“No matter how dramatic the end result, the good to great

1. “No matter how dramatic the end result, the good to great transformations never happened in one fell swoop. There was no single defining action, no grand program, no one killer innovation, no solitary lucky break, no wrenching revolution. Good to great transformation comes about by a cumulative process – step by step, action by action, decision by decision, turn by turn, that adds up to sustained spectacular results. “ Jim Collins Good to Great

2. “No matter how dramatic the end result, the good to great transformations never happened in one fell swoop. There was no single defining action, no grand program, no one killer innovation, no solitary lucky break, no wrenching revolution. Good to great transformation comes about by a cumulative process – step by step, action by action, decision by decision, turn by turn, that adds up to sustained spectacular results. “ Jim Collins Good to Great

3. Meaningful Use Readiness Getting Started: A Meaningful Use Checklist Peter Cucchiara, BSMIS MBA

4. To Readiness See the path before we walk it

5. Do we have the right people in the right seats on the bus? Jim Collins What is this work? Placement & Considerations 3 2 Ways to Plan the Process 4 What is MU to you? 1 Assessment Tool Demonstration 5

6. What is Meaningful Use ARRA specifies three requirements for “meaningful use” Usingcertified EHR technology in a meaningful manner (which includes e-prescribing for eligible providers and meeting the MU criteria) Use Connecting a certified EHR in a manner that provides for the electronic exchange of health information to improve the quality of care. Connect Using the technology to submit informationto CMS on clinical quality measures and other measures selected by CMS. Submit

7. MU Grocery List 25 Requirements of which we need to fulfill 20 15 Core, 5 Discretionary 6 Clinical Measures 16 Numerator/Denominator Calculations 8 Attestation items Determine our EP Adopt implement upgrade incentive opportunity Volume criteria

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9. What is Meaningful Use – The First Cut Improve quality, safety, efficiency, & reduce health disparities Goal A (15) Goal B Engage Patients and Families (4) Goal C (3) Improve Care Coordination Goal D (2) Improve Population and Public Health Ensure adequate privacy and security Protection for PHI Goal E (1)

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11. What is Meaningful Use – The Second Cut - Of the 25 objectives 15 are required - Goal A (11) Goal B (2) Goal C (1) - Goal D (?) Goal E (1) Core • - 10 discretionary/menu requirements from which5 must be chosen • - Must choose1Goal D measure Improving Population & Public Health • Electronic access for patients (PHR, portal) is discretionary. Discretionary Menu - 44 Measures for EP’s - Pick 6 - 3 Core required (BP, Tobacco status, adult weight) or… - 3 Alternates plus additional 3 from remaining pool of 38 Clinical Measures - Of the 25 objectives 16 require N/D Calculations - 10 Calculations require certified EMR technology - 6 Calculations do not require certified EMR technology Numerators Denominators Attests - Of the 25 objectives 8 require attestations

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13. What is Meaningful Use – The Third Cut 4P’s

14. Adopt, Implement, Upgrade (AIU) In their first year of participation in the Medicaid incentive payment program, EPs may qualify for an incentive payment by demonstrating any of the following: that they have adopted (acquired & installed), implemented (commenced utilization), or upgraded (upgrade to a certified version or expanded functionality, e.g. CDSS, e-prescribing)

15. Eligible Providers (EPs) Medicare Doctor of Medicine Doctor of Osteopathy Doctor of Dentistry Doctor of Dental Surgery Doctor of Podiatric Medicine Doctor of Optometry Chiropractor Medicaid Physicians Dentists Nurse Midwives Nurse Practitioners PAs in PA led FQHC* PAs in Rural Health Clinic

16. Volume Criteria • General Rule: 30% patient encounters attributable to those receiving Medicaid. To be measured over any continuous 90-day period in the previous calendar year. • 2 Exceptions: • If EP practicespredominantly in an FQHC or RHC, must have 30% of patient encounters attributable to “needy individuals” • Definition of predominantly = over 50% of patient encounters over a period of 6 months occurs at an FQHC or RHC • Definition of needy individuals = receiving medical assistance from Medicaid or CHIP; receiving uncompensated care; or receiving care at no-cost or reduced cost based on a sliding-scale • 2. Pediatricians may have at least 20% patient encounters attributable to those receiving Medicaid Source: CMS, US DHHS

17. Summing Up So Far 25 Requirements of which we need to fulfill 20 15 Core, 5 Discretionary 6 Clinical Measures 16 Numerator/Denominator Calculations 8 Attestation items Determine our EP Adopt implement upgrade incentive opportunity Volume criteria ? How much work How much time Impact Cost Ready

18. “Meaningful Use” Criteria a Focal Point Across Previously Disparate Initiatives Patient Centered Medical Home Accountable Care Organizations RHIOs & HIE Meaningful Use of EMRs State/Regional Chronic Care Programs Payer Disease/Care Management PHR Platforms (Google MS etc)

19. For example

20. Is it just a matter of Oranges and Apples PCMH MU Recognition/Documentation Paid Per Patient (in NYS) M‘caid, M‘care & Payers State and Federal 9 standards 7 elements 166 factors Certification/Attestation Paid Per Provider Medicaid, Medicare Federal 5 care goals 20 objectives (options and choices) ?

21. A Simple Comparison Medical Home Meaningful Use PPC1: Access and Communication Goal A: Improve quality, safety, _______ efficiency, & reduce health _______ disparities PPC2: Patient Tracking & Registry PPC3: Care Management Goal B: Engage Patients and Families PPC4: Pt Self Management Support Goal C: Improve Care Coordination PPC5: Electronic Prescribing PPC6: Test Tracking PPC7: Referral Tracking PPC8: Performance Rpt/Imprvmnt Goal E: Ensure Adequate Privacy & Security Protection for PHI PPC9: Advanced Electronic Comm Goal D: Improve Population and Public Health

22. How Much Overlap? PCMH Elements that relate to HIT (69%) Ginsburg, Maxfield, O’Malley, Piekes, Pham, Making Medical Homes Work Moving from Concept to Practice Center for Studying Health System Change #1 December 2008

23. Home Sweet Meaningful Medical Home Patient Centered Care

24. The MU Assessment Tool Some Assessment Tool Results

25. Choose Medicare Or medicaid and Calculate 5 year Return (now) EMR Certification (Fall 2010) Count EP’s And volume criteria (now) Adopt Implement Upgrade (Fall 2010 – 2011) Milestone Map of the Journey Assess Numerators And denominators Stage II 2013 - 2014 Stage III 2014 - 2016 EMR Attestation $25K (Late 2010/2011) Stage I April 2011? 2012 Transformational Change

26. Guiding Principle 1 Achieving a balance between Applied Principles Process Gains Recognition Attestation

27. MU Three Main Process Work Strands Process HIT/MU/MH Organizational

28. Questions

29. Thank You