March 15, 2007 Page 1
The National Landscape and Wisconsin’s Role
eHealth Implementation SummitGovernor Doyle’s
eHealth Care Quality and Patient Safety BoardMadison, Wisconsin
Janet M. MarchibrodaChief Executive Officer
eHealth Initiative and FoundationMarch 15, 2007
March 15, 2007 Page 2
Congratulations!
For your leadership, within the Governor’s office, the state, and every sector of healthcare in Wisconsin
For the creation of the Wisconsin eHealth Action Plan…
Your long standing history of collaboration around quality and patient safety, and healthcare IT leadership positions you well for enormous success
March 15, 2007 Page 3
Overview of Presentation
Emerging National Standards and Policies Offer a Foundation for Health Information Sharing
State Leadership: An Overview of What’s Happening in the Field
Getting to Implementation: Key Insights for State and Community Leaders
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National Policies and Standards Offer Foundational Building Blocks
for Health IT and HIE Standards for Health IT and Interoperability:
– Outcomes emerging from HITSP process offer guidance; CCHIT for which government has provided seed funding, offers implementation mechanism
– Federal government compliance with standards will begin to drive critical mass
– President’s Executive Order and DHHS Sec. Four Cornerstones have stimulated private sector purchaser/employer sign-on to requirements for standards for health IT
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National Policies and Standards Offer Foundational Building Blocks for
Health IT and HIE Congressional and Executive Branch Actions
Signal Changes in Payment Policy– President’s Aug 2006 Executive Order calls for
transparency in quality and pricing and directs Federal agencies to “develop and identify approaches that facilitate high quality and efficient care”….Secretary’s Four Cornerstones is driving action by key federal agencies
– Principles of “Four Cornerstones” being rapidly “adopted” by the private sector, with over 200 employers having “signed on”, issuing their vote of support….standard “RFI’s” now include expectations for reporting as well as health IT
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National Policies and Standards Offer Foundational Building Blocks for
Health IT and HIE Congressional and Executive Branch Actions
Signal Changes in Payment Policy– The Tax Relief and Health Care Act of 2006 (H.R.
6111) calls for bonuses to those who report voluntarily on quality measures-- structural measures, such as the use of EHRs and eRx along with reporting of consensus-based measures required in 2008
– Bill also calls for a three year demonstration project on the “medical home” which cannot happen without information mobility and a health IT infrastructure
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National Policies and Standards Offer Foundational Building Blocks for
Health IT and HIE
Congressional and Executive Branch Actions Signal Changes in Payment Policy– March 2007 MEDPAC recommendations call for
changes in payment policy that cannot be achieved without health information mobility, and specifically refers to health IT
March 15, 2007 Page 8
National Policies and Standards Offer Foundational Building Blocks for
Health IT and HIE Some Funding Continuing to Emerge to Capitalize
Early Efforts, and Technical Assistance Efforts Continue– ONC expected to fund states and communities who will
implement “trial implementations” of the Nationwide Health Information Network
– AHRQ now reviewing several applications for funding which evaluate use of health IT for quality and safety
– A majority of Medicaid Transformation grants focus on HIT– Technical assistance being offered by AHRQ (National
Resource Center for Health IT), HRSA (federally qualified community health centers), and CMS (QIO Eighth Scope of Work – support to physician practices)
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State Level ActivityWhat’s Happening?
Over half the states in the country are developing or implementing plans related to health information technology
Emphasis on quality, patient safety and curbing rising healthcare costs rank high as the primary drivers for state leadership around health information technology.
