Meaningful Use: Progress Report and Defining Success Briefing March 1, 2012 Christine Bechtel, Vice President, National Partnership for Women & Families David Lansky, President and Chief Executive Officer, Pacific Business Group on Health 1

Agenda Introduction Background Window of opportunity Stage 1 experiences Discussion on what consumers and purchasers expect Meaningful Use to achieve by

Introduction First of two briefings on the Meaningful Use incentive program – Today: Review Meaningful Use program background, structure, and progress to date Discuss long-term goals for the program in order to provide feedback on short-term program design – Second briefing: Review CPDP’s specific recommendations on the notice of proposed rule making (NPRM) for Stage 2 -- late March/early April 3

Background Health IT is a critical platform for improving patient care Robust use of health IT will result in big gains in care coordination, efficiency, and quality Congress recognized this when it passed HITECH Act of 2009 to reward Medicare and Medicaid providers for “Meaningful Use” of certified electronic health records (EHRs) Meaningful Use is intended to drive use of EHRs in a way that serves the interests of patients and the public -- traditionally, EHRs were employed by providers for largely administrative purposes 4

Meaningful Use is a gradual, escalating program – and providers can get on the escalator whenever they want Who can participate? Background 5 Medicare – Clinicians: Physicians, osteopaths, dentists, podiatrists, optometrists and chiropractors – Hospitals: Acute care and critical access hospitals Medicaid – Clinicians: Physicians, dentists, certified nurse-midwives, nurse practitioners, and physician assistants – Hospitals: Acute care and children’s hospitals

Staging of Meaningful Use 6

Window of Opportunity Meaningful Use is a crucial opportunity for consumers and purchasers to make significant changes to the way care is delivered – Reaches a large swath of Medicare and Medicaid clinicians and hospitals – Has $44B in taxpayer funding behind it – Influences and supports other key federal programs – Impacts care for patients in the private sector 7

Timing Is Everything By 2015, Medicare incentive dollars run out (payment reductions begin) For Medicaid, providers don’t experience payment cuts and incentive payment continue until 2021 Calls from other stakeholders for ONC to slow down Consumers and purchasers must make a strong push so the program reflects what matters and to ensure health IT supports new delivery and payment models (Stages 2 and 3) The wheels for future phases are already in motion: – Stage 2 notice of proposed rule making is out for public comment – Stage 3 criteria are being discussed 8

Program Structure To receive incentive dollars, providers must: – Register for program – Fulfill functional criteria and submit clinical quality measures  Eligible professionals 20 Functional criteria (15 core, 5 menu) 6 Clinical quality measures (3 core/alternate core, 3 alternate set) Eligible hospitals 19 Functional criteria (14 core, 5 menu) 15 Clinical quality measures (all core) – Attest that they successfully met Meaningful Use requirements using certified EHR technology “Attest” to objectives and measures 9

Lessons From Stage 1 Implementation Program is reaching a lot of providers – Active registrants in 2011  120,000 Medicare clinicians  50,000 Medicaid clinicians  2,800 Medicare/Medicaid hospitals – Big ripple effect on health care industry  Number of hospitals using health IT more than doubled in the last two years  Many health systems and doctor’s offices implementing health IT -- even those not eligible for Meaningful Use incentive payments 10

Experiences with Stage 1 Implementation to Date Requirements not as tough as expected (i.e., objectives and thresholds) for early adopters Providers attesting to date have been successful – 99.99% success rate among Medicare clinicians – 100% success rate among Medicare hospitals Providers have the most challenges with – Criteria that require them to create or modify workflows  Patient engagement  Care Coordination – Quality measurement 11 Source: CMS, “Medicare & Medicaid EHR Incentive Program,” January 2012

Deferral and Exclusion Rates for Stage 1 Criteria 12 ObjectiveDeferral rates for EPs Deferral rates for EHs Summary of care transitions85%93% Send reminders to patients77%NA Medication reconciliation56%75% Syndromic surveillance70%79% Patient education resources49%62% Patient lists27%34% ObjectiveExclusion rates for EPs Exclusion rates for EHs E-copy of health information75%68% Office visit summaries2%N/A E-copy of discharge summariesN/A59% Source: CMS, “Medicare & Medicaid EHR Incentive Program,” January 2012

Source: ONC, “HIT Policy Committee Meaningful Use Workgroup, Presentation to HIT Policy Committee,” November A number of providers’ concerns about quality measurement are about technical challenges, and the Health IT Policy Committee is working to address them −EHR products often require significant customization/ reprogramming to retrieve data submission of quality metrics −EHR calculated quality measurement results are often inaccurate −Measure specifications aren’t clear and there are errors in measure definitions (occurred during retooling these measures for e-reporting) Stage 1 Quality Measurement

