Stimulus Bill & HIE, RHIO Market
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Stimulus Bill & HIE, RHIO Market

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Overview of Stimulus Bill and its potential impact on the RHIO & HIE markets

Overview of Stimulus Bill and its potential impact on the RHIO & HIE markets

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    Stimulus Bill & HIE, RHIO Market Stimulus Bill & HIE, RHIO Market Presentation Transcript

    • Stimulus Bill & Health Exchange Market Impact & Analysis By: John Moore John@chilmarkresearch.com Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 1 expressed permission
    • Agenda Macro Market E.g., Stimulus, Provider Market, etc. Current Exchange Market Status, Trends Future Directions Stimulus Impact & Market Direction Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 2 expressed permission
    • Defining HIE & RHIO per NAHIT Health Information Exchange “The electronic movement of health-related information among organizations according to nationally recognized standards.” Internal governance => Hospitals, IDNs, etc Regional Health Information Organization An organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards. External governance => Govt., Payers, Foundations, etc. Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 3 expressed permission
    • Macro Market Trends: ARRA Legislation HITECH Act $300M Directly Targeting “Exchanges” Discretion of ONC director Administered by States Will target RHIOs Dwarfs Previous Federal Investments Other Potential Exchange Funding Sources: $1.5B Health Resources & Services Admin $85M Bureau of Indian Affairs $1.1B NIH & AHRQ Comparative Effectiveness projects may fund Exchanges (HIEs) at hospitals & IDNs Other Stimulus Funding for Exchanges??? $4B+ Broadband, SSA? Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 4 expressed permission
    • Implications of ARRA Legislation (cont.) “Meaningful Use of Certified EHR” Information Sharing for Care Coordination Quality Measures Reported eRx Implications for HIE & RHIOs? Extension of “Certified” to Include RHIO/HIE Technology? CCHIT ‘09 Certification Initiative Research & Extension Centers Focus on Interoperability Core premise of Exchanges New HIPAA Guidelines Consumer Consent & Breach Notification State Attorney Generals Can Sue Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 5 expressed permission
    • Implications of ARRA Legislation (cont.) Funding to States in Two Categories Planning Grants Less restrictive Bring together stakeholders to lay out framework, governance, etc. Forecast minority funding from ONC Implementation Grants (“Shovel Ready”) Must Have… Operating governance structure Detailed technical plan Defined clinical use cases Statewide privacy & security policies in place States Required to Provide Matching Funds After 2011 Rush to Get in Line Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 6 expressed permission
    • ARRA Requires HIT Standardization Secretary Must Adopt Standards for NHIN Deadline: Dec. 31, 2009 All Federal Agencies Must Follow Standards States will likely follow suit Voluntary for Private Entities (HIEs) But: Agencies shall require by contract or agreement the use of standards in new or upgraded systems Standards tied into ability to receive Medicare and Medicaid incentives Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 7 expressed permission
    • Looking Globally Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 8 expressed permission
    • United States vs. Rest of World cont. International Initiatives Based on Top-down Model Driven by National Entity Have a Clear Command Structure High-level Advisors Are Well-funded Long sales & delivery cycles Consistent within Country, not World Cultures, control, engagement Broad Adoption Obtainable National Health Systems drive adoption Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 9 expressed permission
    • United States vs. Rest of World US HIE/RHIO Initiatives are… Bottoms-up Model Local/Regional Consensus Based Significant Legal/Security Issues to Negotiate Funding a Challenge Little Consistency Trial and Error Broad Adoption Elusive Value for who? Exchange Activities in All 50 States Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 10 expressed permission
    • Status of State Initiatives Varies Widely Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 11 expressed permission
    • ~200 RHIOs/HIEs in US Today eHI and HIMSS Significantly Different HIMSS*: Extremely Broad Definition = 475 Exchanges 102 proposed eHI*: Tighter, More Govt. Focused = 130 Exchanges 75% Still in Formative Stages Majority Struggle with Business Model Many Failed Attempts Some barely surviving HIEs Tend to Perform Better Business Case is Clear Value proposition in place *HIMSS: Health Information Mgmt Systems Society *eHI: eHealth Initiative RHIOs & HIEs are Distinctly Different Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 12 expressed permission
    • RHIO Market -> Government Sponsored Driven by Government States: Keen Interest in RHIOs eHI Adoption #1 in 2007 Most have something happening in their State Localized More Failures than Successes Business model Define Value Prop. Leadership Governance Improve Quality, Safety & Lower Costs Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 13 expressed permission
