HealthInsight is a private, nonprofit, community-based organization dedicated to improving health and health care, composed of locally governed organizations in four western states: Nevada, New Mexico, Oregon and Utah. HealthInsight also has operations in Seattle, Wash., and Glendale, Calif., supporting End-Stage Renal Disease Networks in the Western United States. As such, it is able to draw upon the unique social and cultural elements of each region, as well as quality improvement expertise that has been developed over four decades.
The HealthInsight enterprise holds contracts and grants in key areas of health care improvement:
Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO)
HealthInsight is leading health care quality improvement activities for the Medicare Program as the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for a four-state region serving Nevada, New Mexico, Oregon and Utah. The five-year contract awarded by CMS runs from July 2014 to July 2019.
HealthInsight has held federal contracts to support Medicare quality improvement activities continuously for Utah since 1984 and in Nevada since 1988. The New Mexico Medical Review Association continuously held the Medicare Quality Improvement Organization contract for its state since 1984 and affiliated with HealthInsight in 2012. Acumentra Health has also conducted Oregon's Medicare QIO activity since 1984 and joined HealthInsight as a subcontractor under the QIN-QIO structure in 2014. In March of 2016, Acumentra Health entered into a formal affiliation with HealthInsight.As the QIN-QIO, HealthInsight works with providers and the community on multiple, data-driven quality initiatives to improve patient safety, reduce harm, engage patients and families, and improve clinical care locally and across our region. The QIN-QIO work includes transforming physician practices, employing lean methodology, assisting with value-based purchasing programs and developing innovative approaches to quality improvement.
HealthInsight End Stage Renal Disease (ESRD) Alliance
The HealthInsight ESRD Alliance was formed in 2015 to bring together the strengths of all partners to further integrate quality efforts across the care continuum for patients at risk for kidney disease, those with chronic kidney disease, and those on dialysis or receiving kidney transplant care.
The HealthInsight ESRD Alliance is composed of HealthInsight, the Northwest Renal Network 16 (serving Alaska, Idaho, Montana, Oregon and Washington) and Network 18 (serving Southern California), along with stakeholders in both regions. The alliance brings together the strengths of all partners to ensure broader impact and the best quality health care for ESRD beneficiaries. The alliance will serve more than 55,000 patients with ESRD in 569 dialysis facilities.
CMMI Admissions and Transitions Optimization Program (ATOP)
HealthInsight Nevada is one of seven organizations across the nation selected by the Center for Medicare & Medicaid Innovation (CMMI) to lead the initiative to reduce avoidable hospitalizations among nursing facility residents.
The statewide initiative, called the Admissions and Transitions Optimization Program (ATOP), aims to preserve the quality of life for residents in their home by supporting nursing facility staff members, who then help identify, communicate and respond to subtle changes in residents' conditions, which ultimately reduces hospital admissions.
In 2016, HealthInsight Nevada was selected to carry on this work with an added payment reform component. In this model, nursing facilities that provide a higher level of care for specific conditions will be paid at a higher level. Practitioners will also see a change in compensation. In a strategy to equalize pay between sites of care, physicians will receive the same amount for treating the patient within a skilled nursing facility as he or she would in a hospital. ATOP will continue implementing clinical interventions in Nevada facilities and add the payment reform piece to the work. To measure effectiveness, ATOP will also work with nursing facilities in Colorado to test the payment-only component of the intervention.
CMMI Strong Start
Strong Start is an initiative to support pregnant women within the Nevada Medicaid program with the goal of reducing pre-term births and low-birth-weight babies. We are focusing on women with high-risk behaviors, such as alcohol, tobacco and drug use, as well as those with high-risk health conditions.
We promote our goals by teaching healthy behaviors, decisions and experiences using the Group Prenatal Care model. This model begins with routine health assessments, which include a prenatal check by a clinical professional and instruction for patient self-care.
Medicaid External Quality Review Organization (EQRO)
HealthInsight has been the Medicaid External Quality Review Organization (EQRO) under contract with the New Mexico Human Services Department since 2005, providing quality oversight for all Medicaid managed care physical health, behavioral health and long-term care contracts. This work includes assessing contract performance against applicable state and federal standards and policy, the actual measurement of performance using approved methodology, and other audits as requested.
In Oregon, Acumentra Health has served as the Medicaid EQRO since 2004, performing similar quality oversight of the state’s managed care contractors—currently, 16 coordinated care organizations formed as part of Oregon’s Medicaid transformation model. Acumentra Health’s EQRO work also includes conducting major annual surveys of mental health service consumers (adults and youth) on behalf of the Medicaid agency, and performing on-site quality and utilization review of programs that provide inpatient and residential mental health treatment for Medicaid recipients under 21 years of age or 65 and older.
