Provider Directory Services (PDS) March 12, 2015 Karen Hale, Senior Policy Analyst Office of Health Information Technology, Oregon Health Authority

Why tackle a statewide provider directory? 2 Problem Multiple, isolated provider directories in use today Limited in scope (e.g. missing provider HIE addresses) and accuracy May not meet national provider directory standards Opportunity Medicaid Coordinated Care Organizations (CCOs) have told us a statewide provider directory is needed for foundational near term needs Common credentialing efforts that place standards for data are underway in Oregon Emerging national standards for data models and protocols “federated health care directory” (F-HPD) have recently been adopted

Provider Directory Subject Matter Expert (SME) Workgroup In 2014, we convened a 12-member SME workgroup who provided guidance on scope, uses, problems, and parameters for provider directories Work informed and shaped our requirements for the request for information (RFI) and funding request to CMS Members were from: FamilyCare Health PlansPacificSource Jefferson HIEPortland IPA Mid-Valley Behavioral Care Network / WVCH Health IT Committee Providence Health and Services Moda HealthRegence Blue Cross Blue Shield OHSU’s Center for Health Systems Effectiveness Samaritan Health Services Oregon Medical AssociationWomen’s Healthcare Associates

What are we going to do? 4 Procure for Provider directory services (PDS) that will allow healthcare entities access to a state-level directory of healthcare provider and practice setting information. The project comprises design, development, implementation, and maintenance of the technical solution as well as operations and ongoing management and oversight of the program. PDS will leverage data existing in current provider databases and add critical new information and functions. Procure for Provider directory services (PDS) that will allow healthcare entities access to a state-level directory of healthcare provider and practice setting information. The project comprises design, development, implementation, and maintenance of the technical solution as well as operations and ongoing management and oversight of the program. PDS will leverage data existing in current provider databases and add critical new information and functions.

Leverage existing data sources: Connect but not replace existing disparate provider directories Oregon’s Common Credentialing data which requires providers to confirm the accuracy of their information every 120 days EHR and HIE directories via recently adopted national standards called HealthCare Provider Directory – Federated (F-HPD) Access to the provider directory services via web portal, through an EHR/HIT, or through a flat-file exchange Funding Use 90% federal Medicaid funding for initial design, development, and implementation for Medicaid. Use federal/state funding for Medicaid share of ongoing operations/maintenance costs. With enabling legislation (HB2294, 2015) PDS can be expanded beyond Medicaid and sustained by fees Approach to development will be incremental where each phase will build upon the last Leverage existing data sources: Connect but not replace existing disparate provider directories Oregon’s Common Credentialing data which requires providers to confirm the accuracy of their information every 120 days EHR and HIE directories via recently adopted national standards called HealthCare Provider Directory – Federated (F-HPD) Access to the provider directory services via web portal, through an EHR/HIT, or through a flat-file exchange Funding Use 90% federal Medicaid funding for initial design, development, and implementation for Medicaid. Use federal/state funding for Medicaid share of ongoing operations/maintenance costs. With enabling legislation (HB2294, 2015) PDS can be expanded beyond Medicaid and sustained by fees Approach to development will be incremental where each phase will build upon the last What is our approach?

PDS Principles Build incrementally to ensure success, but must have value right out of the gate Scalable solution to allow for future enhancements and additional functionality Establish clear expectations regarding quality of provider information Contract both for implementation and operations Work in collaboration with Common Credentialing database/program (under development) Centralize where needed but allow for federation of existing provider directories

Operations Complete, accurate source of provider data for referrals and care coordination Validation source of provider demographic, specialty, location, and practice information Health Information Exchange (HIE) - Access to HIE "address book" Facilitate HIE outside clinic or system Enable providers to meet stage 2 meaningful use Data available for research and analytics Key Uses Providers and clinics Hospitals Health Systems Health Plans and CCOs State programs such as PCPCH and the Medicaid EHR Incentive Program State departments such as Public Health, Medical Assistance Programs, Addictions and Mental Health, Health Analytics Local HIEs Users and/or Sources of data PDS Uses and Users

PDS concept

PDS activities underway Review RFI responses, RFP planning and refining requirements State procurement approval processes Assemble stakeholder groups - Provider Directory Advisory Group (PDAG), internal OHA users Continue analysis of governance model/criteria and policies Winter 2015 Procurement processes continue Convene stakeholder groups Continue analysis of governance model/criteria and policies Spring 2015

RFI status PDS was one of three projects addressed in our “bundled procurement” RFI that was issued on November 18, 2014 Closed on January 15, 2015 Received a total of 20 responses for one or more bundled procurement components; 10 were specific to the PDS Analysis is underway on those responses and will inform our approach to the Request for Proposal (expected release in spring/summer 2015)

permitted use, data sources, quality of the data, security, and access Policies scoping the operations of the program (onboarding processes, ongoing monitoring of the processes, and modifications) and if OHA has the legislative authority, fees and fee structures Programmatic aspects Refining requirements, phasing approaches, and technical considerations Technical aspects Provider Directory Advisory Group (PDAG) We will be convening an advisory group to inform :

PDAG Schedule Feb 5, 2015 Send out nominations Mar 5, 2015 Nominations due Mar 12, 2015 Nominations decisions Mar 18, 2015 Membership notifications Apr 2015 Convene monthly, 2-3 hour PDAG meetings Envisioned to meet through 2016

For more information on Oregon’s HIT/HIE developments, please visit us at Provider Directory Subject Matter Expert Workgroup (2014) Karen Hale, Provider Directory Lead, OHA