Agenda:

1. Agenda: • Health IT Around the Nation • Health IT in Michigan • Health IT and Healthcare Reform

2. 2004 – Executive Order Goal: Nationwide Interoperable Infrastructure by 2014 Established the Office of the National Coordinator for HIT (ONC) 2009 - American Recovery & Reinvestment Act (ARRA) Goal: promote health IT as a component of healthcare reform Single biggest Health IT investment ~$40 billion Strengthens Privacy & Security Policies The U.S. Health IT Era…

3. 15,000% Budget Increase Government Health IT Spending History Amount of Funding Authorized for HIT in ARRA: $45 Billion 2009 2004 Amount of Funding for HIT before ARRA: $300 million

4. ARRA Funding for HIT Program Agency Recipients Cost Beacon Community Statewide HIE States $550 million ONC Non-Profits Regional Extension Centers $640 Million $250 Million Advanced HIEs HIT Workforce $68 Million Community Colleges MedicaidIncentives CMS Medicaid Agencies $40 Billion Medicare Incentives Hospitals & Providers Source: INPUT 5

5. “Meaningful Use” is the Key Regional Extension Centers Workforce Training Programs Necessary Action Intended Outcomes ADOPTION Improved Individual & Population Health Outcomes Increased Effectiveness & Efficiency Improved Ability to Study & Improve Care Delivery MEANINGFUL USE Medicare and Medicaid Incentives and Penalties State Grants forHealth Information Exchange Standards & Certification Framework Privacy & Security Framework EXCHANGE 6

6. Meaningful Use

7. Meaningful Use • Meaningful Use is using certified EHR technology to: • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • Maintain privacy and security

8. Stage 3 2015+ Stage 2 2013-2014 Stage 1 2011-2012 Meaningful Use Currently in Draft Form – Public Input Closed Defined July 13, 2010 9

9. Meaningful Use Stage 1 10 Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

10. Privacy and Security in ARRA Bans sale of health information Requires ongoing audit trail Strengthens civil and criminal enforcement of HIPAA Expands patient rights to access their information Requires innovative encryption technology to prevent breaches Requires HHS Office for Civil Rights (OCR) to provide consumer education about protected health information

11. 44% EHR Adoption Rate for office-based physicians in 2010, 26.4% plan to adopt in the next 12 months, and 16.4% in the next 18 months 94% Michigan providers without an EHR say cost is a major concern 90% Michigan Hospitals planning to participate in the Medicare and Medicaid Meaningful Use Incentives in 2011 #2 Michigan’s ranking in the nation for e-Prescribing with over 11 million prescriptions ordered through e-Prescribing HIT in Michigan 1. Advancing Healthcare in America, 2010 National Progress Report on E-prescribing, Surescripts, 2. MHA 2010 Member Survey 3. Michigan State Medicaid HIT Plan

12. History of HIT in Michigan • 2005 • Federal Hot Topic translates to issue of interest in Michigan Executive Office and legislature • 2006 • Focus Groups, Planning Process, Statewide Roadmap called “MiHIN Conduit to Care” • Michigan HIT Commission created • 2007 • HIE Grants to seven communities around the state • 2008 • HIE Grants to two more communities to cover every county in the state • 2009 • The American Reinvestment & Recovery Act changes the game

13. MI ARRA Funding for HIT Program Agency Recipients Cost Statewide HIE MDCH $14.9 Million ONC CMS M-CEITA Regional Extension Centers $19 Million Beacon Community $16.2 Million Southeast Michigan HIT Workforce ~ $1 million 4 Community Colleges MedicaidIncentives MDCH > $200 Million 14

14. Statewide HIE Cooperative Agreement • Goal: an interoperable statewide health information exchange • Michigan’s Approach: • Convene Stakeholders for planning • Develop a new not-for-profit entity to implement • Thin centralized services to enable statewide HIE • Emphasis on local (sub-state) initiatives • Connect with state of Michigan public health systems • Designed to meet Meaningful Use criteria • Committed to connecting nationwide

