Da Vinci Update Defining Value Based Care Standards Between Payers and Providers First like to thank HL7 for giving us a home to execute on this project. I’m standing here today through the hard work, openness and willingness of others to work for greater good across many barriers. Thank you to Chuck Jafffe and Karen Van Henteryck through their leadership in creation of Partners in Interopability and long term efforst to bring payers into HL7 development the idea of was able to thrive. We’ll discuss why now, but I’d also like to acknoweldget the relationships and participation from many active payers at HL7 like LJ from BCBSA, Mike Gould from IBC, folks like Bob D to enter into discussions about how and what Da Vinci should and could be as a project. March 6, 2018

The Da Vinci Project The Opportunity to Enable Providers Payers HIT vendors Industry Cooperation Lead the first significant initiative with payers and providers working together with their HIT vendors to solve interoperability problems Empower providers teams to make the best clinical, quality or administrative decision at point of service, in context of their day to day workflows Increase opportunity got provider and payers to do it right the first time -- eliminate rework where possible Leverage HIT vendors to implement one solution for each use case --- reduces cost, complexity, deployment and support Truly a unique opportunity at a point in time to accomplish something of meaningful change for the industry. As more organizations shift their contract models away from FFS and begin to take on risk to show value and improve outcomes with the care they provide, Da Vinci enables all stakeholders to work collaboratively to get the right information and details into care teams hands to be able to make the best decisions for a particular patients. The goal is to move from retrospective to prospective access to critical information about patient to empower teams to make best decisions. It is time to merge what have been two distinct world and bring all the right patient specific data in a way that can scale once we get it nailed down. Payers, providers and HIT vendors solving interoperability problems to improve patient care

Drive to Improve Outcomes Background for folks not following along from home. VBC is not a new concept, but a number of activites on the regularity front is pushing it to the front for all participants in federal programs, and commercial plans are following suite. Market acknowledges we need to fundamentally change the way we pay for care, and the folks at CMS are doing a great job of starting to put the levers in place to bring organizatins across the chasm. Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html

VBC Provides Necessary Alignment of Priorities Cost Control Patient Outcomes Regulatory Impact Regulatory is just one factor. We all well know priorities for the industry, but candid;y they haven’t always been aligned. With regulatory impact and cost containment, we put care providers in a difficult situation frequently to keep focus on patient outcomes. But really, that’s why we are all here, right? Use my primary care practice as an example and my own PHI, I live in Boston, think I’m living future state. well my kid’s, so I have two asthmatics in my house, my multispecialth. Part of early ACO, but after 2-3 ER visits with my youngest, called and scheduled us to come in, discussed what was going wrong, evaluated meds, made a change, ER free for about 5 years. Since then, they left ACO, but practice shifted work model, this past Christmas, did all right things, following regiment and still end up 11pm ER Christmas night. Visit next day, discussed how to avoid in future, and changed emergency inhaler. Key to me isn’t whether did “right” thing, could handled differently, but this practice has incentive alignment to fund to NP that do case/coordination, spot and look for patient’s like my then 6-7 year old and retrained me as a patient so when year later we ended up there again, I was calling, consults and advice, and looking for what tweaks and changes we needed to make and could get an appt nearly immediately in the middle of a budy flu season to see one of the NPs SO why is this important, I live in portion country advancing, high commitment to interop, through relationship changes, left ACO, sold to local regional hospital, custom integrations are now broken and need to be rebuilt. As increasing number of the patients in a practice panel are in value based contracts it will be critically important for practices like mine to have visibility when they see me whether I’m in one of the VBC and each of these events

Vision & Goal Multi-stakeholder The Da Vinci Initiative Realization of a Vision Vision & Goal Multi-stakeholder Utilize best talent High impact Focus on implementable solutions Agile model: learn and deliver fast Open participation: Payers, Providers, HIT vendors and industry Led by experts: Staffed by members and stakeholders Promotes FHIR for VBC: Use cases selected by impact and effort Simplify broad adoption: Concurrent development of reference implementation and implementation guide Creatively flexible & innovative: Identify barriers early, reprioritize as necessary, minimize cycle from requirements to reference implementation Payers, providers and HIT vendors solving interoperability problems to improve patient care

Objective To ensure the success of the industry’s shift to Value Based Care there is a need to establish a rapid multi-stakeholder process to identify, exercise and implement initial use cases between payers and provider organizations. The objective is to minimize the development and deployment of unique solutions with focus on reference architectures that will promote industry wide standards and adoption. Components for success include (and where needed, create extensions to or craft revisions for) common: Standards (HL7 FHIR®), Implementation guides, and Reference implementations and pilot projects to guide the development and deployment of interoperable solutions on a national scale. 6

Working with Founders to Identify Initial Sites by Use Case Founding Members 10 Payers 3 EHRs 9 Use Cases 4 HIT Vendors ½ Dozen Providers Working with Founders to Identify Initial Sites by Use Case

