Colorado is Leading. Colorado is ranked 8 th overall, up from 12 th in /3/2016. Strategy Development for Systems

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1 Strategy Development for Systems Development and Operations Client Eligibility Health Care Claims Processing Business Intelligence & Data Management Health IT Initiatives & Interoperability Oversight of Purchasing & Contracting Chris Underwood Health Information Office Director Representative on Hospital Provider Fee Oversight & Advisory Board and ehealth Commission Participation on task forces related to ending homelessness and individuals involved in the criminal justice system 1 1 Colorado is Leading Colorado is ranked 8 th overall, up from 12 th in 2014 Ranked #9 Ranked #5 Ranked #2 Ranked #11 Ranked #26 2 1

2 How Can We Impact Health? Health Factors that Impact the Length & Quality of Life Clinical Care (20%) Health Behaviors (30%) Social & Economic Factors (40%) Physical Environment (10%) Access to Care Quality of Care Tobacco Use Diet and Exercise ecse Alcohol and Drug Use Sexual Activity Education Employment Income Familyand and Social Support Community Safety Air and Water Quality Housing and Transit 3 Accountable Care Collaborative Integrating Care, Delivering Value 4 2

3 Data & Analysis Evolution Actionable Data Real-Time & Point-in-Time Reporting Cognitive Computing Metrics, Key Performance Indicators & Quality Scores Dashboards & Data Visualize Reporting Panel Datasets with Individual Data & Socioeconomic Points Over Time Inputs for Analysis 5 Medicaid Health IT Ecosystem Eligibility Determinations Case Management Tool PEAK & Client Eligibility Portal Client Mobile App Provider Enrollment/Directory Claims Processing Client Benefit Plans o Benefit Limits, Copayments, TPL Provider & Client Portals Population Management Tool Risk Scores/Quality Measurements Predictive Analytics/Modeling Data from External Systems Client Health Record 3

4 Eligibility Systems 01 7 Overview of Eligibility Systems Client Mobile App Program and Eligibility Application Kit & Client Eligibility Portal Colorado Benefits Management System Eligibility Determinations Case Management Tool 8 4

5 Vital Tool for Care Coordinators 02 9 Overview of VITAL tool Vital Tool for Care Coordinators Care Management Tool Client Assessments/Screening Referrals/Authorizations Interventions & Care Plans 10 5

6 Colorado interchange Overview of Colorado interchange Pharmacy Benefits management System & Interfaces to vendors (Utilization Management, Third Party Liability) interchange Provider Portal & Client Portal Colorado interchange Provider Enrollment/Directory Claims Processing Client Benefit Plans o Benefit Limits, Copayments, Third Party Liability 12 6

7 Business Intelligence & Data Management System (BIDM) Overview of BIDM Data Exchanges with Other Vendors & State Systems* BIDM Provider Portal BIDM Population Management Tool Risk Scores/Quality Measurements Predictive Analytics/Modeling Data Exchanges with Multiple State Systems RAE & PCMP Client Reports RAE & PCMP Query Ability High Utilizers/High Risk Info Quality/Incentive Reporting 14 7

8 HIE through CORHIO/QHN Overview of HIE through CORHIO/QHN Long-Term Services and Supports PHR (TEFT Grant) HIE through CORHIO/QHN EHR Client PHR Physician Quality Metric Reporting Tool (State Innovation Model Grant) All Payers Claims Database 16 8

9 Questions on Medicaid systems? Vital Tool for Care Coordinators Care Management Tool Client Assessments/Screening Referrals/Authorizations Interventions & Care Plans PBMS & Interfaces to vendors (UM, TPL) Single-Sign-On between Portals BIDM Provider Portal Client Mobile App PEAK & Client Eligibility Portal RCCO & PCMP Client Reports RCCO & PCMP Query Ability High Utilizers/High Risk Info Quality/Incentive Reporting interchange Provider Portal & Client Portal CBMS Eligibility Determinations Case Management Tool Colorado interchange Single-Sign-On Provider Enrollment/Directory Claims Processing Client Benefit Plans o Benefit Limits, Copayments, TPL Business Intelligence & Data Management LTSS PHR (TEFT Grant) Client PHR Quality Metric Reporting Tool (SIM Grant) Data Exchanges with Other Vendors & State Systems* Population Management Tool Risk Scores/Quality Measurements Predictive Analytics/Modeling Data Exchanges with Multiple State Systems HIE through CORHIO/QHN All Payers Claims Database EHR Physician Health IT Governance Office of ehealth Innovation ehealth Commission Available Funding Medicaid SIM Future Grants Interoperability Standards Qualified Entity Standards Health IT Project Standards Pi Private Stakeholders State Agencies Health IT Consultants Administrative &Fiscal Agent Support Grant Awards to Qualified Entities who submit proposals with sustainability plans to ehealth Commission Qualified Entities Vendors/ Applications 18 9

