February 12 2018 CHi R Annual Stakeholder Leadership

February 12, 2018 CHi. R Annual Stakeholder Leadership Meeting

Overview • Share information and activities of Arizona health organizations • Brief stakeholders on ASU/CHi. R projects and data management updates • Engage with Patient-Centered Learning Health Network (LHSNet) representatives • Identify opportunities for research collaborations and partnerships

_____ -Position -Affiliation -Why you attended

Rochester Epidemiology Project Alanna Chamberlain, MD

MIHS Overview Anthony Dunnigan, MD, MBI February 12, 2018

Agenda • MIHS Intro − Brief history − Epic history • Data!

Maricopa Integrated Health System • County Safety-Net System for Maricopa County, Phoenix, AZ for 140+ years • Maricopa Medical Center: 555 beds • Level 1 Adult Trauma, Level 2 Pediatric Trauma • Arizona Burn Center: 45 beds, 5, 000 visits annually • Behavioral Health Annex and Desert Vista Behavioral Health Center: 219 beds • 13 FQHC Family Health Centers: PCMH Certified • Overall 550, 000 visits annually • 60% patients on Medicaid; 30% of patients without coverage

MIHS History • 1883: Original hospital built • 1898: Site west of downtown Phoenix purchased for $5, 650— home for next 72 years • 1965: Creation of Burn Unit • 1970: Current facility opens • 2003: Maricopa Special Health Care District Created • 2014: Prop 480 passes; $935 M for replacement of main center and surrounding facilities

MIHS: Epic History October 2009 (Epic v 2008) • Familiy Health Center -- Chandler • Comprehensive Healthcare Center -- Pediatrics • Emergency Department and limited Surgery (scheduling, preference cards, charting) January 2010 • Comprehensive Healthcare Centers -- Internal Medicine, Dermatology, Nutrition • Family Healthcare Centers -- El Mirage, Avondale, Glendale, Maryvale, Guadalupe • Specialty Clinic -- Burn February 2010 • Family Healthcare Centers -- South Central, 7 th Ave, Sunnyslope, Mc. Dowell, Mesa • Comprehensive Healthcare Centers -- Women’s Specialties • Specialty Clinic -- Behavioral Health March 2010 • Comprehensive Healthcare Centers -- All remaining clinics August 2011: Epic v 2010 Upgrade March 2012 • Maricopa Medical Center • Behavioral Health • All Hospital Outpatient Departments (i. e. Dialysis) June 2013: Epic v 2012 Upgrade August 2015: Epic v 2014 Upgrade September 2017: Epic v 2017 Upgrade

Data! Since 2009… • Patients: 1, 671, 581 • Database size: 2. 84 TB

Data Team

Epic Data Model

Data Warehouse

Questions? anthony. dunnigan@mihs. org

Arizona Alliance for Community Health Centers Arizona’s Primary Care Association

AACHC Membership and Health Center Access ● AACHC has 25 full members and 9 associate members with over 230 physical locations throughout the state of Arizona where people can receive services ● Of these, 23 are Community Health Centers or Look-Alikes with over 150 sites

AACHC Mission To promote and facilitate the development and delivery of affordable and accessible community oriented, high-quality, culturally effective primary healthcare for everyone in the state of Arizona. This will be accomplished through advocacy, education and technical assistance.

AACHC’s Support to Arizona’s Health Centers

Statewide Impact 2016 UDS Data

Scope of Services Health Centers Serve as Patient-Centered Medical Homes

Quality of Care Data for 2016

Collaborative Ventures Network CVN Goals • • • Collaboration among and between essential community providers, public programs and health plans for affordable quality health care Demonstrable value-based care through continuous improvement in quality of service, health outcomes and reduction in the overall cost of care Data-based benchmarking and decision making Statewide community-based patient-centered primary care network Fiscally sustainable operations to meet continued growth in populations served

