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, Washington, and Glendale, California, 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) – Nevada, New Mexico, Oregon and Utah
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 the Centers for Medicare & Medicaid Services (CMS) runs from July 2014 to July 2019.
HealthInsight has held federal contracts to support Medicare quality improvement activities continuously in Utah since 1984 and in Nevada since 1988. The New Mexico Medical Review Association continuously held the Medicare Quality Improvement Organization (QIO) contract for its state since 1984 and affiliated with HealthInsight in 2012. Acumentra Health also conducted Oregon's Medicare QIO activity since 1984 and joined HealthInsight as a subcontractor under the QIN-QIO structure in 2014. In March 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 assisting outpatient clinicians to keep pace with the rapid changes of the health care system, employing lean methodology, assisting with quality reporting and incentive programs and developing innovative approaches to quality improvement.
Partnership to Advance Tribal Health (PATH) – New Mexico, Arizona and nationally
CMS selected HealthInsight to become the QIN-QIO dedicated to understanding and supporting quality improvement efforts within the Indian Health Service (IHS) hospital system. IHS hospitals serve American Indian and Alaska Native people, and HealthInsight supports their leadership, providers and staff in providing high quality care for the people they serve. To best support the hospitals, HealthInsight partnered with organizations in Montana, Minnesota, North Dakota, South Dakota and Oklahoma. HealthInsight will serve hospitals in New Mexico and Arizona. Additionally, an American Indian owned small business will provide advice to strengthen patient, family and tribal government engagement. HealthInsight and its partners are working collaboratively with IHS to provide quality improvement training, spread best practices and ensure clinical, operational and safety standards are met or exceeded in order to improve health for American Indian and Alaska Native people.
Hospital Improvement Innovation Network (HIIN) – Nevada, New Mexico, Oregon and Utah
The Hospital Improvement Innovation Network (HIIN) contracts awarded by CMS will build on the momentum of the CMS-funded Hospital Engagement Networks and Quality Improvement Organizations to further reduce patient harm and readmissions. This initiative is part of a broader effort to transform our health care system into one that works better for the American people and for the Medicare program.
Through 2019, the Hospital Improvement Innovation Networks will work to achieve a 20 percent decrease in overall patient harm and a 12 percent reduction in 30-day hospital readmissions as a population-based measure (readmissions per 1,000 people) from the 2014 baseline. Addressing health equity for Medicare beneficiaries and incorporating person and family engagement in health care will be central to these efforts.
HealthInsight End Stage Renal Disease (ESRD) Alliance – Western United States
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, Hawaii and Pacific Islands) 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 serves more than 55,000 patients with ESRD in 569 dialysis facilities.
Centers for Medicare & Medicaid Innovation (CMMI) Admissions and Transitions Optimization Program (post–acute payment redesign) – Nevada and Colorado
HealthInsight Nevada was one of seven organizations across the nation selected by the Centers for Medicare & Medicaid Innovation (CMMI) to lead the charge in reducing avoidable hospitalizations among nursing facility residents in 2012.
The statewide initiative, called the Admissions and Transitions Optimization Program (ATOP), aimed to preserve the quality of life for residents in their homes by supporting nursing facility staff members, who help identify, communicate and respond to subtle changes in residents' conditions, which ultimately reduce unnecessary hospital admissions.
In 2016, HealthInsight Nevada was selected to carry on stage 2 of 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.
Project ECHO Patient Flow – Nevada, New Mexico, Oregon and Utah
Catalyzing Complex Systems Change by Optimizing Patient Flow with the ECHO Model™ is a Centers for Medicare & Medicaid Services (CMS) funded special project. HealthInsight is supporting 50 primary care practices across Nevada, New Mexico, Oregon and Utah in building their capacity to improve their care processes by optimizing patient flows.
While the ECHO model has traditionally been used to increase rural clinicians' ability to care for patients with complex diseases, this initiative will use an ECHO virtual learning community to increase primary care practices' capacity to adapt their internal processes to improve quality and contain cost.
Strong Start – Nevada
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. The program focuses on women with high-risk behaviors, such as alcohol, tobacco and drug use, as well as those with high-risk health conditions.
Strong Start promotes its 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) – New Mexico and Oregon
HealthInsight's New Mexico and Oregon affiliates have served as the Medicaid EQRO for their respective states since 2005, under contract with the state Medicaid agencies. In New Mexico, HealthInsight provides 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, measuring actual performance using approved methodology and performing other audits as requested. The Oregon EQRO performs similar quality oversight of 16 coordinated care organizations formed as part of Oregon's Medicaid transformation model. Oregon work also includes conducting major annual surveys of mental health service consumers on behalf of the Medicaid agency, and performing on-site quality and utilization review of inpatient and residential mental health treatment for Medicaid recipients under 21 years of age or 65 and older.
In April 2017, HealthInsight formed a separate corporate entity, HealthInsight Assure, LLC, to provide independent direction and governance of the company's EQRO contracts and related quality assurance lines of business.
Qualified Entity (QE) – New Mexico and Utah
HealthInsight 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 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) – Nevada and Utah
In Nevada, HealthInsight has collaborated with statewide stakeholders to launch a private, nonprofit, community-based health information exchange, known as HealtHIE Nevada (HIE). Launched in 2011, 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 more 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 more than a decade. UHIN's clinical HIE (cHIE) is online and clinical data currently is being exchanged. HealthInsight staff contributed in many areas of development, including vendor selection, governance design, communication strategy, provider engagement, evaluation design and the resolution of political issues. Marc Bennett, president and CEO of HealthInsight, is the present chairman of the UHIN board.
Learning Systems Support, Knowledge Management and Technical Assistance
CMMI Health Care Innovation Award Round One & Two, Integrated Learning Systems, Quality Innovation Network-Strategic Innovation Engine – National
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 – Utah
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.
UtahHealthScape – Utah
After working with community stakeholders for more than three years, in 2011, HealthInsight launched 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 – Oregon
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 research on prescription opioid topics funded by the Centers for Disease Control and Prevention, the U.S. Bureau of Justice Assistance and the Pew Charitable Trusts.
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 Value
HealthInsight 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 an administrative services arrangement. The coalition aims to improve 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 Health Care 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 NRHI. In this role, HealthInsight provides coordinated multistakeholder support in our communities in a neutral forum for health care transformation.
Oregon Health Care Quality Corporation (Q Corp), with whom HealthInsight has announced a formal merger agreement, is also a RHIC and a member of NRHI. For more information, visit www.nrhi.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 multistakeholder collaborative effort that includes health care purchasers, health plans, providers and consumers.
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 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.
- Patients and families: We are working to bring clinicians and patients together to address the ever-increasing costs and complexities of our health care system. HealthInsight convenes Patient and Family Advisory Councils to bring understanding of the public perspective in order to help improve health outcomes.
Drivers of Change: Improved System Performance Relationships
While HealthInsight's efforts have produced measureable improvements in health care quality, we believe we need a multifaceted approach if we are to move beyond gradual, incremental improvements to produce the major changes needed to achieve 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.