Featured Speakers: Katherine Dyer, MPA Health IT Specialist, National HIE Strategy, CMS Polly Mullins-Bentley State HIE Coordinator, Kentucky Health Information Exchange SUMMARY: In this informal and engaging podcast series, HIE Committee member and CMS Health IT Specialist Katy Dyer talks with the Kentucky Health Information Exchange s Polly Mullins- Bentley about how KHIE has approached everything from onboarding to state-wide collaboration in their ongoing mission to bring reliable and responsible health information exchange to the state of Kentucky. Recorded June 17, 2014 TRANSCRIPT: Katy Dyer: Hi, and welcome to the HIMSS HIE Creative Sustainability Series. My name is Katy Dyer. I am a health IT specialist with the Centers for Medicare and Medicaid Services. Our guest today is Polly Mullins-Bentley with the Kentucky Health Information Exchange, otherwise known as KHIE. KHIE is the state-designated HIE for the state of Kentucky and operates statewide. I d like to move into a few questions around the services that you guys are currently providing with the HIE at a high level, and then start to talk about this nebulous idea of sustainability. We throw that term around a lot, and it s sort of, I think, the new hot word, the big topic in the HIE world. We all sort of understand the merits behind HIE and the possibilities are out there, and I think that the industry is in agreement that that s the direction everybody wants to go, but found that that sort of elusive long-term sustainability has been tough in new markets, with emerging technologies to remain relevant. We ve seen some HIEs try to come up, and fail, frankly, you know; there have been others that have been wildly successful in a private and a public model, and you guys have seen a fair share of that success, so I d like to have you talk a little bit around Kentucky s experience with moving toward and achieving, in some ways, that elusive sustainability. Polly Mullins-Bentley: You heard me just talk about the public health reporting, and so that certainly is a big part of what we do. We have now opened, you know, we provide all the public health reporting required for Meaningful Use immunizations, syndromic surveillance, reportable labs, and an interface to the cancer registry and we are onboarding all of our hospitals in Kentucky, and essentially all of our providers in Kentucky that are pursuing Meaningful Use. So that is a good portion of the work that we do. But in addition to that, of course, we were one of those states that, we were not phased, we were not a phased state. So we did not implement Direct secure messaging until late last year. And we have implemented Direct in a very, very, what I consider, thoughtful and strategic way. Since 2014 and Stage 2 2015 Health Information and Management Systems Society 1
Meaningful Use was upon us, we have implemented Direct with our providers as they prepared for Transitions of Care, Katy. So, back to our model of, every provider is very distinct in what they re doing and what stage are they in, and now it s 2014 and what do we have to do for 2014. And so we contracted with a third party vendor, of course, to bring Direct secure messaging and HISP services to KHIE and it was ICA, Direct Trust accredited and we ve been hard at work really since late last year to onboard providers across the state. Primarily hospitals, right now. And, you know, rolling out Direct in 2014 is very, very different than it was rolling it out in earlier years, because now with the 2014 Certified EHRs and the requirements around Transitions of Care, it s a very different model. So, it s been very interesting. It s a real struggle. We are finding it to be a huge challenge. As you know, I ve spoken with you about that. Our team and our providers were pleased to see the Notice of Proposed Rulemaking that was released, so that gives us a little bit of breath, so, and we needed it. I m glad to hear! [laugh] Yeah, we needed that Katy! Well, we ve established a Transitions of Care Community of Practice, Katy. I should invite you! It s every Thursday morning at 11:00. We have hundreds that are coming to the call. So, Transitions of Care, we are providing that service to our providers, it s become one of our most important services. And just trying to bring the state together, we work very, very closely, as you know, with our RECs the UK REC and the Northeast Kentucky RHIO and so we re actually working, we have a Meaningful Use estate, Meaningful Use Collaborative Workgroup, and we re working on our official comments around the NPRM. But anyway, so that s a big part of what we do, that s a service. And then of course, we offer health information exchange services! [laugh] We have a lot of data now, as I mentioned we have over 800 live connections now, probably around we have 83% of the acute care hospitals are live, so we cover that many licensed beds in the state. But now, it s kind of all over the place, probably around 50% are submitting what I would consider a full data set on a patient, so it s growing, you know. The hospitals always start with the public health reporting requirements, but we get a lot of great data out of that. We received almost 8 million ADTs last month, and close to 3 million lab transactions, so we got a lot of great data in there. We re encouraging organizations to query the HIE, the community record, for look-up, and one of the specific initiatives and this goes back to my discussion about the Cabinet, and being amidst all of these other key programs in the state, we get included. It