-On (FY 2015-16 Budget)
Provider Enrollment/Directory
Claims Processing
Client Benefit Plans
o Benefit Limits, Copayments, TPL
Care Management Tool
Client Assessments/Screening
Referrals/Authorizations
Interventions & Care Plans
Physician
LTSS PHR
(TEFT
Grant)
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Functional Assessment Financial Eligibility
HCBS Service
Provision
Medicaid Waiver Case
Management Self-Service Access
Colorado TEFT CB-LTSS Systems Map (as of November 2015), Developed by The Lewin Group Elderly, Blind and Disabled (EBD) Waiver and Supported Living Services (SLS) Waiver
CORHIO Currently unconnected to CB-LTSS system. Pushes information to RCCOs.
Phone
Website
Access to System
Bidirectional
Interoperable
System
In-person
Mail or Fax
Secure
e-mail Planned TEFT PHR
Key
Acute Care Service
Provision HCBS Billing
HCBS Providers Receive referrals from CCBs and SEPs via fax, phone or mail. Use own IT systems for tracking and submit claims to MMIS.
Colorado TEFT CB-LTSS Systems Map (EBD and SLS Waivers) - Colorado contracts with SEPs and CCBs to provide case management services (includes functional
eligibility determination) for EBD and SLS Waivers.
- SEPs (Non-Profit or County) conduct functional assessment and provide case management for EBD.
- CCBs conduct functional assessment and provide case management for SLS. CCBs also use
CCMS/DDDweb to track DDD services. - Individuals receive paper copies in the mail of their individualized service plan from CCBs (SLS Waiver)
or long-term care plan from SEPs (EBD Waiver).
TEFT Personal Health
Record
Consumer The state is exploring potential data feeds into a Medicaid beneficiaries PHR for the TEFT Demonstration. Considering multiple PHRs.
LTSS
System
Entry
LTSS
Service
Delivery
Information
to
Consumer
(TEFT PHR)
MMIS
CCBs: Case Management CCBs provide case management for SLS. Use BUS, CCMS and DDDweb to manage cases. Update PAR information in CCMS.
Individual Enters
LTSS System
Individual Receives
Services
Individual Accesses
Information
IT
Individual submits financial
eligibility information Individual participates in in-person
assessment
IT System
Planned as
part of TEFT
Current
Exchange
Individual
QHN Currently unconnected to CB-LTSS system.
Hospitals Hospitals connected to QHN and CORHIO.
Business
Utilization
System (BUS)
ILC Referrals to CCBs (SLS) via phone or fax.
HCPF:
CBMS CO PEAK
Individual calls ADRC, AAAs, or ILCs or
visits CO PEAK website or mobile
application
Non-Profit SEP Non-Profit SEP case managers serving EBD complete ULTC 100.2 and input functional eligibility determination into BUS.
ADRC Provide options counseling and make referrals to SEP (EBD) and CCB (SLS) via phone or fax.
AAA Referrals to SEPs (EBD) via phone or fax.
County Departments of Human Services
Determines financial eligibility.
County SEP County SEP co-located with County Departments of Social Services. County SEP case managers serving EBD complete ULTC 100.2 and input functional eligibility determination into BUS.
SEPs: Case Management Non-Profit and County SEPs provide case management for EBD and input care plans into BUS.
DHS: CCMS/
DDDweb
Individual receives individualized service plan
from CCBs (SLS) or long-term care plan from SEPs
(EBD) via mail
CCBs CCB case managers serving SLS complete ULTC 100.2 and input functional eligibility determination into BUS.
Xerox, Inc. SEPs send PAR to Xerox via mail to update in MMIS.
Physician Completes PMIP and faxes to CCBs and SEPs.
CCBs CCBs update PAR information in MMIS and CCMS. Regional Care Collaborative Organization
Connects Medicaid clients to providers and helps find community services.
eLTSS Plan The state is participating in the eLTSS S&I Framework Initiative to pilot test the eLTSS plan.
Regional Care Collaborative Organization*
Connects Medicaid clients to providers and helps find community services.
PHR Gateway Plan* The TEFT team is exploring plans to develop a Single PHR Gateway to connect the two HIEs with the PHRs.
FASI The state is participating in the FASI Tool pilot.
Experience of Care Survey The state is participating in the EoC Survey.
*Indicates change from Year 1 Systems
Map
Financial and
functional
determination may
occur at the same
time
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TEFT (Testing Experience and Functional Tools)
Stakeholder Participation -Colorado
Counties in green may indicate participation in environmental scans, focus group
meetings or both.
Counties in white indicate nonparticipation as of December 2015. Not Participating
Participating Project Tracking #: 5770
Map Created on: 11/18/2015
PHR Environmental Scans Results
Provider and Client Survey results showed the following:
Access to the Internet
Top 3 uses – Email, Facebook and Text Messaging
60% of respondents feel is it valuable to connect the PHR with
other health information systems
Key data elements in the PHR include Clinical and non-clinical
elements:
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Medications Schedule
Vital Signs Contact List
Physical Activity Demographic Info
Hospital ADTs Transportation
Availability of Internet in your area?
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Goals for Continuous Quality Improvement
EoC
• Develop an innovative and electronic mode of delivery that offers options for end-users
• Increased accessibility of survey tool
• Evaluate effectiveness of new modality (response rates)
PHR • Ongoing vetting to stakeholders of PHR components in both test and production environment to
develop the most user-friendly and appropriate tool for the populations we serve
• Implement with challenging populations to identify major challenges early on
• Evaluate effectiveness to inform Department of necessary improvements for statewide
implementation.
FASI - Develop exchangeable data platform for testing purposes
- Evaluate platform usage and accessibility
- Improve system based on outcome of testing
eLTSS
- Develop a care plan that has interoperability features
- Implement among TEFT specific populations
- Evaluate and monitor usage
- Improve system requirements and integration efforts to standardize across populations
Questions?
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Contact Information
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Julie M. Reed, M.A.Ed.
Case Management Unit Supervisor &
Case Management Policy Specialist
Department of Health Care Policy and Financing
Danielle Culp
Quality Health Improvement Specialist
Department of Health Care Policy and Financing
Thank You!
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