OHPI Newsletter

Vol.2, Issue 4 – HIT

Looking Beyond SHIP

With just a few months left in the SHIP grant, one would expect that the health IT activities are winding down. However, it’s just the opposite. The Idaho Health Data Exchange (IHDE) and the SHIP Data Governance Workgroup are busy working on foundational activities that will generate positive impacts well beyond the SHIP.

IHDE has been busy working on two core architecture projects that will enable IHDE to enhance its services in the future. This is in addition to continuing to wrap up the bi-directional connection building projects with SHIP clinics by the end of the grant.

The first project – an IHDE Communication Services Layer – is a system architecture layer that will serve as a “message center” for IHDE. Adding this infrastructure centralizes all connections into an environment controlled by IHDE rather than under the direct infrastructure of an IHDE vendor.

The purpose of the second project – an IHDE Data Service Layer – is to provide a mechanism for insurance companies to receive clinical data based on a membership file provided to IHDE. This Data Service Layer will also enable IHDE to meet specific data requests from other customers that it cannot provide currently.

Both architectural layers are aligned with industry best practices and will equip IHDE to meet the increasing demands of its customers.

As for the SHIP Data Governance Workgroup, its members are discussing how the workgroup will evolve and what its mission and charge will be after the grant ends. The workgroup expects to develop a new charter prior to the end of the grant at the end of January.

Vol. 2, Issue 4 – PCMH

As the SHIP grant comes to an end on January 31, 2019, there is an important update related to the PCMH accreditation reimbursement payments:

A $5,000 reimbursement has been obtainable by any SHIP cohort clinic that achieves PCMH accreditation from a national accreditation body or from the State of Oregon’s PCPCH program (please refer to the Briljent Clinic Agreement for further information).

To receive the reimbursement, PCMH accreditation certificates must be submitted to the PCMH team at PCMHID.Team@briljent.com no later than January 25, 2019, to have payment processed within the grant period.

Vol. 2, Issue 4 – Virtual PCMH

Módulos específicos sobre la salud disponibles en español/Health Specific Modules Available in Spanish

En colaboración con el Departamento de Salud y Bienestar, la Idaho State University está en el proceso de traducir cinco (5) módulos específicos sobre la salud existentes para trabajadores de salud comunitarios (CHW) al español para que puedan ser impartidos en línea.

Más del 12 % de la población de Idaho habla español. Una reciente encuesta a los trabajadores de salud comunitarios (CHW) capacitados indicó que una quinta parte de nuestros CHW capacitados hablan español. Alrededor de una tercera parte habla principalmente español e indicó que habrían preferido haber tomado el curso de trabajador de salud comunitario (CHW) en español.

En su mayoría, los trabajadores de salud comunitarios (CHW) de habla hispana atienden a pacientes que hablan español. Por lo tanto, el brindar capacitación en español facilitará el aprendizaje para estos trabajadores de salud comunitarios (CHW) y los ayudará a utilizar terminología correcta que facilitará la comprensión por parte de sus pacientes que hablan español.

Los módulos específicos sobre la salud a traducir fueron elegidos con base en las zonas de Idaho en donde los hispanohablantes de Idaho tienen desigualdades de salud:

  1. Salud del comportamiento, prevención del suicidio y abuso de sustancias

  2. Tratamiento y prevención de la adición de opiáceos

  3. Educación y control de la diabetes

  4. Salud colorrectal y evaluación de cáncer colorrectal

  5. Salud cervical y evaluación de cáncer cervical

Health Specific Modules Available in Spanish

In collaboration with the Department of Health and Welfare, Idaho State University is in the process of translating five (5) existing Community Health Worker (CHW) Health Specific Modules into Spanish so they can be delivered online.

More than 12 percent of Idaho’s population speaks Spanish. A recent survey of Idaho’s trained CHWs indicated that one-fifth of our trained CHWs speak Spanish. Nearly one-third speak primarily Spanish and indicated they would have preferred to have taken the CHW course in Spanish.

