Fundamentals of IIS Leadership Workshop

1. Fundamentals of IIS Leadership Workshop Decatur, Georgia Thursday, June 6, 2019

2. Welcome Back Bill Brand

3. Days 3 Preview • Sustainability in IIS • CDC-AIRA-PHII panel: Vision for IIS • Complete Action Planning Worksheet • Next steps as a cohort

4. IIS History Trivia Which organization incubated and supported the launch of AIRA in 1999?

5. IIS History Trivia Which organization incubated and supported the launch of AIRA in 1999? All Kids Count, the precursor of PHII The AKC National Program Office conducted a study to see if a membership organization was financially and operationally feasible.

6. IIS History Trivia What was the name of the All Kids Count newsletter?

7. IIS History Trivia What was the name of the All Kids Count newsletter? SnapShots, the same name as AIRA’s signature newsletter, which has now been published continuously for over 25 years.

8. Sustainability Mary Beth Kurilo, Jan Hicks-Thomson Thursday, June 6th

9. Overview of Sustainability Module • Introduction to sustainability: What does it mean? • Diversifying funding/funding partners • Activity: Possibilities in your jurisdiction • Minimizing costs • Wrap-Up

10. Objectives In this module, participants will: • Explore potential new revenue sources • Consider cost sharing or cost lowering approaches • Discuss how to best make decisions in the context of long-term sustainability

11. Introduction to Sustainability Mary Beth Kurilo

12. Sustainability • sus·tain·a·bil·i·ty, noun • the ability to be maintained at a certain rate or level In simple terms, for your IIS: Having the human, financial, and policy resources to meet the goals of your program today, and in the foreseeable future.

13. Bring in more revenue and/or new funders Two Ways To Tackle Sustainability Spend less

14. Why is Sustainability Critically Important to Discuss? Problem: Lack of diversity across funding sources • We’ve seen a steady trend toward reliance on CDC funding • This has shifted from heavier presence of public, private and philanthropic funding for early years of IIS development

15. What’s Contributing to This Shift? • Potential reasons: • Consistent state budgets cuts over many years • Goes hand-in-hand with workforce reductions/hiring freezes • Increasing federal requirements also increase accountability to federal govt. • More stakeholders, functions to maintain = greater cost • And a myriad of other contributors... This is a challenge, given that federal funding fluctuates

16. Diversifying Funds Jan Hicks-Thomson

17. Partnerships for Diversifying IIS Funding • Securing 90/10; 75/25 or 50/50 Medicaid Match. • Being funded by health plans, or Medicaid for HEDIS measurement. • Partnering on training materials, sponsoring training events, or hosting and distributing IIS training materials.

18. Partnering with Medicaid • Medicaid Federal Financial Participation (FFP) • Common names: 90/10, 75/25, or 50/50 Medicaid match • Medicaid pays a portion (e.g., 90%) and the state uses non-federal funds for the other portion (e.g., 10%) • Example: $100,000 of work, non-federal contribution is $10,000 and HITECH supplies the rest ($90,000)

19. Two Primary Funding Streams • HITECH (90/10) - The Health Information Technology for Economic and Clinical Health Act • Expires in 2021 • MMIS (75/25 or 50/50) – Medicaid Management Information System • Ongoing

20. Advance Medicaid/CMS priorities State Medicaid Can Fund Activities That: Are approved by CMS Are matched by the state with non-federal dollars (different levels of match required)

21. HITECH • ACA (Affordable Care Act) and HITECH goals: • Promoting interoperability • Meaningful Use • Incentive programs • 90/10 Match Includes: • Design, Development and Implementation • Interoperability • “New” work – not operations & maintenance

22. Implementation Advanced Planning Document (IAPD) • Formal Medicaid application process • Annual application • Involvement and visibility depends on • Immunization Program or Public Health relationship with Medicaid agency • Initial process can take up to two years • Applications can include multiple years • Updates are possible throughout the year (IAPD-U)

23. MMIS MMIS funding supports broader Medicaid goals • 75/25 Match for maintenance and operations • 50/50 Match for ongoing operations and Medicaid programmatic support (i.e., provider education etc.) • Cost Allocation applies • Medicaid pays for costs proportional to the size of the Medicaid population (aka: Medicaid Fair Share)

24. Example of Cost Allocation • An IIS enhancement is directed at the general population: • Medicaid population is 33% of the general population • Medicaid fair share is 33% • Medicaid pays: .33 x .75 = .2475 • Medicaid contribution is 24.75% of the total cost

25. Example of Cost Allocation • Ifthe first phase or entire enhancement/effort benefits the Medicaid population exclusively • 100% of the activity directed at the Medicaid population • Medicaid Fair-Share is 75% of the total cost • Example: initial build and phased roll-out to hospitals or FQHC w/100% providers serve Medicaid enrollees

