MCORegistry Data Exchange Initiative

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MCO/Registry Data Exchange Initiative

• A Collaboration Between
• Every Child By Two The American
• Immunization Registry Association

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July 2002 ECBT Hosted Health Plan Executives

• Aetna Incorporated
• AMERIGROUP
• AvMed Health Plan
• Blue Cross Blue Shield
• Chartered Health Plan
• CIGNA Corporation
• Geisenger Health Plan

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July 2002 ECBT Hosted Health Plan Executives

• Health Partners Incorporated
• Health Right
• Health Net
• Independence Blue Cross
• Kaiser Permanente
• Mid-Atlantic Permanente
• PHP TennCare
• United Healthcare
• University of Pittsburgh Medical Center
• WellPoint Health Networks

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Benefits of Data Exchange

• Increased coverage rates
• Disease prevention
• Decreased missed days of employment by parents
  who must care for ill children
• Cost savings by eliminating necessity for manual
  record pulls
• Cost savings by eliminating duplicative
  immunizations
• Increase in data completeness and quality

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Benefits of Data Exchange

• Public relations value for benefits managers who
  can compare services offered by various MCOs
• Broader impact on preventive services
• Improved quality ratings for managed care
• Consistent data reporting for providers
• Increased provider and member overall
  satisfaction

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Benefits of Data Exchange

• Increased provider satisfaction by eliminating
  chart reviews by managed care
• Promotion of quality care by providing current
  recommendations and adding new vaccines
• Move toward electronic CIS
• Increased quality of care by utilizing real
  time information (current immunization status,
  recommendations, etc)

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Benefits of Data Exchange

• Assists families when moving by providing access
  to childrens records 
• Potential for long-term access to immunization
  information -alleviates need for record archiving
  by providers
• Shows that health plans care about their
  participants - GOOD PR Value

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Potential Challenges

• Addressing privacy and confidentiality
  regulations
• Ensuring legality of disclosing immunization data
  to public health from managed care
• Ensuring legality of disclosing immunization data
  from public health to managed care
• Participation of Providers
• Requirements should providers be required to
  submit data? This does not always prove to be
  effective in increasing registry data because
  there are few ways to enforce. 

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Potential Challenges

• Incentives there are many examples of managed
  care organizations providing incentives to
  providers that exhibit high immunization rates,
  can there be incentives for providing data to the
  registry?
• Important to ensure that usage of registry is
  simple user friendly ability to look up
  reports, attain batch data

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Potential Challenges

• Registry functionality
• Information technology financial investment by
  health plans must be modest
• Provider and health plan have varying
  technological capacity to access registry
• Data quality issues
• Financing registries/sustainability
• Standardization of performance measures
• Must be Internet based

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MCO/Registry Data Exchange Advisory Committee

• Therese Hoyle, Michigan Dept. of Comm. Health
• Marcina Robertson, Intermountain Health Care
• Dennis Michaud, Mass DOH/CIRSET Chair
• Dr. Allan Lieberthal, Kaiser Permanente, CA
• Kim Salisbury-Keith, Rhode Island DOH
• Reid Kiser, Natl. Cmte for Quality Assurance
• Debbie Mccune Davis, Arizona Partnership for Imm.

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MCO/Registry Data Exchange Advisory Committee

• James Resnick, Health Resources Services Assoc.
• Julie Jones, Centers for Medicare Medicaid
• Linda Murphy, Centers for Medicare Medicaid
• Jennifer Zavolinsky, American Assoc. of Health
  Plans
• Angela Salazar, CDC/NIP
• Janet Kelly, CDC/NIP
• Aurora Oliva, American Imm. Registry Assoc.
• Amy Pisani, Every Child By Two

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Goals of the Advisory Group

• To identify key issues and resources to
  facilitate data exchange between MCOs and
  registries
• To create a how-to manual to guide and
  articulate the challenges successes of data
  exchange

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Advisory Group Activities

• Spent time discussing issues initiatives
• The Vendor Recruitment Model
• Californias SIIS Conference Workgroups
• Partnership for Prevention Insights from
  registries/MCOs
• Examples of data exchange partnerships
• HIPAA ramifications
• Medicaid/Commercial health plan variations

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Products

• Survey of current registry data sharing
  activities
• Data exchange guide for registry offices
• Business template to be developed by registry
  staff
• MCO marketing card
• Available electronically/limited printed

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Registry MCO/Data Exchange Survey Results

