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


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  • Regional exchanges proliferate, a new challenge arises: How to cost effectively connect and integrate more and more complex data, systems.
  • The federal health reform law contains many of the elements states need to achieve major improvements in their health care systems. While states will face significant challenges implementing the new law—in part due to the many tasks they must complete, and in part due to the extremely constrained financial and staff resources available to them—states that rise to the occasion will find that they are rewarded for their efforts. There is a natural tendency to focus the implementation discussion on the most immediate issues—for example the state’s choice regarding the high risk pool. Indeed, you must tackle these issues, but it is equally important that you begin thinking about and planning for the many aspects of implementation that occur in later years, particularly in 2014 when many of the law’s provisions take effect. In NASHP’s analysis of the health reform legislation and in conjunction with our executive committee – a group of state officials working across branches of government in many different states – we identified 10 critical components of successful state health reform implementation. Since my time is short, I will just give several brief examples linked to some of the bullets that seemed of most importance to those Kentucky policymakers and officials we spoke with: Expand provider and health system capacity; pursue population health goals; and engage the public in policy development and implementation.
  • Three tracks... Must Have...plans.... Must Address...domains
  • HIT in the “New World” States, HITECH and Health Reform

    1. 1. HIT in the “New World” States, HITECH and Health Reform Lynn Dierker NASHP Annual Meeting October 6, 2010
    2. 2. The Evolving HIT Context Dierker
    3. 3. HITECH: Build, Expand, Demonstrate MU Anchored by State & Regional Efforts Dierker ITEM AGENCY STATUS State Health Information Exchange Grants (HIE) State or state designated entity <ul><li>All states/territories - Cooperative agreements </li></ul><ul><li>$4-$40 million per state, over $500 million total </li></ul><ul><li>Strategic/Operational plans - ONC approved ( in process) </li></ul><ul><li>Technical assistance program </li></ul>Beacon Community Program ( Demonstrate impact) State agencies Non-profit IDNs Health Information Organizations (HIOs) Regional Extension Centers <ul><li>17 Competitive awards @ $10-$20 million each </li></ul><ul><li>Grantees have advanced HIE and HIT capacity </li></ul><ul><li>Demonstrate improved access, quality, efficiency </li></ul><ul><li>Technical assistance program ( procurement in process ) </li></ul>Regional Extension Centers (Adoption ) Non-for-profit entity per region of 1,000 primary care docs <ul><li>60 competitive awards, over $640m funding/2 rounds </li></ul><ul><li>Entities (mixed), non-overlapping geographic areas </li></ul><ul><li>Soliciting primary care practices: use certified EHR </li></ul><ul><li>Must achieve sustainability </li></ul>Administration of Medicaid Incentives (All of the above plus payment reform) State Medicaid Agency <ul><li>All states eligible </li></ul><ul><li>Planning, Implementation, federal match:90% admin$ </li></ul><ul><li>Optional start date, program begins 2011 - 2021 </li></ul><ul><li>Technical assistance ( procurement in process ) </li></ul>
    4. 4. HIE and Health Care Reform Perspectives - Priorities Adapted Health Affairs June 2010 Buntin, Jain, Blumenthal XX = primary driver X = secondary driver 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
    5. 5. HIT/HIE and Health Reform States and Implementation <ul><li>Insurance Exchange </li></ul><ul><li>Health Insurance Market regulation </li></ul><ul><li>Eligibility System Restructuring </li></ul><ul><li>Provider and Health System Capacity </li></ul><ul><li>Benefit Design </li></ul><ul><li>Dual Eligibles </li></ul><ul><li>Having and Using Data </li></ul><ul><li>Population Health Goals </li></ul><ul><li>Public Engagement </li></ul><ul><li>Performance from the Health Care System </li></ul>Data for risk adjustment? Technical interfaces: HIE,Insur Ex,HPlans, Elig/Enrollment? Data/HIE capacity key populations/providers: foster kids, LTC, b.health Dierker
    6. 6. Change at all Levels - Major Issues <ul><li>Key design principles </li></ul><ul><ul><li>Streamlining, the mobile pt at the center </li></ul></ul><ul><ul><li>Integrated strategies </li></ul></ul><ul><li>New enterprise paradigm for IT </li></ul><ul><li>Statewide “master planning,” shared leadership and decisionmaking </li></ul><ul><li>Call for new business models and relationships </li></ul><ul><li>Opportunities for model development, demonstrations and advocacy </li></ul><ul><li>Business process analysis and redesign </li></ul><ul><li>Timing </li></ul>Dierker
