the road to innovation: an update on nj’s health and ...dowd_the ro… · payment program (dsrip)...

The Road to Innovation: An Update on NJ’s Health and Healthcare

Initiatives June 23, 2015

Department of Health and Senior ServicesNJ Department of Health

Healthcare Landscape


Delivery of Care Trends

Documented Charity Care 6 Year Trend

Documented Charity Care Data submitted by NJ Hospitals to DOH Office of Health Care Financing for 2007-2014



Visits to Federally Qualified Healthcare Centers 2008-2014

All visits data submitted by FQHCs to DOH Office of Primary Care 2008-2014



General Acute Care HospitalsInpatient Admissions Year: 2010-2014

Admissions Data Submitted by Hospitals to DOH Office of Health Care Financing 2010-2014


Delivery System Incentive Payment Program (DSRIP)

Receive Funding

Incentives

Achieve Measurable

Clinical Outcomes

Implement Quality

Initiatives

• NJ 1 of 6 states• 1st incentive-based hospital

funding program in NJ • 5-year pilot $833M total

− Currently in 3rd year

• 49 hospitals participating

• Asthma • Behavioral Health • Cardiac Care • Chemical Addiction/Substance Abuse • Diabetes • Obesity • Pneumonia • HIV/AIDS


Regional Planning


Regional Planning

NJ has 3 Efforts: • Trenton Health Team, Greater Newark Health Care Coalition, & Camden

Coalition of Healthcare Providers• All 3 Initiatives share Common Goals:

− Organizational non-profits status − Active HIE to ensure patient info is in the hands of provider while patient is

in front of provider− Communicating with each other & communities through use of Community

Advisory Boards & health advocates

• Develop policies & a plan informed by data to:− Target specific conditions for improvement of health outcomes (e.g., diabetes,

asthma)− Collaborate on care (ambulatory, acute, behavioral, social services) to

manage/improve residents’ health outcomes with specific conditions− Collaborate on care to manage ED utilization and ED super-utilizers

• Collaborate on wellness initiatives for residents


Clinical Decision Supports Care Coordination

Trenton HIO

Clinical Decision Support


HIT & Clinical Health Data


DOH HIE Partners

State HIE Partners• HCFFA• NJIT• NJHIN Advisory

Council

• Office of Information Technology (OIT)• Department of Banking & Insurance• Department of Human Services

• Department of Children & Families

• Department of Labor

Healthcare Stakeholders

• HIOs• Patients• Providers• Healthcare

facilities• Payers• Biotech• Pharma• Pharmacies• Labs• Professional

Associations

Department of Health – HIT Office

DHS

Medicaid

Mental Health & Addiction Services

State Medicaid HIT Plan

DOH

Hospitals, FQHCs & other Licensed

Healthcare Facilities

Medicare & Medicaid Provider EHR Incentive Program (PH registries)

NJHIN Advisory Council

DOBI

Health Insurance Payers

eHIT Office

Medicaid Provider EHR Incentive

Program

NJ Health Information Network

(NJHIN)

NJ-HITEC • Physician Training

FederalInfluencers

• ARRA• HIPAA• OBRA• ONC• HHS

HCFFA • Oversight of ONC funds• Financing to grantees

• Awareness Education

OIT

CTO for Affinity Group

Strategy


Camden HIO

Highlander

Jersey Health Connect

Trenton Health Team

Virtua HIO

NJSHINE

AtlantiCare Regional – City Campus & Mainland CampusMemorial Hospital of Salem County

Bergen Regional Medical Center

Mountainside Hospital

Bayonne Hospital CenterHoboken University Medical CenterChrist Hospital

St Luke’s Warren Hospital

St Mary’s Hospital

University Medical Center at Princeton

Unaffiliated Hospitals


Phase 1: NJHIN Architecture

Camden HIO

Jersey Health

Connect

NJHIN Core Services

HighlanderVirtua NJSHINE

Trenton HIO

State Registries

Node

Legend

Health Information Organization (HIO)

Physician’s Office

Hospital

FQHC

Behavioral Health Provider

Long-Term Care Provider

Patient (Access to PHR)

Radiology

Laboratory

Social Services

Local Public Health

Rehabilitation (Physical)


NJSHINE

List of Available Patient Info

Jersey Health Connect & NJSHINE respond to Camden HIO:

“Here is the patient info we have for John Does.”