Qualified Entity (QE)
HealthInsight New Mexico is certified as a Qualified Entity (QE) by CMS under its Qualified Entity Certification Program, developed to implement Section 10332 of the Affordable Care Act. This status, active for three years, certifies HealthInsight New Mexico as qualified to access and handle certain Medicare claims data and protect patient privacy during the process. Qualified entities are able to combine Medicare and private insurance data to create comprehensive, useful reports on provider performance, intended to help consumers get more information regarding their local doctors, hospitals and other health care providers. HealthInsight is also currently preparing to publicly report Medicare and commercial data in Utah, in partnership with the Utah All-payer Claims Database.
Health Information Technology/Health Information Exchange (HIT/HIE)
Community Health Information Exchange (HealtHIE Nevada and cHIE)
In Nevada, HealthInsight has collaborated with statewide stakeholders to launch a community-based health information exchange, known as HealtHIE Nevada (HIE).
HealtHIE Nevada lets doctors' offices, hospitals, clinics, labs, pharmacies and other health care professionals access and share patient medical records quickly, securely and accurately at the point of care. This exchange improves timeliness, quality and coordination, and eliminates the need for costly and duplicative testing.
By working together toward a unified system for managing care, medical professionals can focus more time and energy on patients instead of paperwork. The management of HealtHIE Nevada and its services are performed by HealthInsight Nevada.
In Utah, HealthInsight was a founding member of the Utah Health Information Network (UHIN) administrative data exchange, which has been active for over a decade. UHIN's clinical HIE (cHIE) is online and clinical data is being exchanged. HealthInsight staff contributed in many areas of development, including vendor selecting, governance design, communication strategy, provider engagement, evaluation design and resolving political issues. Marc Bennett, president and CEO of HealthInsight, is the present chairman of the UHIN board.
Health Information Technology Regional Extension Center (REC)
HealthInsight served as the Health Information Technology Regional Extension Center (REC) for Nevada and Utah, and in New Mexico as a major subcontractor.. Designated by the Office of the National Coordinator for Health Information Technology in February 2010, RECs were created out of the American Recovery and Reinvestment Act of 2009 for the purpose of improving the quality and value of health care throughout the country.
As the REC, HealthInsight assisted approximately 2,200 outpatient and critical access hospital providers through hands-on, one-on-one customized assistance in selecting and effectively using electronic health records to improve patient care and obtain meaningful use payments.
Learning Systems Support, Knowledge Management and Technical Assistance
CMMI Health Care Innovation Award Round One and Two, Integrated Learning Systems, Quality Innovation Network-Strategic Innovation Engine
Since 2012, HealthInsight has provided learning system development, training and technical assistance support to national health care innovation programs. Support includes environmental scans, lessons learned synthesis, knowledge product development, collaborative learning facilitation and direct technical assistance to innovations projects. Support customers include the full health care-to-community continuum. Support targets range from strategic design, applications of emerging science, operations and challenges common to innovations initiatives, sustainability and payment model design.
Patient and Family Engagement
End of Life/POLST
HealthInsight Utah is funded via the Utah Department of Health under the State Innovation Model cooperative agreement from CMMI to focus on multiple aspects of advanced care planning. HealthInsight Utah created an Advanced Care Planning Advisory Group that focuses on empowering patients and their families to engage in meaningful end-of-life conversations with their physicians. The group provides training to providers in facilitating these critical discussions, and enhancing the portability and accessibility of documented preferences (Physician Order for Life Sustaining Treatment, or POLST, and other documents) at the time of need using a secure electronic process. This group has come together to plan Utah’s first-ever conference specifically targeting advanced care planning challenges and successes, with hopes of improving awareness and education on end-of-life topics for providers, families and the community.
After working with community stakeholders for over three years, in 2011, HealthInsight launchedwww.UtahHealthScape.org, a comprehensive health care quality data reporting website, for providers, health plans and the public, representing a significant step forward in health care transparency. The site provides consumers with a directory of Utah providers, listing their characteristics and service offerings, quality of care data and patient experience/satisfaction survey results for health plans, hospitals, nursing homes and home health agencies. The site is available in English and Spanish.
