Northwest Regional Primary Care Association2011 Spring Primary Care Conference

Health IT Funding, Writing Winning Grants, and Ensuring Ongoing Success

with Technology

23 May 2011Seattle, Washington

OCHIN, Inc.; PTSO of Washington

Presentation Overview

• Health IT financing

• Health IT grants

• Elements of winning grants

• Strategies for ongoing success with health IT (HIT)

Health IT FinancingSources for Upfront Funding• Vendors• Government grants• Private sources (e.g., hospitals)

Sources for Ongoing Funding• Vendors• Federal incentives for “meaningful use” of an electronic

health record

Health IT FinancingInitial Payment at Contract Signing• Financing (monthly or annual payments)

Staggered Payments• x% at Signing• x% at “Go-Live”• x% at x days past “Go-Live”

Reallocated Pricing• Lower install, higher maintenance costs

Health IT FinancingGreat time to borrow. Rates have never been lower and federal incentive payments for adopting EHRs can be used to service loans.

Health IT FinancingTraditional Capital Funding• Leasing Overview

– Tougher lending/leasing requirements vs. five years ago – Leasing brokers want to collateralize technology loans– Ask where the funding is coming from (the company or a 3rd party)– Be cautious! – Receive and review all documentation up front– Use your bank to review leasing contract

• Potential for predatory leasing– NAELB (National Association of Equipment Leasing Brokers)

• Two types of lease financing vehicles

1. Operating leases

2. Capital leases

Health IT FinancingTraditional financing• Banks• Forgivable loans from hospitals• Community Development Financial Institutions

Loans that are part of capital projects• Bonds (New Market Tax Credit)• HRSA loan guarantee program• USDA facilities program• Affordable Care Act (e.g., New Access Point, Health IT

and IT Network grants, etc.)

Recent HRSA GrantsPTSO Integrated Healthcare Home projectThree discrete but interrelated phases aimed at integrating primary, dental, and specialty care: • Customized Clinical Decision Support (CDS) with supportive

reporting capabilities• Electronic Dental Record (EDR)• On-line Patient Portal (Portal)

OCHIN Network Innovation GrantThree discrete but interrelated phases aimed at meaningful use: • Installation and meaningful use of EHRs in 16 new health centers• Develop and deploy online Patient Portal across entire network• Develop and deploy kiosks systems to facilitate check-in and patient

education

Health IT GrantsTraditional kinds of grants

• Federal appropriations (“entitlements”)

• Federal agencies (e.g., HRSA, USDA, etc.)

• Affordable Care Act (specific programs)

• Private foundations (grants and low-interest loans)

Health IT GrantsFederal appropriations (“entitlements”)• Entitlement grants often resulted from lobbying elected

officials

• Earmarks often attached to other spending bills are being fiercely debated in Congress

• Congress seems determined to dramatically reduce earmark spending

• Don’t count on entitlements for near future

Health IT GrantsFederal agencies (primary source for CHCs)

• HRSA – www.hrsa.gov/grants/index.html– Strong focus on health centers and HCCNs

• USDA Rural Development– www.rurdev.usda.gov/RD_Grants.html – Technology, broadband, equipment for rural service areas

• Affordable Care Act– ACA grant programs are in flux, but there are a number of

planning, facility, and health IT programs scheduled

Affordable Care Act Grants• Status of grants in flux given fiscal debates in Congress• We are often finding out when they are posted at

grants.gov• Search HRSA.gov/grants• Makes preparation difficult, but there are still things you

can be doing (e.g., self-assessment of need/goals, work with local REC)

• Look at previous opportunities to discover what needs to be done in advance of a grant (e.g., needs analysis, formalization of par

• Tried to contact HRSA to find out more

Sample of ACA Grants• Health Center Planning Grant• Health Center Program Grant  • New Access Point Grant • Rural Health Network Development Planning

Grant  • Rural Health HIT Network Grant• School-Based Health Centers• Nurse Managed Health Clinics• Etc. (I have asked HRSA to provide more info

via its website)

Health IT GrantsFoundation grants• Grants (from local and regional foundations and

corporations)– Knowledge of and commitment to local community– Requires significant matching– Long lead times from initial inquiry to award

• Program-Related Investments (PRIs)– Low-interest loans– Can be combined with grants to cover more of the

costs

Health IT GrantsCommunity development financial institutions (CDFIs)• Created to expand availability of credit, investment

capital, and financial services• Private-sector financial intermediary• Community-focused mission• Specialized lenders in niche markets• Best option for smaller scale projects (<$5M)• Can include equipment (EMRs)• For more info go to: www.cdfifund.gov

Writing Winning GrantsFederal grants• Follow directions!• Make it readable (clear and jargon-free)• Use the review criteria as your guide• Structure grant response work effort as a project; create and

use a formal project plan• Emphasize your proven HIT successes or partner with a

proven network• Write clearly to your audience - Don’t make it hard on the

reviewer!• Have someone else read your proposal; Employ a third party

to review and critique your application• Leave time for revision (writing is rewriting)

Writing Winning GrantsFederal grant proposals• Essentially a response to an Request For

Proposals = RFP• RFP includes checklist of requirements for the

narrative and the entire application package• The instructions for the narrative state (a) what

has to be included, (b) how many points assigned to each area, and (c) how the reviewers will be tasked to score the proposal

Writing Winning GrantsMajor components• Abstract• Narrative (typically the only scored component)• Budget and budget narrative• Documentation (letters of support, MOUs,

resumes, etc.)• Application forms (budget form, other

disclosures)