For the most part, Spanish-speaking CHWs see Spanish-speaking patients. Thus, providing training in Spanish would facilitate learning for these CHWs and assist them with using accurate terminology that would facilitate understanding by their Spanish-speaking patients.

The Health Specific Modules to be translated were chosen based on areas in Idaho where Spanish speaking Idahoans have health disparities:

  1. Behavioral Health, Suicide Prevention, and Substance Abuse

  2. Opioid Addiction Treatment and Prevention

  3. Diabetes Management and Education

  4. Colorectal Health and Colorectal Cancer Screening

  5. Cervical Health and Cervical Cancer Screening

Vol. 2, Issue 4 – Administrator’s Update

As the SHIP grant winds down, there are a number of activities taking place to help ensure sustainability of the healthcare transformation work that has been accomplished in Idaho to date. Among these is the work of the Transformation Sustainability Workgroup in creating the charter and business case for the Healthcare Transformation Council of Idaho (HTCI). There will be more about this council in the next issue of the newsletter.

Another new activity is the creation of a legacy project for SHIP that will take the form of a public-facing ‘microsite.’ A ‘microsite’ is an individual webpage meant to function as a discrete entity within an existing website – in this case, the SHIP website. This new microsite will be interactive and dynamic and will allow users to explore the history, accomplishments, and lessons learned during the SHIP initiative. It will be a broad and encompassing site that will address SHIP’s legacy from the perspective of its seven goals.

An introduction along with each of the goals will have its own area on the website. Each can be clicked to see successes and lessons learned through this model test process displayed in informative, concise formats such as graphics, videos, infographics and narratives.

This project will assist Idaho not only by chronicling the project outcomes but also by serving as a starting point as new transformation projects are determined and implemented. Using the SHIP lessons and products as a basis for the next chapter of transformation maximizes the effectiveness and ultimately the impact on Idaho.

Look for the new microsite to be up and running by the end of January 2019.

Vol. 2, Issue 3 – Stakeholder Profile

Congratulations to Martha Madero, Community Health Worker (CHW) for Family Medicine Residency of Idaho (FMRI). Martha was nominated as a Health Center Hero by the National Association of Community Health Centers. She was selected as one of ten nominees from among hundreds around the country.

Martha began her career as a medical assistant and now is a CHW working mostly with Latino seasonal farmworkers.

“Martha is incredibly effective at her job as a CHW due to her perseverance, her motivational interviewing skills, and her deep understanding of the culture in which her patients live,” writes Penny Beach, MD, Chief Medical Officer FMRI.

She understands her patients because she has lived their lives. Her parents immigrated to the United States from Mexico, working as seasonal farmworkers. Martha was born in the U.S. and started working in the fields with her family at the age of nine. Her formal education ended after tenth grade when she went to work in the fields full time. In her early 20s, while caring for her two small children, she went back to school and finished her GED and her medical assistant certification.

As a medical assistant, Martha’s language skills and cultural competence were a huge asset. She picked up quickly on medical concepts and translated them into a language understood by her Latino clientele. Soon she was doing much of the Spanish-speaking patient education for the physicians for whom she worked.

When FMRI began its CHW program in 2014, Martha was the natural choice to hire as their first CHW. When Martha started, FMRI cared for 10 migrant farmworkers. Thanks to the outreach efforts of Martha and her colleagues, FMRI now has more than 400 migrant farmworker patients.

Martha has worked with illiterate, non-compliant patients who have complex health care needs by helping them understand how to take their medications and wrangling up family support. She has kept elderly patients out of the hospital by showing them how to take their medications correctly, removing fall hazards from their homes, and connecting them with health education, dental care and housing resources.

“Martha Madero…has saved hundreds of thousands of health care dollars in her work with complex medical patients. In the process, she has helped reduce health care disparities. And most of all, she improves the quality of life for all the patients she touches,” writes Beach.