• CDC/NIP 2002 annual report data showed that 41
  of grantees provided data to health plans to
  assist in HEDIS
• Data did not delineate whether electronic, paper,
  or by MCO staff designated to download

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Registry MCO/Data Exchange Survey Results

• Our Survey sent to all 64 of 317 grantees
• 38 registries returned survey
• 14 of the 38 are electronically exchanging data

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Survey Results - Reasons for Not Exchanging Data

• Nine due to technical reasons
• Registry system being upgraded
• System relatively new, staff focused on
  deployment to providers and health depts.
• Not HL7 compliant
• Eight due to legal or policy issues
• State laws or local interpretation of HIPAA not
  favorable to exchange
• Consent-based registry policies act as a barrier

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Survey Results- Reasons for Not Exchanging Data

• Six due to other issues
• Desire to focus on enrolling private providers
• Awaiting higher data saturation to make it
  worthwhile to health plans
• Lack of staff resources
• Lack of marketing skills

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Anecdotal Findings

• Several of Arizonas commercial and Medicaid
  plans used registry as primary source of
  information to conduct HEDIS assessments. Costly
  record reviews conducted only when information
  not found in registry

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Key Findings - Arizona

• Review of imm. coverage levels for four health
  plans from 1998 (when registry was launched) and
  2001 showed avg. increase of 8 percentage points
  for 431 series
• One of largest AZ health plans used reg. to raise
  adolescent levels
• Levels rose by 18 and 22 points for MMR Hep B
  in just three years time

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How to Guide Outline

• Health Plan Attributes and Needs
• Quality performance measures
• Registries benefits to health plans
• Health plan benefits to registries
• Increased immunization rates
• Increased data completeness/quality

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How to Guide Outline

• Health plan benefits to registries
• Increased Medicaid enrollment in registry
• Promote the awareness and use of registries by
  providers
• Provide funding to registry
• Educate members and providers about importance of
  immunizations and registries

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How to Guide Outline

• Getting started
• Evaluate registrys resources and assets
• How much time/staff can registry office allocate
• Does your registry have enough imm. records to
  make it worthwhile for health plans
• Making it Happen
• How to identify health plan contacts
• Identify health plan structure

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How to Guide Outline

• Determine the requirements
• Check with your legal department and agency staff
• What laws/rules in your state/county influence
  data exchange

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HIPAA Interpretations

• Special Cmte. On Aging hearing HIPAA Medical
  Privacy and Transaction Rules Overkill or
  Overdue?
• Status from federal agencies on implementation
  impact of policies on providers and consumers

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HIPAA Interpretations

• Richard Campanelli, director of HHS Office of
  Civil Rights
• Testimony dispelling much misinterpretation
• www.ecbt.org/news sept/october
• Majority of registries are not covered entities
  therefore not governed by HIPAA

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HIPAA Interpretations

• While registries not covered entities, most users
  of registries (health plans) are
• Rule allows covered entities to disclose to a
  public health authority authorized by law to
  collect

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HIPAAs Good Intentions

• Jarad Adair Director of CMS Office of HIPAA
  Standards reported that there are 400 different
  formats used to submit insurance claimsHIPAAA
  requires that there be just one.

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HIPAA Arm Yourself with Pro- Data Sharing
Examples

• resources should be devoted to proper and
  vigorous implementation (of the rule), and not to
  using misunderstanding and mishap to build public
  opposition to the law.
• Health Privacy Projects Director-Janlori Goldman

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How to Guide Outline

• Issues to Consider
• HIPAA clear examples of pro data sharing
  interpretations included
• NY State Immunization Information System
  explanation
• MOUs from various states

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How to Guide Outline

• Making it Happen Cont.
• Meet with immunization department staff to
  discuss how this initiative fits in with
  strategic plans/goals of entire department
• Create specific marketing plans
• Individualize for staff models, network models,
  Medicaid, commercial plans

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Specific Marketing Plans

• Sept, 2003 JAMA reported that quality of care for
  commercial MCOs was significantly higher than
  that of Medicaid MCOs
• of Complete Childhood Imm. Series Commercial
  MCOs 64 , Medicaid 49
• of Adolescent MMR Shots
• Commercial MCOs 52, Medicaid 43

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Make a Good Sales Pitch

• Think like a business person, not a health care
  professional Dr. Allan Lieberthal
• Use sales techniques
• Deal with health plan decision makers
• Highlight cost savings on manual record pulls,
  decreased duplicative imms, data collection
• Highlight public relations/sales benefits
• Improved data quality and consistency

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