26. State Match • Non-federal dollars required for the state match • General State Funds • Private contributions and donations • Jurisdictions need to ensure that the state funds will still be available when final CMS approval comes through

27. Important to Know: This is a Reimbursement Model Medicaid reimburses Immunization Program for their portion IIS/ Immunization Program • Does work • Spends funds • Invoices Medicaid

28. Starting the Application Process • Engage leadership • Identify leader with best relationship with Medicaid • Engage highest level leader with relationship • Assure Immunization Program leadership involvement • Establish value proposition for Medicaid • Understand Medicaid priorities and articulate how the IIS supports them • Coordinate across public health programs • Establish MOU / IAA

29. Partnering Beyond Medicaid Jan Hicks-Thomson

30. Potential Private Partners for Funding • Health plans • Support and charge for HEDIS performance measurement • In-kind support • Example: design of Minnesota’s promotional materials and patient notification materials provided by a health plan • Local philanthropies • Typically new rather than ongoing initiatives or operations • Support the goals of the organization and promote public relations image for them

31. Potential Additional Sources of Funding • State dollars • Rationale: The IIS Supports • State required population health performance measures • Outbreak and emergency response • Delivery of the VFC and state childhood vaccine programs • Contributions from local health systems, payers • Cultivating relationships takes time / requires credibility • Engage Leadership and Stakeholders

32. Partnering with other Programs • Support goals of other public health or state programs • Early hearing programs • Lead programs • WIC • Note: Carefully consider shared vs. separate goals

33. Activity: Sustainability Brainstorming Instructions Discuss in small groups Select a spokesperson who will record group’s summary discussion and report out Brainstorm around creative ways to diversify funding and funding partners

34. Activity: Sustainability Brainstorming • What new funding partners or funding sources might you be interested in exploring? • What IIS sustainability topics are you interested in learning more about?

35. Share Your Group’s Collective Input with the Larger Group

36. Minimizing Costs Mary Beth Kurilo

37. Use of Shared Services • AIRA has a Joint Development and Implementation (JDI) Initiative focused on collaboratively created services and products • JDI Defined: • Joint Development is any collaborative development of standards, business requirements, functional or system requirements, design specifications, or production of actual software tools or applications by two or more IIS/Awardees

38. Examples of JDI/Shared Service Products • Address Cleansing • MQE Tool • Vocabulary Code Set project in collaboration with CDC’s Shared Service • Intra-platform work • Many of the same product users are coming together to collaboratively set priorities and collectively fund them

39. Open Source or Commercial Modules Examples: Open Source Immunization Calculation Engine AMCI’s onboarding and customer management modules Commercial Public Domain Wisconsin Immunization Registry

40. Leveraging Available Guidance • CDC Functional Standards and Operational Guidance Statements • AIRA Repository • Measurement and Data • CDC Dashboard • Measurement and Improvement/AART • NIST Test Sites

41. Configuration vs. Customization • Take advantage of a standard product to reduce your enhancement and maintenance costs • Minimize local customizations • The community can no longer afford to meet the same goal ten different ways

42. Potential for Alternate Hosting Options • Could a move toward the cloud or external hosting limit costs? • Could it limit risks? • Could it free up staff time within or outside of your department?

43. Automate and Streamline • Automating manual processes (data quality, password resets, etc.) can save valuable staff time • Documenting current procedures in SOPs (standard operating procedures) can ensure they are “lean” and repeatable • Limit hand-offs, simplify processes, eliminate waiting periods

44. Resources Within and Beyond Public Health • Central IT resources may be able to provide Project Management, Change Management, Business Analysis, Contract Management and other forms of expertise • These may come at no cost to you or as part of your ongoing financial support of the office/department

45. Resources Within and Beyond Public Health • Surveillance/research/epidemiology may be able to provide analytic resources • Programs outside PH may offer expertise to improve processes • Minnesota example

46. Discussion: Sustainability Additional examples or ideas about how to minimize costs or improve efficiencies within your jurisdiction?

47. There are no easy answers to the questions of sustainability In Summary However, it is critical that all of us continue to work toward providing stable, cost-effective, long-term services Diversifying funds and reducing costs can help stabilize and sustain your IIS

48. CDC, AIRA, and PHII Panel Lynn Gibbs-Scharf, Rebecca Coyle, and Bill Brand Thursday, June 6, 2019

49. Question for Lynn Gibbs-Scharf, CDC • As the new Branch Chief for IISSB, what is your emerging vision for IIS over the next 5-10 years?

50. Question for Rebecca Coyle, AIRA • In light of the growing emphasis on interoperability across health IT, how do IIS need to best position themselves in the next five years?