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

Lynn DierkerNASHP Annual Meeting

October 6, 2010

The Evolving HIT Context

2Dierker

3

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

ITEM AGENCY STATUS

State Health Information Exchange Grants

(HIE)

State or state designated entity

•All states/territories - Cooperative agreements•$4-$40 million per state, over $500 million total •Strategic/Operational plans - ONC approved (in process)•Technical assistance program

Beacon Community Program

(Demonstrate impact)

State agencies

Non-profit IDNs

Health Information Organizations (HIOs)

Regional Extension Centers

•17 Competitive awards @ $10-$20 million each•Grantees have advanced HIE and HIT capacity• Demonstrate improved access, quality, efficiency•Technical assistance program (procurement in process)

Regional Extension Centers

(Adoption)

Non-for-profit entity per region of 1,000 primary care docs

•60 competitive awards, over $640m funding/2 rounds•Entities (mixed), non-overlapping geographic areas•Soliciting primary care practices: use certified EHR•Must achieve sustainability

Administration of Medicaid Incentives

(All of the above plus payment reform)

State Medicaid Agency •All states eligible•Planning, Implementation, federal match:90% admin$•Optional start date, program begins 2011 - 2021•Technical assistance (procurement in process)

Dierker

HIE and Health Care ReformPerspectives - Priorities

Improve Quality Reduce Costs Access/coverage

Measure Reward Payment Reform

Care coordination

Admin Simplification

Pt Engage Affordability

Adoption/MU

XX XX X XX X XX X

REC X X

HIEs X X XX X XX

Workforce

Beacon Communities

X XX XX XX XX

NHIN X X XX X XX

Policy & Standards

X XX XX X

4Adapted Health Affairs June 2010 Buntin, Jain, Blumenthal

XX = primary driver X = secondary driver

HIT/HIE and Health Reform States and Implementation

1. Insurance Exchange

2. Health Insurance Market regulation

3. Eligibility System Restructuring

4. Provider and Health System Capacity

5. Benefit Design

6. Dual Eligibles

7. Having and Using Data

8. Population Health Goals

9. Public Engagement

10. Performance from the Health Care System

5

Data for risk adjustment?

Technical interfaces: HIE,Insur Ex,HPlans, Elig/Enrollment?

Data/HIE capacity key populations/providers: foster kids, LTC, b.health

Dierker

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

6Dierker

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?

7Dierker

From the “As Is” to the “To Be”?State-level Leadership & Organization to Make it Real

Physicians Labs Health Plans ACOs Community Clinics LTC HospitalsPhysicians Labs Health Plans ACOs Community Clinics LTC Hospitals

Beacon CommunitiesRegional

Extension CentersLocal HIEs

AcademiaTelehealth Consortia

ONC AHRQCMS

MedicareCMS

MedicaidHRSA

Dept ofCommerce

Dept of Agriculture

Nat Science Foundation

State HITCoordinator

Stimulus - ReformCoordination

State GovernmentState Government

MedicaidCHIP

PublicHealth

CorrectionsOther

HumanServ

State Designated EntityState Designated Entity

PublicSector

PrivateSector

EHR Loans

Ins.Ex

9

ONC State HIE Program

Approval Required “Domains” to Address

-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

-Governance-Finance-Technical infrastructure-Operations(Business- tech)-Legal and Policy

Goal: Plan and develop the HIE infrastructure to ensure•Widespread interoperability across entire state•Providers and hospitals can achieve meaningful use

Types of Exchange

– 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 engagementHIT Coordinator Role

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

10Dierker

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

11Dierker

2011 2012 2013 2014 2015

HITECH

PPACA

•ACO Incentives •Medicare Value-based Purchasing Program•Plan for integrating PQRI with meaningful use

•Insurance exchanges •Medicaid expansions

•Medicare payment penalties for hospital-acquired conditions•Value-based modifier to Medicare physician fee scheduleNew health

home state option

Bundled payment pilot

•Medicaid Incentives (optional start)

•Medicare Incentives

State HIE Program endsFinal year of REC Program

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

13Dierker

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

14Dierker

NASHP HIT Program

• Under development

• Leveraging existing programs, expertise

• Targeting interface of HIT with Health Care Reform

• Ldierker@nashp.org

• Thank you!

15Dierker