Nevada State Innovation Model (SIM) Taskforce Agenda
Agenda for the Nevada State Innovation Model (SIM) HIT Taskforce meeting discussing topics such as data discussions, diabetes report update, other state approaches, gaps in data, ownership, and governance. Also includes insights from Oregon's healthcare transformation efforts.
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Presentation Transcript
Nevada State Innovation Model (SIM) HIT Taskforce July 27, 2015 Division of Health Care Financing and Policy 1
Agenda Introductions CHIA/DHSS Data Discussions and Approach Update on Diabetes Report Other State s Approach Interim Approach Review of Long Term Approach Gaps in Data Asset Inventory Summary of Business Needs Conceptual Model Ownership and Governance Wrap-Up/Next Steps Wrap Up and Next Steps DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 2 Prepared by Myers and Stauffer
CHIA/DHHS Data Discussions and Approach Deb Sisco 3
Update on Diabetes Report Joseph Greenway 4
Oregon Background Legislative mandate for transformation prior to SIM Had an existing all payer claims database (APCD) SIM served to accelerate transformation efforts Developed Coordinated Care Organizations (CCO) Need Integrate and share data with multiple entities DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 6 Prepared by Myers and Stauffer
Oregon Approach Convene stakeholders to collaborate on solution Connect existing series of community HIEs Adopt direct messaging as floor for sharing data Developed clinical quality measure registry for Medicaid using QRDA III Includes aggregate data only no patient level data No current plans for an all payer clinical registry Leverage existing state registries DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 7 Prepared by Myers and Stauffer
Oregon Implemented an Emergency Department alert system (EDIE) Users pay a fee to access Three year pilot Working to implement a patient profiling system (PreManage) for providers as well Conference call and demonstration held with EDIE and PreManage vendor DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 8 Prepared by Myers and Stauffer
Colorado Enhance existing centralized data hub that integrates clinical and claims information under the Comprehensive Primary Care initiative (CPCi) Existing all payer claims database Pull information from HIE Leverage existing clinical/quality measures DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 9 Prepared by Myers and Stauffer
Colorado Track provider and state level performance Will create provider dashboards Create payer and provider benchmarking information Leveraged existing Master Patient Index tool Independent Authority created to procure and own the SIM HIT proposed technology DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 10 Prepared by Myers and Stauffer
Interim Approach Interim Approach - the strategy for measuring population health prior to availability of an analytics tool with access to all patient level data. Aggregate existing quality/outcome metrics and other data points Reported manually from each payer to central entity Supplemented by existing state registries DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 12 Prepared by Myers and Stauffer
Interim Approach Phase I: Highly Manual Payer submit outcomes data to administrator Administrator aggregates data and normalizes based on payer covered lives Omits uninsured/self-paid claims Phase II: Some Automation Provider or Payer submits QDRA III to payer who contributes electronically to clinical repository Programmers create basic queries against data Phase III: Long Term Solution DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 13 Prepared by Myers and Stauffer
Data Asset Inventory Define Business Needs Develop Conceptual Model Ownership, Roles, Responsibilities, Organizational and Governance Structure Funding and Sustainability Identified Request for Information Refine Model Request for Proposals Design, Development, and Implementation Go-Live DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 15 Prepared by Myers and Stauffer
Data Asset Inventory Checkpoint on complete data from key payers Medicaid/CHIP PEBP Indian Health Services Culinary Health Fund Gap identification Strategy for closing gaps DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 16 Prepared by Myers and Stauffer
Business Needs Provide a population health analytics tool to measure population health and population health improvement Incorporate information and data from other sources that are not historically considered to be medical in nature. Present useful information at an aggregate level as well as at a payer, provider and possibly patient level along with a public view. DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 17 Prepared by Myers and Stauffer
Conceptual Model Clinical Inputs HIE: Hospital, Physician/Clinic, Dental, Pharmacy, Laboratory, School-based clinics, DOC, DJJ Clinical Registries Electronic Health Records CCD of Case Management Records from Payers Administrative Inputs Payer Claims DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 18 Prepared by Myers and Stauffer
Conceptual Model Reference Information Patient Provider State Demographics Zip, County, Population, Income, Etc. Codes ICD, CPT, HCPC, ADA, DSM, NDC DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 19 Prepared by Myers and Stauffer
Conceptual Model Other Inputs Public Assistance Programs: SNAP, TANF, WIC Department of Education: Attendance; Scores/Grades DJJ and DOC Encounters Foster Care/Adoption Assistance Flags DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 20 Prepared by Myers and Stauffer
Provider Administrator Patient Public Views Analytics Tool Clinical Administrative Other Reference DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 21 Prepared by Myers and Stauffer
Considerations Sources of Data Data Validation Flow of Data Method of Transmission Security Measures Access to Data Outputs DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 22 Prepared by Myers and Stauffer
Ownership and Governance Who will procure the system? Where does the data reside? Who has access and performs the analytics? What is the data governance structure and how are data governance issues handled? DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 23 Prepared by Myers and Stauffer
Discussion 24
