Definitions – ARRA & HITECH

2. Definitions – ARRA & HITECH ARRA American Recovery & Reinvestment Act $787 Billion federal stimulus package passed by Congress and signed by President Obama in February 2009. HITECH Act Health Information Technology for Economic & Clinical Health Act Title XIII and Title IV of the ARRA, the section of the stimulus package focused on supporting the more widespread adoption of health information technology. 2 Discussion Document – Not for Distribution

3. Definitions – Health IT, HIE, and RHIO HIT Health Information Technology Provides the umbrella framework to describe the comprehensive management of health information and its secure exchange between consumers, providers, government and quality entities, and insurers. Health IT (or HIT) in general are increasingly viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system. HIE Health Information Exchange The electronic movement of health-related information among organizations according to nationally recognized standards. RHIO Regional Health Information Organization A health information organization that brings together healthcare stakeholders within a defined geographic area and governs health information exchange among them for the purpose of improving health and care in that community. 3 Discussion Document – Not for Distribution

4. Definitions – EMR, EHR, PHR EMR Electronic Medical Record An electronic record of health-related information on an individual that can be created, gathered, managed and consulted by authorized clinicians and staff within one healthcare organization. EHR Electronic Health Record An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization. PHR Personal Health Record An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared and controlled by the individual. Source: National Alliance for Health Information Technology Report to HHS/ONC 4 Discussion Document – Not for Distribution

5. HITECH FundingHIT & HIE infrastructure New Incentives for Adoption Funding for Health IT • Medicare & Medicaid incentives for HIT adoption • ~$19.1 to $29.8 B total in expected outlays (revised estimate) • $1.2 B for loans, grants & technical assistance for: • Regional Extension Centers ($640M) • Workforce Training ($80M) • Research and Demonstrations Community Health Centers Funding for HIE $1.5 B in grants through HRSA for construction, renovation and equipment, including acquisition of HIT systems • $564 M for Statewide HIE Development • States receive between $4M & $40M $220 M for “Beacon” Community Program • 15 HIEs receiving between $10M & $20M Broadband and Telehealth $4.3 B for broadband & $2.5 B for distance learning/ telehealth grants Discussion Document – Not for Distribution

6. HITECH FundingAccomplishments & what remains... New Incentives for Adoption Funding for Health IT • Feb ’10...Workforce training awards • Feb ’10...1st Round of REC awards • Apr ’10.... 2nd Round of REC awards • Apr ’10.... Community College awards to train HIT professionals • Apr ’10... CHIPRA grants • July 2009...Federal HIT Policy Committee approves Meaningful Use definition • Dec 2009... Meaningful Use NPRM released • June 2010...Final rule on Meaningful Use • July 2010...State Medicaid Agencies define Meaningful Use and start building systems to administer incentives Community Health Centers Funding for HIE • Feb-Mar 2010... 56 State HIE Coop Agreements awarded • May 2010... 15 Beacon Community Grants awarded • June ‘09...$851M to CHCs for CIP • Sept ’09...$27M to CHCs for HIT ~ Spring ’10...$88M to HCCNs Broadband and Telehealth • Feb ’10... $1.3 B awarded in first-round Discussion Document – Not for Distribution

7. Meaningful Use Overview Regulatory Definition To be a “meaningful user,” EPs must use a certified EHR to satisfy all Criteria and all Measures. In HITECH, Congress specified three types of requirements for meaningful use: • use of certified EHR technology in a meaningful manner (e.g. Electronic Prescribing); • that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and • that, in using certified EHR technology, the provider submits to the Secretary information on clinical quality measures and such other measures selected by the Secretary. Discussion Document – Not for Distribution

8. Meaningful Use Funding Timeline MEDICAID CMS NPRM and ONC IFC Released Dec. 30 2009 Medicaid: hospitals that adopt after 2017 not eligible for incentives Medicaid incentives begin ONC Final Rule Medicaid: non-hospital based physicians1st yr cost no later than 2016 Medicaid: non-hospital based physicians no payments after 2021 or more than 5 yrs. 2009 2010 2011 2012 2013 2014 2015 2016 2017….. 2021 CMS Final Rule for Incentives Medicare phase down incentive payments for physicians Medicare penalties begin for non-meaningful users FY15 for hospitals calendar 2015 for physicians Medicare (FY2011) incentives begin Oct. 2010 for hospitals Medicare incentives End 2016 Medicare incentives begin Jan 2011 for non-hospital based physicians Medicare: Physicians who 1st payment is after 2014 receive no incentives MEDICARE Discussion Document – Not for Distribution

9. Meaningful Use Overview A Phased, Incremental Approach Health IT-Enabled Health Reform Stage 1 Capture data in coded format Stage 2 Expand exchange of information in the most structured format possible Stage 3 Focus on CDS for high priority conditions, patient self management, and access to comprehensive data Discussion Document – Not for Distribution