Is Stage 1 Improving Patient Care? Stage 1 (data collection) lays an important foundation To realize the full value of Stage 1, must put the pedal to the metal in Stages 2 and 3 (information exchange and improvement) Key wins from Stage 1 – 5 Part Framework includes quality/safety/disparities, patient engagement, care coordination, population health and privacy -- for example:  CPOE  Drug-drug and drug-allergy interaction checks  Medication reconciliation at transitions in care*  Reminders for preventive and follow-up visits*  Patient-specific educational resources*  Patient access to electronic health information*  Collection of RELG, smoking status, and vital signs 14 * = Menu option

Back To The Future Consumers and purchasers need to make it clear what they expect Meaningful Use to achieve by 2015 – Then use 2013 criteria as the launch pad A cohesive and robust advocacy strategy is needed to hold the line and ensure the biggest gains 15

Four Goals Meaningful Use Should Achieve By Welcome audience feedback on where they think these goals hit the target, and where they miss it

The Goals 17 1.Longitudinal EHR contains information needed to support high quality care and decision-making, and data to support quality measurement and public reporting 2.Improve care coordination and efficiency by sending and receiving appropriate personal health information to and from all participants in the care process, including patients, caregivers, providers, and others 3.Apply best-in-class evidence-based care practices to promote safety, efficiency, effectiveness, and patient-centered care 4.Report and improve key indicators of quality and efficiency (multi-site and longitudinal) for consumer choice, quality improvement, and accountability

Goal #1 Longitudinal EHR contains information needed to support high quality care and decision-making, and data to support quality measurement and public reporting 18 Patient-reported outcomes Granular data categories related to disparities Patient-reported symptoms Care plans Care team members Patient preferences Lab results – esp. hospital labs Health risks Formulary linkage address Indications for assessing appropriateness Examples:

Goal #2 Improve care coordination and efficiency by sending and receiving appropriate personal health information to and from all participants in the care process, including patients, caregivers, providers, and others 19 Networked information model for sharing and querying of data residing in multiple locations (include a focus on specialty registries) Electronic platform to collect patient-reported outcomes, patient experience, and quality of shared decision-making Secure, user-friendly platforms for patients to access information, share information with their providers, and gain easier access to the health care system itself

Goal #3 Apply best-in-class evidence-based care practices to promote safety, efficiency, effectiveness, and patient-centered care 20 For clinicians – Decision support for prescribing and adjusting medications – Decision support algorithms for test ordering (e.g., MRI for back pain) – Reminders for preventive screenings, follow-up care For patients – Use of mobile phone texts for reminders and follow-up care – Personalized, customized education resources – Shared decision-making tools and resources Examples:

Goal #4 Report and improve key indicators of quality and efficiency (multi- site and longitudinal) for consumer choice, quality improvement, and accountability 21 Clinical outcomes Patient-reported outcomes Patient experience Patient activation and engagement Disparities (Measures that are considered “disparities sensitive” and stratifying quality reports by demographic data to reduce disparities) Appropriateness of care Care coordination and care transitions Patient safety Efficiency of resource use Examples:

22 How the world would look for a knee replacement patient in 2015 Data capture (Goal 1) Race, ethnicity, language, gender (RELG) Patient preferences Care team members Care plan Patient’s risk factors Patient’s symptoms and function prior to and after surgery Information exchange (Goal 2) Rehabilitation center and specialists all have access to needed information Consumers have online access to their health information Care summary and plan sent to primary care post-surgery Reporting and improving quality indicators (Goal 4) Providers display performance dashboard Robust quality and outcomes data used for payment CMS publicly reports which surgeons are improving patient functioning and providing cost-effective care Use of best-in class evidence-based care (Goal 3) Selection of appropriate patients and implants based on patient requirements and evidence of effectiveness Most cost-effective drug is applied Care is aligned with patient values and preferences

Discussion On 2015 Strategy 23

Opportunities To Get Involved CPDP is active in ONC’s Health IT Policy Committee and other forums CMS and ONC notice of proposed rule making (NPRM) for Stage 2 requirements (February-April) Advanced notice of proposed rule making (ANPRM) on governance of health information exchange (March/April) Health IT Policy Committee request for comments (RFC) for Stage 3 (later this year) 24

About the Consumer-Purchaser Disclosure Project The Consumer-Purchaser Disclosure Project is a coalition dedicated to improving the quality and affordability of health care in America for consumers and health care purchasers. The project’s mission is to put the patient in the driver’s seat — to share useful information about provider performance so that patients can make informed choices and the health care system can better reward the best performing providers. The coalition is comprised of leading national and local consumer organizations, employers and labor organizations. The Consumer-Purchaser Disclosure Project is funded by the Robert Wood Johnson Foundation along with support from participating organizations. For more information go to Or Contact: Christine Chen Senior Policy Analyst Consumer-Purchaser Disclosure Project 25