    • Objectives Drive Attributes - (RHIOs) RHIOs Focus on Public Health Quality reporting Need for metrics/analytics Patient Safety Minimize ADEs Lower Costs Care Coordination Disease Mgmt Data aggregation & distribution Minimize duplicate testing Alerts Today, Strong Focus on eRx Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 14 expressed permission
    • Sustainability Remains a Challenge Over 80% Report Very to Moderate Difficulty in Creating Self-Sustaining Model Financial Models in State of Flux Subscription or Transaction Fees Dominant Often insufficient Migration to Value-added Services Produce reports (eg Quality) Coordinate financial incentives EMR implementation guidance EMR data uploads Workflow analysis Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 15 expressed permission
    • HIE Market Driven by Hospitals & IDNS More Difficult to Measure Number of HIEs Wide Range of Deployments Wide range of Models Some in HIMSS numbers are little more than a portal A Portal is not an Exchange Most Large IDNs Have Something Live or “In the Works” Increasing Interest in Highly Competitive Markets Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 16 expressed permission
    • Objectives Drives Attributes (HIEs) HIEs Focus on Erecting Competitive Barriers Strengthen & Retain Relationships Affiliated Practices & Physicians Ease data access Push via publish/subscribe Drive Revenue Facilitate transactions Keep referrals, orders, etc. in network Lower Costs Distribution of results Tap P4P Initiatives Analytics for reporting Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 17 expressed permission
    • Two Dominant Architectures Repository (Hub n’Spoke) - Common in RHIOs Ph1 Ph2 H1 H2 Positives: Common Data Model & GUI, Common Security/Access, L1 L2 Population Health Hub Challenges: Negotiating Data Im1 Im2 Ownership, Complex and Long Implementations, Cost Sharing, Rx1 Rx2 Higher Upfront Costs Pa1 Pa2 Example: Axolotl Struggles with Complex Data Ownership Issues Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 18 expressed permission
    • Two Dominant Architectures (cont.) Federated - Common in HIEs Positives: Fast Installs, Data H1 Ph1 Ph2 H2 Ownership Preserved, Lower Upfront Costs L1 L2 Challenges: Scalability, Im1 Im2 Security/Access, Standards, Population Health Studies Rx1 Pa1 Pa2 Rx2 Example: Novo Innovations Federated Architecture Does Not Scale Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 19 expressed permission
    • Cloud on the Horizon? Utility Service Model Im1 H1 Ph1 Ph2 H2 Im2 Positives: Similar to Repository, Scalability, L1 L2 Lower Costs? Pa1 Pa2 Challenges: Access Privileges, Audit Trail, Data Rx1 Rx2 Ownership Utility Example: HealthVault, Google Health Trust in a Third Party Entity? Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 20 expressed permission
    • Future Trends Massive Stimulus Funding will Distort Market More than Doubles Current Exchange Software Market Strong Likelihood of Many More “Santa Barbaras” Current NHIN Vision will Never Materialize Too Many X-State Data Ownership & Regulatory Issues ARRA makes situation worse with new State AG powers NHIN will Model Rail System in US, vs. Interstate System Health Clouds will Resolve Data Ownership & Consent Issues for “Engaged Consumers” Despite Funding, RHIO Market will Remain Difficult for Vendors HIE Market: Far More Lucrative Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 21 expressed permission
    • Key Points Two Distinct Markets, HIEs & RHIOs Requires Separate Go-to-Market Strategies Little Overlap in Operational Structure Modest Overlap in Needs No Dominant Vendors Large HIT/EMR Vendors are Out RHIOs are Migrating to Services Exchanges Moving Beyond Subscription/Transaction Model Payers Stepping Up to the Plate Large Employers Beginning to Engage Other Federal Agencies Showing Interest SSA is Getting Increasingly Involved Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 22 expressed permission
    • ??? Big Question Marks Will ONC Legitimize CCHIT CCHIT Released New ‘09 Certification Guidelines for Exchange Solutions Focus on Security & Simple Exchange Exchange one of three scenarios Will Health Banks Gain Trust=Traction Hybrid, Consumer/Patient-centric Track Roll-out in WA State, 3 Sites 1 Google Health & 2 HealthVault New HIPAA Guidelines Interpretation of Consent in HITECH Act Implications to Data Ownership & Sharing Definition of “Meaningful Use of EHR” Legislation Highlights Info Sharing Proof via an Exchange? Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 23 expressed permission
    • Final Thoughts… Does RHIO Know What They Are Doing? Do they Understand Value Proposition? For whom? Ultimately, it must work for Physician!!! 2009 is the Set-up Year for RHIOs 2010 Funding for Shovel Ready - a Rush? 2011 States Provide Matching Funds HIEs will Move Ahead Steadily in Competitive Markets Wild Card: “Meaningful Use of EHR” Copyright: Chilmark Research For internal use only, not for distribution without March 4, 2009 24 expressed permission