Civitas (formerly the Network for Regional Healthcare Improvement and the Strategic Health Information Exchange Collaborative) has long-standing experience working with its members on grant funded programs. Our model of leveraging regional innovation and the diverse expertise of the membership to provide training, technical assistance, tools, and resources has proven successful and has created national impact. Through these programs, regional members and their stakeholders have opportunities to share best practices and lessons learned across national, multi-site learning collaboratives. Examples of our programs are listed below.
This multi-phased program is a partnership between Civitas Networks for Health (Civitas), HL7 International (HL7) and America’s Health Insurance Plans (AHIP) and is aimed at improving upon existing demographic data standards so that health care organizations can better identify disparities and inform culturally responsive care. Specifically, this program is focused on the refinement and enhancement of demographic questions and response choices proposed by AHIP’s Health Equity Workgroup after a multi-year, stakeholder-driven approach.
As part of the initial refinement and enhancement phase, program partners have worked together to bring a diverse set of stakeholders to the table by hosting a series of national virtual focus groups to discuss questions and response choices for demographic domains including race, ethnicity, sexual orientation, sex, gender, relationship status, pronouns, military experience, disability status, preferred language, and spiritual beliefs. During these national virtual focus groups, participants from across the health and care ecosystem were able to collaboratively discuss their experiences with each set of demographic questions and response choices and offer their expertise and insights on potential revisions.
Subsequent phases of this program include psychometric testing of refined and recommended data elements, as well as working with subject matter experts from HL7 to shepherd the information gathered throughout the initial phase of this work through HL7’s established consensus building process for the development of data standards.
The overarching goal of this work is to modernize and enhance national demographic data content and exchange standards so that they are culturally sensitive, sufficiently granular, and aligned across stakeholders. This will permit the collection of accurate, complete, actionable, and interoperable data that supports better outcomes, fewer disparities, improved patient trust, and enhanced operational efficiency.
Civitas Networks for Health has released their Health Data Utility (HDU) Framework, developed in collaboration with the Maryland Health Care Commission (MHCC). The HDU Framework is intended to guide states, regions, HIEs, and community partners in the design and implementation of an HDU that provides deeper integration of health-related data to support public health and care delivery.
HDUs represent a new paradigm to support multi-stakeholder, cross-sector needs by serving as a data resource for use cases beyond clinical care delivery through multi-directional exchange.
The Patient Centered Data Home® (PCDH) is a cost effective, scalable method of exchanging patient data among health information exchanges (HIEs). It’s a national trust agreement between regional and statewide HIEs to govern the cross-border sharing of health data. PCDH is based on triggering episode alerts, which notify providers a care event has occurred outside of the patients’ “home” HIE and confirms the availability and the specific location of the clinical data, enabling providers to initiate additional data exchanges to access real-time information across state and regional lines and the care continuum. PCDH is an initiative of Civitas Networks for Health members, governed by the Patient Centered Data Home Governance Council, that puts into practice the vision that clinical data should be available whenever and wherever care occurs and “centered” around the patient to improve patient care. In this model, all clinical data becomes part of the comprehensive longitudinal patient record in the HIE where the patient resides, called the Patient Centered Data Home.
*Patient Centered Data Home is a registered trademark of Civitas Networks for Health Association and is used with permission.
With generous support from the Robert Wood Johnson Foundation (RWJF), Civitas Networks for Health has partnered with the Gravity Project leadership, Health Level 7® (HL7®), and Civitas members to facilitate the dissemination and implementation of Gravity Project® standards. Our efforts involve engaging with national, regional, and local partners as well as community members to gain insights from and provide assistance to the Gravity pilots workstream.
Through this project, Civitas is supporting four early-stage pilot projects addressing public health and/or health equity use cases by actively engaging with experts to deliver webinars, offering technical assistance, developing implementation guidelines and best practices, providing tools and resources, and creating opportunities for ongoing interaction and support. These resources and lessons learned will be disseminated, shared broadly etc. to inform future implementation. The project’s main objective is to utilize the existing infrastructure at the community level while identifying possibilities for new infrastructure, systems. This approach will empower communities to effectively adopt and advance the collection and utilization of social determinants of health (SDOH) data, ultimately leading to equitable care for all.