15. Statewide HIE Cooperative Agreement MiHIN Shared Services Board

16. Statewide HIE Cooperative Agreement Phase 1 MiHIN Shared Services - Inter-HIE Gateway - Master Provider Index - Network Index - Interoperability with Statewide Resources - Supports MU Stages 1&2

17. Statewide HIE Cooperative Agreement Phase 2 MiHIN Shared Services • Expanded Services • Focus on National Connection • Query/Pull Functionality • Supporting MU Stage 3 in 2015

18. Beacon Community

19. Beacon Community Must produce Measurable & Reproducible Outcomes

20. Southeast Michigan Beacon Community • Goal: Improve continuity, quality and safety of care for underserved patients with chronic diabetes in: • Detroit, Hamtramck, Highland Park, Dearborn and Dearborn Heights, Michigan • Why? • Diabetes has a very high prevalence among the target population: 12.8 percent of adults, or 93,000 people

21. Southeast Michigan Beacon Community • Aggressive 31 month timeline • Implementing a technology Infrastructure • Target specific clinical interventions • Example: Patient Navigators • Specific Measure Examples • Cost: Unscheduled acute care 30 day re-hospitalization • Quality:HbA1c, LDL, Eye exam within 12 months • Population Health: Disparity ratios for quality of care and population health measures

22. For more information… Terrisca Des JardinsProgram DirectorSoutheast Michigan Beacon Community CollaborativeSEMHAtdesjardins@semha.orgph: 313.873.9302 Gary PetroniDirector, Center for Population Health Director SEMHAInterim Beacon Directorgpetroni@semha.orgph: 313.873.9302

23. HIT Workforce • Goal: • To expand medical health informatics education programs to ensure the rapid and effective utilization and development of HIT • Michigan is in a consortium of 10 states • Train 1,100 citizens in two years • Credit bearing, non-degree certificate • Four Locations in Michigan • Lansing Community College • Macomb Community College • Delta College • Wayne County Community College

24. HIT Workforce • Six “roles” for training • Practice workflow and information management redesign specialists • Clinician/practitioner consultants • Implementation support specialists • Implementation managers • Technical/software support staff • Trainers • Most classes are online or hybrid • More information at: http://www.mwhit.org/

25. Medicaid EHR Incentives • State Agency Responsibilities: • Administer the incentive payments to eligible professionals and hospitals • Conduct adequate oversight of the EHR incentive program • Pursue initiatives to encourage adoption of certified EHR technology to promote health care quality and the exchange of health care information

26. Medicaid EHR Incentives • In order to receive payments: • Be an “eligible” provider • Use “certified” EHR technology • Meet the “meaningful use” criteria

27. Medicaid EHR Incentives • Who is eligible? • Eligible Professionals: (Non-hospital based with at least 30% Medicaid volume) • Physicians • Dentists • Certified Nurse Mid-wives • Nurse Practitioners • Physician Assistants (PA) practicing in a PA-led FQHC or Rural Health Clinic • Hospitals: • Acute care -- at least 10% Medicaid volume • Children’s hospitals -- no volume requirement • Critical access hospitals -- currently excluded

28. Medicaid EHR Incentives Requirements • Successfully interface with federal registration system (NLR) • Have approval from CMS for State Medicaid HIT Plan (SMHP) • Be capable of accepting provider attestations • Be capable of paying EHR incentive payments to providers • Have proper audit and oversight ASAP Ongoing

29. Medicaid EHR Incentives • Estimated enrollment by fiscal year

30. Medicaid EHR Incentives • Estimated Payments by fiscal year in Millions

31. The Accountable Care Act & HIT

32. The Accountable Care Act & HIT • Accountable Care Organizations: • Guiding Principle: If physicians and hospitals work together to prevent readmissions, duplicate tests and other unnecessary costs, healthcare will be less expensive and safer. • Health IT needs: • Capture patient data electronically - EHR • Gather patient data from all levels of care – HIE • Population data for care management - Registry • Real time decision support, alerts, patient access • Quality data warehouse

33. The Accountable Care Act & HIT

34. Key Challenges Opportunities • Money – Too much • Money – Not enough • Time • Coordination • Collaboration • Adoption • Trust