Community Health Care Association of New York State / Arcadia Solutions

Building the New York State Center for Primary Care Informatics:

CHCANYS’ Data Warehouse

Monday, October 17, 2011

Today’s Objectives

1. Learn benefits of statewide data and why CHCANYS and many PCAs nationwide are establishing data warehouses.

2. View examples of reports from the Arcadia reporting platform.

3. Learn about the pilot project and what it means for a participant health center.

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Agenda

• Statewide Center for Primary Care Informatics Overview

• About Arcadia

• Challenges and Arcadia Perspective

• Pilot Demonstration: Data Aggregation and Reporting Demonstration

• Summary and Next Steps

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Project: Statewide Data Warehouse of Health Center Data

• Identified as a priority goal in CHCANYS Strategic Plan.

• Will be known as the Center for Primary Care Informatics.

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Statewide Primary Care Informatics Benefits

Phase 1 Phase 2

Practice management (EPM)

Health records (EHR)

Payer

Federal (e.g., census, labor)

State (e.g., SPARCS)

Analysis and reporting to support the following:

Quality Improvement -quality measurement

& benchmarking with peers

PCMH

Health Home

MU

UDS

Analysis & Reporting to support the following:

Demonstration of VALUE delivered by the

FQHC model - the Triple Aim: higher quality,

better outcomes, lower cost

Advocacy

Pay-for-Performance (P4P)

Partnerships

Planning for growth

Fund development

Proposed Scope

Benefits

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About Arcadia: Our Primary Care Associations Clients

Arcadia is helping PCAs and FQHCs across 10 states and our list of clients is growing.

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Bending The Cost Curve = Opportunity

2009 $2.5 Trillion

1990 $724 Billion

2019 $4.6 Trillion

Source: CMS

Under healthcare reform, there is an opportunity to share in the cost savings achieved.

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Landscape Is Changing Quickly

Sept. 26, 2011

Aug. 30, 2011

9/16/2011

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• Health Centers are better equipped to thrive under health reform than private physician networks.

• Emerging payment models align with comprehensive primary care.

• Success will require care delivery transformation:

– New technical tools & methods for measuring success.

– Rethinking roles and responsibilities.

• Leaders of our Health Centers should be focused on the cultural challenges of making the leap.

FQHCs Should Embrace Reform

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Can you precisely articulate and demonstrate the value of primary care?

• Engages stakeholders to ensure their needs are met.

• Have a consistent understanding on how each component is measured.

• Leverage the primary care value formula:

Advocacy Must Change As Well

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Own Your Data…Own Your Future

Meaningful Use may not achieve all your organizational goals.

FQHCs will need to demonstrate improved effectiveness, insight, and efficiency throughout the continuum of care. The depth and quality of data will be critical in determining success.

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• Meaningful Use of EHR will be the “floor” not the “ceiling.”

• “Recognition” as a Health Home will be a requirement, top-performers will go beyond.

• Competition will be increasingly fierce as the overall system re-evaluates the value assigned to Primary Care.

• How you are paid is how you should pay. This creates more opportunities than down-side, but will be a painful transition.

Health Home As A Methodology

EHR / Registry /

Meaningful Use

Data Aggregation /

Exchange (HIE) PCHH

Performance Management

SHIFT FOCUS OF CARE

ESTABLISH INFRASTRUCTURE ALIGN INCENTIVES

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Demonstration Program Value for Health Centers

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• Quality of Document = Quality of Clinical Care Delivered: Get credit for the high quality work your providers are delivering. Ensure clinical care delivered is reflected accurately and reportable from your EHR.

• Increase Transparency: Know where how ALL your patients stand. No need for selective sampling (70 pt manual chart audit).

• Identify Best Practices And Benchmarking: Identify your best performers and bring everyone up to their level.

• Improve Quality: Use the information to identify and prioritize the areas of opportunity. Baseline performance and track progress against your improvement programs. Easily manage your patients by population.

• Easy to Run Reports (UDS, MU, PCHH): Run your reports with the click of a button. Drill down to health center, location, provider and patient levels to understand where you stand. Make course corrections long before the submission date.

• Improve Reporting Efficiency: Free up analyst time for analysis vs. spending hours, days or even weeks on data collection.

