Slide Deck Outline

This comprehensive slide deck includes a clear and concise overview of the HFS HealthChoice Illinois ADT Program, its challenges, and the recommended actions. This was presented to the HFS HealthChoice Illinois ADT Internal Executive Meeting through WebEx on August 7, 2024.

1. Title Slide

2. HIE Overview and Purpose

3. HITECH Act and Promoting Interoperability Program

4. Illinois HIE Journey

5. Major Achievements

6. Current Challenges

7. The Importance of Integration with Enterprise Data Warehouse

8. Challenges of Running an HIE without Integration

9. Conclusion and Next Steps

10. Current Contract Issues Overview

11. Major Problem 1: Definitions and Data Handling

12. Major Problem 2: Data Matching and Reporting

13. Major Problem 3: Technical Support and Help Desk Operations

14. Major Problem 4: Phase II Implementation

15. Major Problem 5: Financial and Subscription Models

16. Minor Problems Overview

17. Program Specific Differentiators

18. Recommendations

19. Internal Issues and Grievances at HFS

20. Shared Responsibility for Program Success

21. Conclusion and Next Steps (Reiteration)

PowerPoint Presentation Slides for HFS HealthChoice Illinois ADT Program

Slide 1: Title Slide

Content:

• Title: HealthChoice Illinois ADT

• Subtitle: Project Update - HFS Meeting

• Presented by: Dana R. Wilson, Div of Medical Programs, Program & Policy Coordination, Federal Health Information Planning

• Date: 08/07/2024

Dialog: "Good [morning/afternoon], everyone. Thank you for joining us today. My name is [Your Name], and I will be presenting an overview of our Health Information Exchange (HIE) initiatives, the history of our efforts, where we currently stand, and the challenges we face. Let's dive in."

Slide 2: HIE Overview and Purpose

Content:

• Objective of HIE:

• Improve patient care quality, safety, and efficiency through data sharing.

• Enhance care coordination among healthcare providers.

• Streamline public health reporting and improve health outcomes.

• Reduce healthcare costs through increased efficiency.

Dialog: "The primary objective of our Health Information Exchange is to improve the quality, safety, and efficiency of patient care through seamless data sharing among healthcare providers. By enhancing care coordination and streamlining public health reporting, we aim to achieve better health outcomes and reduce overall healthcare costs."

Slide 3: HITECH Act and Promoting Interoperability Program

Content:

• HITECH Act:

• Enacted in 2009 to promote health IT adoption.

• Provided funding for EHR adoption and HIE development.

• Promoting Interoperability Program:

• Formerly known as Meaningful Use.

• Encouraged providers to use certified EHR technology.

• Tied to achieving specific objectives for data sharing and patient engagement.

Dialog: "The HITECH Act of 2009 was a significant milestone in promoting the adoption of health information technology. It provided substantial funding for EHR adoption and the development of HIEs. The Promoting Interoperability Program, previously known as Meaningful Use, incentivized healthcare providers to use certified EHR technology to achieve specific data sharing and patient engagement objectives."

Slide 4: Illinois HIE Journey

Content:

• Initial Efforts:

• Initial partnership with Tennessee (TN) faced challenges.

• Current Partnership:

• Transitioned to partner with Michigan for IMPACT integration.

• Successfully integrated HIE with Michigan's system.

• IMPACT's Role:

• Tied HIE to Provider Enrollment and Enterprise Data Warehouse.

Dialog: "Illinois' journey with HIE began with learning and understanding. Our initial efforts included a partnership with Tennessee, which unfortunately faced several challenges. We then transitioned to a partnership with Michigan, successfully integrating our HIE with their system. IMPACT plays a crucial role in our HIE efforts, tying provider enrollment and the Enterprise Data Warehouse together."

Slide 5: Major Achievements

Content:

• EHR Adoption:

• Over 80% of office-based physicians adopted EHRs.

• Over 95% of hospitals adopted EHRs.

• Enhanced Data Sharing:

• Improved data exchange capabilities among healthcare providers.

• Public Health Reporting:

• Streamlined public health reporting and surveillance.

Dialog: "One of our major achievements includes significant EHR adoption, with over 80% of office-based physicians and 95% of hospitals using EHRs. We've also enhanced data sharing capabilities among healthcare providers and streamlined public health reporting and surveillance."

Slide 6: Current Challenges

Content:

• Interoperability Issues:

• Persistent challenges in achieving seamless data exchange.

• Financial Sustainability:

• Ongoing financial challenges post-HITECH funding.

• Variable Adoption:

• Inconsistent adoption and utilization across regions.

• Security Concerns:

• Ensuring the privacy and security of health data.

Dialog: "Despite our successes, we face several challenges. Interoperability remains a significant issue, with persistent challenges in achieving seamless data exchange. Financial sustainability is another concern, especially after the expiration of HITECH funding. Adoption and utilization of HIEs are inconsistent across regions, and ensuring the privacy and security of health data is a constant challenge."

