Indigent Care Collaboration HIE Supports Community Collaboration

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Indigent Care CollaborationHIE Supports
Community Collaboration

• Ann Kitchen ? Executive Director David Vliet ?
  CEO
• ICC ? Austin, Texas CCSD ? Austin, Texas
• 512.804-2090 ext.201 512.972.5205
• akitchen_at_icc-centex.org david.vliet_at_ci.austin.tx
  .us

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Introduction to the ICC
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ICC Mission

• Affordable access to effective healthcare for the
  uninsured in central Texas.
• ICC initiatives designed to give safety net
  providers collaborative tools
• to undertake initiatives together
• that none could do as effectively alone
• that result in increased revenues or reduced
  costs
• in providing health and mental health care to low
  income patients

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ICC Regional Membership
Williamson County Travis County Hays County
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ICC Approaches to Achieving Access

• HIE - ICare Capacity Building
• Regional Planning Analyses
• Affordable Health Coverage Project
• Care Coordination (PharmCare, Asthma)
• Eligibility Screening
• Integrated Behavioral and Primary Care
• Centralized Scheduling, Screening, Triage
• Public Health Information Links

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Health Information ExchangeICCs ICare System
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ICare Vision

• Goal - fully operational, physician and user
  friendly system containing timely and complete
  data sufficient to support two primary uses
  program evaluation and clinical care.

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ICare Shared Health History

• ICC Members share patient demographic, encounter,
  pharmacy and other data electronically with the
  ICC through HIPAA compliant Business Associate
  Agreements.
• Master Patient Index/Clinical Data Repository
  created using Application Service Provider.
• Aggregate data available for all patients, no
  duplicate data entry required.
• Providers access individual shared health records
  after authorizations are signed and in system.

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ICare Snapshot June 2007

• Over 60 locations 13 hospitals, 50 clinics, 1
  Mental Health Authority (with various community,
  state and residential facilities), 2 Physicians
  Networks.
• Over 550,000 patients (uninsured / underinsured).
• 2.9 Million encounters, from 2002 present.
• More than 510,000 prescriptions.
• Data includes ICD-9, CPT-4, Provider, Payer.
• Encounter Types Inpatient, Outpatient, ED, Lab,
  Call Center, Clinic Visits, Dental,
  Prescriptions.

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CHR EMR Integrated System
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Types of Electronic Health Records

• Provider Electronic Medical Record (EMR)
• Community Health Record - ICare
• Personal Health Record (PHR)
• Personally-managed health data
• Populated with data from CHRs and EMRs
• Wellness programs/condition mgmt.

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Electronic Medical Records EMR

• EMRs replace traditional paper charts in a
  doctors office or hospital with an electronic
  record that includes
• What therapy or treatment was provided
• What medications were prescribed
• What labs were ordered and the results
• What progress has been made to date to manage the
  condition
• Provides continuity of care.

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Health Information Exchange HIE

• Supports accountability measuring results
• Decreases duplication of services
• Attacks fragmentation coordinating care
• Provides individuals medical information to
  doctors, hospitals, nurses and other providers
• Provides aggregate data for community health
  measurement
• Helps patients learn self-management strategies.

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Screen Shots
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Doe, John
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Expanded Single Encounter
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Filtered by Department
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Show Filtered Encounters
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Break the Glass Function
John Doe
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Medication Summary
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Medication Detail
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Adoption and Use Cases
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Approaches to Adoption Metrics

• Individual (point of care). Usage by the
  clinician / caseworker for the patient in front
  of them. Typically, the clinician either
  accesses individual patient data him/herself, or
  has the relevant reports prepared in advance of
  the appointment by administrative or other
  clinical staff (e.g. Nursing staff).
• Epidemiologic. Potentially the area of greatest
  impact for improving health outcomes in the
  community.
• Communication and Reporting Use. Use of the
  ICare data for ICC member, community, and
  organizational reporting purposes.

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Use Case City Clinic (CoA-RZ)

• Data Pushed to EMR. Outbound interface sends
  ICARE encounter data from Brackenridge Hospital
  ED to CoA-RZ clinics EMR, ideally within 24
  hours of encounter.
• Preconditions/Triggers. Patient had encounter at
  ED and has subsequently presented at the CoA-RZ
  clinic.
• Value. Patients treated at ED have
  well-coordinated follow-up care at clinic to
  reduce unnecessary ED use, better manage care.
• Alternative paths. Patient had recent ED
  encounter, but failed to make follow-up
  appointment at clinic.
• Clinic staff generates weekly report from EMR
  which shows ED visits not followed within
  expected number of days by a clinic visit.
• Clinic staff contacts these patients to schedule
  an appointment.

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Appendix A Use Case Patient Flow Diagram
CoA-RZ Clinic
Schedule appt at CoA-RZ Clinic
Schedule appt at CoA-RZ Clinic
Presents for appt at CoA-RZ Clinic, is directed
to registration
Presents for appt at CoA-RZ Clinic
Access NextGen, Including ICare tab, to search
for recent encounters new clinical data.
Pull/create Chart
Access NextGen to update chart with any new
information
Add additional ICARE and NextGen data to chart
Add additional ICARE and NextGen data to chart
Pull/create Chart
Add intake data to chart
Perform patient intake
Add intake data to chart
Perform patient intake
Create patient treatment plan based on data from
chart, NextGen, notification, and clinical
observation.
Automatic notification of all ICare hospital
encounters is sent to PCP in NextGen
Perform patient encounter while referring to the
chart and NextGen Data.
ICARE
NextGen
Invision (Brack)
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EMR Screen Shot ICare ER Data
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Healthcare Utilization Patterns
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Healthcare Utilization Patterns
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Healthcare Utilization Patterns
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Healthcare Utilization Patterns
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Utilization Respite Program
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ROI Examples
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Patient Results Based on ICare Data

• Pharmacist started working with 44 year old,
  African American male (Type 2 diabetes, asthma)
  on 12/28/05

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Potential Budget Impact - PharmCare
1Patients with at least one ED encounter or
inpatient admission, primary diagnosis of asthma
(ICD 9493.x) in CY 2006. 2Percent change in
utilization observed in pilot PharmCare Program.
Figures in ( ) reflect reduction in use. 3Total
cost calculated by multiplying net difference in
use (days/encounters) by unit cost in dollars.
Unit costs based on proxy pricing using 2004
Medicaid reimbursement values. Inpatient
1,083 ED 254 Clinic 51 OPD
254 4Inpatient days and ED encounters excluded
obstetric-related visits
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Value of Eligibility Screening
Some members do not always verify that patients
received drugs, so prescriptions filled, pts
who received meds, and AWP values are either not
reported, or are under-reported. Cumulative
data represents all the data since each site's
inception into the shared ICC database in MDS as
of 12/05 (Earliest inception date 6/9/04).
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Value of Eligibility Screening
1Patients screened as eligible for 3rd party
payor using Medicaider software Medicaid,
County Indigent, CHIP, SSI 2Unduplicated patients
with ICare encounter within Medicaider
entitlement effective dates in a clinic, lab,
outpatient, emergency room, or inpatient. 3Value
calculated using Medicaid proxy pricing
methodology. Clinic avg / patient 210
Inpatient avg / patient 8.199 Outpatient/ER
avg / patient 863