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4th Meeting Date : July 22, 2010 Time : 4:00 pm – 6:30 pm Location : WebEx

4th Meeting Date : July 22, 2010 Time : 4:00 pm – 6:30 pm Location : WebEx Dial-in : 1-866-699-3239 Code: 664 759 134. WebEx Link and Log-on Information. Topic: NC HIE Finance Workgroup Webinar - July 22 2010 

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4th Meeting Date : July 22, 2010 Time : 4:00 pm – 6:30 pm Location : WebEx

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  1. 4th Meeting Date: July 22, 2010 Time: 4:00 pm – 6:30 pm Location: WebEx Dial-in: 1-866-699-3239 Code: 664 759 134

  2. WebEx Link and Log-on Information Topic: NC HIE Finance Workgroup Webinar - July 22 2010  Date and Time:July 22, 2010 4:00 pm, Eastern Daylight Time (New York, GMT-04:00) Event number: 664 759 134 Event password: NCHIE For teleconference audio portion: 1-866-699-3239Access code: 664 759 134-------------------------------------------------------To join the online event-------------------------------------------------------1. Click here to join the online event.Or copy and paste the following link to a browser: https://manattevents.webex.com/manattevents/onstage/g.php?d=664759134&t=a&EA=bpawlak%40manatt.com&ET=b47d6cab710219392f88e5fc8baf8df3&ETR=01ee3b43fe961c67e07468c86373a5c4&RT=MiMxMQ==&p 2. Click "Join Now".

  3. Agenda

  4. Meeting Objectives – Key Decisions • Review updates from other workgroups • Review Statewide Operational Plan outline, schedule and status • Identify source for information on controls and reporting • Review additional data received including EHR adoption information • Review analysis of assessments as a source of ongoing revenue; Determine appropriate recommendations for Advisory Board • Review and recommend Financial model assumptions: • Cost • EHR adoption and HIE connectivity • Qualified Organizations • Determine modifications for alternate versions of models

  5. NC Statewide HIE Cooperative Agreement Timeline Strategic Plan Operational Plan Stakeholder Outreach Biweekly+ Workgroup Meetings with Monthly Board Meetings Strategic Plan Submitted to HHS LaunchPhase 2 Publish Draft Operational Plan for Review/ Comment NC HIE Formed Workgroups Formed & Begin Meeting Submit Operational Plan to HHS State HIE Grant App. • Convene Advisory Board & Workgroups • Draft Operational Plan • Publish Draft Operational Plan for Review • Engage and educate stakeholders Funding Announcement Letter of Intent Submitted 5

  6. Updates from Other Workgroups July 13 Board Meeting

  7. NC HIE Vision Statement The NC HIE, a public/private collaboration, will create a secure, sustainable technology infrastructure to support the real time exchange of health information to improve medical decision-making and the coordination of care to improve health outcomesand control health care costs for all residents of North Carolina.

  8. Clinical/Technical Operations

  9. Recommendations Related to Technical Approach

  10. Clinical Principles for Statewide HIE

  11. Clinical Principles for Statewide HIE

  12. Technical Principles for Statewide HIE

  13. Legal & Policy Workgroup

  14. Recommendation on Next Steps

  15. Recommended Breach Principles for Statewide HIE 15

  16. Recommended Breach Principles for Statewide HIE 16

  17. Governance Workgroup

  18. Recommendations Related to Bylaws

  19. Recommendations Related to Consumer Engagement

  20. Recommendations Related to Governing Participation in the Statewide HIE

  21. Recommendations Related to Governing Participation in the Statewide HIE

  22. Finance Workgroup July 13, 2010 Board Update

  23. Key Assumptions • Governance and operations costs will focus on the State-level HIE and not the governance and operations of any Regional Health Information Organizations (RHIOs) or local HIEs. • Costs for participants’ connectivity to the HIE based on adoption curves by participant type • Excludes participant costs to implement new EHRs or remediate existing EHRs and clinical information systems (CIS), with the exception of: • Medicaid system implementation or remediation required for HIE • Estimated cost for portion of providers to connect to HIE using an HIE provided EHR lite. • Identify additional value added HIE products / services that can help drive revenue, including potential added costs for incremental development and/or delivery