Prescription Drug Monitoring Programs Research
HealthInsight Oregon plans and manages research projects on behalf of, and in coordination with, research partners in academic, health care and government settings. Current projects include a five-year study, funded by the National Institute on Drug Abuse, to research the effectiveness of Oregon’s Prescription Drug Monitoring Program (PDMP) as a clinical decision tool for providers; a collaboration with Oregon State University in a three-year research grant from the Agency for Healthcare Research and Quality to develop a PDMP toolkit for pharmacists; and a partnership with the Washington State Department of Health to develop a GIS mapping tool to identify “service deserts” for substance abuse treatment.
HealthInsight is a key partner in the following areas:
- New Mexico Coalition for Healthcare Value – New Mexico
- Network for Regional Healthcare Improvement Collaborative (NRHI) – Nevada, New Mexico and Utah
- The Nevada and Utah Partnerships for Value-Driven Health Care (NPV, UPV) – Nevada and Utah
New Mexico Coalition for Healthcare ValueHealthInsight New Mexico is a founding member and a strong supporter of the New Mexico Coalition for Healthcare Value, a not-for-profit organization that includes private and public employers, health care providers and insurers. The coalition was formed as a result of the momentum generated by the Robert Wood Johnson Foundation's Aligning Force for Quality (AF4Q) grant that had been operating in New Mexico under the auspices of HealthInsight. HealthInsight offices are home to the coalition and operations are conducted through and administrative services arrangement. The coalition is dedicated to improving health care value and cost transparency in the state.
Network for Regional Healthcare Improvement Collaborative (NRHI)
Through the work of the Nevada and Utah Partnerships for Value-driven Healthcare and the New Mexico Coalition for Healthcare Value, HealthInsight is designated in each state as a Regional Health Improvement Collaborative (RHIC) and is a member of the Network for Regional Healthcare Improvement (NRHI). In this role, HealthInsight provides coordinated multi-stakeholder support in our communities in a neutral forum for health care transformation. For more information, visit www.NHRI.org.
The Nevada and Utah Partnerships for Value-driven Health Care (NPV and UPV)
HealthInsight is the Agency for Healthcare Research and Quality Chartered Value Exchange (CVE) in Nevada and Utah. The CVE is a multi-stakeholder collaborative effort that includes health care purchasers, health plans, providers and consumers. It is actively working to advance transparency of health care quality, promote adoption of health information technology and align financial incentives with quality and improvement goals.
The HealthInsight Value Program is working with a diverse set of community stakeholders to lead, develop and implement appropriate change around the value and transparency of health care. HealthInsight has identified the value proposition (quality/cost=value) as a key strategy to improving the overall health of our communities. The program's key agenda strategies include:
- Aligning health care payment with quality
- Reporting provider performance
- Engaging consumers
- Promoting and advancing health information technology
Convening our Community
At HealthInsight, we understand the complexity of the health care system and the points of leverage for change:
- Health care providers: We work intensively with hospitals, physician offices, long-term care and home health providers. As a thought leader and trusted adviser to those actively delivering health care, we engage our community partners in “learning labs” for continuous improvement.
- Payers, purchasers, policy makers: We lead our communities in improving our health care system.
- Public/consumers: We translate health care data into actionable information that patients and their families can use to navigate the health care system and improve their health.
Drivers of Change: Improved System Performance Relationships
While HealthInsight’s efforts have produced measureable improvements in the quality of health care provided in our communities, we believe we need a multifaceted approach if we are to move beyond gradual, incremental improvements to produce the major changes needed to achieve demonstratively better outcomes at reasonable costs.
This figure represents a model developed at HealthInsight to show the interrelated efforts we believe our communities must work on simultaneously in order to create sustainable gains. Our organizational strategy is to organize, expand upon existing efforts, support our partners and reinforce, encourage or otherwise foster initiatives that move these levers.
These levers for change include:
- Sharing clinic data across the continuum of care
- Making optimal use of health information technology to improve and coordinate care
- Promoting transparency of quality and cost data and continuously providing actionable data to front-line workers
- Redesigning work flow and care processes and supporting associated culture change
- Engaging consumers of health care in owning their own care and their own health, enabled with cost and quality data
All of this has to happen in an environment with payment aligned to reward quality and efficiency. No single entity can drive all that change. Effectively engaging as a community, including alignment of government efforts, has to be an overarching key strategy.
Currently many of these efforts are funded from different sources as independent projects. HealthInsight is working to coordinate across these efforts in our communities and obtain funding in the areas not covered. We are working toward building a sustainable integrated community approach through the many initiatives we take on.