Vol. 2, Issue 3 – Virtual PCMH

Community EMT – a “call to action”

In partnership with the Bureau of Emergency Medical Services and Preparedness (BEMSP), SHIP, and the Bureau of Rural Health and Primary Care (BRHPC) is excited to announce the first Idaho CEMT training. This training, offered through Idaho State University (ISU), will be delivered live online beginning in August 2018 and will be taught by experienced Community Paramedics. Individuals who successfully complete the CEMT training will be at an advantage to better understand their patients in a more holistic manner, and be a part of successful, collaborative-driven healthcare teams.

A Community Emergency Medical Technician (CEMT) works by filling gaps in the local healthcare team, by providing primary care, post-discharge follow-up care, integration with local public health agencies, and/or providing education and health promotion programs. The knowledge, trust and respect developed as a first responder positions the CEMT as a unique part of the healthcare team. CEMT’s help individuals and communities overcome barriers that prevent them from accessing and benefiting from healthcare services by increasing access to care and keeping patients local.

For more information regarding CEMT opportunities and trainings, please contact SHIP project manager, Madeline Russell at Madeline.Russell@dhw.idahol.gov. Or the Bureau of EMS and Preparedness at CHEMS@dhw.idaho.gov or (208)334-4000.

Vol. 2, Issue 3 – HIT

Changes to SHIP Data Analytics

The SHIP data analytics project is undergoing a ‘pivot’ – a change that will substitute previously agreed upon clinical quality measures (CQM) reporting with new CQM reporting.

This change came about because we found that the data completeness and quality issues were far more complex than we anticipated. It thus became evident that we would not be able to provide the actionable CQM reports for providers and regional collaboratives as intended through the SHIP analytics solution within the SHIP timeframe.

Before making this change, the SHIP operations team conducted an analysis to determine the value and feasibility of possible options for data analytics. Several key constraints and findings identified through this analysis included:

  • The SHIP data analytics solution is not funded beyond the grant period, which ends January 31, 2019.
  • Major health systems and payers have their own analytic solutions and do not have a need for a statewide reporting solution.
  • One of the possible options was to build additional data feeds to clinics. However, the Idaho Health Data Exchange (IHDE) does not have the capacity to build new data feeds beyond what has already been planned. The enhancements required to address the data issues and provide valuable SHIP CQM reporting could not be completed in the remaining grant timeframe.
  • Medicaid has developed a quality measurement/analytics solution for its Shared Savings program and is launching a provider portal in September 2018.
  • The SHIP grant requires a CQM reporting effort and the CQMs list must include tobacco and obesity related measures.

After much discussion of decision factors, constraints, and options available to us, we arrived at a new data analytic solution that will enable us to continue to meet the grant criteria. The Idaho Healthcare Coalition agreed to these changes during its August meeting. The following outlines the new solution for SHIP CQM reporting:

  • Leverage Medicaid’s quality reporting capabilities on the 11 measures Medicaid selected for its Shared Savings program. All but one of the SHIP clinics treat Medicaid patients and these measures will be based on the claims data from those Medicaid patients. Clinics will have access to the Medicaid provider portal in September 2018.
  • Leverage statewide Cigarette Smoking; Smokeless Tobacco Use and Obesity measures reported in the Idaho Behavioral Risk Factor Surveillance System (BRFSS) survey results.
  • Continue to report the Childhood Immunization Status measure through data from Idaho’s Immunization Reminder Information System (IRIS) and the Access to Care measure through the patient interviews conducted by the SHIP State Evaluation Team.

A crosswalk between the old measures and new measures can be found HERE.

It is important to note that the IHDE will continue to establish clinic EHR connections with its database. These CQM reporting changes do not impact the connection building efforts.

Vol. 2, Issue 3 – PCMH

Save the Date | Change Management Leadership Workshops Coming this October!

Change is an ongoing process, not a single event. We understand that continually improving your clinical practice is a long-term process. Whether you’re updating payment structures, implementing a new Electronic Health Record (EHR) system, or transforming into a Patient Centered Medical Home (PCMH), we all know it will not take place over night. These changes will involve planning and dedication by all staff members to achieve the clinic’s goals and to meet leadership and PCMH expectations.

