eHealth Exchange Transition Update October 2, 2012 Mariann Yeager Interim Executive Director Healtheway, Inc

Discussion Topics Context eHealth Exchange eHealth Exchange Strategic Road Map State engagement Transition Strategy Healtheway eHealth Exchange Anchor Participants Healtheway Members Cross-industry Collaborative Initiatives Harmonized testing program with HER HIE Interoperability Workgroup Q&A 2

Context Nationwide Health Information Network (NwHIN): A set of standards, services and policies deemed by ONC as NwHIN. eHealth Exchange: A community of exchange partners who, via a contractual relationship, share information using NwHIN or other standards, services and policies. Started as an NwHIN program initiative in 2007 Transitioning to public-private partnership in 2012 Rebranded as eHealth Exchange Healtheway assuming operational support, starting Oct 2012 Healtheway: non-profit organization chartered to support the eHealth Exchange 3

eHealth Exchange Strategic Road Map Initial Rollout (2009 – 2011) Mature, Grow, Scale Sustainability 2014 Phase 1 Phase 2 Phase 3 Early adopters Federal business cases Shared infrastructure Early lessons learned Success / viability ONC program pilot concludes Production ramps up Transition to public- private model Grow participation and transactions Refine and scale Expand value cases Align with NwHIN governance Implement sustainability model Continued growth in participant and transactions Revenue model sustains operations Nationwide deployment Interoperable exchange among private entities 4

eHealth Exchange Vision / Mission Vision To serve as a critical element of the nationwide health information infrastructure; and To improve the health and welfare of all Americans through health information exchange that is trusted, that scales, and enhances quality of care and health outcomes by supporting comprehensive longitudinal health records. Mission To expand trusted, secure and interoperable exchange of health information across the nation by providing shared governance and necessary shared service to public and private organizations who wish to interconnect as a network of networks. 5

eHealth Exchange Participants and Technology Partners eHealth Exchange Participants: Rapidly growing community of exchange partners Facilitate and govern exchange, meet eligibility criteria and successfully complete production readiness testing of Exchange- Ready system 34 organizations in production, representing hundreds of hospitals, thousands of providers and millions of patients Another two dozen organizations in the pipeline Dramatic growth, primarily in private sector Technology Partners Provide Exchange-Ready technology solutions to eHealth Exchange Participants Approximately 20 solutions support participants, with rapid growth 6

eHealth Exchange Participants* Alabama One Health Record Centers for Medicare and Medicaid Services (CMS) Childrens’ Hospital of Dallas Community Health Information Collaborative (CHIC) Conemaugh Health System Department of Defense (DOD) Department of Veterans Affairs Dignity Health Douglas County Individual Practice Association (DCIPA) Eastern Tennessee Health Information Network (etHIN) EHR Doctors HealthBridge HEALTHeLINK (Western New York) Idaho Health Data Exchange Inland Northwest Health Services (INHS) Kaiser Permanente Lancaster General Health Marshfield Clinic Medical University of South Carolina (MUSC) MedVirginia MultiCare Health System National Renal Administrators Association (NRAA) New Mexico Health Information Collaborative (NMHIC) North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA) OCHIN Quality Health Network Regenstrief Institute Social Security Administration (SSA) South Carolina Health Information Exchange (SCHIEx) South East Michigan Health Information Exchange (SEMHIE) Strategic Health Intelligence University of California, San Diego Utah Health Information Network (UHIN) Wright State University 7 * 6 others in activation stage

State Engagement in eHealth Exchange Current status 4 in production 1 in activation 2 engaging in pilot of new testing program 11 others in the pipeline Approaches Coordinated with state: States connect to eHealth Exchange as a participant (e.g. SC) States refer regional HIEs to join eHealth Exchange (e.g. NY) Complimentary Regional HIO joins Exchange since states focus on other types of exchange modalities (TN) Bridge Health System joins Exchange until state is in production (e.g. HI) Independent Health systems or regional HIOs join Exchange independent of state effort 8

Technology Solution Providers* ApeniMED Aurion Axolotl CareEvolution CGI Cogon CONNECT CSC Epic Harris K Force MEDecision MedFX Medicity Mirth MobileMD Northrop Grumman OneHealthPort Orion Health SAIC Talis Thompson Vangent Wright State Research Institute 9 * Plus other vendors engaged EHR HIE Interoperability Workgroup

National Return on Investment Efficiencies and cost savings realized to date through multi-party trust agreement, shared infrastructure and governance Significant potential savings by lessening the burden of testing prior to exchanging with a new partner Expands coverage throughout the US, reaching hundreds of hospitals, thousands of providers and millions of patients Incremental costs per participant decrease as participation grows, lowering the costs to HIE, while enabling HIE to scale nationwide Value to clinical decision making and cost savings increase exponentially with utilization 10

eHealth Exchange Benefits 11 Value Proposition Implement once, exchange with many Recognition as part of trusted community Expanded connectivity Cost effective and efficient Enforced compliance and accountability Functional and scalable shared services

TRANSITION STRATEGY 12

Transition Goals and Objectives Remain aligned with the national strategy Facilitate a smooth transition from ONC to a non-profit public- private endeavor, while assuring continued growth and continuity of eHealth Exchange operational support Double participation in the eHealth Exchange and increase utilization by 50%, with ability to support a full rollout in