Writing Winning GrantsProject narrative• Most important component of proposal –

this is where you earn your score!• Applicant provides evidence of need,

program design, capability, evaluation, project staff and resources

• Write clearly and avoid jargon• Pay close attention to page limits and

other formatting requirements

Writing Winning GrantsTricks of the trade• Get to the DNA of the project early – develop project

abstract and budget early on• Develop narrative template based on RFP

requirements – and answer the questions clearly and concisely

• Write first draft early and plan to spend time revising – at least five drafts

• Clearly document how expenses will support project design – budget narrative

• Revise the abstract – first thing reviewers read

Writing Winning GrantsFoundation grants (varied approach)• Large regional or national foundations

– considerable resources, subject matter experts, directed giving, formal process

• Medium sized regional foundations – good local knowledge, opportunity to make connections,

formal process, significant resources

• Small local and family foundations – often generalists, family members make decisions, less

resources but shorter wait periods, may decide to fund long-term

Ongoing Success with ITHIT is only the tool• Goal is to leverage health IT systems to

test, prove, and support lasting care delivery reform

• Workflow and clinical protocol improvements primary focus

• Training and professional development is essential

Ongoing Success with ITNext steps• What are my options?

– Install and support your own systems– Work with a vendor (there are vendors who

are working with health centers)– Join a HCCN!

Ongoing Success with ITNext steps• Be realistic about your ability to support HIT

– Is your organization ready to assume support for complex and highly integrated HIT?

– Does your core mission include developing, implementing, and supporting HIT, or if this a better fit as an outsourced service?

– Assess your ability to attract, train, and retain HIT workforce

Ongoing Success with ITNext steps• Consider new costs

– Operating expense: staff and data center– Capital costs: equipment - 3 to 5 year refresh

cycle), multiple environments - Dev, Test, Train, Prod

– DR/BCP

Ongoing Success with ITHCCNs are intermediaries between health centers and vendors that deliver significant value by building capacity and supporting collaboration that bolster the capability of health centers to effectively use their health IT tools to achieve ongoing clinical, operational, and financial improvement goals

Health Center(client)

Health IT Vendor

(product)

HCCN(intermediary)

Focus on safety netCollaborative approach

Workflow evaluation and redesignEconomies of scaleQuality improvement

Population-based servicesTraining/workforce development

Disaster and risk mitigationLong-term partnership

Ongoing Success with ITLeveraging data to achieve strategic priorities• Most HCCNs believe that collaborative installation, optimization, and

use of HIT are the most essential components of success and its broader HCCN mission

• In the beginning, the main focus of the HCCNs was to support selection and successful implementation of PMS and EHR systems

• Today, the most successful networks are constantly enhancing their ability to leverage health IT and data to support their members’ quality improvement and sustainability

• HCCNs help health centers tap into effective relationships with other healthcare organizations, researchers, academic health centers, consultants, etc. and to develop and deploy coordinated strategies that support the medical home model and achieving Triple Aim Goals (i.e., improving public health, patient experience, and controlling costs)

Ongoing Success with ITReporting – Automation and enhancement of public health reporting and registration in insurance exchanges• Federal public health reports – HCCNs are leveraging EHRs to automate

Uniform Data System (UDS) reports. UDS data is critical for the HRSA to note and monitor trends and establish or expand programs and services in order to advance the health of underserved communities.

• State public health reports – HCCNs are working with rural and school-based health centers and migrant farm worker clinics and others to augment the kind, quality, and quantity of data transmitted to state health agencies

• Immunization reporting – Several HCCNs are completing bi-directional interfaces to state immunization systems to ensure more timely, less duplicative immunization records and forecasting.

• Insurance and Information exchanges – OCHIN recently applied to the Centers for Medicare and Medicaid Services to use its systems to enhance the identification of children and adults eligible for insurance exchanges mandated by the Affordable Care Act.

Ongoing Success with ITQuality Analysis – “You can’t improve what you can’t measure”• HCCNs understand that health IT systems (e.g., EHRs) alone are not

sufficient to improve the quality of care provided to patients.• Health centers need health IT applications that enable necessary data

collection, analysis, and reporting as well as support services to interpret and use these data to improve quality of and access to care for the underserved.

• Safety net providers are uniquely positioned to move from patient-specific disease management by taking advantage of HCCN’s data aggregation services, which are essential for advanced analysis and management of patient populations.• While the EHR will provide data to inform measurement, additional attention to data

cleanliness, aggregation, analysis, and application are necessary to improve quality and access to care.

• This necessitates more specialized staff and requires integration with other technology platforms and vendor software customizations

• Our populations have unique needs and require additional resources when compared with for profit and inpatient care.

Ongoing Success with ITAdditional technology perspectives and considerations• Ongoing HIT costs, 3 to 7% of revenue• Integration, integration, integration• Create a continuum of care for patients and providers• Increasing consumer role• Metric reporting will continue to increase

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Conclusion• Do research to find the right financing/grant opportunity

for your needs – don’t chase the money• Develop your plan internally – translate that into a clearly

written funding proposal that responds to the funder’s priorities (whether private or public)

• Engage a HCCN to help you install – get the ongoing technical and peer support you need to achieve long-term clinical, operational, and financial goals

• Use your local HIT regional extension center (REC) for more info on EHR products and financing– There are significant federal incentives for adopting now!

Thank You!

• Roy La Croix, CEO, PTSO of Washington – 206-613-8876; RLaCroix@PTSOWA.org

• Sean Whiteley-Ross, CFO, OCHIN– 503-943-2500; whiteley-rosss@ochin.org

• Tom Kuhn, Director of Grants, OCHIN– 503-943-2534; kuhnt@ochin.org