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3rd Meeting Date : July 8, 2010 Time : 4:00 pm – 6:30 pm Location : NC Hospital Association

3rd Meeting Date : July 8, 2010 Time : 4:00 pm – 6:30 pm Location : NC Hospital Association 2400 Weston Parkway, Cary, NC Dial-in : 1-866-922-3257; Participant Code 654 032 36#. Agenda. Meeting Objectives – Key Decisions. Review updates from other workgroups

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3rd Meeting Date : July 8, 2010 Time : 4:00 pm – 6:30 pm Location : NC Hospital Association

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  1. 3rd Meeting Date: July 8, 2010 Time: 4:00 pm – 6:30 pm Location: NC Hospital Association 2400 Weston Parkway, Cary, NC Dial-in: 1-866-922-3257; Participant Code 654 032 36#

  2. Agenda

  3. Meeting Objectives – Key Decisions Review updates from other workgroups Review data collection progress Review on-going revenue sources Develop guiding principles for on-going revenue

  4. 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 4

  5. NC Statewide HIE Operational Plan Development Timeline Operational Plan Consensus Recommendations Drafting of Operational Plan Governance WG: Confirm governance model, advise on scope of governance, craft recommendations on bylaws and board structure for new entity; develop recommendation for consumer engagement plan approach Clinical/Technical WG: Recommendations on technical architecture approach for statewide HE, begin prioritization of core and value-added services, begin landscape assessment Governance WG: Develop recommendations on roles of State in public/private partnership; participation policies and enforcement mechanisms for the statewide HIE; processes for coordination with other ARRA funded programs in the state Clinical/Technical WG: Development of clinical and business use cases, prioritization for core and value-added services, technical approach May 14 – initial NC HIE Board Meeting Master project planning, develop WG charters and workplans; stakeholder meetings, Legal/Policy WG meetings Aug. 31: Submit Operational Plan to HHS Legal/Policy WG: Conduct legal scan for NC laws related to consent for treatment purposes; draft legal principles; conduct legal scan for NC laws related to health information data security; develop recommendations on approach to 4As; develop initial consent approach recommendation under existing law Finance WG: Develop financial model assumptions; data collection to inform financial models. Legal/Policy WG: Finalize consent approach recommendation under existing law; review emerging consent policies in neighboring states and identify barriers; develop recommendations for changes to current law to support data exchange; develop recommendations on breach policy principles and role based access principles; develop security recommendations beyond access. Finance WG: Develop 2-3 financial models based on modeling assumptions and develop process for sustainability planning. • Compile NC HIE Board & Workgroup recommendations and decisions • Draft Operational Plan – iterative process with WG review • Publish Draft Operational Plan for Public Review Workgroups formed Workgroups formed 5

  6. HIE Financial Model Timeline Jul 22 Governance Recommend HIE Model Approach Clinical / Technical Update and Finalize Core and Value Added Services Week of Aug 9 Target Draft Operational Plan Draft Project Budget 8/30 Final Operational Plan to ONC Jul 8 Clinical / Technical Recommend Core and Value Added Services

  7. Workgroup Updates

  8. Governance Workgroup - June 23, 2010 Meeting 8

  9. Technical/Clinical Operations Workgroup – June 23, 2010 Meeting 9

  10. Policy Subcommittee– June 28, 2010 Meeting 10

  11. Finance Workgroup - June 23, 2010 Meeting 11

  12. Data Collection Update

  13. Data Collection Follow Up

  14. General Information • As of the 2009 Census, North Carolina’s population is around 9.3 million. There are 100 counties, 85 of which are rural. Rural is defined as a population density of no more than 250 people per square mile at the time of the 2000 U.S. Census. Source: US Census Bureau (2009), State Health Facts (Kaiser Family Foundation)

  15. Physicians • Distribution of physicians by license type • For further analysis, should we limit the license subcategories to only “full and unrestricted”? Source: CareNet

  16. Physicians • The majority of physicians work in internal medicine and family practice. Source: CareNet and Blue Cross Blue Shield

  17. Physicians • Below is a table of the top 10 counties of where physicians work Source: CareNet

  18. 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? Source: Blue Cross Blue Shield

  19. Physician Offices • Next, using additional data from the NC Medical Society, an analysis was created to understand: • The number of physicians, by office size • The number of physician offices • Using the Blue Cross Blue Shield percentage distribution (in blue), the number of physicians per office was calculated with the NC Medical Society’s data of total physicians (22,392). The number of physician offices was calculated with the ratio providers to physician offices (Blue Cross Blue Shield data) Source: NC Medical Society, Blue Cross Blue Shield

  20. Hospitals • There are 162 hospitals in 84 counties • 78 of 162 hospitals (48%) are located in rural areas • 84 of 162 hospitals (52%) are located in urban areas • Distribution of hospitals by specialty and urban/rural area Source: NCHA

  21. Hospitals • Distribution of hospitals by specialty and bed-size (based on licensed beds) • Distribution of hospitals by specialty and bed-size (based on discharges) Source: NCHA

  22. Hospitals • Distribution of hospital systems by size (based on number of licensed beds). • There are a total of 118 hospitals that are affiliated with 33 systems. • Carolinas HealthCare and Novant Health are larger health systems, affiliated with10 or more hospitals Source: NCHA

  23. Hospitals • There are a total of 162 hospitals. • The majority (118 hospitals, 73%)of hospitals are affiliated with a system • 102 (88%) are owned • 16 (12%) are managed • Managed hospitals consist of only small and medium sizes • Distribution of hospitals by system type and size (based on number of licensed beds, “LB”) Source: NCHA

