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Overview
Tom Simmer, MD, Senior VP and Chief Medical Officer
Blue Cross Blue Shield of Michigan
Enabling Statewide ADT Services
Tim Pletcher, Executive Director
Michigan Health Information Network
2013 Timeframes
Rick Wilkening, MIHIN/BCBSM
PO Preparation
Joe Neller, Integrated Physician Advocacy
Michigan State Medical Society
Questions
2
Overview
Tom Simmer, MD, Senior VP and Chief Medical Officer
Blue Cross Blue Shield of Michigan
3

Produce comprehensive daily census reports on
admissions and ER visits
◦ Improve care transitions
◦ Improve efficiency
◦ Avoid unnecessary services

Streamline utilization management obligations to
payers

Platform to develop additional HIE reporting
capabilities
◦ Medication Reconciliation
◦ Lab values
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Every PO has patients in numerous hospitals
140000
160
Hospital Count and Admissions
120000
100
80000
Admissions
60000
80
Hospital Count
60
40000
Hospital Count Scale
120
100000
Admissions Scale
140
40
20000
20
0
0
PGIP POs
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Admissions are distributed across many hospitals,
even for a highly integrated system.
All other
hospital
systems
Primary
hospital
system
16%
Secondary
hospital
systems
7%
15%
62%
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Hospitals should be able to communicate ADT
information once, regardless of the number of
recipients.
Hospitals should be able to send the information
through the electronic channel of its choice, as
long as it connects to the appropriate clinical
process for managing transitions.
Practitioners should be able to receive the
information in the manner they choose to support
their clinical processes.
Report information should meet standard
expectations related to common data definitions,
fields etc.
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Enabling
Statewide ADT Services
Tim Pletcher, Executive Director
Michigan Health Information Network
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Agenda
1. Make sure everyone understands statewide HIE model
2. Review of the Statewide Use Cases
3. Ensure legal protections in place that protect everyone
and conform with HIPAA and the new HITECH rules
4. Discuss statewide ADT Use Case
5. Deep dive into ADT & Patient Provider Attribution
6. Current plans around the business model
7. Value proposition to become early adopters
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Establishing Statewide Shared Services
Transparency
via HIT
Commission
Monitoring
MDCH Data Hub
State of Michigan
Internal
(formally SOM HIE)
MiHIN & the Qualified
Data Sharing Organizations
STATEWIDE
SHARED SERVICES
External
Shared
Governance via
MiHIN BOD
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Basic Data Flow
Health Plans
(more coming)
Federal
MSSS
HIEs
State-wide
Shared Services
(Qualified sub-state
HIEs)
MDCH Data Hub
Data
Warehouse
Doctors & Community
Providers
Virtual
Qualified
Organizations
State
LABS
Medicaid
DIRECT
HISP
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MiHIN Statewide Use Cases
Public Health
Reporting
Health Provider
Directory
Push Alerts &
Notification
Pull/Query
Care Summaries
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Legal Infrastructure for Data Sharing
ORGANIZATION AGREEMENT
(QDSOA or VQDSOA)
Definitions
Basic Connection Terms
Basic BAA Terms
Minimal Operational SLA
Data Sharing Agreement
Contracting & Payment
Cyber Liability Insurance
Use Case
#1
Use Case
#2
Use Case
#3
Termination
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State-wide ADT Use Case
• Phase One: ADT Pilots & BCBSM
Feeds
• Phase Two: All Patient ADT Service
• Phase Three: Convert Syndromics
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The ADT Use Case
• Every hospital in the State of Michigan is already
creating ADT messages
• 85 hospitals voluntarily send a variation of an ADT
message to the state of Michigan to support syndromic
surveillance
• A hospital can send an ADT message with no impact on
internal workflow & typically no new technology
• Currently there are lots of point to point interfaces, but no
statewide effort until now
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Point-to-Point Doesn’t Scale
25000
20000
Physicians
Physicians
Patients
Patients
& Families
Families
PublicHealth
Health
Public
15000
Clinics
Specialty
Specialty
Providers
Providers
Hospitals
& Clinics
Hospitals
& Clinics
Medications
Medications
Insurance
Insurance
Companies
Companies
Interfaces
10000
5000
N*(N-1)/2
0
1
13
25
37
49
61
73
85
97
109
121
133
145
157
169
181
Labtests
tests
Lab
&&
XRAYs
XRAYs
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ADT Notification Service
Alerts &
Notification
• Statewide, all-payer, all-patient Transitions of Care
(TOC) Notification Service
• For each organization responsible for the patient’s care,
the message is routed based on preferences defined in
MiHIN’s Health Provider Directory
• Enable the exchange of ADT messages to the patient’s
relevant providers and health care organizations
• Receives HL7 Admission, Discharge, Transfer (ADT) and
uses the patient’s information to match against patient
attribution lists maintained by physician organizations,
care coordinators, and payers participating in the service
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Alerts &
Notification
ADT Notification Service
Animation
Qualified
Sub-state HIE
or VQO
Qualified
Sub-state HIE
or VQO
Delivery
Preference
Lookup
Specialist
Primary Care
Patient to Provider
Attribution
Care
Coordinator
1) Patient goes to the hospital, hospital sends a registration message
2) MiHIN checks Patient Attribution Lists and identifies three providers
3) Using the HPD, MiHIN identifies a Delivery Preference for each provider
