IHA Daily Briefing: April 12

Thursday, April 12, 2018

IHA Quality Advocacy Showcase Held Today in Springfield
HFS Announces Sanctions for Medicaid MCO
IDPH Releases Opioid Data Dashboard
Apply to Be Innovation Challenge Spread Partner

IHA Quality Advocacy Showcase Held Today in Springfield
Leaders from over 90 hospitals and health systems gathered on the first floor of the State Capitol today to meet with state legislators about hospital quality improvement efforts during the 3rd annual IHA Quality Advocacy Showcase—an important and growing IHA advocacy event.

Along with IHA President and CEO A.J. Wilhelmi and IHA staff, hospital and health system leaders shared how their quality improvement initiatives are benefiting patients, families and communities while reducing healthcare costs.

A total of 92 projects were submitted for the event—81 from hospitals and 11 from health systems—representing the collective efforts of Illinois' hospital community to address quality and cost savings in the following categories:

  • Patient Safety;
  • Infection Prevention;
  • Care Coordination;
  • Behavioral Health;
  • Population Health; and
  • Workplace Safety.

IHA-produced posters describing each project were set up in the Capitol rotunda and hallways. See all posters in this year's compendium.

These projects cover a wide variety of quality improvement and patient safety initiatives, including efforts to:

  • Decrease opioid use;
  • Use telehealth to improve access to behavioral health;
  • Prepare for potential workplace violence incidences;
  • Reduce avoidable readmissions and healthcare-associated infections;
  • Improve outcomes for patients with strokes, total joint replacements and acute chest pain; and
  • Combat childhood obesity.

The showcase is part of the ongoing work of IHA's Institute for Innovations in Care and Quality to measurably strengthen the quality of healthcare across Illinois. We thank all participating hospitals and health systems and the leaders who attended. We look forward to your participation in next year's showcase and encourage members who did not participate this year to do so next year.

See our Twitter page or #IHAQualityShowcase18 for photos from the event.

HFS Announces Sanctions for Medicaid MCO
The Illinois Department of Health Care and Family Services (HFS) has announced a series of sanctions against Blue Cross Blue Shield (BCBS) of Illinois that include both monetary and membership penalties and cover three administrative areas:

  • Network adequacy - Effective April 1, 2018, BCBS is no longer included in the auto assignment algorithm stemming from the organization's failure to comply with network adequacy standards established by HFS. Based upon ongoing network evaluations, BCBS was notified in Jan. 2018 that sanctions were forthcoming and official notice was provided on March 21, 2018. BCBCS was determined to be unable to comply with network adequacy standards. However, should they be able to demonstrate corrective actions that result in demonstrating network adequacy, HFS may opt to restore enrollment options.
  • Reporting requirements for grievance and appeals - Effective April 1, 2018, BCBS has been sanctioned for failing to meet appeals and grievance reporting requirements. Among the items cited by HFS include failure to meet reporting deadlines as well as material changes in reports with no explanations.  In addition to a financial sanction of $150,000, enrollment also has been halted. HFS will ultimately determine when BCBS comes into compliance.
  • Grievance and appeals - Effective April 6, 2018, BCBS has also been sanctioned for $87,500 for multiple issues related to grievance and appeals. Those issues include failing to meet Medicare-Medicaid Alignment Initiative standards guiding the grievance and appeals process, ongoing non-compliance with contract requirements, inaccurate and incomplete paperwork maintained by BCBS's subcontracted vendor and lack of appropriate training of BCBS staff on grievance and appeals.

IHA will be monitoring next steps and timeframes as to when BCBS may come into compliance and any additional impacts this may have on our members.

IDPH Releases Opioid Data Dashboard
Yesterday, the Illinois Department of Public Health (IDPH) announced the launch of its Opioid Data Dashboard that generates a visual snapshot of data on opioid overdoses and deaths.

The Opioid Data Dashboard is an interactive website that consists of three categories: Morbidity and Mortality, Trends, and Prescription Opioids. Morbidity and Mortality data includes the rate of fatal and non-fatal opioid overdoses by county, as well as the number of overdoses by zip code. Trends looks at fatal and non-fatal opioid overdoses by age group, race, sex, and cause (heroin vs. other opioids). Prescription Opioids includes data on the rate, by county, of opioids being prescribed, as well as the daily average of opioids being prescribed. It also includes the annual number of total patients being prescribed an opioid and total number of prescriptions issued.

The dashboard is part of IDPH’s efforts to combat the opioid epidemic and implement the State of Illinois’ Opioid Action Plan.

Relatedly, as reported in the Daily Briefing yesterday, IHA released its Opioid Prescribing Guidelines: For Patients in the Emergency Department and Immediate Care Centers. The guidelines, developed by leaders from IHA's Institute for Innovations in Care and Quality and from the Illinois College of Emergency Physicians, are meant to assist clinicians in treating patients with acute and chronic pain the emergency department. Both long and short versions of the guidelines are available.

Meanwhile, this week the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee and the U.S. House Energy and Commerce Committee have been holding legislative hearings to discuss proposals to combat the opioid crisis in the United States.  Both committees are expected to move forward with markups of legislation in the coming weeks. Click here for information on the HELP Committee efforts, and here for Energy and Commerce.

Apply to be Innovation Challenge Spread Partner
The Great Lakes Partners for Patients Hospital Improvement Innovation Network (GLPP HIIN) is accepting applications for spread partners through its Partners in Progress Innovation Challenge. Earlier this year, GLPP HIIN selected HSHS St. John's Hospital, St. Anthony's Hospital and Advocate Good Shepherd Hospital as Innovation Challenge award recipients based their efforts to implement promising quality improvement projects. In this next stage of the program, award recipients will partner with other hospitals to spread their innovations and improve patient care.

As part of the Innovation Challenge, award recipients attended a two-day training event in January to learn more about design thinking and work with IHA HIIN staff to strategize about spreading their innovation to a partner facility. Site visits with the innovation teams at each facility were completed by the end of February, and additional monthly visits are scheduled through May.

Over the course of the next three months, award recipients will develop and finalize their spread implementation plans, while the IHA HIIN team will identify ideal spread partners for each site. Awardees and their spread partners will convene in May and spend the remainder of 2018 working through their spread implementation plans.