2.  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

3. Overview 3 Tom Simmer, MD, Senior VP and Chief Medical Officer Blue Cross Blue Shield of Michigan

4.  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 4

5. 5

6. Admissions are distributed across many hospitals, even for a highly integrated system. 6 All other hospital systems

7.  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. 7

8. Enabling Statewide ADT Services Copyright 2013 - Michigan Health Information Network 8 Tim Pletcher, Executive Director Michigan Health Information Network

9. 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 Copyright 2013 - Michigan Health Information Network 9

10. Establishing Statewide Shared Services Copyright 2013 - Michigan Health Information Network 10 State of Michigan Internal External STATEWIDE SHARED SERVICES MDCH Data Hub (formally SOM HIE) MiHIN & the Qualified Data Sharing Organizations Transparency via HIT Commission Monitoring Shared Governance via MiHIN BOD

11. Federal MDCH Data Hub Medicaid MSSS State LABS Doctors & Community Providers HIEs (Qualified sub-state HIEs) Basic Data Flow Data Warehouse Copyright 2013 - Michigan Health Information Network 11 State-wide Shared Services Virtual Qualified Organizations Health Plans (more coming)

12. MiHIN Statewide Use Cases 12 Copyright 2013 - Michigan Health Information Network Push Alerts & Notification Pull/Query Care Summaries Health Provider Directory Public Health Reporting

13. ORGANIZATION AGREEMENT (QDSOA or VQDSOA) Basic Connection Terms Basic BAA Terms Minimal Operational SLA Contracting & Payment Definitions Termination Cyber Liability Insurance Data Sharing Agreement Use Case #1 Use Case #2 Use Case #3 Legal Infrastructure for Data Sharing 13 Copyright 2013 - Michigan Health Information Network

14. State-wide ADT Use Case Phase One: ADT Pilots & BCBSM Feeds Phase Two: All Patient ADT Service Phase Three: Convert Syndromics Copyright 2013 - Michigan Health Information Network 14

15. 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 Copyright 2013 - Michigan Health Information Network 15

16. Point-to-Point Doesn’t Scale Copyright 2013 - Michigan Health Information Network 16 Insurance Companies Physicians Specialty Providers Hospitals & Clinics Patients & Families Lab tests & XRAYs Medications Public Health N*(N-1)/2 Insurance Companies Physicians Specialty Providers Hospitals & Clinics Patients & Families Lab tests & XRAYs Medications Public Health

17. ADT Notification Service 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 Copyright 2013 - Michigan Health Information Network 17 Alerts & Notification

18. Qualified Sub-state HIE or VQO ADT Notification Service Copyright 2013 - Michigan Health Information Network Patient to Provider Attribution Delivery Preference Lookup 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 Primary Care Specialist Care Coordinator Alerts & Notification 18 Animation

19. 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 Copyright 2013 - Michigan Health Information Network 19

20. Health Provider Directory Trusted source of secure routing information for providers and HIEs Statewide Provider Lookup (PLU): Direct addresses HIE / IHE routing info (OIDs) Referrals and required info Notification and delivery Uniquely holds complete inter-HIE and provider-provider routing info Not a phone book! 20 Copyright 2013 - Michigan Health Information Network HPD Direct Address Book Directory Services Provider Relationship Management Routing Preferences

21. 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 Copyright 2013 - Michigan Health Information Network 21

22. Phase 1: MiPCT Member Lists via CTC Partnership TIMING (TARGET): July/August 22

23. Transitional Care Management Medicare Fees Jan 2013 CODENon-FacilityFacilityLocality 99495$120.39$99.38Detroit 99496$169.65$145.70Detroit Copyright 2013 - Michigan Health Information Network 23 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 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

24. Health Plan- Pricing Model 24 Copyright 2013 - Michigan Health Information Network Participation Fee PMPM Core Services Offset by HIE incentives 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 Reduced by HIE specific incentives paid to providers

25. 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? Copyright 2013 - Michigan Health Information Network 25

26. More information about MiHIN Questions? www.mihin.org 26 Copyright 2013 - Michigan Health Information Network Tim Pletcher pletcher@mihin.org

27. ADT Notification Service PGIP Quarterly Copyright 2013 Michigan Health Information Network 27 Rick Wilkening, MIHIN/BCBSM

28. MiPCT Member List / ADT Distribution 28 Copyright 2013 Michigan Health Information Network 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

29. ADT Notification Service Onboarding 29 Copyright 2013 Michigan Health Information Network DMC UMHS Beaumont Trinity UPHIE DMC UMHS Beaumont Trinity UPHIE Initial Target Hospital Systems Initial Recipients CareBridge (VQO) MiPCT (via CareBridge) MedNetOne (via MHC) UPHIE (QO) CareBridge (VQO) MiPCT (via CareBridge) MedNetOne (via MHC) UPHIE (QO) Beacon (QO) Ingenium (QO)

30. PO Preparation 30 Joe Neller, Integrated Physician Advocacy Michigan State Medical Society

31.  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.  Standard Data Elements ◦ 108 discrete data elements possible in ADT “spec” ◦ 45 identified by physicians for clinical care

32.  Next Steps for Statewide ADT Notification ◦ Physician/Care Team/Patient Attribution  Health Provider Directory ◦ Workflow and clinical processes redesign  Other Use Cases ◦ Continuity of Care Documents (CCD) ◦ Medication reconciliation ◦ Query Functions  Physician Organization connections to HIEs

33. Questions? 33