  24. Hospitals • 53 of 162 hospitals are NCHEX ready Source: NCHA

  25. FQHCs • North Carolina’s network of FQHCs consist of: • 26 Health Center Grantees at 136 locations • 2 Federally Qualified Health Center Look-Alike organizations at 6 locations • Within this network, there are: • 155 Physicians • 101 Nurse Practitioners/Physician Assistants/Cert. Nurse Midwives • 434 Nurses and other medical personnel • 51 Dentists • In 2008, North Carolina’s FQHCs served 389,841 patients, of which 49% of patients were uninsured (192,301) and 21% receive Medicaid (82,126) Source: North Carolina Community Health Center Association

  26. Rural Health Clinics • North Carolina’s network of rural health clinics consist of: • 86 clinics • 60 of 114 hospitals are in a rural area Source: Rural Assistance Center, North Carolina Rural Health Research and Policy Analysis Center

  27. Pharmacies • North Carolina is ranked 6th in the nation for e-prescribing. 6.4% of all prescriptions are routed electronically. • 2,461 total in-state pharmacies • 12,526 active pharmacists licensed in North Carolina. • Where they work: • 3,286 work at retail chain pharmacies • 2,117 work at hospital pharmacies • 1,407 work at retail independent pharmacies Source: North Carolina Board of Pharmacy

  28. Pharmacies • North Carolina is ranked 6th in the nation for e-prescribing. 6.4% of all prescriptions are routed electronically. Source: Surescripts

  29. Pharmacies • 84.5% of total community pharmacies are activated for e-prescribing, ranking them 14th in the nation Source: Surescripts

  30. Pharmacies • 23.3% of all physicians are using e-prescriptions, ranking them 4th in the nation Source: Surescripts

  31. Pharmacies • Over 3.8 million NC residents are requesting prescription benefits electronically. They are ranked 10th in the nation for the ability to electronically access a patient’s prescription benefit. Source: Surescripts

  32. Labs • North Carolina has: • 44 labs, of which 11 are hospital based Source: Blue Cross Blue Shield of North Carolina

  33. Radiology Centers • North Carolina has: • 73 free standing centers in 293 locations • 120 hospital-based sites • 17 organizations are located at 3 more sites. Source: Blue Cross Blue Shield of North Carolina

  34. RHIOs • North Carolina has: • 4 RHIOs: CCHIE, WNCHN Data Link, Sandhills Community Care Network HIE, and Southern Piedmont Partnership for Public Health (SoPHIE)

  35. Guiding Principles for On-going Revenue

  36. Ongoing Revenue Sources

  37. Examples From Other States Health Information Organizations (HIOs) are employing a diverse range of strategies to finance regional and statewide HIE.

  38. Example: Applying VT Claims Assessment to NC • The State of Vermont began in October 2008, having each health insurer choose to pay 0.199% of all health care claims paid for its Vermont members in the prior year or a fee based on the insurer’s proportion of overall claims in the prior year. • Expected to raise $32M over a seven year period • With a population of 621,270 this equates to approximately $51.51 per capita or $7.36 per capita / per year • Using population to apply a similar approach to North Carolina’s population of 9,380,884 results in: • Revenue of just less than $483M over a seven year period, or $69M per year

  39. Payment Flow in a Membership Fee Model Statewide HIO • Qualified Organization (QO) Fees: • QO startup charge • QO monthly membership fees • Per provider registration charge and monthly membership fees • Per hospital registration charge and monthly membership fees (based on size) Bundled Startup Payment Bundled Monthly Membership Fees Qualified Organization Hospitals Providers Fee Pass-Through: QO may pass through startup and monthly membership fees directly or cover as part of participation fee (which may or may not be increased based on QO’s business model)

  40. Payment / Value Flow in a Cost Savings Model Medicare/Medicaid Incentive Payments Qualtiy/P4P Reimbursement Membership / Reimbursement Fee Membership / Transaction Fee Statewide HIO Payers Providers • Payer Value: • Medical cost savings costs • Reduced duplication of Lab / Radiology • Reduced ADE • Formulary adherence • Increased generic substitution Fewer Claims Medical Cost Savings • Provider Value: • Lower costs through improvedadministrative efficiencies • Access to patient data at the point of care • Actionable health information • Potential for incentive payments • Increased reimbursement Patients • Patient Value: • Improved quality of care • Ability to actively manage own care • Fewer duplicate tests and co-pays • Personal health record

  41. Guiding Principles in Developing Membership and Subscription Fees • High enough to cover costs and promote sustainability • Low enough to encourage broad participation • Directly related to the exchange of health information • Avoid transaction and usage fees which may discourage use/ access to health information for treatment purposes • Paid for by all participants and beneficiaries of health information exchange • Participant fees may be paid through a Qualified Organization (QO) pass-through

  42. Questions in developing membership and subscription fees • Developing Membership Tiers: • Core Services • Core Services plus one or more value-added services • Should the Statewide HIO un-bundle core services and provide single services as an on-demand service or limited subscription (e.g. Provider Directory, MPI, etc.)? • Start-Up Fees: • Should the Statewide HIO offer discounts or subsidies for early adopters or pilots? • Are connectivity costs: • Direct pass-through or generate a margin? • Subsidized with revenue from ongoing membership and subscription fees? • Fees for Organizations: • How are costs for an organization determined • Size? • Type of organization (Hospital system vs. rural hospital vs. provider group vs. single provider vs. Other)? • Number and type of providers?

  43. Next Steps

  44. Next Steps • Upcoming Meetings • Board Meeting – July 13 • Finance Workgroup Meeting – July 22 • Questions or Comments? • Contact nc.hie@healthwellnc.com.

  45. New NC Health IT Website Launched www.healthit.nc.gov

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