10. Medicare and Medicaid Incentives Discussion Document – Not for Distribution

11. Framework of Health Reform: Payment Policy Changes Reduce Cost of Care Improve Coordination of Care Alter Content of Care • Stimulate Administrative Efficiencies • HIT Incentives • Limit FFS Payment Updates • Medicare captures productivity gains • FFS becomes less attractive • Encourage creation of new delivery organizations including: • Medical Homes, particularly for chronic care populations • Accountable care organizations • Tie Payments to Broader Units of Service • Hospital and Physician Payment Bundles • Episode-Based Payment Bundles • Improving Scientific Basis of Healthcare Decisions • Based on Comparative Effectiveness Research • Payment Tied to Patient Outcomes • Based on Quality Measures Discussion Document – Not for Distribution

12. Above $1 Billion $500 Million - $1 Billion $100-500 Million Below $100 Million Meaningful Use IncentivesMedicare/Medicaid Estimates by State Discussion Document – Not for Distribution

13. Statewide HIE EffortsStatus of Operational Plan Submission to ONC DC Operational Plan submitted prior to May 10, 2010 Operational Plan to be submitted prior to Aug 1, 2010 Operational Plan to be submitted after Aug 1, 2010 RFP for statewide HIE technical services released Discussion Document – Not for Distribution

14. North Carolina Health IT Awards • ARRA: • State HIE Cooperative Agreement: $12.9 million • Medicaid Meaningful Use Planning: $2.29 million • Regional Extension Center: $13.9 million NC AHEC (North Carolina Area Health Education Centers Program @ UNC Chapel Hill) • Beacon Community: $15.9 million Southern Piedmont Community Care Plan • Health IT Workforce Community College Consortia Program (non degree programs): $10.9 million Pitt Community College • Health IT Curriculum Development: $1.8 million Duke University • University-level Health IT Workforce Training (degree programs): $2.1 million Duke University • Broadband: $28.8 million MCNC / North Carolina Research and Education Network (NCREN) • CHIPRA (non-ARRA): $9.2 million (one of 10 state awards) • Testing medical home for children with special health care needs through three provider-led community-based models • Implementing a model electronic health record format for children Discussion Document – Not for Distribution

15. Medicaid ConsiderationsAdministration of Meaningful Use Incentives Step 1: Submit P-APD Statement of Need/Objectives Project Management Structure Work Plan Budget Focused on Planning 37 states/territories received funds for implementation planning: Alaska Alabama Arizona Arkansas California Colorado Florida Georgia Idaho Illinois Iowa Kansas Kentucky Maine Michigan Mississippi Missouri Montana Nebraska Nevada New Mexico New York North Carolina Oklahoma Oregon Puerto Rico Pennsylvania South Carolina Tennessee Texas Utah Vermont Virgin Islands Virginia Wisconsin Washington Wyoming Step 2: Submit Medicaid HIT Plan Implementation Plan for the Medicaid Incentives Assessment of State’s HIT Capabilities Vision for State’s HIT Future in 2014 Roadmap for State HIT Initiatives Closely linked and complement the State’s MMIS, MITA adoption, and State HIE Strategic and Operational Plans • *Last updated: April 29th • *States awarded funds in March/April Discussion Document – Not for Distribution

16. Health Information Exchange Pharmacies Pharmacies Labs Hospitals Labs Hospitals Health Info Exchange Physicians Physicians Clinics Clinics Government Consumers Government Payers Payers Consumers • Current Confusion • Evolving and Competing • Landscape • Future Vision • Improved Access and Use of • Health Information 16 Discussion Document – Not for Distribution

17. What States Have Been Doing – Same Goals, Differing Approaches Goals • Organize stakeholders, take inventory of resources and needs • Develop statewide plan for federal funds and long term healthcare roadmap • Develop plan for implementing Medicaid incentives Sample Approaches to Statewide HIE Idaho New York Indiana HIE: Local HIEs linked through common policies, technical specifications and shared services Governance: Strong public-private collaborative framework. HIE: Multiple, independent local HIEs, no statewide architecture Governance: Limited centralized authority. HIE: A single statewide network, Idaho Health Data Exchange Governance: Strong public-private collaborative framework. 17 Discussion Document – Not for Distribution

18. North Carolina’s Action Plan 6 Coordinated Planning Tracks Establish governance and decision-making process Develop privacy and security plan Develop technology plan Develop financing plan Develop EHR adoption plan Develop consumer engagement plan 3 Key Work Products State HIE Plan Strategic (finalize) Operational (develop) State Medicaid Plan Regional Extension Center Application EHR adoption plan Health IT is the enabler, not the end result. Health IT is an enabler, not the end result. 18 Discussion Document – Not for Distribution

19. State-level HIE Governance & Technical Operations In support of a statewide organizing capacity, state-level efforts serve two important and distinct roles: Governance: A primary role to convene health care stakeholders, promote collaboration, develop consensus, coordinate policies and procedures to secure data sharing, and lead and oversee statewide efforts. Technical operations: An optional and variable role to manage and operate the technical infrastructure, services, and/or applications to support statewide efforts. 19 Discussion Document – Not for Distribution