• Drive More Patients To Your Health Center: Demonstrate improved quality and cost effectiveness of CHCs; driving more patients to CHCs. Seize the opportunity provided in 2014 by the health benefits exchange.

• Prepare for Uncertain Future & Assure Sustainability: Empower your providers and staff to address patient center health home, Pay For Performance contracts, Accountable Care Organizations, and develop evidence based guidelines.

Participation in the pilot program will deliver substantial cost savings to the health centers and their providers and serve as the foundation for continued savings through improved healthcare quality and outcomes.

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Data Aggregation & Reporting: DRVS Overview

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The application contains real data that has been de-identified to protect our customers privacy and contains

quality measurement data on approximately 250,000 patients.

DRVS is a quality measurement and improvement platform that specializes in ambulatory measurement at community health centers. The demonstration outlined in this document represents a typical scenario covering how DRVS is leveraged to support quality improvement at provider organizations.

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Reporting: DRVS Architectural Overview

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• PCA and CHC focused solution

• Data from disparate EHR and EPM systems.

• Daily data refresh.

• Data unified in EHR-agnostic Data Warehouse for apples to apples comparison.

• Web-based reporting platform accessible from any major browser.

• User role differentiation and data blinding.

• Graphical and text based depictions of datasets.

• External data links geographic characteristics to patients & providers

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DRVS Demo

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Statewide Primary Care Informatics Approach

Our approach to getting our clients to the end state consists of the following activities: Discovery and Strategy Development, Pilot Program, and Implementation Phase 1 and Phase 2.

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Discovery

& Strategy

Solution

roadmap

Assess QD = QC and

develop benchmarking

for 6-10 health centers

Pilot Program

& Quick Wins

Implementation

Phase 1

(EPM/EHR)

Implementation

(Clinical Outcomes)

Business case

development

3 Weeks 4-8 Weeks 4-6 Weeks per CHC

Pilot Program

Current state

assessment

Implementation

Phase 2

(External Data/Claims)

Implementation

(External Data)

4-6 Weeks per CHC

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Pilot Program Approach and Timeline

The initial set of reports will be developed during the first six weeks. After our onsite meeting, we’ll meet weekly to review and validate our results.

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Select pilot site

Review workflow Develop preliminary

metric analysis

Develop metric reports

Present draft reports and solicit feedback

Finalize initial reports

Connect to EHR

Review variability analysis

Analysis Preparation Measure Continuous

Improvement

Review EHR data Create ability to self-run reports

Weeks One to Three Week Five Week Four Weeks Six and Onward

Update metric reports

Present draft reports and solicit feedback

Present draft reports and solicit feedback

Expand assessment metrics

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QD = QC Data Fidelity Process

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Standard metric

definition Agree on standard metric definitions.

Where’s info

captured?

Structured or

unstructured?

Variation in

definition?

Provider variation

Root cause

analysis

Improvement plan

Is smoking cessation captured in one field in the social history template or is it captured

in 22 places across 5 templates?

Are results captured in free text fields? Look for impact on patient safety.

Check for standardization of drop down lists (e,g, white, Caucasian, WHTE, W).

Conduct analysis by provider (variations by practice, specialty, location).

If numbers are low, we look for reasons why (e.g., data capture, configuration).

Provide patient level data to help resolve issues.

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Pilot Health Center Team and Time Commitment

Provider (MD or NP)

– Review of work flows and how providers document care in EHR

Quality Director

– Review current reports and metrics

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Technologist/EHR manager

– Help with EHR login and data validation

Health Center Project Lead

– Health Center central point of contact

The Arcadia team will perform the majority of the analysis. However, health center collaboration is critical to the success of the project.

We will need your help with the following:

• 30 min onsite preparation call

• 3 hour onsite visit

• Up to three 1-hr data validation review

• Additional time will be required for data validation and process improvement

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Summary

• As delivery and payment systems evolve, the most successful organizations will be those that use data to drive quality improvement and to prove their value (outcomes & costs).

• CHCANYS and its health center members are well positioned.

• Through this effort, you’ll have the data you need to further enhance your position as heath care leaders.

• Your data becomes even more powerful when you combine your health center data with external data sources to support planning, negotiation and partnership development (e.g. payers, census, other government data bases, etc).

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Next Steps

• Convene governance group.

• Continue to reach out to funding organizations.

• Kick off pilot program.

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