Addressing Readmissions: Opportunities through MiHIN Medication Reconciliation Use Case (MRUC)

BIOGRAPHY Allison Combs Director – Pharmacy Business Performance & Insights BCBS of Michigan Contact Info: Phone: 313-448-6446 Email: acombs@bcbsm.com Current responsibilities include Strategic planning and execution, Product pricing & initiative valuation support, Product business performance & analytics (financial, marketing, and overall business analytics), Pharmacy data governance, Base budgeting & management, Pharmacy strategic project support, and “Chief of Staff” and “Secretary of State” for VP of Pharmacy Services Louis Polite IT Director – Information Management and Health Care Value Phone: 313-983-2558 Email: lpolite@bcbsm.com Current responsibilities include Enterprise Data Warehouse (EDW) Operation Support, Clinical Program Data Mart (CPDM) Project Delivery and Production Support, Customer IT Responsibilities for Pharmacy, and Contract and Vendor Management (Internal to HVC-IT & IM)

Statewide Health Information Exchange Service ..

State of Michigan Health Information Exchange Model: MiHIN is the “Network of Networks” Statewide Shared Services MDHHS Data Hub Chronic Diseases MSSS State LABS Providers & Health Systems HIE Qualified Organizations (QOs) Data Warehouse Health Plan QOs Single point of entry/exit for state Virtual QOs Pharmacies (more coming) Immunizations MI Syndromic Surveillance System MI Disease Surveillance Consumer QOs (more coming) Federal PIHPs (10) Other Data Sharing Organizations MyHealthPortal MyHealthButton

MiHIN Key Foundational Services

All requirements based on transmission through MiHIN BCBSM Incentive Progression & Alignment Continued ADT and Medication Reconciliation Statewide Lab or Find Patient Record 2014 2015 2016 2017 Start ADT data flow Address HIPAA concerns ADT data quality and integration into practice workflows New ADT participants (SNFs, small rural hospitals) Medication reconciliation Common Key Service and additional new use case Potential considerations: Continued data improvement Transmit additional fields on the summary of care document Conduct queries for patient data or provider-patient relationships Other clinical data All requirements based on transmission through MiHIN

Opportunities to integrate MiHIN Use Cases

Benefits and Cost Structure to BCBSM

BCBSM Business Drivers

Opportunities to leverage MRUC

Potential Savings

Pilot Project Scope and Duration

BCBSM Use Case Requirements

C-CDA Document Requirements

MiHIN MedRec – High-Level Process Flow

BCBSM Reporting Data Flow

Challenges Identifying ancillary members (non-medical) from ACRS file before it’s sent to MiHIN Identifying, securing, and creating separate views for the business analyst to use employee and super PHI data Identifying relative data within the C-CDA (HL7) data record and converting it to a simplified XML file for business use

July 2017 Dashboard Hospital-Health System Participation: Monthly Volume YTD 62,827 63,786 Processing Errors Monthly Total 850 867 Hospital-Health System Participation: 58 Michigan facilities participating (80%) 80% of C-CDA’s from participating facilities are routed to MiHIN BCBSM Med Rec Production Date 6/29/17

Glossary: ACRS – Active Care Relationship System ADT – Admissions Discharge and Transfers BCN – Blue Care Network C-CDA – Consolidated Clinical Document Architecture CDODS –Clinical Data Operational Data Store EDW – Enterprise Data Warehouse HEDIS – Healthcare Effectiveness Data and Information Set HCV – Health Care Value HIPAA – Health Insurance Portability and Accountability Act HICM – High Intensity Care Management HPD – Health Provider Directory MA – Medicare Advantage MedRec – Medication Reconciliation MiHIN – Michigan Health Information Network MiPCT - Michigan Primary Care Transformation MRUC – Medication Reconciliation Use Case PCMH-N – Patient-Centered Medical Home Neighborhood (Neighborhood includes specialists where PCMH is only the PCPs). evaluation program PDCM – Provider Delivered Care Management PHI – Protected Health Information OSC – Organized System of Care SAS – Analytic data storage and retrieval software SNF – Skilled Nursing Facility QRS – Quality Rating System XML - Extensible Markup Language WCM – Wellness Care Management