Executive Roadmap: Examining the Impact of Healthcare Reform, Stimulus Funding and HIT Regulations Miriam Paramore, SVP

1. Executive Roadmap: Examining the Impact of Healthcare Reform, Stimulus Funding and HIT Regulations Miriam Paramore, SVP Clinical and Government Services AAHAM Conference, Laughlin, NVApril 15, 2010

2. Stakes Are Very High • Medicare Trust Fund Reserves to be exhausted by 2017 (2009 Annual Report, Social Security and Medicare Board of Trustees) • 41 states face budget shortfalls adding up to $35 Billion (Kaiser Commission on Medicaid and the Uninsured, February 2010) X X $ $ $ $ $ X X

3. YEA 219 NAY 212 March 21, 2010

4. House Passes Healthcare Reform in Historic Sunday Night Vote • H.R. 3590, Patient Protection and Affordable Health Care Act (previously passed by Senate) • + • H.R. 4872, Health Care & Education Affordability Reconciliation Act of 2010 • Fiscal Impact • Costs $938 billion over a decade • Cuts the deficit by $143 billion in the first ten years (2010- 2019) • Cuts the deficit by $1.2 trillion in the second ten years • Expands health insurance coverage to 32 million Americans (or 94%)

5. Basic Provisions H.R. 3590 + H.R. 4872:Insurance Reforms • Prohibits insurance companies from denying coverage to individuals with preexisting conditions (effective immediately for children and applies to all individuals beginning in 2014) • Closes the “doughnut hole” gap in Medicare prescription drug coverage • Prohibits insurance companies from placing lifetime caps on coverage • Requires health plans to allow young adults up to age 26 to remain on their parents’ insurance policy • Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program

6. Basic Provisions H.R. 3590 + H.R. 4872:Access to Coverage • Individual health insurance mandate for most US residents; penalties for individuals who do not obtain insurance • Penalties for employers that do not offer health insurance • Expands Medicaid to cover individuals with income less than 133 percent of the federal poverty level • Increases funding for Community Health Centers • Establishes 50 health insurance exchanges, administered by states, through which small businesses and individuals can buy coverage • Subsidies for premiums and cost sharing through the new insurance exchanges • Tax credits to small businesses to make employee coverage more affordable

7. Beyond the Headlines:Administrative Simplification Provisions • Accelerates HHS adoption of uniform standards and operating rules for electronic transactions governed under the Health Insurance Portability and Accountability Act (HIPAA) • Expands HIPAA transactions and requires uniform standards and operating rules for the following: • Eligibility verification • Claims status • Claims remittance • Claims attachments • Referral certification and authorization • Electronic funds transfer (EFT) payments • Requires health plans to certify compliance or face financial penalties

8. 4% on Prevention Where does the money go? 85% 15% Admin Costs = $360 B Cost of Care = $2 T Total U.S. Healthcare Spend = $2.4 Trillion

9. Practical Savings Today: Measuring Progress Through the US Healthcare Efficiency Index™ ushealthcareindex.com

10. Independent Advisory Council

11. Index Development and Implementation • Phase 1: Industry data • 5 basic transactions • Phase 2: Primary data collection • “National Progress Report on Healthcare Efficiency” (April 2010) • Phase 3: Expansion: Pharmacy Adherence and Safety Index • With Vanderbilt Center for Better Health • Phase 4: Expansion: Dental Index

12. National Progress Report on Healthcare Efficiency: 2010 Key Learnings • Transparency on costs is vital to the nation’s economy; healthcare is murky at best • Lines are blurring between manual and electronic processing • Costs must be removed at the system level to avoid perpetual cost shifts • Efficiency is a journey, not a destination: continue to drive transaction value ushealthcareindex.com

13. Don’t Throw it Away! Stopping paper checks in healthcare would save $11 billion a year

14. To Get There, Start From Where You Are B A

15. what would u dow/ $30 B?ushealthcareindex.com

16. But It’s Not Just About Healthcare Reform… HITECH: February 17, 2009

17. ARRA and HITECH ACT: Unprecedented Investment in Health IT

19. HIPAA Simplified: Practical Tools One-Stop Shop Simplified Gap Analysis Full Gap Analysis

20. What Technologies Are Likely To Get Attention /Budget Approval in 2010? • Seventy-one percent of U.S. health care executives surveyed said that electronic health record systems are likely to get attention and budget approval in their hospitals in 2010, according to a recent StatCom survey. • Meanwhile, 53% of U.S. health care executives surveyed said that computerized physician order entry systems are likely to receive attention and budget approval in their hospitals in 2010, the survey found. • Thirty-one percent of survey respondents predicted that patient flow and logistics technology would receive attention and hospital budget approval in 2010. • Results are based on a November 2009 survey of 440 U.S. health care executives.

21. Meaningful Use:RCM + EMR + HIE = MU

22. Meaningful Use is Easy! • Eligible healthcare providers want to meet Meaningful Use requirements in order to qualify for stimulus funds • To do so, they need to be able to connect payers and to other providers for exchange of administrative, financial, and clinical data • Emdeon’s Meaningful Use Portal integrates Emdeon Office and Emdeon Clinician EMR Lite* to deliver one solution to EPs *Certification in process pending the final rules from the federal government

23. Navigating HIT Over the Next 5 Years: 5010/ICD-10 + HITECH/Meaningful Use + Healthcare Reform

24. Questions? Miriam Paramore SVP Clinical and Government Services mparamore@emdeon.com