Anthony Rodgers, Director Arizona Health Care Cost Containment System July 31, 2009

1. Academy Health State Coverage Initiatives ProgramStrategic Opportunities for States in the ARRA HITECH Provisions Anthony Rodgers, Director Arizona Health Care Cost Containment System July 31, 2009

2. Definitions- HII, HIE and HIT HII Health Information Infrastructure The wider arena of policies, procedures, technologies and industry standards that facilitate secure and accurate online sharing of electronic medical information between providers, payors and ultimately, patients and their guardians via HIE/HIT. HIE Health Information Exchange “The Network” The electronic movement of health-related information among organizations according to nationally recognized standards. HIT Health Information Technology “The Record” Use of technology to support storage, retrieval, sharing, and use of healthcare information for communication and decision making within healthcare organizations.

3. Definitions- Network Terms HIE Health Information Exchange The electronic movement of health-related information among organizations according to nationally recognized standards. HIO Health Information Organization An organization that oversees and governs the exchange at 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. Source: National Alliance for Health Information Technology Report to HHS/ONC

4. Definitions- E-Records Terms 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

5. Building the State Level HIT Infrastructure EHR1 HIE EHR2 EHR3 EHRn Labs EHR1 EHR2 EHR3 Rxs EHR4 PHR5 Aggregate Database Other PHRn • Highly desirable to couple with HIE

6. State Opportunities for Funding HIT Hospitals Appropriation Program Area Agency Categories of Funds Medicare EHR Incentive Program $23.1 B CMS Medicare $745 M EHR Incentives via Carriers & TPA Doctors EHR Incentive Funds $46.8 Billion Medicaid EHR Incentive Program $21.6 B CMS Medicaid $300 M State Medicaid $1.05B Incentive via State Medicaid Health Centers HITECH FUNDING PROVISIONS ONC Planning Grants HIE Planning & Implementation $300 M Implementation Grants State Designated Entity Loan Funds for States Other Providers Appropriated Grant Funds $2.0 B EHR Adoption Loan Program TBD Health IT Research States Regional Tech Program Regional Tech Centers Universities Medical Informatics HHS NSF Workforce Training Tribes EHR For Med Education GME Training New Technology Research HIT Enterprise Research Research

7. State Readiness Check List • Has an state level environmental scan and gap analysis been completed? • Is there a comprehensive state level roadmap or strategic plan with specific measurable goals and project accountabilities? • Is the public and private health care leadership engagement and organized? • Do you have key stakeholder involvement? • Has your Governor and legislature demonstrated the political will to support adoption of HIT? • Has the Governor identified the state’s accountable authority for HIT coordination? • Has the role of the Medicaid agency in driving HIT adoption been clarified and accepted? • Is the planning process addressing the long term view in the state’s HIT planning and development? • Will you have adequate public and private capital for health information system infrastructure development and operating funds? • Have the technical and support resources for provider EHR adoption been identified and organized?

8. State-wide HIT Strategic Alignment

9. Return on Investment From HIT

10. ROI of EHI at Point of Care: • Improved Patient Safety • Reduced Complications Rates • Reduced Cost per Patient Episode of Care • Enhanced cost & quality performance accountability • Improved Quality Performance Lower Costs Return on Investment: Wide Spread Adoption of Electronic Health Information (EHI) Technologies Can Better Outcomes and Lower Cost Improving Health Care Quality and Cost Performance Better Outcomes

11. MedicareIncentives for Non-Hospitals/Providers • Criteria: • For eligible professionals in a healthcare professional shortage area (HPSA), • the incentive payment amounts will be increased by 10% • Payments are not available to hospital-based professionals, such as • pathologist, emergency room physician, or anesthesiologists) • 3. In 2015 Medicare starts reducing provider Medicare payments for not having EHRs

12. Opportunities: Medicaid Incentives for Non-Hospitals/Providers Criteria: Must demonstrated meaningful use for certified electronic health record Must have at least 30% Medicaid volume 3. Ability to produce quality reports and demonstrate quality improvement

13. Opportunities: Medicare & Medicaid Incentives for Hospitals • Criteria: • Demonstrates use of a certified EHR in a meaningful manner • Demonstrates the EHR technology is connected in a manner that • provides electronic exchange of information to improve the quality • of health care, such as promoting care coordination • Submits information for each period on clinical quality measures

14. What States Need to Do to Create a Medicaid EHR Incentive Program? • Definition of Meaningful Use in Medicaid • A clear set of definitions for each category of eligible provider • Create an auditable EHR meaningful use validation process • Steps to administering a Medicaid EHR incentive program • Develop state specific policies and procedures for EHR incentive program • Develop and implement provider education and EHR adoption assistance • Identify providers that will be participating and track progress • Phase in of meaningful use requirements over three years • Payout Medicaid incentives on an annual basis • Provide other recognitions for physician EHR adoption for providers that don’t qualify for Medicaid or Medicare EHR incentive • Verify return on investment in quality improvement and cost containment

15. Developing a Performance Outcomes for HIT Performance Outcomes Strategic HIT Focus Areas HIT Strategic Performance Metrics Reduced Unnecessary Cost/Utilization = Reduced PMPM & Lower % Admin Cost Meaningful Use of EHR to reduce Duplication, Errors and improve Admin Efficiency Cost Containment Quality Improvement Meaningful Use of EHR to better coordinate care and Quality Performance Improved Quality Against HEDIS and Other Benchmarks Strategic Planning Logic Map Higher Provider Satisfaction & Reduction in Admin. Cost Administrative Efficiency Meaningful use of EHR to Reduce Admin. Process Cycle Times Public Health & Research Meaningful Use of EHR to build Population Health Mgmt. & Research Public Health Responsiveness Reduction in Health Disparities Meaningful USE Barrier PERFORMANCE Management Barrier