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State Level Activity: eHI Survey Results
Recognition of the need for HIE among multiple stakeholders in your state, region, or community
No coordinated, statewide activity
Stage 1AWARENESS15%
Stage 2REGIONALACTIVITY17%
Stage 3STATE LEADERSHIP25%
Stage 4STATEWIDE PLANNING 29%
Stage 5STATEWIDEPLAN 8%
Regional or community-specific HIE activity
Silos of HIE activity with possibly some cross-over
No coordinated, statewide activity
Either legislation has been passed or an executive order issued
Statewide planning initiative being formulated
Well underway with coordinated, statewide planning
Structures in place have statewide representation
Clear on how to deliver statewide plan
Implementation of state plan or Roadmap is well underway, with key milestones completed
Stage 6STATEWIDEIMPLEMENTATION6%
Plan / Roadmap complete and accepted
Plan / Roadmap communicated to the public
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eHI’s Recent Analysis of Leadership by Governors
Fourteen executive orders were issued by U.S. governors calling for HIT and HIE to improve health and healthcare– Arizona, 2005– California, 2006– Florida, 2004– Georgia, 2006– Illinois, 2006– Kansas, 2004– Mississippi, 2007– Missouri, 2006– North Carolina, 1994– Tennessee, 2006– Texas, 2006– Virginia, 2006– Wisconsin, 2005– Washington, 2007
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eHI’s Recent Analysis of State Legislative Activity
HIT State Legislative Activity Is on the Rise. State legislatures are increasingly recognizing the importance of IT in driving health and healthcare improvements.
In 2005 and 2006:– 38 state legislatures introduced 121 bills which
specifically focus on HIT – 36 bills were passed in 24 state legislatures and
signed into law. In 2007 So Far:
– 17 bills have been introduced in 10 states which specifically focus on HIT
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eHI’s Recent Analysis of State Legislative Activity
Focus of HIT State Legislative Action The authorization of a commission, committee,
council or task force to develop recommendations
The development of a study, set of recommendations, or a plan for HIT
The integration of quality goals within HIT-related activities; or
The authorization of a grant or loan program designed to support HIT
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Critical Role of States• Participant in the dialogue• Convener of the dialogue• Providing funds • Commissioning or funding a study • Providing education to stakeholders • Requiring use of standards (a la Four Cornerstones)• Providing financial and other incentives through
Medicaid • Providing financial and other incentives in role as
purchaser • Integrating other functions of the state with the work
of the private sector (e.g. public health, etc.)
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State-Wide Dialogue
Establishing policies for information sharing (assuring privacy and confidentiality), Federal government funding initiatives
Removing regulatory barriers Integration of public health goals into health IT
strategy Facilitating integration with Medicaid program Education and awareness-building, targeting all
stakeholders, including consumers Sharing of best practices among regions and
stakeholders in the state
March 15, 2007 Page 17
Insights About Wisconsin’s Plan Your plan focuses on improving the health and
healthcare for the citizens of Wisconsin…which is absolutely the right strategy
Incremental, thoughtful, feasible Supporting both health IT adoption and health
information exchange (we need both) Recognizing the importance of aligning health IT platform
with both value-based purchasing strategies and disease/chronic care management is critical
It’s actionable, it’s measurable….it’s business-like Positions you well for great success Congratulations!
March 15, 2007 Page 19
Getting to ImplementationSome Key Questions
How should communities leverage the initial capital/grants we’ve received to develop a sustainable business model for health IT and health information exchange?
What should communities do first? What provides the most value?
How do we support clinician adoption?
March 15, 2007 Page 20
eHI 2006 SurveyMost Difficult Challenges
Securing upfront funding – (57 percent) Developing a sustainable business model
– (44 percent) Accurately linking patient data – (30
percent)
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eHI 2006 SurveySources for Upfront Funding
Federal Government – (42 percent) State or Local Government – (29 percent) Hospitals – (24 percent) Philanthropic – (23 percent)
March 15, 2007 Page 22
eHI 2006 SurveyFunding Sources for Ongoing Operations
Hospitals – (24 percent) Payers – (21 percent) Physician practices – (16 percent) Labs – (13 percent) Philanthropic (9 percent)
March 15, 2007 Page 23
Getting to SustainabilityConnecting Communities Program
Background Provided funding support for 13 learning
laboratories in ten communities, related to health information exchange
Engaged an expert panel, including not only healthcare experts, but also experts in economics, business, and financing
Took a very close look at three advanced stage communities in IN, OH and NY
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Getting to SustainabilityEarly Key Findings
Sustainability of health information exchange is indeed possible, and probable if certain factors are in place….