s very, very cool, we get included. So we have an initiative right now called our Kentucky ER Smart initiative. It s around Emergency Department super-utilization, it is focused on Medicaid. And we are looking at the Medicaid population and where there s a lot of utilization of the Emergency Department that s, I don t want to say inappropriate, but we are looking to steer individuals to a primary care setting where they can receive more appropriate primary care services rather than going to the Emergency Department. And we selected 16 pilot communities, and one of the criteria was that the local community hospital was live on KHIE, because we re going to use the ADT messages to send out alerts by Direct. And those are not ready yet, but we re working on that. So we re very, very pleased that KHIE is included in initiatives like that, because that s going to help 2015 Health Information and Management Systems Society 2
us demonstrate our value proposition as an HIE, so it s a wonderful opportunity, and so really excited about that. So that s a service that we re offering, and also, Katy, we re including Direct messaging there because our local health departments do not yet have an EHR so we re provisioning them with our Direct messaging products, pulling them into the fold, so working on that community of care network, and so really excited about that. That sounds great, Polly. It sounds like you guys have a lot of really interesting things in the works, and that, you know, one of the successes you have is the opportunity to, sort of, be at the table and be on the front end of new, interesting, innovative projects that the state is undertaking and choosing to leverage KHIE in that development, instead of coming at the back end and having to, sort of, find ways to maybe, at times, fit square pegs into round holes. You guys are there at the front end, and the innovation models are created with you in mind, so that seems like a real opportunity there. Well, we are a Cabinet, we have a team working on this Round 2 opportunity under the state Innovation model, funding opportunity. And it s very exciting to me, Katy, to be at the table, okay. So I was asked to provide a lot of information about our strategic goals for KHIE, and what we want to be when we grow up, and what do I think about how KHIE can impact or facilitate payment reform in the state. And so, the Cabinet in Kentucky is thinking about this, okay, so isn t that great? I feel very, very fortunate, I have a great group of stakeholders all across the state. I feel very, very fortunate. It sounds like really great work, and I think that, I know I can speak from the CMS perspective, we are all so excited, and I think naturally I can speak from the HIMSS perspective that it all sounds very exciting, as well. So really appreciate the work that you re doing and sharing with everybody out here in the HIMSS community. So let s take, sort of, the turn into the sustainability concept. I know you guys have an innovative model for funding, and I know a lot of times, sustainability is not always just funding, but obviously we all know funding plays a huge role in long-term sustainability. I like to say that when I talk to states, sustainability, I think of as sort of like a stool, and you have to have services that you provide to the community within the HIE; you have to have providers on board and willing to participate; and then you ve got to have a payment model that allows you to really continue to remain relevant. And without any of those pieces, it really is hard to remain relevant and to be sustainable. No matter what, those pieces really are core. What s been your experience in Kentucky, and how have you guys approached sustainability and funding for your HIE? So, back in the early days, when we first received the ONC Cooperative Agreement Fund, you know one of the first things that was required, Katy, was a sustainability plan. And so we worked very hard at that. I was very fortunate, I had, as I mentioned, a great group of stakeholders. A coordinating council made up of a number of individuals from key organizations across the state, also a number of committees. One of my committees is a business development and finance committee. Wonderful group of folks, just worked tirelessly to do a lot of research around, you know, what makes sense, what should this model look like, and 2015 Health Information and Management Systems Society 3
did a lot of research to determine what other states were doing. We wanted to be on par, you know, we didn t want to be an outlier. And that model, that original model, was based on subscription fees you know, it was hospitals, and clinics, and providers, and subscription fees based on number of beds. Very traditional. We were proud as we put it together that we were keeping it very nominal, we felt like it was the lowest across the nation, and all that. And we prepared that model because, I mean, this was in 2011, 2012. We prepared all that. We put together a couple of different-looking models so that, you know, our leadership the Secretary and the Budget Officers here within the Cabinet, and of course the Governor s Office, the big Budget Office could look at it and determine what we needed to do. I spoke openly about that as I was out speaking with providers across the state. Hospitals definitely are much more receptive. [laugh] Physicians are a little bit tougher. And actually at the end of the day when we were looking at this, we finally actually decided, well perhaps maybe the model should just be