  24. Recommended Guiding Principles in Developing Membership and Subscription Fees

  25. Statewide HIE Operational Plan

  26. Proposed Operational Plan Drafting Schedule July 13 Board Meeting • Review Operational Plan structure • Approve, reject or modify Workgroup recommendations July 14 – August 2 • Draft Operational Plan components by Domain including decisions endorsed through July 13 Board meeting. • Meaningful Use final rules expected in mid-July. Educational webinar for Board and all workgroups on final regs. August 2 – August 6 • Core project team and co-chair review of working draft • August 6 Workgroup final meetings prior to Operational Plan August 9 – August 12 • Updates and revisions to Operational Plan draft to include August 6 August 17 • Board meeting to review July and August recommendations and preliminary Operational Plan draft August 19– August 25 • Board and public review of revised Operational Plan draft (revisions based on direction in August 17 board meeting) August 27 • Board conference call August 27 – August 30 • Prepare final draft for submission to ONC by August 31

  27. Operational Plan Outline • NC HIE • Combined Strategic & Operational Plan • I. Introduction • NC HIE Initiative Background • Collaborative Stakeholder Process • Timeline and Next Steps • II. Strategic Plan • Guiding Principles by Domain • Vision • III. Operational Plan • Approach to Statewide HIE • Meaningful Use • A. Governance • Overview • Public/Private Partnership, Articles of Incorporation and Founding Board • Bylaws • Board Nomination Process Moving Forward • Authority and Involvement of the State • Ongoing Development of Governance and Policy Structures • Next Steps • B. Technical Infrastructure • Overview • Planned Technical Architecture • Planned Core Infrastructure • Standards • Technology Deployment • Next Steps • C. Business & Technical Operations • Overview • Core Services • Value-Add Services • Leveraging HIE Capacity in NC • Implementation Timeline • Next Steps • D. Legal & Policy • Overview • Consent, including: • State law scan - consent for TPO • Pathways 1 & 2 • Authorization, Authentication, Access, Audit and Breach • CIA – Confidentiality, Integrity, Availability • Next Steps

  28. Operational Plan Outline, cont’d • E. Finance • Overview • Financial Model Methodology • Financial Model Key Assumptions • Environmental Data Collection • Cost and Revenue Models • Sustainability Planning • Controls and Reporting • Next Steps • IV. Coordination • Overview • Medicaid • ARRA Programs • Veterans Affairs • V. Development of Stakeholder Communication Plan • Appendices

  29. Operational Plan Outline – Finance Domain Progress • E. Finance • Overview • Financial Model Methodology • Financial Model Key Assumptions • Environmental Data Collection • Cost and Revenue Models • Sustainability Planning • Controls and Reporting • Next Steps In progress In progress In progress Identify Source

  30. Data Collection and EHR Adoption

  31. E-Prescribing • As of 2009, in North Carolina, 20% of all prescriptions are routed electronically. Source: Surescripts 31

  32. E-Prescribing • As of 2009, there were over 9 million prescription messages in the state. Source: Surescripts 32

  33. E-Prescribing • More patients are choosing to interact electronically regarding prescriptions. Source: Surescripts 33

  34. Physician Offices Using the Blue Cross Blue Shield data (in blue), an analysis was created to understand: The average number of providers per office Distribution of all providers, by office size Does the total number of providers (~62,000) seem valid? Confirmed that it is due to providers working in more than one office This suggests that providers, on average, work at 2 to 3 (2.8) different offices Need to understand: Relationship of offices to practices, provider groups, hospitals, etc. If providers have a primary location and how we can identify Source: Blue Cross Blue Shield 34

  35. Free Clinics • There are 37 free clinics in the state • 20 are small clinics • 27 are medium clinics • 10 are large clinics 35