No “one-size-fits-all” approach or silver bullet, it depends on the market’s needs and requirements
Social capital formation is necessary for leaders to identify and coalesce divergent interests in a common cause ….due to fragmentation of our healthcare system and current payment policy
Time, commitment, charisma and honesty are required to keep a large, diverse stakeholder group at the table. Managing an HIE is not a part-time job and consistent execution is necessary to maintain the social capital that has been created as part of the initial endeavor
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Getting to SustainabilityEarly Key Findings
Social capital will help communities build trust and develop consensus on policies for information sharing
Strong leadership team with good business acumen is one of the key criteria for success as communities move to the implementation stage
Rigorous analysis of the value that potential services provide to each customer is crucial…
Need to better understand how value for each customer translates to revenue to cover the costs of the endeavor. This takes time and discipline…and business orientation
Today, while many community leaders understand this concept, it is often not well executed
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Exploring Areas of Value
Highlights of 2006 eHI Survey of Health Information Exchange at State and Local Levels– Fielded in May 2006– Includes 165 responses from health
information exchange (HIE) initiatives located in 49 states, the District of Columbia and Puerto Rico.
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eHI 2006 Survey: Who’s Involved Stakeholder Engagement
Engagement of the multiple stakeholders in healthcare is expanding considerably.
Largest increases in:– Hospitals – 96%– Health plans – 69%– Employers – 54%– Primary care physicians – 91%
What does this mean for the value proposition?
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eHI 2006 SurveyTypes of Data Exchanged
Laboratory – (26 percent) Claims – (26 percent) ED Episodes – (23 percent) Dictation – (22 percent) Inpatient Episodes – (22 percent) Outpatient Lab – (22 percent) Radiology – (20 percent) Outpatient Prescriptions – (18 percent)
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eHI 2006 SurveyServices Provide Value that Focuses
on Care Delivery for Providers
Clinical documentation (26 percent) Results delivery (25 percent) Consultation/referral (24 percent) Electronic referral processing (23 percent) Alerts to providers (20 percent)
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eHI 2006 SurveyNew Valuable Services are Emerging
Chronic or Disease Management – (20%) Quality Performance Reporting for
Purchasers or Payers – (11%) Quality Performance Reporting for
Clinicians – (10%) Public Health Surveillance Consumer Access to Information (in light of
rapidly emerging PHR initiatives)
March 15, 2007 Page 31
Taking a Harder Look at the Use of Health Information Exchange to
Support Quality Improvement and Performance Reporting
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BTE-Funded Towers Perrin Study Identifies Measures That Produce Improvements in Cost and Quality
HTN 42 BP<140/90 HTN 43 SBP<140 HTN 44 DBP<90 DM 23 BP<140/90 DM 21 HbA1c>9% DM 22 HbA1c<7% DM 25 LDL<100 DM 26 LDL<130 CAD 6 LDL<100 after discharge for AMI, CABG, PCI CAD 7 LDL<130 after discharge for AMI, CABG, PCI CAD 8 LDL<100 any CAD CAD 9 LDL<130 any CAD
March 15, 2007 Page 33
You Really Need Clinical and Claims Data to Make This all Work
Health Information Exchange
Claims Data Aggregation
Plan A
Plan B
Plan C
Medicaid
Medicare
March 15, 2007 Page 34
eHI’s Parallel Pathways Framework requires alignment
You Can’t Get There Without Building the Information Foundation
Quality and Value
Quality Expectations Quality Expectations
Physician Practice HITCapabilities
Physician Practice HITCapabilities
Health Info Exchange Capabilities
Health Info Exchange Capabilities
Financial IncentivesFinancial Incentives
March 15, 2007 Page 35
Points of Intersection:Health IT and Value-Driven Healthcare Both require leadership and multi-stakeholder
collaboration at the market level Value driven healthcare needs a health IT infrastructure
to effectively and efficiently measure quality (particularly as we look at 2008 expectations)
Health IT facilitates quality improvement at the same time as performance measurement…which is critical
Health IT enables care coordination which is a necessary component of value-driven healthcare
Health IT provides necessary linkages to clinical data for consumer engagement strategies to support consumer activation for healthcare improvement
So…..incentives should support process, structure and outcomes…and all align with health IT
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We’re at a Unique Point in Time
The confluence of efforts surrounding not only health IT but also value-driven healthcare and consumer activation, create an enormous opportunity for transformation in Wisconsin and across the U.S. healthcare system.
March 15, 2007 Page 38
Janet M. MarchibrodaChief Executive Officer
eHealth Initiative and Foundation
www.ehealthinitiative.org818 Connecticut Avenue, N.W., Suite 500
Washington, D.C. 20006202.624.3270