HealthInfoNet has a long history of working in collaboration with Maine’s Department of Health and Human Services and its agencies, most prominently with the Office of MaineCare Services (OMS), to advance shared goals through the use of health information technology. Over the years, OMS has provided various incentives for new connections to the statewide Health Information Exchange (HIE), including long-term care facilities participating in Dual-Eligible Special Needs Plan (D-SNP) networks and behavioral health facilities participating in Behavioral Health Home (BHH) and Opioid Health Home (OHH) programs. Most recently, OMS is encouraging expanded HIE connections among primary care providers as part of the agency’s new Primary Care Plus (PCPlus) program.
The PCPlus program is a new value-based approach to support primary care that replaces OMS’s Primary Care Case Management, Primary Care Incentive Payment, and Health Home program predecessors with a single integrated initiative. The program offers greater flexibility and incentives for primary care practices to meet MaineCare (Medicaid) members’ health-related needs by transitioning away from a fee-for-service payment system and moving toward an approach that provides population-based payments tied to cost- and quality-related outcomes.
While the PCPlus program does not require participating primary care practices to maintain a connection with the statewide HIE to meet its basic level of reimbursement (i.e., Tier I), a connection is required for the higher intermediate (i.e., Tier II) and advanced (i.e., Tier III) reimbursement levels. In order to be eligible for the highest two tiers of reimbursement, a practice must maintain a data-sharing (sometimes known as a “bi-directional”) connection with the HIE that encompasses the transmission of varying levels of data elements to support specific clinical quality measurement:
- Tier II HIE Connection Requirement: A practice must be a participant of the statewide HIE and share a minimum clinical data set via a Health Level-7 (HL-7) Admission, Discharge & Transfer (ADT) interface containing all patient demographics, encounter and visit information (including diagnosis and procedure coding). Note: Tribal health facilities connected to the HIE as a viewing participant (not a data-sharing participant) are also eligible to receive the Tier II reimbursement level.
- Tier III HIE Connection Requirement: A practice must be a participant of the statewide HIE and share a minimum clinical data set via a HL-7 ADT and/or Observation Result (ORU) interface(s) containing all patient demographics, encounter and visit information (including diagnosis and procedure coding), vital signs, and laboratory test results.
Since the program’s first-year enrollment period, a number of new and expanded connections have been made with the statewide HIE, including:
- Hometown Health Centers – Expanded existing data-sharing connection to include vital signs.
- Katahdin Valley Health Centers – Expanded existing data-sharing connection to include vital signs.
- Nasson Health Care – Expanded existing data-sharing connection to include vital signs.
- Houlton Band of Maliseet Indians – Newly connected as viewing participant.
Additionally, several other participants are actively working with their electronic health record (EHR) system vendors to determine the feasibility of expanded HIE connections in the near future.
HealthInfoNet is pleased with the work achieved so far and the ongoing momentum among HIE participants to continue to broaden their data-sharing connections in the value of improving the quality, safety, and delivery of patient care throughout the state. A special thank you to OMS’s Delivery System Reform Unit for their partnership in facilitating and incentivizing the use of HIE services throughout the state.
To learn more about how your organization can expand its data connections with the statewide HIE, please contact our Client Engagement team at email@example.com.