around hospitals and payers, okay, so many cents per member per month for the payers. And so we landed on that model, Katy, and this was probably, I think in 2012, okay? And so we knew that we needed to get things in place, and we needed to have a regulation actually in place to be able to charge fees. Anytime that you have to set up a fee schedule, you know, within state government, there s a lot of steps to that. Well at the same time, though, the Affordable Care Act and implementation of the Affordable Care Act was really looming and was really a priority in this state. And I think everybody s aware that, as I mentioned earlier, Kentucky embraced the Affordable Care Act. We implemented a health benefits exchange, quite successfully, even though I have to say, being here, I know about all the angst behind the curtain, okay, as well as angst behind the curtain with the HIE, let me tell you that. There s a lot of great things, but its heavy lifting every day. But anyway, as all of that was coming about, I feel like this Cabinet was very, very strategic in moving forward about how we were going to sustain our Affordable Care Act, for one thing, and our exchanges, and so we began to talk about a different model last year. So, early in 2013, as things were really coming down to the wire, we were working hard, we brought in some consultants to work around the health benefits exchange. They began to put together kind of a different looking plan. And so today what the plan is, is that the health information exchange and the health benefits exchange will come together under one umbrella. And so, that is actually in the works. It s not totally totally finalized, it will actually be effective July 1 of this year [2014]. And so what that means is that we will be under one umbrella, we will be under one budget, and there is a funding stream through our high-risk pool that, of course, with the Affordable Care Act as of January 1, this is a payer assessment fee of 1% that will be funneled to both the health benefit exchange and the health information exchange moving forward. That becomes available January 1 of 2015. So, we thought that was very strategic, it puts us, I think, in a very nice organization that makes a lot of sense, and we re really excited about it. That s great, thanks Polly. So, to be clear, I m trying to anticipate questions, so at this point when a provider decides to partake of KHIE s services, what is the process for that? Are there subscription fees, are there onboarding costs? What s your process currently for getting providers in the door, what are the costs necessary for that? 2015 Health Information and Management Systems Society 4
Well of course, it depends on the provider. If it s a big hospital, it s going to be more costly to them than if it s a small provider office. But the first thing that happens when a provider approaches us to participate is, of course, the legal agreement. So we have a participation agreement that is essentially a business associate s agreement that talks about data sharing, and so that s the first thing that we engage in. Let s get the legal agreement signed. The next thing, we have an intake call so that we can gather a lot of-- and the intake call may happen before the participation agreement gets signed. We don t hold things up while we re waiting for legal to review. We ll go ahead, we ll have what we call an intake call. We have a fairly robust onboarding process, as you might imagine. We ve had to really nail that down to keep this thing moving efficiently. But we ll have that intake call, gather a lot of information around that provider: what it is that they need to do, what does their path look like. What stage of Meaningful Use are you in? What have we got to do here? What s our scope of work, and what s the timing? Who s your vendor, and how quickly can we get on a call with your EHR vendor? We ll secure the signed participation agreement, so the light is green. We ll have a technical kick-off call with the EHR vendor, and then determine what it s going to take to connect that provider. And again, you know, what we re finding now under Stage 2 is, depending on the vendor it really, really depends on the EHR vendor, Katy. What it is, what kind of interfaces does the provider need for the EHR that they are currently operating under, okay? Because we have found now, you know, they have special public health reporting interfaces some of the vendors do, not all of them do, but for syndromic and for reportable labs. And we will work with the provider and their vendor to make sure that they have exactly what they need. We do not charge them anything from KHIE, okay, but they do have the costs on the vendor side for the interfaces that are needed. But we work very diligently to make sure that they have so that we don t have any wasted time, or any waste anywhere that they have what they need to have as we proceed on to connectivity. I think that that s an interesting model to share with the listeners today. So really appreciate that insight, I think that you guys are approaching this in a really innovative, interesting way. Until next time, thank you so much, have a great day! Thanks so much Polly. Thank you Katy, appreciate it. ------------------------------------------------- This is the second of a multi-part series on Creative Sustainability. Be sure to listen to Part 3 next, as Katy Dyer and Polly Mullins-Bentley wrap up their discussion on the Kentucky Health Information Exchange. 2015 Health Information and Management Systems Society 5