16. State Specific Strategies State specific strategies for achieving wide spread adoption and meaningful use of electronic health records must include: • Strategies for building state HIT infrastructure • Strategies for supporting successful provider EHR adoption • Strategies for financing and sustaining HIT at the state level

17. Building State Wide HIT Infrastructure • Scope of HIT infrastructure • Data sources • Health Information Organizations • Data exchange systems • Health information business associates • Electronic health record system • Clinical Data Repositories • Health information users community • State designated authority • HIT planning and development • Policy setting • Standards • Priority setting • Oversight • Financing mechanisms • Public and private contributions • Payers contributions • Providers use fees • Consumers subscriptions • Provider user support and technical Assistance • Technical Assistance Extension Centers • Medicaid • Others

18. Strategies to Support Provider EHR Adoption and Meaningful Use • Technical assistance extension centers • Medicaid program support of provider adoption • State designated authority • Graduate medical education training programs • Federal outreach and education • Other state agencies • Hospitals and major group practices

19. HIT Financing Strategies • Federal EHR incentive funds for Medicare and Medicaid • Provider EHR loan program • Pool EHR provider financing support • Payers • Hospitals • Others • Transaction or user fees to support HIE sustainability • Health plan tax for HIE support • 90/10 federal Medicaid funding • Grants • Research fund assessment

20. Managing Risk of Failure • Building a sustainable HIT Infrastructure and achieving wide spread EHR adoption is a high risk enterprise that requires a multi-year commitment and a well organized process at the state level • Identify the potential risks • Identify the risk mitigation strategies • Build-in adequate planning and development time • Environmental Assessment • Stakeholder involvement • Develop common planning and system development tools • Identify organizational accountability

21. Scope of State Level HIT Activities from 2010 thru 2015 • Health System strategic HIT plan • Statewide environmental scan to determine readiness and gaps • Description of approaches, methods, and timelines for organized EHR adoption assistance and financial support • HIE network infrastructure and EHR interface design development • Clinical Data Repositories data architecture design and development and data flows • Widespread EHR system acquisition, upgrade, or integration • Health information exchange infrastructure development and expansion • Provide on-going technical support and assistance • Provide practice reengineering support • Clinical practice staff training and EHR competency development • Clinical decision support integration • Public Health Alert and Monitoring system integration • Care management systems integration • Integration of patient decision support tools

22. Logical Phases of State Level HIT Development • HIT infrastructure development phase • EHR initial implementation and use phase • Practice workflow redesign • Training and user support • EHR managed performance phase • Improve practice workflow and EHR use • Better process outcomes • EHR optimization phase • EHR configuration for optimization • Improved quality and cost effectiveness outcome • Maximized return on investment

23. Structural Development Phase2010 thru 2012 • Acquisitions and Installation of a certified EHR • E-prescribing • Computerize order entry results reporting • Quality reporting capabilities • Clinical Decision Support capability • Ability to exchange health information and continuity of care documents (CCD) at each patient care delivery point • Development of clinical data repository and disease registries • User support for provider practice and clinical process reengineering and EHR integration

24. E-Health Infrastructure Configuration

25. EHR “Initial Use” Phase2011 thru 2013 • Building EHR Meaningful Use Competency (EHR System Burn In) • Technical assistance and support for provider practice • Focus on process and practice productivity improvement • Data conversion assistance and support • Implement EHR system failure “risk reduction” strategies • Interface external data sources and HIE connectivity

26. EHR Managed Performance Phase2012 thru 2014 • Participation in quality networks for comparable performance analysis and improvement • Medicaid specific configuration and effective use of clinical decision support • Web connectivity with patients for compliance management (electronic reminders, messaging, and telehealth) • Use of health e-learning tools for patient health literacy and compliance • Electronic performance reporting • Disease registries

27. Medicaid e-Health Information Technology Environment2011 and Beyond

28. EHR “Optimized Use” Phase2013 and Beyond • System configuration for optimization of patient management • Optimization analysis and system configuration • Patient center care • Best practice • Personal Electronic Health Record extensions from the EHR • Advanced messaging and alerts • Integration of Web 2.0 functionality for patient support and care management • Integration of remote monitoring tools, telemedicine, telehealth and health e-learning functionality and tools • Integrated with health plan care management systems • Translational research participation and quality network infrastructure

29. Integrating Clinical and Patient Decision SupportFor Value Added E-Health Care

30. Organizing YourTools Box of HIT Planning, Development and Adoption • Identify designate HIO entities • Create or identify an accountable organization that is dedicated to support EHR adoption and achievement of meaningful use (State QIO etc.) • Organize HIT development phases • Create a preferred list of EHR vendors to help with providers adoption • Develop a provider loan program • Create opportunities for joint EHR purchasing arrangements • Support hospital organized EHR assistance programs • Develop hub and spoke EHR support strategies

31. The Connected Healthcare System Hospital Care Coordination Diagnostics Specialist Referral Primary Care Medical Home Provider Order Entry Lab Result Reporting EHR/HIE Research E-Prescribing Remote Patient Self Monitoring MCO Medical Medical Mgmt.

32. Questions?