Camden HIOJersey Health

Connect

Here is the Patient Info we need Here is the list of

Patient Info we have

Patient Info1. Facesheet2. Discharge

Summary3. History &

Physical4. Continuity of

Care Summary5. Progress Notes6. Nurses Notes

Patient Info1. Facesheet2. Discharge

Summary3. History &

Physical4. Continuity of

Care Summary5. Progress Notes

NJHIN Core ServicesWeb Services

DirectoryCertificate/Registration

Authority


HIE Accomplishments

• $11.6M ARRA Grant for health information exchange (HIE) – spent down 99.23% of grant by 3/14/14− $9.8M awarded to HIOs− $1.6M for NJ Health Information Network (NJHIN)− $200K for ONC required evaluation

• Expanded Regional HIOs to statewide coverage - 2013• Facilitated achievement of meaningful use & award of

$723+ M in federal EHR incentive funds to NJ providers –through 2015− Invested in Immunization Information System modernization to

expedite achievement of meaningful use by providers− Provided 3 ways to achieve meaningful use for providers

− DOH Immunization registry

− DOH Electronic lab reporting

− DOH Syndromic surveillance


Care Coordination/Patient Matching

• Failures of care coordination cost $35 billion¹ in annual healthcare waste and cause:− Complications− Hospital readmissions− Declines in functional status− Increased dependency

• Links from patients to electronic medical information increasingly complicated to establish & maintain− Data is stored in various formats across

disparate systems− Demographics may be outdated and

are subject to human error • Medical mistakes cause 46 deaths

per hour in US²

Benefits of Coordination/Patient Matching:• Minimizes mismatches / finds right

records• Links individuals and their health

information across multiple organizations, applications and services

• Improves patient safety through higher data integrity

• Reduces workflow significantly in care coordination

• Improves outcomes and reduces cost• Enables mapping any HIT/HIE endpoint

to Master Person Index (MPI)

¹ Eliminating Waste in US Health Care” JAMA, April 11, 2012—Vol 307, No. 14

² “The Witching Hour” Philadelphia Inquirer. Dec 28, 2014


Data Sharing Organization

(DSO)


(DSO)

Discharge Summary Example –Patient Matching Challenges

1) Tricia is admitted to hospital with MRN 19860122 and discharge summary (ADT) initiated

2) Tricia has slightly different demographics in each provider EHR 3) Care Team challenged to coordinate care across organizations and systems

Tricia Franklin

Tricia FranklinMRN: 19860122

Specialist

Primary Care

Care Coordinator

Trish FranklinMRN: 20100116

Franklin TrishaMRN: 19360204

Trisha FranklinMRN: 19980119

NJHIN

Source: Michigan Health Information MiHIN



(DSO)Data Sharing Organization

(DSO)

Discharge Summary Example –With Patient Matching

1) Tricia admitted to hospital with MRN 19860122 and ADT initiated

Tricia Franklin

Specialist

Primary Care

Care Coordinator

Trish FranklinMRN: 20100116

MPI: 2FZ4UR79H

Franklin TrishaMRN: 19360204

MPI: 2FZ4UR79H

Trisha FranklinMRN: 19980119

MPI: 2FZ4UR79H

2) MPI accurately and reliably links Tricia to her Care Team3) ADT is enriched with MPI for efficient and safe coordination of Tricia’s care

Tricia FranklinMRN: 1234567

CK: 2FZ4UR79H NJHIN

Source: Michigan Health Information MiHIN


Prevention & WellnessPromoting Healthy People & Communities


Partnering for a Healthy New Jersey

• Goal is to reduce chronic disease burden

• Launched a statewide approach for collaboration

• Highlights evidenced-based strategies for intervention

• Promotes a culture of prevention and wellness

Winnable Battles:

