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

2. BIOGRAPHY Allison Combs
Director – Pharmacy Business Performance & Insights
BCBS of Michigan
Contact Info:
Phone:
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:
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)

3. Statewide Health Information Exchange Service ..

4. 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

5. MiHIN Key Foundational Services

6. 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

7. Opportunities to integrate MiHIN Use Cases

8. Benefits and Cost Structure to BCBSM

9. BCBSM Business Drivers

10. Opportunities to leverage MRUC

11. Potential Savings

12. Pilot Project Scope and Duration

13. BCBSM Use Case Requirements

14. C-CDA Document Requirements

15. MiHIN MedRec – High-Level Process Flow

16. BCBSM Reporting Data Flow

17. 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

18. 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

19. 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