Current – Future State Current ONC NwHIN initiative - NwHIN Exchange Coordinating Committee* DURSA* Onboarding & testing facilitated by ONC Operations supported / funded by ONC Services provided to participants for free Future Public-private initiative - eHealth Exchange Coordinating Committee* DURSA* Testing facilitated by testing body designated by CC Operations supported/ funded by Healtheway Participants begin paying for services in future 14 * Unchanged

Exchange Trust Framework Unchanged DURSA remains in full force and effect Coordinating Committee retains all authorities as specified in the DURSA Healtheway board does not have any oversight responsibilities with respect to eHealth Exchange, but will operate under an agreement with the Coordinating Committee 15

Exchange – Healtheway Interactions 16 Exchange Coordinating Committee Healtheway Community Collaboration Program May wish to join as members Industry Eligible for CC Representation Federal Participants State Participants Private Participants eHealth Exchange Healtheway Join Select Healtheway to run Exchange / CC operations Exchange / CC Operations Support Program Staff, legal support Certificates Service Registry Exchange Testing Body Select Contract eHealth Exchange Participation Fees

17 Exchange CC – Healtheway Board Functions Federal Participants State Participants Private Participants eHealth Exchange Coordinating Committee Exec Director Healtheway Board 3 CC Reps Up to 9 Elected Members Oversee eHealth Exchange participation Approve specs, test guides, policies Enforce DURSA Handle disputes / breaches Approve changes to DURSA Designate Healtheway to support eHealth Exchange operations Assure corporation is effectively supporting and providing value to its customers (e.g. Exchange, etc.) Make financial decisions (e.g. annual budget, membership program, funding, etc.) Engage & oversee Executive Director / staff Guide business strategy and oversee business (e.g. programs, marketing, partnerships, etc.) Set strategic direction Appoint Any organization that wishes to be a part of Healtheway community collaboration (e.g. HIE, vendor, payer, non-profit, academic institution, etc.) Governm ental Liaisons

HEALTHEWAY 18

Healtheway Mission To provide the infrastructure to support the safe and secure exchange of data which eHealth Exchange Participants use to further their respective missions to: Improve clinical decision making and coordination, quality and affordability of care; Support meaningful use; Enhance disease surveillance, support preparedness and routine public health missions to improve public health; and Realize efficiencies and expedite provision of funding and services to individuals to support their care and well-being. To provide services and programs to Healtheway Members to advance implementation of HIE. 19

eHealth Exchange Participation Fees & Deliverables Annual Participation Fees: subscription fees that Participants, as defined in the Data Use and Reciprocal Support Agreement (DURSA), pay an annual basis to: Continue use of shared eHealth Exchange infrastructure – use of digital certificate and service registry to discover exchange partners Reliance on shared testing process The right to exchange with other Participants Reliance on Coordinating Committee (CC) oversight mechanisms established in the DURSA (e.g. breach notification, dispute resolution, etc.) Eligible for representation on the Coordinating Committee 20

eHealth Exchange Anchor Participant Program eHealth Exchange Participants who pay subscription fees for the first two years (FY 2012 and FY 2013) will qualify for the program. eHealth Exchange will begin charging all Participants subscription fees, starting in FY Anchor program benefits Significantly discounted fees Recognition and added visibility and promotion Priority for pilots Featured in profiles, webinars, etc. 21

22 Non-Federal Participant Tier Anchor Participant < $1M$ 4,750 $ 3,300 $1 - $10 M$ 9,950 $ 7,000 More than $10 M$ 19,000 $ 14,500 Other Participant < $1M$ -$ 4,750 $1 - $10 M$ -$ 9,950 More than $10 M$ -$ 19,900 Fiscal Year: May 1 st of current year through April 30 th of following year * Average annual savings to Anchor Participants, starting FY 2014 – 30% Exchange: Anchor Participant Fee Schedule

Healtheway Member Benefits Eligible for voting seat on Healtheway board of directors, with ability to help shape the future of Healtheway and HIE implementation Right to select up to 9 members to serve on board Voting rights at annual member meetings Input on strategic direction Input on strategy and joint work products with other initiatives Voice in cross-industry collaborative efforts, with unique opportunity to foster the future of the largest public and private exchange community of its kind in the US Promotion in member list, web site, communications and annual report Recognition of organizational commitment to cross-industry collaboration to unify industry 23

Founding Members Members who join by December 31, 2012 and commit to two- years of membership Founding Member status, with a unique logo Priority consideration for participating in Exchange pilots Members who join by early September Visible role in launch of Healtheway Eligible for board representation at its formation (September 2012) 24

Healtheway Membership Dues 25 Annual Revenue* Annual Membership Fee >$50 Million$50,000 $25-$50 Million$30,000 $10–$25 Million$18,000 $5–$10 Million$8,000 <$5 Million$5,000 * NOTES Annual revenue shall be based upon annual healthcare revenue when organizations operate in different industry sectors. For governmental agencies, professional associations and academic institutions, the tiers are based upon annual budget in lieu of annual revenue.

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