• Increase physical activity• Improve nutrition• Eliminate tobacco use• Improve environmental

health• Enable self management• Increase early detection• Improve access to quality

health care

nj.gov/health/fhs/chronic/index.shtml


Working Well in NJ

Working Well in NJ Toolkit provides:• Key elements of healthy lifestyles in NJ

worksites• Successful strategies used by NJ employers to

support and maintain a culture of wellness• Resources to support, establish, and maintain

worksite wellness initiatives• Tools to support the Return on Investment

(ROI) for employers

Working Well in NJ Toolkit can help:• Identify the strengths and limitations of

current health and wellness promotion policies• Convene a Wellness Committee for worksite• Develop a Work Plan to improve the worksite

wellness program

www.state.nj.us/health/fhs/workingwell/toolkit.shtml

Improving Birth Outcomes

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCO-c0dGYhcYCFWxJjAod9ZAINg&url=http://www.state.nj.us/transportation/gis/map.shtm&ei=RjZ4Ve_hOuySsQT1oaKwAw&bvm=bv.95039771,d.cWc&psig=AFQjCNHgt-yAppdaFPMtm2JyJjf6awPnfg&ust=1434027971772934

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCO-c0dGYhcYCFWxJjAod9ZAINg&url=http://www.state.nj.us/transportation/gis/map.shtm&ei=RjZ4Ve_hOuySsQT1oaKwAw&bvm=bv.95039771,d.cWc&psig=AFQjCNHgt-yAppdaFPMtm2JyJjf6awPnfg&ust=1434027971772934

Department of Health and Senior ServicesNJ Department of Health 23

Improving Pregnancy Outcomes Initiative

Community Health Worker (CHW)

•Community Outreach•Identifies women & families needing services•Completes intake•Refers to Central Intake (CI)

Ex.•Medical Home/Primary Care•Mental Health & Addiction •Child Behavioral Health•Developmental Disabilities •Domestic Violence Services •WIC Program •Food Assistance / SNAP •Family Success Centers•Child Lead Poisoning•Local Health Departments•And more…

Prenatal & Early ChildhoodCommunity-Based Services

•Home Visiting - Evidence-based models•Early Head Start and Head Start Programs•Pregnant/Parenting Teen Services – Parent Linking Program / Project TEACH•CCR&R - Infant & Child Care Providers •State-Funded Preschool - Family Outreach •Early Intervention - Part C - Birth to 3•Special Education - Part B - 3 and up•Special Child Health Services – Birth to 21 yrs

Central Intake (CI)Reviews, refers & links parent/family to partneragency for follow-up for initial assessment,prevention education, and/or other neededservices. Children are linked to a medicalhome/developmental screening

Community-Based Health, Family

Support & Social Services

Community-Based Agencies

Consumers and Families

Prenatal Care Providers

Primary CareProviders

Agenda for Local Collaboration•Develop interagency agreements for referral/data sharing•Establish a referral flow chart •Provide cross-training & shared in-service•Tracking & analysis•Identify gaps in resources & referral network•Coordinate Consumer-Driven Community Advisory Board


0

500

1000

1500

2000

2500

July August September October November December January February March

Referrals to Central Intake FY 2014 vs FY 2015 Year To Date

FY14 FY15 YTD

Central Intake Referrals


Improving Birth Outcomes Working Groups

DataChair: George Rhodes, MD, MPH School of Public Health, Rutgers

WellnessChair: Ruth Perry, MD

Payment StrategiesChair: Wardell Sanders, Esq.

New Jersey Association of Health Plans

Optimize/use data sources to:• Enhance data collection

across the state• Deepen understanding of

issues affecting outcomes • Maximize success of efforts

with surveillance• Standardize data definitions

Create a mechanism to:• Enhance collaboration,

communication & coordination of interventions to promote wellness across life span

Engage payors to:• Discuss best practice

financing• Explore opportunities for

evidence-based initiatives to improve outcomes


For more information visit:

www.nj.gov/health

Follow us on Twitter:https://twitter.com/NJDeptofhealth

http://www.nj.gov/health

https://twitter.com/NJDeptofhealth

the road to innovation: an update on nj’s health and ...dowd_the ro… · payment program (dsrip)...

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