PRACTITIONER DATABASE PROJECT
Advisory Committee Meeting
HealtheConnections Health Planning (CNYHSA)
Monday, February 24, 2014
14th Floor Conference Room, Corning Tower
Empire State Plaza, Albany, NY 12237
Agenda
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Understanding the Possibilities
potential uses of CAQH provider database (UPD)
potential for streamlined physician credentialing
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Understanding Vendor Capabilities
Data Work Group Recommendations
System Development Issues
Next Meeting
Uses and Potential Uses of CAQH
Universal Provider Datasource (UDP)
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Welcome CAQH
 Christine Stroup, Credentialing Sales Manager
 Sorin Davis, UDP Managing Director
CAQH (Council for Affordable Quality Health Care)
was established in 1999 to promote administrative
simplification, common HIE operating rules, etc.
The CAQH Universal Provider Datasource (UDP) is
used to support credentialing processes across the
nation including those of the NYS Medicaid program,
major insurers, hospital systems and provider
organizations such as IPAs.
Council for Affordable Quality Healthcare
CAQH Universal Provider Datasource (UPD)
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Demographics, Licenses and Other Identifiers
(including NPI)
Education, Training and Specialties
Practice Details – Sites of Service, Days and Hours,
Contact Information
Billing Contact Information
Hospital Affiliations
Malpractice Liability Insurance
Work History and References
Disclosure Questions
Images of Supporting Documents
Massachusetts
Credentialing Verification System
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Welcome Lori Burgiel, Executive Director, Health Care
Administrative Services (HCAS)
HCAS was established by Mass Association of Health
Plans as a non-profit entity to operate the program.
Program uses Aperture Credentialing as its CVO
(Credentialing Verification Organization), partners
with CAQH for data submission, serves non-public
payors.
Other Examples
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Credentialing Systems
 Washington State (Complex Structure, Uses
Aperture as CVO, partners with CAQH)
 Arkansas (State is its own CVO)
Common Credentialing Application Forms (19 States)
 Florida, North Carolina, Colorado, Illinois, Maine
 Minnesota, Oklahoma, Maryland, West Virginia
Health Care Exchange Directories (Colorado)
All Payer Databases (Most States)
Other Examples
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Consumer Oriented Physician Profile Systems
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Many states have these systems. Most are modeled after
New York State’s System. Most do
Virginia is one of few states that post a downloadable file
Most states do not allow for data downloading. North
Carolina, for example, has a profile system, but it is not part
of state’s workforce analysis system which relies on
licensure and survey data, much like NYS at the present
Self grown database with Quality Measures (Maine)
Potential for Streamlining
Physician Credentialing in NYS
Keith Servis
Acting Deputy Executive Director
Office of Primary Care and Health System Management
Understanding Vendor Capabilities
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Data Validation
 Mark Biddle (Enclarity, a LexisNexis Company)
 Josh Schoeller, VP, Chief Solutions Architect
Master Data Management Services
 Joe Kelly (Treo Solutions)
Other Services
 Special Datasets (eg. SK&A, Health Market
Science)
 Taxonomies
 Unique Applications (e.g. ZocDoc)
Data Work Group Recommendations
Should have certain desired capabilities
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be searchable, queryable, and able to produce simple
tables and tabulations.
be downloaded and readily incorporated into user
projects
have geographic and other algorithmic fields that
support data analysis and file linking
have strong internal validation and/or error correction
capabilities
able to incorporate or receive user input (e.g.