4) Notification is routed to the providers based on their preference
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Patient Attribution List
• Physician organizations can provide patient lists in Excel or
another MiHIN-provided format
• “Active” means patient seen within 2 years
• Regular updates required
• Coordination via MiPCT / CareBridge & sub-state HIE’s
• Health plans can deliver standard X12 834 enrollment files to
populate MiHIN Plan-Provider tables
• Work with QO’s, MHA, and hospitals to utilize ADT messages
for hospitals seeking to subscribe to patients discharged in
previous 30 days
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Health Provider Directory
• Trusted source of secure routing
information for providers and HIEs
• Statewide Provider Lookup (PLU): Directory
Services
• Direct addresses
• HIE / IHE routing info (OIDs)
• Referrals and required info
Provider Relationship
Management
• Notification and delivery
• Uniquely holds complete inter-HIE
and provider-provider routing info
• Not a phone book!
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HPD
Routing
Preferences
Direct Address
Book
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Two Data Delivery Options
1. Receive ADT’s via your Qualified Sub-state HIE
a. Sub-state HIE processes message and delivers it
how you want (as their vendor solution allows)
b. Sub-state HIE sends you a “raw” data feed
c. Some sub-states have begun using DIRECT
2. Via Care Bridge VQO & MiPCT
a. Contract with Care Bridge for care coordination
support
b. Utilize the MiPCT-funded application
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Phase 1: MiPCT Member Lists via CTC Partnership
TIMING (TARGET): July/August
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Transitional Care Management
Medicare Fees Jan 2013
9949• Communication (direct contact,
telephone, electronic) with the
patient and/or caregiver within 2
business days of discharge
• Medical decision making of at
least moderate complexity
during the service period
• Face-to-face visit, within 14
calendar days of discharge
CODE
Non-Facility
99496 • Communication (direct contact,
telephone, electronic) with the
patient and/or caregiver within 2
business days of discharge
• Medical decision making of high
complexity during the service period
• Face-to-face visit, within 7 calendar
days of discharge
Facility
Locality
99495
$120.39
$99.38 Detroit
99496
$169.65
$145.70 Detroit
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Health Plan- Pricing Model
Participation Fee
• PMPM
• Core Services
• Offset by HIE incentives to providers
Reduced by HIE specific
incentives paid to providers
Ala Carte
•
•
•
•
ADT (read-only, full feed)
MTM (fill status, CMR notice, query)
Labs (per result, per source)
Query / Audit (per trx, per service)
Custom Engagement
• Services
• DIRECT feeds
• Unique query or data standardization
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PO Actions to Get Ready:
1. Figure out where your digital identity is going to be:
Where & how will you receive electronic clinical
communications? MiPCT? QO Sub-state? Other? Multiple?
2. Get in the Health Provider Directory:
How will your clinical preference for data routing be
expressed state-wide?
3. Generate your patient attribution lists:
For which active patients do you want to be notified for
ADTs? For other TOC events?
4. Create a plan for the workflow implications:
Where is this work going to land and how will the activities be
processed?
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More information about MiHIN
Questions?
www.mihin.org
Tim Pletcher
pletcher@mihin.org
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ADT Notification Service
PGIP Quarterly
Rick Wilkening, MIHIN/BCBSM
Copyright 2013 Michigan Health Information Network
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MiPCT Member List / ADT Distribution
• Opportunity (option not a requirement) for MiPCT POs and practices
• Allows for direct member list distribution (with ADT alerts where possible)
to care managers and practices.
• Aims to reduce the administrative burden on POs and to allow them to
focus their efforts on supporting the provision of team-based care within
their practices
• No fee to PO for participating (covered in the MiPCT administrative
budget)
• POs that participate would continue to receive their member list and
other products from the MDC as well as any future MDC reports
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ADT Notification Service Onboarding
Initial Target
Hospital Systems
DMC
UMHS
Beaumont
Trinity
UPHIE
Initial Recipients
CareBridge (VQO)
MiPCT (via CareBridge)
MedNetOne (via MHC)
UPHIE (QO)
Beacon (QO)
Ingenium (QO)
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PO Preparation
Joe Neller, Integrated Physician Advocacy
Michigan State Medical Society
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MSMS and MHA convened ADT Workgroup
◦ Representation from Trinity Health, Henry Ford
Health System, Ascension Health, Metro Health,
Spectrum Health, Huron Valley Physician
Association and United Health.
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Standard Data Elements
◦ 108 discrete data elements possible in ADT “spec”
◦ 45 identified by physicians for clinical care
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Next Steps for Statewide ADT Notification
◦ Physician/Care Team/Patient Attribution
 Health Provider Directory
◦ Workflow and clinical processes redesign
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Other Use Cases
◦ Continuity of Care Documents (CCD)
◦ Medication reconciliation
◦ Query Functions
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Physician Organization connections to HIEs
Questions?
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