States play a critical role in improving health and advancing information interoperability and reusable infrastructure. Civitas launched the State Health Technology Commons to support the pivotal work of state leaders working in government agencies.
The State Health Technology Commons provides a neutral forum for state leaders to share best practices, facilitate collaboration, and receive targeted technical support to enhance their effectiveness and efficiency in advancing shared health technology agendas.
This work will convene learning communities for peer-to-peer knowledge sharing on specific topics such as financing, public health data modernization, and other cross-cutting issues. Also, participants can access collaborative workshops that offer technical assistance in a hands-on environment to collectively build resources for strategy, policy, and implementation of state-level technology solutions.
Recognizing the critical partnerships between Civitas members and state health IT leaders, the program includes regular communication between the Commons and Civitas members. This will help address the complexities of state and federal health IT priorities, health information exchange (HIE), health data utilities (HDUs), the integration of social needs data, and public health modernization.
The Association of State and Territorial Health Officials (ASTHO), National Network of Public Health Institutes (NNPHI), and Public Health Accreditation Board (PHAB) recently announced the launch of a new Implementation Center Program to support public health agencies as they modernize their data systems.
The U.S. Centers for Disease Control and Prevention (CDC) provided $255 million in funding through the Public Health Infrastructure Grant (PHIG) for the new program, which will provide tailored support and technical implementation services. Guidehouse was selected to serve as an Implementation Center (IC) through the program, which builds upon previous investments made through PHIG, and will expand the number of public health agencies eligible to receive support. The goal of the program is to reduce the burden on public health agencies, health systems and providers, labs, and other data providers to seamlessly exchange information for rapid detection of and response to health threats.
Civitas will support Guidehouse in the design and implementation of a TEFCA onboarding and technical assistance framework for State, Tribal, Local, and Territorial Health Departments (STLTs) that leverages the strengths of existing HIE infrastructure to maximize operational flexibility for public health authorities and minimize administrative burdens and redundancies. Civitas technical assistance will promote dual connectivity through TEFCA and resident HIEs across the full scope of the program, from the assessment phase through education, QHIN selection, official guidance development, priority use-case testing, benchmarked implementation, and the dissemination of findings consistent with program requirements.
Civitas served as a lead partner on an Institute for Healthcare Improvement (IHI) COVID-19 Vaccine Learning Initiative. In Phase 1, this project undertook a rapid innovation cycle to learn from early experiences, scan emerging best practices and challenges, and develop a model for mounting a rapid local response to the US vaccine crisis. Initial research conducted by IHI, The Health Collaborative, Parkland Center for Health Innovation (PCCI), and Cincinnati Children’s Hospital Medical Center produced a vaccine implementation and delivery model as well as a set of change ideas for testing and scaling vaccine distribution in defined local populations. The rapid innovation cycle identified three key objectives to guide efforts at the local level:
To test this change theory and support local implementation of equitable vaccine distribution, IHI engaged Civitas and identified five locally led collaboratives, including four Civitas members, to participate in shared learning through virtual forums to further define successful activities that support public health response, with a goal of increasing vaccine access and uptake in vulnerable communities. The five partners participated in virtual peer-to-peer learning sessions, developed case stories, and shared lessons learned through a national virtual event. This initial phase also resulted in a publication in NEJM Catalyst: Innovations in Care Delivery.
In Phase 2, the Initiative engaged in qualitative interviews with health departments and HIEs (including Civitas members in Nebraska, North Carolina, Maryland, Indiana) to better understand how data has been used to support public health efforts during the COVID-19 pandemic. Through the work done in Phase 1 and Phase 2, a prototype tool has been developed to support data sharing. This is now live.
Between March 20th and August 10th, 2020, NRHI and research partners conducted qualitative research of off-site COVID-19 testing centers (OSCTCs) in more than twenty states across the country.
Many NRHI members supported the work by serving as advisors to shape the project approach and to support connecting the research team with OSCTC leaders in their communities.