AACHC and CVN : Working Together for Value

AACHC/CVN Data Priorities & Challenges For Individual Health Centers: ● Integrating physical, behvioral and oral health for clinical decision making ● Integrating information regarding social determinants of health ● Complete bi-directional Health Information Exchange ● Patient attribution versus health plan Member assignment ● Total Cost of Care by medical expense category For Primary Care Network: ● Timely Aggregation of Patient-related Data ● Clinical Quality Measure Alignment across Multiple Stakeholders

Arizona Community Health Centers

Mountain Park Health Center John Swagert, MD

CHi. R Annual Stakeholder Leadership Meeting Nancy Johnson, RN, Ph. D Chief Executive Officer Douglas J Spegman MD, MSPH, FACP Chief Clinical Officer

Cultural Beliefs Step Up: I am accountable for making El Rio a world class health center I Matter I make a difference by voicing my opinions and knowing I am heard Break Boundaries I work with others to achieve success Value health I take time for my own health to promote yours Honor Patients I always put the patients first Create Tomorrow I embrace effective change and seek innovative solutions Vision To be a national model of excellent healthcare. Mission Improving the health of our community through comprehensive, accessible, affordable, quality and compassionate care. Key Results World Class Experience For Patients and Staff Healthier Patients and Employees Positive Financial Results

Meeting the Health Needs of Our Patients v 12 Campuses throughout Tucson

Our Practice 2016 UDS Data Total Number of Patients Served 94, 190 Total Number of Patient Visits 361, 285 Number of Employees 1, 073 Number of Sites 12 Specialties: IM, FP, Peds, Ob/Gyn, Midwifery, HIV, Dental, Integrated Behavioral Health, Radiology, Lab, Pharmacy

Our Patients El Rio Patients By Race/Ethnicity [VALUE] 4% Hispanic/Latino White [VALUE] 30. 0% best served in a language other than English Native American *2017 UDS Data

Our Patients El Rio Patients by Payer Source 11, 7% 12, 2% Medicaid Private 54, 7% 21, 3% Medicare Uninsured *2017 UDS Data

Data Management at El Rio v. Performance Goal and/or benchmark for the process measured v. Numerator/Denominator description of data v. Timeframe of measurement v. Interpretation of the data presented v. Action plans based on analysis of the data to drive/sustain improvement

Data as Foundation

Cascading Real-Time Relevant Data

El Rio Statistical Process Control Chart

Using Data to Drive Quality Improvement v Pediatric-Dental Health Homes v Colorectal Cancer Screening v Senior Care Services v Abnormal Lab Results v Medication Adverse Drug Reporting System v HIV Opt Out Screening v PAQ Management v Adolescent Health v MA Checklist v Transforming Health Care Teams v Chronic Pain (Project ECHO) v Hepatitis C Screening

Native Health Susan Levy

Center for Health Information & Research (CHi. R)

About CHi. R • CHi. R began as a research group in 1999 before organizing into a multidisciplinary unit now part of the College of Health Solutions. • Our AZ Board of Regents designated research center serves as a resource and partner for individuals and organizations that need comprehensive health care information and data analytics for public, private and research uses. • We collect identifiable health information and information on social determinants of health from a variety of sources across the state voluntarily. • We can track the health care and well-being of individuals and populations over time and across providers and health insurers through our linkable data sources.

Services/Capabilities Data curation & integration Population health reporting Customized data requests Descriptive and predictive analysis Health outcomes studies Health workforce supply/demand Quality and performance assessments

Linkable Data Sources ● Complete Arizona Medicaid Claims ● State Inpatient and Emergency Department Data ● Community Health Center Electronic Health Records ● Criminal Justice Data ● Physician, Nursing & Pharmacy Workforce Information ● Vital Statistics Records (Birth/Death) ● Other Health Care and Social Determinants Data Characteristics ● Individual level health encounter data on millions of Arizona residents ● Geographically-based ● Secure storage & processing ● Voluntary data sharing partnerships

Examples of Current CHi. R Projects & Initiatives

Arizona Health Care Workforce • Since 1991, CHi. R has conducted ongoing collection of licensing data on allopathic and osteopathic physicians who hold Arizona licenses through partnerships with the Arizona Medical Board and the Board of Osteopathic Examiners. CHi. R regularly receives all physician licensing information collected by the medical boards along with survey questions that are included in the licensing application process. • Under an ongoing collaboration with AHCCCS (2007 - ), CHi. R tracks the use and exchange of electronic medical records among Arizona physicians, with a special focus on physicians who serve AHCCCS members. • This same data collection model is also applied to other health care professions, including RNs, APNs, LPNs, pharmacists and pharmacy technicians through data from their respective licensing boards.