The IDHW is excited to invite SHIP Cohort Clinics to attend a Change Management Leadership workshop near you, free of charge and put on by our partner in Change Management, Briljent, to better understand what is needed to successfully move your practice through the transformation process. Learn about: Organizational Change Management (OCM) activities to help during transformation efforts, how to engage your staff during the changes, and how to create your own OCM plan for continuous improvement and success.

Every change initiative should have a Change Champion who spearheads and believes in the changes, and pushes changes forward. We encourage clinics to send someone who is leading or will lead the change and transformation efforts of your clinic to attend a workshop at four locations throughout Idaho; with the opportunity to attend a virtual conference at one location for those who aren’t able to attend in person.

During and after the workshop, you will have access to Change Management professionals with whom to share your ideas and strategy.

Watch your inboxes in September for an October ‘Save the Date’ and location information! Sign up early so you can take advantage of this great opportunity!

Any questions? Please email the PCMHID.Team@briljent.com mailbox.

Vol. 2, Issue 3 – Administrator’s Update

As I make the transition from Operations Manager to Program Administrator of the Office of Healthcare Policy Initiatives (OHPI), I can’t help but think about how far we’ve come with Idaho’s healthcare transition. From its planning stages in 2015 to 163 participating primary care practices today, 80 clinics bi-directionally connected to IHDE, and payment transformation continuing to support the work we’ve done, we’re definitely changing the Idaho healthcare landscape.

Sustainability is a key concept to any grant initiative and there are several required plans OHPI is submitting to CMMI: part one of the plan, discussing SHIP’s progress and the impact it has achieved, was sent May 30; part two, which will provide a more detailed plan of post-SHIP activities to support Idaho’s healthcare transformation, was due August 30.

As part of our sustainability activities, a survey was sent to members of the Idaho Healthcare Coalition (IHC) to determine what they thought were the most important elements of Idaho’s healthcare transformation sustainability. The top five responses were: Health Information Exchange (HIE) development to support data exchange and analytics, payment reform, alignment of common CQMs across payers, PCMH training and TA, and telehealth. Respondents also felt that support of OHPI would be needed in the future to keep engagement, focus, and support of transformation activities.

It’s important to note that Idaho’s efforts to transform the healthcare system started long before we received the CMMI grant and will continue after the fact. To that end, planning the framework for this next chapter of Idaho’s transformation is being accomplished by the IHC Transformation Sustainability Workgroup which has been established to determine how we strategically drive transformation in Idaho and how we overcome identified barriers and gaps. The workgroup will submit a draft of its charter to the IHC in September and with the support of the IHC will begin drafting the business case. The Office of Healthcare Policy Initiatives and the Department of Health and Welfare continue to support these ongoing transformation efforts.

Vol. 2 Issue 2 HIT

IHDE on the Street

Since the start of February, the Idaho Health Data Exchange (IHDE) has conducted more than 35 clinic site visits to ensure the providers are receiving the highest value from their connection to IHDE. The site visits typically include the following:

  • Reviewing the connection build process with the clinics to learn what went well and what didn’t so IHDE can make improvements.
  • Verifying that the connections are working properly and ensuring the staff know how to access patient data from the IHDE clinical portal.
  • Providing additional training, as requested, and offering quick tips that other clinics have found beneficial to improving patient care.
  • Obtaining suggestions from clinic staff for future system functionality that would improve the IHDE services.

These visits have proven to be quite helpful for the participating SHIP clinics. Several have reported that the Frequently Asked Questions (FAQ) document that IHDE provides is beneficial. The providers appreciated the additional training and the ability to ask questions. And IHDE has taken the constructive feedback from the clinics and has been working to improve its processes. The future functionality suggestions from the clinics are also going to be used in helping IHDE prioritize future system development.

IHDE will be continuing these site visits, with the objective of visiting all SHIP clinics well before the end of the SHIP grant.