Phase I (March-April 2020) was a rapid assessment of the then promising practices for off-site testing for COVID-19. A summary of the findings was published in Healthcare: The Journal of Delivery Science and Innovation and a more detailed report was also published. The major considerations were organized in an easy-to-follow infographic and disseminated broadly to support sites looking to establish or improve testing center operations.
During Phase II (June – August 2020), the research focused on questions addressing access to testing among vulnerable populations, the alignment of OSCTCs with public health entities, community-based organizations, governmental agencies, and other health systems to effectively address the testing needs, limitations, and opportunities across the population. After an extensive qualitative analysis, the findings were organized in a comprehensive Off-Site Testing Toolkit. Findings were also published in Healthcare: The Journal of Delivery Science and Innovation.
Throughout the project, the team curated existing tools and resources, provided summaries of the tools, and developed a webpage to house the resources. All resources, reports, toolkits, and blogs were disseminated broadly via newsletters, social media, through network members and partners, and during national virtual events.
With support from the Archstone Foundation, a private grantmaking organization aimed at improving the health and well-being of adults 65 and older, Civitas Networks for Health (Civitas) provided expertise on health IT topics, including an assessment of major state-based and national interoperability and health data exchange initiatives and requirements. This program included a comparison of the California Data Exchange Framework (DxF) with the Trusted Exchange Framework and Common Agreement (TEFCA), and how these interact with certain programs such as MediCal’s California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 waiver.
Civitas supports the Office of the National Coordinator for Health Information Technology (ONC) Immunization Data Exchange, Advancement, and Sharing (IDEAS) program intended to improve partnerships and data sharing between Health Information Exchanges (HIEs) and Immunization Information Systems (IISs).
Along with technical assistance partners American Immunization Registry Association (AIRA), Association of Immunization Managers (AIM), Mathematica, and Guidehouse, Civitas supports the Association of State and Territorial Health Officials (ASTHO) in assisting five awardees in the development of HIE and IIS data sharing policy and technical implementation. The ONC IDEAS program developed a comprehensive environment scan exploring the factors influencing IIS and HIE data sharing.
Between February and July of 2021, NRHI, with support from The Rockefeller Foundation, held a twelve-part Innovations Series- COVID-19 Testing to Support the Reopening of Schools: A National Forum for Regional Leaders.
The Innovation Series was developed to support school leaders and their cross-sector partners working to implement onsite screening testing programs to identify and contain cases of COVID-19. Each of the twelve events in the series highlighted the work of specific schools and their partners, and/or showcased tools and resources developed by national thought leaders such as The Duke-Margolis Center for Health Policy, The Rockefeller Foundation, Chiefs for Change, and COVID Response Advisors.
The series reached 621 attendees representing many different sectors and organization types including regional health improvement collaboratives, public health, colleges/universities, community-based organizations, government, health systems/medical practices, K-12 schools, and social services. Key takeaways were summarized after each event, and all takeaways and event recording were disseminated broadly. Blogs were also produced and published in local and national media outlets.
Led by NRHI, the NRHI SAN worked with eight regional health collaborative members and with national partners to advance the goals of Practice Transformation Networks (PTNs) across the country. It provided educational resources, tools, and TA to PTNs through a variety of learning programs. RHICs served as expert faculty offering programming with QI at the foundation to support practices in preparing for the transition to APMs.
The programming was broad and customized based on PTN needs, offering foundational skills for QI Advisors in a number of areas. The NRHI SAN has delivered nearly 40 learning modules (Webinars) and over 60 learning labs (live PTN-specific sessions) to more than 5,000 TCPi community members on high-value care topics. Many resources were “bundled” and made available through easy to access online modules. Programs yielded strong evaluation results with 90% of attendees reporting plans to share the program information with others including the practices that they are working with.
The Getting to Affordability project highlights NRHI’s past success in accelerating regions’ ability to advance healthcare cost transparency. Six regions participated in producing three national benchmarks reports providing insights into the cost drivers of healthcare variation. Drill down reports were also provided to primary care practices in 5 states to identify opportunities for price and utilization interventions for improved quality and reduced costs.