Slide 7: The Importance of Integration with Enterprise Data Warehouse

Content:

• Integration Benefits:

• Centralized data management.

• Enhanced data accuracy and consistency.

• Improved analytics and reporting capabilities.

• Provider Enrollment through IMPACT:

• Ensures all providers are part of the HIE.

• Facilitates seamless data flow and coordination.

Dialog: "Integration with the Enterprise Data Warehouse is crucial for the success of our HIE. It allows for centralized data management, enhanced data accuracy and consistency, and improved analytics and reporting capabilities. Additionally, tying the HIE to provider enrollment through IMPACT ensures that all providers are part of the HIE, facilitating seamless data flow and coordination."  This is stated in the contract – Healthcare Data Exchange System 2020-36-003

Slide 8: Challenges of Running an HIE without Integration

Content:

• Data Fragmentation:

• Without integration, data is scattered and inconsistent.

• Inefficiencies in Care Coordination:

• Disjointed data flow leads to care coordination challenges.

• Increased Costs:

• Managing multiple data sources increases operational costs.

• Security Risks:

• Higher risk of data breaches and privacy issues.

Dialog: "Running an HIE without integration poses significant challenges. Data fragmentation becomes a major issue, leading to scattered and inconsistent information. This disjointed data flow hampers care coordination, increases operational costs, and heightens security risks due to the higher likelihood of data breaches and privacy issues."

Slide 9: Conclusion and Next Steps

Content:

• Key Takeaways:

• Integration with Enterprise Data Warehouse is essential.

• Continuous improvement in interoperability and data security.

• Sustainable financial models for long-term success.

• Next Steps:

• Enhance integration efforts.

• Address financial and operational challenges.

• Focus on improving interoperability and user adoption.

Dialog: "In conclusion, integrating our HIE with the Enterprise Data Warehouse is essential for its success. We need to focus on continuous improvement in interoperability and data security while developing sustainable financial models for the long term. Our next steps include enhancing integration efforts, addressing financial and operational challenges, and improving interoperability and user adoption."

Slide 10: Current Contract Issues Overview

Content:

• Major Problems:

• Definitions and Data Handling

• Data Matching and Reporting

• Technical Support and Help Desk Operations

• Phase II Implementation

• Financial and Subscription Models

• Minor Problems:

• Report Formats and Delivery

• Provider Group Definition

• Web-Based User Interface Documentation

• Deliverables and Payment Schedule

Dialog: "Our discussion will now focus on both major and minor problems currently affecting the contract. We'll delve into issues such as definitions and data handling, data matching, and support operations. Additionally, we'll address financial models, report formats, and more. Let's start with the major problems."

Slide 11: Major Problem 1: Definitions and Data Handling

Content:

• Issue:

• Clarification needed for key terms like "HFS Data."

• Handling of unmatched HL7 messages.

• Impact:

• Potential compliance issues.

• Data integrity concerns.

Dialog: "One major issue revolves around the need for clear definitions of key terms, such as 'HFS Data.' Additionally, there are concerns about how HL7 messages that do not match the beneficiary list are handled, which could lead to compliance issues and data integrity problems."

Slide 12: Major Problem 2: Data Matching and Reporting

Content:

• Issue:

• Accuracy of matching Medicaid patients to MCOs, IHHs, and providers.

• Reporting on mismatches.

• Impact:

• Inaccurate patient information.

• Affected care coordination and reporting accuracy.

Dialog: "Another significant issue is the accuracy of matching Medicaid patients to various providers and the need for detailed reporting on mismatches. We currently receive no reports with regard to mismatch results – even those with percentages of an accurate match but did not send because it didn’t meet criteria.  Collective Medical/PointClickCare expresses that they have a team that works on these issues but no reports are provided to the State for validation.  Inaccurate data matching can result in the dissemination of incorrect patient information, which affects care coordination and overall reporting accuracy."

Slide 13: Major Problem 3: Technical Support and Help Desk Operations

Content:

• Issue:

• Help desk does not meet 24/7 operational requirements.

• Lack of internal metric tracking for training and support performance.

• Impact:

• Unresolved issues and decreased system reliability.

• User dissatisfaction.

Dialog: "The current help desk operations do not meet the 24/7 requirements, and there is a lack of internal metric tracking to assess training needs and support performance. This insufficiency can lead to unresolved user issues, decreased system reliability, and overall dissatisfaction among users."

Slide 14: Major Problem 4: Phase II Implementation

Content:

• Issue:

• Documentation and agreement needed for Phase II details, including HL7 segment types.

• Impact:

• Misunderstandings and implementation delays.

• Affected project timeline and objectives.

