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Georgia Department of Community Health
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October 29th, 2015
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Agenda
Introduction
Business Drivers
Pilot Use Case
Pilot Timeline and Process
Ecosystem
Defining Success
Resources/References
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Introduction: Pilot Team
Name Role
Laura Ellis Project Director
Bonnie Young Project Manager
Waiver Program Directors SME
Program Integrity Managers SME
Waiver Program IT Specialists SME
Irina Connelly Georgia Tech Research Institute (GTRI) Technical Support
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MissionThe Georgia Department of Community Health
We will provide Georgians with access to affordable, quality health care through
effective planning, purchasing and oversight.
We are dedicated to A Healthy Georgia
Georgia Department of Community Health (www.dch.georgia.gov)
Pilot Introduction: Business Drivers
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Georgia Business Drivers:Development of Health Information Technology (HIT) standards that:
• Support program monitoring and improvement of all waivers
• Support cross-waiver program information sharing
• Help bridge the gap between clinical and non-clinical data
• Support incremental adoption by members of the ecosystem
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Support cross-waiver program information sharing
Entities in Long Term Services and Support Transitions:• Waiver programs, hospice care, nursing homes, hospitals, rehab
facilities, etc.
Lack of information sharing leads to…– Uncertainty in service eligibility– Delay in receiving eligible services– Lost productivity and time impact on case managers– Miscommunication between LTSS stakeholders
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Use Case: Support cross-waiver program information sharing
Transitioning between LTSS services:Pilot Focus –
Beneficiary moving between CCSP and ICWP waivers
• Information currently flows within each waiver.
• Information flowing across waiver groups are not currently supported.
• Identifying and documenting the information and process needs across waiver groups will illuminate common/overlapping as well as distinct data components.
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Overview of 2 Waiver Programs
- Community Care Waiver Program (CCSP)
- Independent Care Waiver Program (ICWP)
CCSP ICWP
Population Size 8,866 1,375
Age Range Any 21-64
Impairment Eligibility Functional impairment caused by physical limitations (including Alzheimer’s and dementia)
Severe physical impairment and/or Traumatic Brain Injury
Service Eligibility Determination
Care Coordinators involved in eligibility determination subject to validation by External Quality Review Organization
External Quality Review Organization involved in eligibility determination
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Waiver Program Services
Services CCSP (Any) ICWP (21-64)
Team-based Care (i.e., jointly developed Plan of Care)
Case Management
Adult Day Health
Alternate Living Services (24-hour personal/nursing supervision)
Behavior Management Services
Counseling Services
Emergency Response System
Home-delivered Meals
Home-delivered Services (skilled nursing/therapy)
Home Environment Modification
Personal Support Services (e.g. personal care tasks and ADL)
Respite Care
Skilled Nursing Services
Specialized Medical Equipment and Supplies
Consumer Directed Care Option for Personal Support Services
Financial Support Services
Vehicle Adaptation
• Both waivers serve different populations with some overlap
• Similar services provided by both
• Similar data needs
Comparison between CCSP and ICWP
Georgia’s Round 1 pilot focusIdentifying data requirements (i.e., identify overlapping and
distinct data)
Georgia Waiver Programs (www.dch.georgia.gov/waivers)
Georgia Pilot Timeline – Tier I
Oct Nov Dec Jan ’16 Feb March April (round 1 complete)
Kick-off & Pilot plan
finalization
Participant Identification/Recruitment
- conduct outreach activities
- prepare materials for pilot participants
Conduct Pilot- identify and validate data
items via stakeholder interviews, focus group, town halls
- identify and validate potential vocabulary standards for coded data items
- solicit input for additional data items not in use today
- capture qualitative feedback
Results AnalysisBased on input received
- summarize findings on common data items and associated domains
- summarize findings on unique data items and associated domains
- identify potential candidate standards applicable to data items
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Round I Pilot Details
GOAL 1: Develop a data profile for CCSP and ICWP – begin with Service Plans
- Inputs (i.e., data collection)- Outputs (i.e., data sharing)- Data Format (semantics/syntax)- Identify Standards (i.e., data, forms, etc.) - Business Process Flows- Actors (i.e., internal and external)
GOAL 2: Identify existing ecosystem problems HIT can help solve- Improve timely access to critical information- Reduce redundancy and burden of manual data input- Identify current barriers to eLTSS implementation
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How do you define success
Deliverables: 1. Identified and documented data that exists in both programs2. Gap analysis3. Identified and documented essential service plan data to
share
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Resources/References
For more information:
Georgia Department of Community Health, Division of Health IThttps://dch.georgia.gov/health-information-technology
Georgia Department of Community Health, Waiver Programshttps://dch.georgia.gov/waivers
Georgia Tech Research Institutehttp://www.gtri.gatech.edu/icl