State of Colorado Health Care Policy and Financing

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Colorado TEFT Team

November 5, 2015

Agenda

Introduction

Goal of PilotTier PilotingActivity to PilotRole of Colorado TEFT Team in the pilot

Standards and Technologies Under Consideration

Logistics

Ecosystem

Defining Success

Resources/References

Improving health care access and outcomes for the people we serve while demonstrating

sound stewardship of financial resources

Our Mission

Introduction: Colorado TEFT eLTSS Pilot Team

Introduction: Colorado TEFT Team

• Who we are: – CO Department of Health Care Policy and Financing, TEFT Grantee– CORHIO - Colorado Regional Health Information Organization– QHN – Quality Health Network

• What we do: – HCPF administers Medicaid, Child Health Plan Plus, and other health care programs for Coloradans

who qualify.– CORHIO – HIE on the front range connecting hospitals, labs, physicians, emergency services,

behavioral health, skilled nursing, home health, hospice and – QHN – HIE on the western slope - first HIE in Colorado

• Collaborative: – Colorado TEFT Team includes members of the HCPF LTSS department, internal IT Interchange staff,

quality and health improvement unit and the Governor’s Office of Health IT– Two state HIE’s, Quality Health Network and CORHIO– Focus Group members in five communities across the state of Colorado

Pilot Introduction: Business Drivers

• Business Drivers:– Comprehensive assessment and re-assessment of clients– Person-centered services provided to clients

• Business Use Case:– Create and test new means of sharing LTSS data

electronically with clients and our current LTSS Service providers and stakeholders

– Identify new and efficient ways of exchanging information– Include both clinical and non-clinical data

Goal of the Pilot

Colorado will be using:User Story 1 for our Pilot in Round One: LTSS Eligibility, eLTSS Plan Creation and Approval

User Story 2

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User Story 2:Sharing a Person-CenteredeLTSS Plan

Tier 2 – Pilot in Round 2

Pilot Workflow

• Single Entry Point: Case managers have approximately 100 clients in their caseload– Annual assessments per case mangers average 8-10 in-home each month – Each assessments can take up to three hours – Assessments are currently conducting by taking notes on paper - with an ink

pen – All assessments must be entered and submitted within 10 days of conducting

the assessment into the BUS (Business Utilization System)

• Intake Case managers conduct between 20-30 assessments per month and follow same workflow process.

• The BUS is the living document for clients’ assessments and service plans.

• If clients meet functional eligibility through the assessment, case managers need to check financial eligibility. This process differs among agencies.

• Currently information gathered for clients include ADLs, IADLs and service plans.9

Which Tier are you piloting in Round 1?

• The Colorado TEFT Team will be using a three tiered approach with each tier building on the previous tier with advancing technology.

• We will be piloting Tier 1 - Basic non-Electronic Information Exchange in Round One – targeting workflow redesign and testing to facilitate future electronic information sharing

• Objectives:– Share what eLTSS data elements are currently in use

• Ex. SEP enters all information online onto the BUS (Benefits Utilization System at HCPF).

• PAR (Prior Authorization Requests) Client face sheets and the Professional Medical Page all on paper

– Identify gaps in data elements – Evaluate if any subdomains overlap – Develop tangible Use Case piloting options of mutual value between participating

providers and clients– The eLTSS data will be shared as a file compatible with existing standards (ie. C-CDA)– Assess the value of engaging the client in developing and sharing their eLTSS plan

Which Tier are you piloting in Round 2?

• We will be piloting Tier 2 – in Round 2 – Secure, Electronic Data Exchange – Tier 2 will build on the objectives in Tier 1 and incorporate electronic

information exchanges with readily available services, transport standards, and content standards.

– Tier 2 will target use of the data, reports, and files defined in Tier 1 and exchanging them with participating providers by means of established secure exchange standards.

• Objectives:– Use the data/reports/files from Tier 1 and exchange with participating

providers using established secure exchange standards– Investigate additional methods available to participating providers to utilize

established e-Health secure exchange methods

What are you intending to pilot

• Pick which one(s) apply– Tier I - Create Plan– Tier II– Send and Receive Plan

• Update Plan

– Tier III – Send and Receive Plan• Update Plan

• Have you identified a Service provider with which to work, if so who? – We have identified two Focus Group Communities:

• Northern Colorado – Weld County and Larimer County• Southern Colorado – Colorado Springs area

• Do you know if they have an electronic system?– Northern Colorado Focus group members do not utilize an electronic system– Southern Colorado Focus Group providers are connected to CORHIO and one

provider is in implementation with Care At Hand • Do you know which sub-domains from the FR document will you pilot:

– The sub-domains will be discussed with both communities for their input and agreement

What role do you play in the pilot

Colorado TEFT Team

Our role will be to work with the two Focus Group Communities to:

• Identify and recruit providers in the LTSS continuum• Train/educate providers on the pilot and objectives• Inventory existing Provider technology• Assess readiness of Provider to work with eLTSS data• Map data elements in plan to the eLTSS dataset• Share data elements among partners• Develop Use cases of mutual interest• Document and implement changes to provider workflow• Test secure exchange of data

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Standards Under Consideration:

• Tier 1– E.g. Non Electronic – Paper to an on-line submission into the BUS

(Benefits Utilization System)– E.g. Electronic – exchange eLTSS data as a report object

• Tier 2– E.g. CCDA– Use the data/reports/files from Tier I and exchange with participating

providers using established secure exchange standards• Option: FEi and Care At Hand

• Tier 3:– E.g. CCDA (content and transport), OAUTH (security), FHIR etc.

Pilot Logistics:

• Timeline• Kick off: November 2015 –On-site meetings at both communities • Identification of Provider staff and clients- December 2016• Completion of Provider Data Use/Sharing Agreements – January 2016• On-site meetings with the vendor technology and readiness – January

2016• Develop methods to produce eLTSS data appropriate for sharing –

February 2016• Exchange eLTSS data via paper, fax or other secure method – March

2016• Completion of Pilots: April 2016

• Challenges:– Identification of common data elements across providers

Pilot Ecosystem

• Partners:– Two Northern County Department of Human

Services/SEP working with EBD Waiver clients• Case Managers and EBD clients

– Southern Colorado – Regional Care Collaborative Organization, Community Center Boards, combination of EBD and SLS ID/DD clients

• Systems:– HCPF systems include MMIS, BUS, BIDM, PAR

(financial eligibility determination), as well as the new care assessment redesign tool

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How do you define success

• Support from the two Focus Group Communities to assist in TEFT/Evaluation and validates eLTSS Use Cases

• Engages the eLTSS Focus Group members and clients in new ways

• Pioneer methods of creating eLTSS output, in various forms, from multiple LTSS Health IT Systems to increase access

• Gap analysis with domains completed

• Impact workflow by reducing time in processing paper notes into electronic exchanges

• Establishes transport framework that will be built upon in Tier 2 and Tier 3

Helpful References

For more information:

Colorado Department of Health Care Policy and Financing https://www.colorado.gov/hcpf

Colorado Regional Health Information Organization HIEwww.corhio.org

Quality Health Network HIEwww.qualityhealthnetwork.org