HIT in the “New World” States, HITECH and Health Reform

1. HIT in the “New World”States, HITECH and Health Reform Lynn Dierker NASHP Annual Meeting October 6, 2010

2. The Evolving HIT Context Dierker

3. HITECH: Build, Expand, Demonstrate MUAnchored by State & Regional Efforts Dierker

4. HIE and Health Care ReformPerspectives - Priorities Adapted Health Affairs June 2010 Buntin, Jain, Blumenthal XX = primary driver X = secondary driver

5. HIT/HIE and Health Reform States and Implementation • Insurance Exchange • Health Insurance Market regulation • Eligibility System Restructuring • Provider and Health System Capacity • Benefit Design • Dual Eligibles • Having and Using Data • Population Health Goals • Public Engagement • Performance from the Health Care System Data for risk adjustment? Data/HIE capacity key populations/providers: foster kids, LTC, b.health Technical interfaces: HIE,Insur Ex,HPlans, Elig/Enrollment? Dierker

6. Change at all Levels - Major Issues • Key design principles • Streamlining, the mobile pt at the center • Integrated strategies • New enterprise paradigm for IT • Statewide “master planning,” shared leadership and decisionmaking • Call for new business models and relationships • Opportunities for model development, demonstrations and advocacy • Business process analysis and redesign • Timing Dierker

7. Key Questions for State LeadersAcross Government, Sectors • What should the government do (vs the private sector)? • What is the right blueprint for “shared services” (e.g. HIE, Insurance Exchange)? • How should business processes be redesigned? • How best can shared investments be made, resources leveraged, new business models implemented? • How will decisions be made, leadership provided, projects managed to get the job done? Dierker

8. From the “As Is” to the “To Be”? State-level Leadership & Organization to Make it Real Stimulus - Reform Coordination State HIT Coordinator State Government State Designated Entity Medicaid CHIP Human Serv Public Health Corrections Other EHR Loans Public Sector Private Sector Dept of Commerce ONC AHRQ CMS Medicare CMS Medicaid HRSA Nat Science Foundation Dept of Agriculture Ins. Ex Beacon Communities Regional Extension Centers Local HIEs Academia Telehealth Consortia Physicians Labs Health Plans ACOs Community Clinics LTC Hospitals

9. ONC State HIE Program • Goal: Plan and develop the HIE infrastructure to ensure • Widespread interoperability across entire state • Providers and hospitals can achieve meaningful use Approval Required “Domains” to Address Types of Exchange • -Governance • -Finance • -Technical infrastructure • -Operations(Business- tech) • -Legal and Policy • Eligibility & claims transactions • *eRx & refill requests • *Lab ordering & results delivery • Public health reporting • Quality reporting • Rx fill status and/or med fill history • *Clinical summary for care coordination & patient engagement -Strategic Plan: State’s vision, goals, objectives and strategies for statewide HIE; including plans to support provider adoption -Operational Plan: Detailed explanation, targets, dates for execution of strategic plan HIT Coordinator Role

10. HITECH and Medicaid • Design principles = integration, flexibility, modernization • Collaboration and coordination • Innovation • Cost allocation, risk based approach • Financing: Enhanced 90% FFP administrative match • Administer Medicaid EHR incentive program (payments, oversight) • Pursue strategies to encourage adoption and meaningful use of certified EHR and HIE Dierker

11. Medicaid EHR ProgramSix Milestones for States • Approved Plans: • State Medicaid HIT Plan (SMHP) • PAPD and IAPD submissions (Planning - Implementation Advance Planning Documents) • Target launch date • Provider outreach • Capacity • Interface to NLR (interface control) • Accept provider attestations ≤ 3mo • Make provider payments ≤ 5 mo • Oversight e.g. risk based audits Dierker

12. 2011 2012 2013 2014 2015 State HIE Program ends Final year of REC Program • Medicare Incentives • Medicaid Incentives (optional start) HITECH PPACA • Insurance exchanges • Medicaid expansions • Medicare payment penalties for hospital-acquired conditions • Value-based modifier to Medicare physician fee schedule Bundled payment pilot • ACO Incentives • Medicare Value-based Purchasing Program • Plan for integrating PQRI with meaningful use New health home state option

13. The Timeline from 10,000 ft • Final rules in late spring/early summer 2010 • Medicare must begin in 2011 (statute) • States can decide when to start the Medicaid EHR Incentive Program • Medicare fee schedule reductions begin in 2015 • Medicare program ends in 2016 • Medicaid program continues through 2021 • CMS will revisit meaningful use for Stage 2 and 3 in future rulemaking Dierker

14. States’ Navigating Current Challenges • Pending State Plan approvals – draw down of resources • (Re) Structuring effective governance • Focus on integrated planning with Medicaid – State HIE • Effective planning, sequencing implementation • How to effectively deploying HIT Coordinator • Developing shared investment strategies - business model(s) for sustainability • Responding to evolving opportunities, capacity issues e.g. multi-state procurements, technology landscape • Navigating political-administrative changes Dierker

15. NASHP HIT Program • Under development • Leveraging existing programs, expertise • Targeting interface of HIT with Health Care Reform • Ldierker@nashp.org • Thank you! Dierker