1. HIT in the “New World” States, HITECH and Health Reform Lynn Dierker NASHP Annual Meeting October 6, 2010

2. The Evolving HIT Context 2004 – 2008 Broad strategic goals & principles Early entrepreneurial activity HITECH 2009 Major capacity goals and milestones Authorities, policymaking framework HIT/HIE Infrastructure investments (federal, state, local) PPACA Health Reform 2010 Comprehensive Policy Provisions (requirements, incentives) Investments to drive innovation Goals, milestones for demonstrating value-based system changes (using HIT) 2 Dierker

3. 3 HITECH: Build, Expand, Demonstrate MU Anchored by State & Regional Efforts ITEMAGENCYSTATUS State Health Information Exchange Grants (HIE) State or state designated entity All states/territories - Cooperative agreements $4-$40 million per state, over $500 million total Strategic/Operational plans - ONC approved (in process) Technical assistance program Beacon Community Program (Demonstrate impact) State agencies Non-profit IDNs Health Information Organizations (HIOs) Regional Extension Centers 17 Competitive awards @ $10-$20 million each Grantees have advanced HIE and HIT capacity Demonstrate improved access, quality, efficiency Technical assistance program (procurement in process) Regional Extension Centers (Adoption) Non-for-profit entity per region of 1,000 primary care docs 60 competitive awards, over $640m funding/2 rounds Entities (mixed), non-overlapping geographic areas Soliciting primary care practices: use certified EHR Must achieve sustainability Administration of Medicaid Incentives (All of the above plus payment reform) State Medicaid AgencyAll states eligible Planning, Implementation, federal match:90% admin$ Optional start date, program begins 2011 - 2021 Technical assistance (procurement in process) Dierker

4. HIE and Health Care Reform Perspectives - Priorities Improve QualityReduce CostsAccess/coverage MeasureRewardPayment Reform Care coordination Admin Simplification Pt EngageAffordability Adoption/M U XX X X X RECXX HIEsXXXXX Workforce Beacon Communities XXX NHINXXXXX Policy & Standards XXX X 4 Adapted Health Affairs June 2010 Buntin, Jain, Blumenthal XX = primary driverX = secondary driver

5. HIT/HIE and Health Reform States and Implementation 1.Insurance Exchange 2.Health Insurance Market regulation 3.Eligibility System Restructuring 4.Provider and Health System Capacity 5.Benefit Design 6.Dual Eligibles 7.Having and Using Data 8.Population Health Goals 9.Public Engagement 10.Performance from the Health Care System 5 Data for risk adjustment? Technical interfaces: HIE,Insur Ex,HPlans, Elig/Enrollment? Data/HIE capacity key populations/provid ers: foster kids, LTC, b.health Dierker

6. Change at all Levels - Major Issues Key design principles –Streamlining, the mobile pt at the center –Integrated strategies New enterprise paradigm for IT Statewide “master planning,” shared leadership and decisionmaking Call for new business models and relationships Opportunities for model development, demonstrations and advocacy Business process analysis and redesign Timing 6 Dierker

7. Key Questions for State Leaders Across Government, Sectors What should the government do (vs the private sector)? What is the right blueprint for “shared services” (e.g. HIE, Insurance Exchange)? How should business processes be redesigned? How best can shared investments be made, resources leveraged, new business models implemented? How will decisions be made, leadership provided, projects managed to get the job done? 7 Dierker

8. From the “As Is” to the “To Be”? State-level Leadership & Organization to Make it Real Physicians Labs Health Plans ACOs Community Clinics LTC Hospitals Beacon Communities Regional Extension Centers Local HIEs Academia Telehealth Consortia ONCAHRQ CMS Medicare CMS Medicaid HRSA Dept of Commerce Dept of Agriculture Nat Science Foundation State HIT Coordinator Stimulus - Reform Coordination State Government Medicaid CHIP Public Health C orrection s Other Human Serv State Designated Entity Public Sector Private Sector EHR Loans Ins. Ex

9. 9 ONC State HIE Program Approval Required“Domains” to Address -Strategic Plan: State’s vision, goals, objectives and strategies for statewide HIE; including plans to support provider adoption -Operational Plan: Detailed explanation, targets, dates for execution of strategic plan -Governance -Finance -Technical infrastructure -Operations(Business- tech) -Legal and Policy Goal: Plan and develop the HIE infrastructure to ensure Widespread interoperability across entire state Providers and hospitals can achieve meaningful use Types of Exchange –Eligibility & claims transactions –*eRx & refill requests –*Lab ordering & results delivery –Public health reporting –Quality reporting –Rx fill status and/or med fill history –*Clinical summary for care coordination & patient engagement HIT Coordinator Role

10. HITECH and Medicaid Design principles = integration, flexibility, modernization –Collaboration and coordination –Innovation –Cost allocation, risk based approach Financing: Enhanced 90% FFP administrative match –Administer Medicaid EHR incentive program (payments, oversight) –Pursue strategies to encourage adoption and meaningful use of certified EHR and HIE 10 Dierker

11. Medicaid EHR Program Six Milestones for States Approved Plans: –State Medicaid HIT Plan (SMHP) –PAPD and IAPD submissions (Planning - Implementation Advance Planning Documents) Target launch date Provider outreach Capacity –Interface to NLR (interface control) –Accept provider attestations ≤ 3mo –Make provider payments ≤ 5 mo –Oversight e.g. risk based audits 11 Dierker

12. Meaningful Use Stage 1 Year 3 of REC program begins; RECs must be self- sustaining Meaningful Use Stage 2 Last year to begin participation in Medicare EHR Incentive Program Meaningful Use Stage 3 Payment adjustments begin for Medicare providers who are not meaningful users 20112012201320142015 HITECH PPACA ACO Incentives Medicare Value-based Purchasing Program Plan for integrating PQRI with meaningful use Insurance exchanges Medicaid expansions Medicare payment penalties for hospital- acquired conditions Value-based modifier to Medicare physician fee schedule New health home state option Bundled payment pilot Medicaid Incentives (optional start) Medicare Incentives State HIE Program ends Final year of REC Program

13. The Timeline from 10,000 ft Final rules in late spring/early summer 2010 Medicare must begin in 2011 (statute) States can decide when to start the Medicaid EHR Incentive Program Medicare fee schedule reductions begin in 2015 Medicare program ends in 2016 Medicaid program continues through 2021 CMS will revisit meaningful use for Stage 2 and 3 in future rulemaking 13 Dierker

14. States’ Navigating Current Challenges Pending State Plan approvals – draw down of resources (Re) Structuring effective governance Focus on integrated planning with Medicaid – State HIE Effective planning, sequencing implementation How to effectively deploying HIT Coordinator Developing shared investment strategies - business model(s) for sustainability Responding to evolving opportunities, capacity issues e.g. multi-state procurements, technology landscape Navigating political-administrative changes 14 Dierker

15. NASHP HIT Program Under development Leveraging existing programs, expertise Targeting interface of HIT with Health Care Reform Ldierker@nashp.org Thank you! 15 Dierker