RWJF Integration for Mental Illness and Substance Abuse Co-Principal Investigators from the School for the Science of Health Care Delivery and School of Criminology and Criminal Justice are integrating AHCCCS data with county jail bookings and adult probation data in order to explore opportunities for better coordinating services for persons with mental illness and/or substance abuse disorders. Using interactive system dynamics modeling and network analysis methods, this study identifies how people and dollars move between and within the state’s medical, mental health, and criminal justice systems. Interactive simulation models informed by stakeholder input will then explore how changes to funding streams and service delivery models can produce improved health and social outcomes. • Collaborators: College of Health Solutions, CHi. R, Center for Applied Behavioral Health Policy • Future plans: Add statewide criminal justice data from all counties.

RWJF Integration: Example Stakeholders Arizona Center for Law in the Public Interest Mental Health America Arizona Department of Health Services Mercy Care/Mercy Maricopa Integrated Care AHCCCS National Alliance of Mental Illness Crisis Response Network Native American Connections Lifewell Behavioral Wellness Phoenix Municipal Court MARC Behavioral Health Services Southwest Behavioral Health Services Maricopa County Adult Probation Terros, Inc. Maricopa County Department of Public Health Vitalyst Health Foundation Maricopa County Justice System Planning & Information Viva la Esperanza MIHS Many More…

Value of Federally Qualified Health Centers • Sponsor: Arizona Alliance for Community Health Centers (2014 ongoing) • Understand the value of Federally Qualified Health Centers (FQHCs) care of patients enrolled in AHCCCS by studying their health care utilization, cost, and quality of care. CHi. R is preparing the analysis data sets, conducting the analyses, and reporting aggregate results. CHi. R also provides technical services, creating databases of health information and analyzing local data.

Impact of Medicaid/SCHIP Disenrollment on Adult and Children’s Healthcare Use & Cost in AZ ● Robert Wood Johnson Foundation (Research in Transforming Health and Health Care Systems program) sponsored alliance with the University of Arizona to study the impact of Arizona’s Medicaid enrollment freeze (2010 -2011) and 2014 restoration and Medicaid expansion on the health care utilization and cost of Proposition 204 Childless Adults and Kids. Care beneficiaries. ● 1 of 7 projects addressing the individual health insurance market, Medicaid expansion, and Medicaid policy changes.

Medical Respite Care for Homeless Persons • National Health Care for the Homeless Council tested a model of providing medical respite care for homeless Medicaid & Medicare members in five states. • Study evaluates the outcomes of medical respite care on health, health care, and costs of care. • CHi. R is providing health care utilization data from Medicaid claims on consenting patients who received treatment at Circle the City, Phoenix’s only medical respite care provider. The data consists of all treatment received 12 months prior to entering respite care and 12 months after leaving the respite center.

Healthy Kiddos, Healthy Communities • Collaborative intervention program (2017 -2018) sponsored by Dignity Health Grants Program Keogh Health Connection CHi. R Valle del Sol Isaac School District St. Joseph’s Family & Medicine • Identifies at-risk children and families in three high-need Phoenix zip codes, conducts health risk assessments, and provides education and referrals for health care and other community services. • CHi. R is program data collector and evaluator.

Asthma in Maricopa County • ASU & Mayo Clinic AZ researchers are studying children with asthma in Maricopa County • To understand the root causes of asthma exacerbations that are potentially preventable in children and • To develop a sustainable model for asthma care to reduce preventable admissions and emergency department visits. • CHi. R is conducting analysis of its Medicaid claims data and providing summary results of the health care utilization of this population to the study team.

