Optimizing HIT/HIE to Achieve Meaningful Use

1. Optimizing HIT/HIE to Achieve Meaningful Use Toby Douglas Chief Deputy Director, Health Care Programs California Department of HealthCare Services

2. Promoting the Adoption of E-Prescribing in Medi-Cal Completed system changes to deliver medication histories and drug formulary file to the point of care Northern Sierra Rural Health Network Implemented August 2008 Safety Net Institute pilot Implemented for San Mateo County Health System September 2009 Preparing for implementation in three other counties (Kern, Riverside and Contra Costa) Statewide E-Prescribing Consortium

3. “Meaningful Use” of EHRs • Focus moved away from e-prescribing to a goal of e-prescribing as part of an EHR. • All funding is contingent upon meeting “meaningful use” requirements • CMS will issue Meaningful Use rules as early as the end of the calendar year

4. Medi-Cal HITECH Incentive Program • Matching Funds Requirement: • 10% state match on administrative expenses, including tracking of meaningful use, conducting oversight and pursuing initiatives to encourage adoption • 100% federal match on incentive payments • Timing: Begins in 2011 • Funds Flow Through: Department of Healthcare Services • Requirements for Funding • Demonstrated “meaningful use” of certified EHR technology in a way that provides for health information exchange; compliance with reporting requirements

5. Estimate of California HITECH Incentive Program Funding *Congressional Budget Office estimate of outlays **California’s proportionate share estimated at 10% 5

6. Potential Hospital-based Incentives • Funding amounts for acute care and children’s hospitals will be limited to the amount calculated under Medicare, by Medicaid share • Funding for FQHC-based practicing physicians will be by determination of the Secretary • Third-party sponsoring entity can keep 5% of funds as pass-through.

7. Potential Medicare Incentives Payments begin in 2011 with lower incentives each year, including eventual penalties for those who fail to adopt certified EHRs by the end of 2015.

8. Eligible Providers • Non-hospital-based physicians (including pediatricians) with at least 30% Medicaid volume can receive up to $63,750. • Eligible providers can initially receive up to $21,250 (85% of the max $25,000 in “net average allowable costs”) to cover the cost of purchasing or upgrading certified technology. • Office-based pediatricians with at least 20% Medicaid patient volume could receive up to $42,500 ($8,500/yr x 5 yr).

9. Potential Medicaid Provider Incentives • Note: Medicaid payments can be made in advance of actual meaningful use so that adoption itself can be undertaken. • Year 1 payment does not need to be in 2011, but cannot be later than 2016. • No penalties for failure to adopt certified EHRs.

10. HITECH Project: Overview and Timeline RFP Released July 2009 Planning Project Launch September 2009 Vision for State EHR Strategy and Adoption December 2009 Implementation Plan February 2010 Federal Funds Disbursement Jan 2011 • In coordination with the Statewide HIT/HIE Plan: • Regional Extension Centers (RECs) • EHR Loan Fund • Workforce Training/Development Programs • New Technologies and Research Centers • Broadband/telehealth expansion 10

11. Groundwork for the Planning and Implementation of Medi-Cal’s EHR Initiative Engage Stakeholders and Develop Vision for Success Implementation Planning July - October November- March • Develop incentive program plan perspectives • Strategic plan: meaningful use criteria, program components, performance targets • Campaign plan: to educate and increase awareness • Conduct landscape assessment of CA providers and EHR vendors • Implementation plan: including operational requirements • Gather stakeholder perspectives • Conduct interviews • Lead a visioning session • Develop a vision for the adoption and meaningful use of EHRs by California’s providers The goal of the project is to lay the foundation for increasing EHR adoption, driving improved quality, safety, and efficacy of healthcare for all Californians

12. Medi-Cal EHR Incentive ProgramVision Statement The health and well-being of all Californians will be dramatically improved by the widespread adoption and use of Electronic Health Records.

13. EHR Incentive Program:Stakeholder Feedback • Participants emphasized that EHRs are a tool, not the actual standard of care. • Stakeholders believe that the program should focus on the use of information and clinical support that results from the information-rich environment created by EHRs, not the EHR itself. • Incentivize Medical Home models for delivering care to Medi-Cal patients

14. ONC—Meaningful UseHealth Outcome Policy Priorities • Improve quality, safety, and efficiency and reduce health disparities • Engage patients and families • Improve care coordination • Improve population and public health • Ensure adequate privacy and security protections for personal health information

15. Provider Roles in Health Outcome Priorities

16. Statewide HIEMeaningful Use Priorities • E-prescribing and medication reconciliation • Electronic lab ordering and results reporting • Continuity of care • Administrative transactions (claims and eligibility) • Public health reporting • Quality reporting 16

17. Provider Roles in Meaningful Use Priorities

18. Section 1115 Waiver • Promotes organized systems of care • Mandatory enhanced medical home • Coordinated care (facilitated by HIT and HIE) • Better connection to specialty providers • Incentives that reward providers for achieving desired outcomes. • Value-Based Purchasing Strategies • Made possible by newly available data from organized delivery systems of care and HIT/HIE infrastructure investments • May include • Standardized reporting of provider utilization and outcomes info • Risk sharing • Pay-for-performance programs • Healthy rewards and incentives for beneficiaries • Nonpayment for healthcare acquired conditions

19. Medi-Cal Enhanced Medical Home • Evidence-based medicine • Enhanced access • Engage patients • Payment

20. Questions?

21. Functional Requirements for “Meaningful Use” Medical Home Provider Roles Clinical Information Exchange 2009 Clinical Note Details 2008 Consultations & Transfers of Care 2007 Medication Management 2009 Medication Gaps 2006 EHR-Lab Results Reporting 2008 Immunization & Response Management Information Exchange Between Patient & Provider 2008 Patient-Provider Secure Messaging 2007 Consumer Access to Clinical Information 2008 Remote Monitoring Quality Reporting 2006 Quality Use Cases Information Sources and Recipients (may be one or more of those listed): Healthcare Payors Labs Diagnostic Imaging EHRs Medication Networks Intermediaries Registries Quality Organizations/ Health Agencies