updates and feedback on the status of practitioners)
Data Work Group Recommendations
Build on/relate to Other Initiatives
Should leverage state acquisition/investment in
internal/external sources and systems
 Physician Profile Redesign
 Innovation Plan/Primary Care Development
 All Payer Database
 Medicaid Information System RFP
 NYeC/HIT/Info Exchange
 Health Benefit Exchange
May need to improve existing management information
systems, especially those related to licensure
Data Work Group Recommendations
Meet Needs of Multiple Stakeholders
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NYSDOH Offices (Primary Care, Health
Insurance, Quality and Patient Safety,
Public Health Practice, Information
Technology Transformation)
NYSED Office of the Professions,
Board of Regents, and professional
boards
Center for Health Workforce Studies
Regional health planning agencies and
quality improvement collaboratives
Economic development councils,
county & regional planning agencies
and development organizations
County health departments
Rural Health Networks/NYSARH
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RHIOs/NYeC/HI-TECH/SHIN-NY
Entities with IT expertise
Area Health Education Centers
Health Advocates and disease
associations (e.g. Cancer Society,
Arthritis Foundation)
Hospitals, Health Centers, and other
providers of health care
Provider and Insurer Associations
Foundations which support health
related projects
Consultants and private sources of
Information
Schools of Public Health, Medical
Schools, and other institutions involved
in provider training and research
Education/Training
Licensure
Foundations
Funders
Planners/Policy
Makers
Workforce
Development
Consumers
Data Work Group Recommendations
Other Recommendations
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Should incorporate/reflect national standards for
provider directories but not be inhibited by them
Should use Profile or other system to collect data that
cannot be gathered from other sources
Should have indices or other mechanisms to permit
user to understand the relationship between practice
locations, corporate structures, hospital systems,
IPAs, ACOs, and managed care networks
Should have robust validation, standardization, and
error correction processes
Data Work Group Recommendations
Desired Data Elements Should Include:
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name
degree and type of licensure
key identifying information
(NPIN, License Number)
associated practice group(s)
practice location(s)
specialization & subspecialization
professional education,
advanced training, &
certifications
nature of professional activity
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PCMH status
FT/PT status and clinical work
hours/FTE
time devoted to patient care
birth date or age
staff appointments at hospitals
willingness to accept new
patients and/or Medicaid
patients (or % of practice
allocated to Medicaid patients)
practice volume & productivity
geographic identifiers
analytical algorithms/classifiers
Data Work Group Recommendations
Sources Reviewed
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New York State: DOH Profile, Center for Health Workforce
Studies Registration Survey, NYSED Licensure Files, Medicaid
Managed Care Directory, Medicaid Provider Enrollment Data
Federal: National Plan and Provider Enumeration System (NPI),
Medicare Enrollment Files and PECOS, National Provider Data Bank,
DEAA, TRICARE (Dept of Defense)
Association: CAQH, AMA Profile, Medical Society of the State of
NY (MSSNY), Federation of State Medical Boards (FSMB), American
Board of Medical Specialties (ABMS)
Commercial: SK&A, Treo Solutions, Maximus, ZocDoc, Health
Market Science, FolioMed, Medical Marketing Services (AMA
License), MEDICAlistings, Medical Mailing Services and similar
services (USAData, Physicians Lists, DoctorListPro)
System Development Issues
Continued Discussion
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How should it be related or connected to other data
systems and functions
Where should the system be housed or operated
how should it be supported?
how can data be shared with the widest range of
users?
should different classes of users or privilege levels be
established
are legal and regulatory changes needed
Potential
Systems and Functions
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Licensure/Registration
Workforce Surveys
DOH Physician Profile
All Payer Database
Medicaid Information Systems
Insurers/Payors/Managed Care Networks
NYeC/HIT/Info Exchange
Health Benefit Exchange
Private Vendor Systems
Credentialing Processes
Other
Potential Hosting Options
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creation of a state sponsored system such as SPARCS used for
hospital discharge data. Such a system could be run by NYSDOH
which oversees the provision and quality of health care, NYSED which
is responsible for licensing or joint venture of both departments
component of an existing or yet to be developed system such
as the All Payer Database, an HIE structure, or a statewide
credentialing system
creation of a statewide collaborative that involves governmental
and non-governmental entities such as the New York eHealth
Collaborative (NYeC) which coordinates the joint activities of NYSDOH
and regional health information organizations (RHIOs)
use of an existing independent non-profit entity with workforce
expertise such as the Center for Heath Workforce Studies (CHWS)
contract with a proprietary entity that specializes in practitioner
databases and provider directories
Potential Financing Options
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licensing and registration fees
assessments and user fees
state and federal budget appropriations
Medicaid waivers, or use of funds related to
implementation of the Accountable Care Act
and NYS Health Care Reform.
Demonstration program funded by Federal,
State, and Foundation Sources
Next Steps
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Finalize/accept recommendations related to:
 Data elements and sources that should be included
 Broad information system requirements and principles
 Strategy that should be used to develop, implement, and
operate the system on a long term basis
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where should the system be housed
how should it be supported
how should it be related or connected to other data systems
should different classes of users or privilege levels be
established
are legal and regulatory changes needed
review project final report that will outline preferred strategy for
plan implementation
Project Objective:
Develop Plan for a database that:
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covers physicians, physicians’ assistants, midwives,
and nurse practitioners (100,000-120,000 individuals)
integrates information from multiple sources
provides accurate, validated, geographically-based
information on number of practitioners, associated
practice group(s) and office locations; specialization
and sub-specialization; professional education and
advanced training; age, major professional activities,
and other practice characteristics
meets the needs of a wide range of users
How to reach us
HealtheConnections Health Planning (CNYHSA)
109 South Warren Street,
State Tower Building Suite 500
Syracuse, NY 13202
(315) 472-8099
Sara Wall Bollinger, Executive Director
swbollinger@healtheconnections.org
Terry Richmond, Deputy Director/Senior Associate
gmrichmond@healtheconnections.org