Patient-Centered Network of Learning Health Systems • PCORI funded Clinical Data Research Network of 7 institutions (3 universities & 4 health systems) includes CHi. R and partners, led by Mayo Clinic • Supports research that improves health/care for patients, families & providers. • Focuses on learning, translating & reporting information from health studies. • Uses a Common Data Model to execute data queries and participate in applicable research studies • Contains Medicaid (AHCCCS) claims and clinical data (EHRs) from local community health centers. • Data feeds into PCORnet’s 100+ million patient network of clinical data ready for research.

Partner with CHi. R • CHi. R welcomes data sharing partners and study collaborators. Contact us for more information. • Requests for data and other services can be submitted online at our website: https: //chs. asu. edu/chir or via email/phone.

& Véronique L. Roger, MD

Collaborative Opportunities and Initiatives

Research Collaboration Request • Title: The effects of a multifaceted mobile application intervention to improve self-monitoring and self-management in heart failure • Primary Objective: Determine if a mobile application designed to improve selfmonitoring and self-management improves outcomes in heart failure. • PI: Dr. Michael Dorsch, Pharm. D, University of Michigan • This is a prospective multi center randomized 2 x 2 x 2 factorial designed study of a multifaceted mobile application in patients being discharged with acute on chronic heart failure. The three part intervention includes adaptive push messages to improve self management when patients are clinically worse, adaptive push messages about low sodium alternative foods at restaurants and grocery stores, and a medication optimization tool to facilitate a discussion with the patient's provider about improving evidence based medicine. The primary outcomes will be the change in Minnesota Living with Heart Failure Questionnaire, Self Care Heart Failure Index and 30 day readmission rate. • Seeking collaborators for an NIH R 01 grant proposal submission in June 2018. If an investigator expresses interest, please provide the Research core their name, location, email and contact number. Responses due Monday Feb 12, 12: 00 pm CST.

Front Door Collaboration Request • Title: Childhood Obesity Healthcare Costs Comparison • Dr. Suzanne Lazorick and her study team at East Carolina University are seeking collaborators to assist with investigator expertise, patient/participant engagement expertise, site identification and recruitment and enrollment for a retrospective observational study. • Primary Question: What is the average annual total claims cost for each insurer, and is there a difference in cost between the weight categories? • Sponsor: BCBS or BCBS Foundation • Children age 3 -18 years with BCBS insurance, and Medicaid insurance (analyzed separately) by weight category: underweight, healthy weight, overweight, and obese. • For the most recent calendar year for which claims are available- compare annual claims costs for a 12 month period (total, as well as broken down by pharmacy, hospital, outpatient) and analyze by weight category. This requires CDRN electronic health record (EHR) data to be linked to Healthplan claims data. • The deadline to respond to this request is February 16, 2018. • If you or someone within your Network is interested in collaborating or talking further with Dr. Lazorick, please fill out the Front Door Response Form.

Closing Remarks

Contact Info George Runger, Ph. D Chair, Department of Biomedical Informatics George. Runger@asu. edu Ph: 480. 884. 0225 Anita Murcko, MD, FACP Clinical Associate Professor Anita. Murcko@asu. edu Ph: 602. 549. 8610 William G. Johnson, Ph. D Professor of Biomedical Informatics & Founder of CHi. R william. g. johnson@asu. edu Ph: 602. 516. 4241 Gevork Harootunian, MS(c) Principal Statistical Programmer Gevork. Harootunian@asu. edu Ph: 602. 496. 2008 Center for Health Information & Research 502 E Monroe St, Ste C 320 Phoenix, AZ 85004 Web Site: http: //chs. asu. edu/chir Email: chir@asu. edu | Phone: 602. 496. 2009 Tameka Sama, MBA, CRA Senior Coordinator Tameka. Sama@asu. edu Ph: 602. 496. 2009