Define solutions for Value Based Care (VBC) use cases Relationship Between Da Vinci & P2 FHIR Task Force Using FHIR to Solve Payer-Provider and Provider-Provider Interoperability Problems Solve VBC Exchange Scope Scale the Solution HL7 ONC Convener Da Vinci Stakeholder Participants P2 FHIR Task Force Define solutions for Value Based Care (VBC) use cases Establish FHIR ecosystems standards and best practice to allow solutions to scale nationally Focus Start with a VBC use case (e.g. 30-day medication reconciliation) Define the requirements (business, technical) Create implementation guide and reference implementation Pilot the solution Identity management Security and Authentication API discovery Scaling solutions Content identification and Routing Testing and certification

Da Vinci and P2 FHIR Task Force Payer, Provider and HIT vendors Using FHIR to Solve Payer-Provider and Provider-Provider Interoperability Problems P2 FHIR Task Force Scale Solutions Nationally HIT Solutions How can a payer scale this to 30,000 providers serving 3 million members Payers/Providers Providers Da Vinci Solutions to VBC Use Cases How can a payer request and receive a response from a provider regarding 30-day medication reconciliation (content and semantics of the messages) HIT Solutions

2018 Use Case Inventory and Project Deliverables 30 Day Medication Reconciliation* Coverage Requirements Discovery* Documentation Templates and Coverage Rules* Project Deliverables Define requirements (technical, business and testing) Create Implementation Guide Create and test Reference Implementation ( prove the guide works Pilot the solution Deploy the solution eHealth Record Exchange: HEDIS/Stars & Clinician Exchange Notification (ADT): Transitions in Care, ER admit/discharge Risk Based Contract Member Identification Authorization Support Quality Measure Reporting Laboratory Results * Initial use cases 10

Scope of Work Targets “Payer – Provider” and “Provider – Provider” exchanges Leverage existing FHIR resources and identify gaps for concurrent standards development Enable improved patient care outcomes Empower better clinical decision making by integrating historical “administrative” decisions into the provider workflow Open Source- Da Vinci specifications and artifacts will be made available to the community and where relevant brought into standards process at HL7 for balloting. INITIAL FOCUS AREAS: Agree upon short and long term use cases to support VBC workflows Business case priorities established by Steering Committee Ideal phase one includes one simple and one complex use case to demonstrate value of using FHIR to establish ecosystem standards vs. one-off solutions NOTE: High membership interest and related resources could mean TWO simple use cases and initiation of a complex use case. Goal is to promote and accelerate FHIR for data exchange required for Value Based Care Delivery (VBC) 11

Goal is to develop repeatable production focused projects Project Artifact Definitions Implementation Guide (IG) A specification that defines how the capabilities defined by the FHIR specification are used in particular data exchanges, or to solve particular problems (adapted from the HL7 FHIR Foundation Implementation Guide Registry (http://www.fhir.org/guides/registry) Reference Implementation (RI) A reference implementation is, in general, an implementation of a specification to be used as a definitive interpretation for that specification . During the development of the ... conformance test suite, at least one relatively trusted implementation of each interface is necessary to (1) discover errors or ambiguities in the specification, and (2) validate the correct functioning of the test suite.[1] Characteristics of a Reference Implementation: Developed concurrently with the specification and test suite; Verifies that specification is implementable; Enables the test suite to be tested; Serves as a Gold Standard against which other implementations can be measured; Helps to clarify the intent of the specification in situations where conformance tests are inadequate Goal is to develop repeatable production focused projects

x Draft Timeline Phase 1* Use Case 3 Use Case 2 Use Case 1 Program Start Up Dec Jan Feb March April May June July Aug Sep Oct Nov Dec Establish Project Test Use Case 1 Concepts Test Use Case 3 Reference Implementation Test Use Case 1 Reference Implementation Test Use Case 2 &3 Concepts Prelaunch Use Case 1 Use Case 2 13 * Pending use case approval and SOU agreement/funding Use Case 3

Project Timeline (small fast project) Plan on 2 week sprint cycles Represents 4 weeks 2-4 sprints IG Development Specify profiles, … IG Framework Create Draft IG Revise and Finalize IG FHIR Gap Analysis Assemble Team Requirements RI Tech Approach Project start Build Initial RI Test RI Update Final RI RI Development Build Data Set Build Test Set Week 0 2 4 6 8 10 12 14 16

HIMSS18 Events Topic Location Time Speaker Audience Da Vinci: The Art of Value-Based Care HL7 Booth #5623 Tuesday, March 6 9:40 -10:10 am Viet Nguyen, MD Public Payer Provider Panel Discussion HIMS18 Interoperability Showcase Wednesday, March 8 11:30-12:30pm Lenel James, BCBSA moderator Dr. Rab, CMIO, Rush Medical Kirk Anderson, CTO, Cambia Health Mark Gingrich, CTO, Surescripts Thursday, March 8 3:00 – 3:30 pm Jocelyn Keegan 15

Da Vinci Project Manager Payer Practice Lead Point of Care Partners Jocelyn Keegan Da Vinci Project Manager Payer Practice Lead Point of Care Partners jocelyn.keegan@pocp.com (781) 264-1630 www.pocp.com Viet Nguyen, MD Da Vinci Technical Director Founder Stratametrics vietnguyen@stratemetrics.com (801) 707-6225