Production and dissemination of comparative reports at the practice, community and national levels identify regional cost drivers and provide physicians with the data to change practice patterns, thereby reducing overutilization and total cost. Most notable is the activation of key players in these regions to act on total cost of care information.
This project sparked policy changes in CO, increased the focus on hospital pricing impact in Oregon, pointed to the all-payer hospital rate regulation program in Maryland having a positive impact for the commercially insured population and prompted St. Louis to launch a community collaborative to reduce avoidable emergency room utilization. Over 200 participants engaged in this work via the G2A online learning platform where resources and learning modules were made available.
Network of Regional Healthcare Improvement (NRHI) partnered with two of its members – Comagine Health (formerly HealthInsight) and Mountain-Pacific Quality Health – to provide technical assistance to small practices in Utah, Oregon, Nevada, Montana, Wyoming, and Alaska.
NRHI was 1 of 11 organizations chosen by the Centers for Medicare & Medicaid to provide technical assistance and support to eligible individual or small group practices of 15 or fewer to support their transition of Medicare payments from a fee-for-service system to one based on performance and patient outcomes under the Quality Payment Program (QPP) Small, Underserved, & Rural Support (SURS) program.
The QPP-SURS program was established in 2017 as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to enable local, experienced organizations help individual Merit-based Incentive Payment System (MIPS)-eligible clinicians and small practices:
* Quality, Cost, Improvement Activities, and Advancing Care Information
Providing this support to clinicians is helping them to navigate the Quality Payment Program, while making sure they are able to focus on the needs of their patients.
With support from the Robert Wood Johnson Foundation (RWJF) and the ABIM Foundation, NRHI coordinated and delivered Choosing Wisely learnings to six participating members with the goal of increasing dialogue between patients and providers and empowering consumers. Topics included, but were not limited to: Employer Engagement, Measuring Impact, Sustainability, and Community Engagement. Participating organizations had dramatic reductions in inappropriate tests and treatments across the life of the project.
The Network for Regional Healthcare Improvement and regional health improvement collaborative (RHIC) members in Colorado (CIVHC), Massachusetts (MHQP), and Oregon and Utah (Comagine Health) partnered with the National Bureau of Economic Research (NBER) and Harvard University in the Comparative Health System Performance Initiative Study funded by the Agency for Healthcare Research and Quality (AHRQ). The RHICs developed methods to comparatively study eight quality measures across systems and geographies, in addition to cost across geographies by standardizing measurement for disparate regional databases. They also developed a Uniform Data Structure (UDS) file format that can be scaled across populations, measures, and research dimensions to provide a consistent method of producing comparable findings across regions. Their research was published in the May 2019 issue of The American Journal of Managed Care: “Producing Comparable Cost and Quality Results from All-Payers Claims Databases.” Examination of the impact of health system structure on healthcare costs (resource utilization and price) in Oregon and Utah. This project is supported by grant number U19HS024072 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the political views of the Agency for Healthcare Research and Quality.
Between 2014 and 2019, with funding from the Robert Wood Johnson Foundation, NRHI hosted the HealthDoers Network, a premier network for health and health care changemakers to come together to connect, collaborate, and accelerate their work. Throughout the course of the project, we convened over 1,000 organizations and 5,000 individuals through in-person and virtual events, online learning communities, and dissemination of relevant curated content. At the heart of HealthDoers was an easy-to-use online platform that supported tailored collaboration and shared learning.
HealthDoers fostered strong community connections to accelerate health improvement, bringing together groups and individuals with shared goals. The partnerships and expertise gained through HealthDoers offerings such as a customizable newsletter, in person and virtual convenings, and curated content using innovative technology to package complex information into easy-to-use formats continues to be critical to organizational success.
NRHI partnered on this Institute for Healthcare Improvement (IHI)-led initiative along with Stakeholder Health, American Heart Association, and Public Health Institute to develop a framework, tools, and resources to help health care leaders chart the path towards progress in population health. NRHI supported scale and spread by using its HealthDoers online platform and engaged five of its members and like partners to adopt and/or distribute the tools. NRHI also provided national virtual training on the framework developed.
