Georgia Department of Community Health 1 October 29 th, 2015

Agenda Introduction Business Drivers Pilot Use Case Pilot Timeline and Process Ecosystem Defining Success Resources/References 2

Introduction: Pilot Team 3 NameRole Laura EllisProject Director Bonnie YoungProject Manager Waiver Program DirectorsSME Program Integrity ManagersSME Waiver Program IT SpecialistsSME Irina ConnellyGeorgia Tech Research Institute (GTRI) Technical Support

Mission The Georgia Department of Community Health We will provide Georgians with access to affordable, quality health care through effective planning, purchasing and oversight. We are dedicated to A Healthy Georgia 4 Georgia Department of Community Health (

Pilot Introduction: Business Drivers 5 Georgia Business Drivers: Development of Health Information Technology (HIT) standards that: Support program monitoring and improvement of all waivers Support cross-waiver program information sharing Help bridge the gap between clinical and non-clinical data Support incremental adoption by members of the ecosystem

Support cross-waiver program information sharing Entities in Long Term Services and Support Transitions: Waiver programs, hospice care, nursing homes, hospitals, rehab facilities, etc. Lack of information sharing leads to… – Uncertainty in service eligibility – Delay in receiving eligible services – Lost productivity and time impact on case managers – Miscommunication between LTSS stakeholders 6

Use Case: Support cross-waiver program information sharing Transitioning between LTSS services: Pilot Focus – Beneficiary moving between CCSP and ICWP waivers Information currently flows within each waiver. Information flowing across waiver groups are not currently supported. Identifying and documenting the information and process needs across waiver groups will illuminate common/overlapping as well as distinct data components. 7

Overview of 2 Waiver Programs - Community Care Waiver Program (CCSP) - Independent Care Waiver Program (ICWP) CCSPICWP Population Size8,8661,375 Age RangeAny21-64 Impairment EligibilityFunctional impairment caused by physical limitations (including Alzheimer’s and dementia) Severe physical impairment and/or Traumatic Brain Injury Service Eligibility Determination Care Coordinators involved in eligibility determination subject to validation by External Quality Review Organization External Quality Review Organization involved in eligibility determination 8

Waiver Program Services ServicesCCSP (Any)ICWP (21-64) Team-based Care (i.e., jointly developed Plan of Care) Case Management Adult Day Health Alternate Living Services (24-hour personal/nursing supervision) Behavior Management Services Counseling Services Emergency Response System Home-delivered Meals Home-delivered Services (skilled nursing/therapy) Home Environment Modification Personal Support Services (e.g. personal care tasks and ADL) Respite Care Skilled Nursing Services Specialized Medical Equipment and Supplies Consumer Directed Care Option for Personal Support Services Financial Support Services Vehicle Adaptation 9 Both waivers serve different populations with some overlap Similar services provided by both Similar data needs Comparison between CCSP and ICWP Georgia’s Round 1 pilot focus Identifying data requirements (i.e., identify overlapping and distinct data) Georgia Waiver Programs (

Georgia Pilot Timeline – Tier I OctNovDecJan ’16FebMarch April (round 1 complete) Kick-off & Pilot plan finalization Participant Identification/ Recruitment - conduct outreach activities - prepare materials for pilot participants Conduct Pilot -identify and validate data items via stakeholder interviews, focus group, town halls -identify and validate potential vocabulary standards for coded data items -solicit input for additional data items not in use today -capture qualitative feedback Results Analysis Based on input received -summarize findings on common data items and associated domains -summarize findings on unique data items and associated domains -identify potential candidate standards applicable to data items 10

Round I Pilot Details 11 GOAL 1: Develop a data profile for CCSP and ICWP – begin with Service Plans - Inputs (i.e., data collection) - Outputs (i.e., data sharing) - Data Format (semantics/syntax) - Identify Standards (i.e., data, forms, etc.) - Business Process Flows - Actors (i.e., internal and external) GOAL 2: Identify existing ecosystem problems HIT can help solve -Improve timely access to critical information -Reduce redundancy and burden of manual data input -Identify current barriers to eLTSS implementation

How do you define success Deliverables: 1.Identified and documented data that exists in both programs 2.Gap analysis 3.Identified and documented essential service plan data to share 12

Resources/References For more information: Georgia Department of Community Health, Division of Health IT Georgia Department of Community Health, Waiver Programs Georgia Tech Research Institute 13