  36. EHR Adoption: Hospitals • In 2009, a survey was created to understand the current landscape on hospital adoption of EHR • A total of 125 hospitals responded to the survey • 15% (19 hospitals) are using electronic health records exclusively • 49% (61 hospitals) are using both paper and electronic records • 21% (26 hospitals) are not using electronic health records • 15% (19 hospitals) had no response or did not know • One major barrier commonly noted was the amount of capital needed to adopt EHR • 59% of respondents indicated that this was an issue of major significance • Other major barriers to adoption include: • Finding an EHR that meets providers’ needs (38% of respondents indicated it as an issue) • Resistance to adoption by physicians (33%) • Capacity to select, install and implement an EHR (28%) Source: North Carolina DHHS 36

  37. EHR Adoption: FQHC/RHC • In 2009, 32% of both state-funded rural health clinics and federally funded community health centers have implemented EHRs • This is the equivalent of: • 8 out of 25 state-funded rural health clinics • 9 of 28 federally-funded community health centers Source: Sheps Center 37

  38. EHR Adoption: Physicians • In 2006, 22% of North Carolina physicians had adopted EHRs and another 30% were actively considering implementing an EHR system • Smaller practices were less likely to use EHRs and other health information technologies • Common concerns to adoption are: • capital purchase costs • concerns about return on investment and loss of productivity • Facilitators of adoption include: • access to technical assistance during selection and implementation • grants to assist with purchase and other financial incentives • Based on the 2006 data above and 2009 data about FQHCs and RHCs, can we assume the providers as a whole have achieved 32% adoption of EHRs in North Carolina? Source: Sheps Center , NC Academy of Family Physicians 38

  39. Ongoing Revenue Analysis: Assessments

  40. Assessment: Certificate of Need • In 2009, there were 102 applicants for North Carolina’s Certificate of Need: • 3 (3%) were disapproved • 29 (27%) were conditionally approved • 1 (1%) was withdrawn • 73 (69%) are pending decision/no decision • By the end of 2009, a total of $400 million of CONs were conditionally approved Source: NC Division of Health Service Regulation, Dec 2009 report 40

  41. Assessment: Certificate of Need • Below is a table of possible revenue generated from certificates of need. Source: NC Division of Health Service Regulation, Dec 2009 report 41

  42. Assessment: Provider Licensing • Currently, it costs $175 to annually renew a license for both medical doctors (MDs) and osteopathic medicine (DOs). Source: NC Medical Board 42

  43. Assessment: Summary • Below is a summary of potential revenue streams for North Carolina. • Key questions for consideration: • Can we recommend to the Advisory Board that we propose pursuing assessment related to the CON or Licensing processes at the above rates? Some other rate? Other type of assessment? • Subscription will be based on adoption and HIE connectivity assumptions • Working with Medicaid on 90/10 match 43

  44. Financial Model Assumptions

  45. Cost Assumptions

  46. EHR Adoption and HIE Connectivity Assumptions • Assumptions: • Hospital System Providers was calculated by using the number of Hospital Providers and splitting them between systems and stand-alone facilities based on the ratio of facilities. Only includes Hospitalists. • Rural Health Center Providers and Non-Phys were calculated using FQHC Providers and Non-Phys assuming a similar ratio per site • Rural Health Centers and FQHCs sites were categorized evenly by size (33% each size) in the absence of actual size information • Providers in provider offices was determined based on a total of 22,137 practicing physicians in North Carolina subtracting out providers working in Hospital Systems, Hospitals, RHCs and FQHCs

  47. EHR Adoption and HIE Connectivity Assumptions

  48. Qualified Organization Assumptions As qualified organizations are still in the process of being defined, we can only make assumptions about them related to how many, adoption timing and types Two approaches to developing assumptions: Define a generic or average Qualified Organization Identify as many likely candidates for Qualified Organizations and their existing or expected provider coverage; Assign remainder of market to a generic or average Qualified Organization Hospital Association / NCHEX Top 3 to 4 health systems Existing RHIOs Other? Based on assumption of 50 QOs

  49. Next Steps

  50. Next Steps • Upcoming Meetings • Finance Workgroup Meeting – August 6th • Questions or Comments? • Contact nc.hie@healthwellnc.com.

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