Dialog: "Phase II of the project requires detailed documentation and agreement on various HL7 segment types. Without this clarity, misunderstandings can arise, leading to implementation delays and affecting the overall project timeline and objectives."

Slide 15: Major Problem 5: Financial and Subscription Models

Content:

• Issue:

• Discrepancies in financial

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PowerPoint Presentation Slides for HFS HealthChoice Illinois ADT Program (Continued)

Slide 15: Major Problem 5: Financial and Subscription Models (Continued)

Content:

• Issue:

• Discrepancies in financial and subscription models.

• Number of entities and associated costs.

• Impact:

• Budget overruns and cost disputes.

• Financial sustainability concerns.

Dialog: "There are notable discrepancies in the financial and subscription models, particularly regarding the number of entities and associated costs. These discrepancies can lead to budget overruns and disputes over service costs, posing a threat to the project's financial sustainability."

Slide 16: Minor Problems Overview

Content:

• Report Formats and Delivery:

• Agreement needed on format, content, and delivery schedule.

• Provider Group Definition:

• Clear definition required.

• Web-Based User Interface Documentation:

• Inclusion of system documentation.

• Deliverables and Payment Schedule:

• Establish clear deliverables and payment schedule.

Dialog: "In addition to the major problems, there are several minor issues that need to be addressed. These include agreeing on report formats and delivery schedules, defining provider groups clearly, ensuring the web-based user interface includes system documentation, and establishing a clear deliverables and payment schedule."

Slide 17: Program Specific Differentiators

Content:

• Data Matching Algorithm:

• Proprietary algorithm for accurate patient matching.

• Comprehensive Support Metrics:

• Detailed internal metric tracking for help desk.

• Phase II Expansion:

• Inclusion of various HL7 segment types beyond ADT.

• Integration with Data Sources:

• Compliance with USCDI and HIPAA standards.

Dialog: "Our program has several unique differentiators. The proprietary data matching algorithm ensures accurate patient information. We have detailed internal metric tracking for help desk operations, and Phase II will expand to include various HL7 segment types beyond ADT. Additionally, we integrate data from multiple sources while complying with USCDI and HIPAA standards."

Slide 18: Recommendations

Content:

• Clarify Definitions and Data Handling Procedures:

• Finalize definitions and procedures.

• Document Data Matching and Reporting Processes:

• Establish clear documentation and reporting requirements.

• Enhance Technical Support Operations:

• Ensure 24/7 support and robust metric tracking.

• Detail Phase II Implementation:

• Provide comprehensive documentation for Phase II.

• Review Financial and Subscription Models:

• Resolve discrepancies and document terms clearly.

Dialog: "To address the issues identified, we recommend clarifying definitions and data handling procedures, documenting data matching and reporting processes, enhancing technical support operations, detailing Phase II implementation, and reviewing financial and subscription models to resolve discrepancies and ensure clear documentation."

Slide 19: Internal Issues and Grievances at HFS

Content:

• Internal Challenges:

• Staffing Shortages and Resource Constraints

• Delayed Response Times and Inconsistent Communication

• Insufficient Training and Support for Staff

• Technical and Logistical Issues

• Grievances:

• Multiple internal grievances reported regarding program management

• Issues with data handling, reporting, and technical support

Dialog: "In addition to the challenges faced by our vendor, it's crucial to acknowledge the internal issues and grievances within HFS. These include staffing shortages and resource constraints, delayed response times, inconsistent communication, insufficient training, and various technical and logistical issues. Multiple grievances have been reported, highlighting problems with data handling, reporting, and technical support."

Slide 20: Shared Responsibility for Program Success

Content:

• Joint Accountability:

• HFS and Vendor Collaboration

• Mutual Fulfillment of Contract Obligations

• Adequate Resource Allocation by HFS

• Commitment to Improvement:

• Continuous Communication and Feedback

• Proactive Problem-Solving and Issue Resolution

• Shared Goals for Program Success

Dialog: "The success or failure of the HFS HealthChoice Illinois ADT Program is not solely the responsibility of the vendor or HFS. It requires joint accountability and collaboration between both parties. HFS must allocate adequate resources and provide necessary support to ensure the program runs smoothly. Both organizations must fulfill their contract obligations, engage in continuous communication and feedback, proactively solve problems, and work towards shared goals for program success."

Slide 21: Conclusion and Next Steps (Reiteration)

Content:

• Key Takeaways:

• Address major and minor issues for contract improvement.

• Focus on unique program differentiators.

• Next Steps:

• Implement recommendations.

• Monitor progress and adjust as needed.

Dialog: "In conclusion, by addressing both the major and minor issues identified, we can significantly improve the contract and ensure the success of the HFS HealthChoice Illinois ADT Program. We need to focus on our unique program differentiators and implement the recommended actions. Monitoring progress and making necessary adjustments will be crucial as we move forward. Thank you for your attention, and I look forward to any questions or discussions."