10 CAII Background Colorado Advanced Interoperability Initiative (CAII) ONC awarded Colorado the grant in July 2015 Builds upon current infrastructure to produce new capacity for exchanging summary of care documents to share with ambulatory, Long-Term and Post-Acute Care (LTPAC), and behavioral health providers CORHIO & QHN lead CAII and are responsible for achieving goals 19 CAII Continued Three Milestones: Adoption 10% complete with LTPAC providers; 54% complete for ambulatory providers; and 100% with BH providers Exchange Interoperability Key Activities to help achieve milestones: Developing software for achieving consent to share Behavior Health data. Conversion of Minimum Data Sets (MDS) and OASIS to Consolidated Care Documents (CCDs) 20 10

11 ONC Advanced Interoperability Grant The Colorado solution starts with acquiring encounter-based summaries from ambulatory, long-term care and behavioral health providers via continuity of care documents (CCD). This solution will allow ambulatory, long-term care and behavioral health data to be queried from providers systems using standards-based protocols. This conversion will enable effective health information exchange between these entities and other providers. Ambulatory Providers LTPAC/SNF and Home health Agencies BH health systems Goal: Expand acquisition of encounter based summaries from ambulatory providers via continuity of care documents (CCDs) Target: 500 providers Goal: LTPAC/SNF/home health will be able to share the Minimum Data Set (MDS) or Outcome and Assessment Information Set (OASIS) data that they are required to obtain and send to CMS electronically using the Vorrohealth KeyHIE Transform Tool, and convert that MDS or OASIS data into a CCD. Target: 30 long-term care facilities across Colorado Goal: The inclusion of patient-directed consent and pilot expanding the traditional HIPAA exchange model by adding to it a patient-centric, exchange driven model. We will use two different models for the behavioral health work, one that includes the Jericho tools enabling patient-driven consent, and one that uses a point-ofcare consent model. Target: 2 pilots 21 ONC Advanced Interoperability Grant Roles and Responsibilities (current state) Program Officer: Larry Jessup ONC Project Sponsor: Chris Underwood Project Coordinator: Micah Jones HCPF State t Health IT Coordinator: Carrie Paykoc Primary Contact: Kate Horle Technical Lead: Kelly Joines Innovation Lead: Paul Marola Long Term Care Lead: Pam Russell BH Lead: Toria Thompson CORHIO Primary Contact: Marc Lassaux Project Lead: Rich Warner Technical Lead: Marc Lassaux LTC & BH Lead: Jacque Jones QHN BH consent subcontractor SNF/LTPAC subcontractor VorroHealth KeyHIE TBD(sub) TBD (BH subcontrator) 22 11

12 ONC Advanced Interoperability Grant Funding Distribution (current state) Funding Source Grants Administrator ONC Funding distributor (contracts/sow) Grant Coordinator/Administrator Project Manager HCPF OeHI Project Oversight Strategy Alignment Communications coordination HIE Performance metrics (Ambulatory, BH, SNF/LTPAC) Interstate CORHIO QHN HIE Performance metrics (Ambulatory, BH, SNF/LTPAC) Interstate t t BH consent subcontractor VorroHealth (LTPAC subcontractor) SNF/LTPAC subcontractor CCD conversion tool TBD (BH subcontractor) BH Consent tool TBD (BH subcontractor) 23 + Contact Information o Chris Underwood Health Information Office Director Chris.Underwood@state.co.us Micah Jones Medicaid Health IT Project Coordinator Micah.Jones@state.co.us 24 12