    7. 7. Key Questions for State Leaders Across Government, Sectors <ul><li>What should the government do (vs the private sector)? </li></ul><ul><li>What is the right blueprint for “shared services” (e.g. HIE, Insurance Exchange)? </li></ul><ul><li>How should business processes be redesigned? </li></ul><ul><li>How best can shared investments be made, resources leveraged, new business models implemented? </li></ul><ul><li>How will decisions be made, leadership provided, projects managed to get the job done? </li></ul>Dierker
    8. 8. From the “As Is” to the “To Be”? State-level Leadership & Organization to Make it Real Physicians Labs Health Plans ACOs Community Clinics LTC Hospitals Beacon Communities Regional Extension Centers Local HIEs Academia Telehealth Consortia ONC AHRQ CMS Medicare CMS Medicaid HRSA Dept of Commerce Dept of Agriculture Nat Science Foundation Ins. Ex State HIT Coordinator Stimulus - Reform Coordination S tat e Government Medicaid CHIP Public Health C orrection s Other Human Serv State Designated Entity Public Sector Private Sector EHR Loans
    9. 9. ONC State HIE Program 9 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 <ul><ul><li>-Governance </li></ul></ul><ul><ul><li>-Finance </li></ul></ul><ul><ul><li>-Technical infrastructure </li></ul></ul><ul><ul><li>-Operations(Business- tech) </li></ul></ul><ul><ul><li>-Legal and Policy </li></ul></ul><ul><li>Goal: Plan and develop the HIE infrastructure to ensure </li></ul><ul><ul><li>Widespread interoperability across entire state </li></ul></ul><ul><ul><li>Providers and hospitals can achieve meaningful use </li></ul></ul>Types of Exchange <ul><ul><li>Eligibility & claims transactions </li></ul></ul><ul><ul><li>*eRx & refill requests </li></ul></ul><ul><ul><li>*Lab ordering & results delivery </li></ul></ul><ul><ul><li>Public health reporting </li></ul></ul><ul><ul><li>Quality reporting </li></ul></ul><ul><ul><li>Rx fill status and/or med fill history </li></ul></ul><ul><ul><li>*Clinical summary for care coordination & patient engagement </li></ul></ul>HIT Coordinator Role
    10. 10. HITECH and Medicaid <ul><li>Design principles = integration, flexibility, modernization </li></ul><ul><ul><li>Collaboration and coordination </li></ul></ul><ul><ul><li>Innovation </li></ul></ul><ul><ul><li>Cost allocation, risk based approach </li></ul></ul><ul><li>Financing: Enhanced 90% FFP administrative match </li></ul><ul><ul><li>Administer Medicaid EHR incentive program (payments, oversight) </li></ul></ul><ul><ul><li>Pursue strategies to encourage adoption and meaningful use of certified EHR and HIE </li></ul></ul>Dierker
    11. 11. Medicaid EHR Program Six Milestones for States <ul><li>Approved Plans: </li></ul><ul><ul><li>State Medicaid HIT Plan (SMHP) </li></ul></ul><ul><ul><li>PAPD and IAPD submissions (Planning - Implementation Advance Planning Documents) </li></ul></ul><ul><li>Target launch date </li></ul><ul><li>Provider outreach </li></ul><ul><li>Capacity </li></ul><ul><ul><li>Interface to NLR (interface control) </li></ul></ul><ul><ul><li>Accept provider attestations ≤ 3mo </li></ul></ul><ul><ul><li>Make provider payments ≤ 5 mo </li></ul></ul><ul><ul><li>Oversight e.g. risk based audits </li></ul></ul>Dierker
    12. 12. 2011 2012 2013 2014 2015 <ul><li>ACO Incentives </li></ul><ul><li>Medicare Value-based Purchasing Program </li></ul><ul><li>Plan for integrating PQRI with meaningful use </li></ul><ul><li>Insurance exchanges </li></ul><ul><li>Medicaid expansions </li></ul><ul><li>Medicare payment penalties for hospital-acquired conditions </li></ul><ul><li>Value-based modifier to Medicare physician fee schedule </li></ul>New health home state option Bundled payment pilot <ul><li>Medicaid Incentives (optional start) </li></ul><ul><li>Medicare Incentives </li></ul>State HIE Program ends Final year of REC Program HITECH PPACA
    13. 13. The Timeline from 10,000 ft <ul><li>Final rules in late spring/early summer 2010 </li></ul><ul><li>Medicare must begin in 2011 (statute) </li></ul><ul><li>States can decide when to start the Medicaid EHR Incentive Program </li></ul><ul><li>Medicare fee schedule reductions begin in 2015 </li></ul><ul><li>Medicare program ends in 2016 </li></ul><ul><li>Medicaid program continues through 2021 </li></ul><ul><li>CMS will revisit meaningful use for Stage 2 and 3 in future rulemaking </li></ul>Dierker
    14. 14. States’ Navigating Current Challenges <ul><li>Pending State Plan approvals – draw down of resources </li></ul><ul><li>(Re) Structuring effective governance </li></ul><ul><li>Focus on integrated planning with Medicaid – State HIE </li></ul><ul><li>Effective planning, sequencing implementation </li></ul><ul><li>How to effectively deploying HIT Coordinator </li></ul><ul><li>Developing shared investment strategies - business model(s) for sustainability </li></ul><ul><li>Responding to evolving opportunities, capacity issues e.g. multi-state procurements, technology landscape </li></ul><ul><li>Navigating political-administrative changes </li></ul>Dierker
    15. 15. NASHP HIT Program <ul><li>Under development </li></ul><ul><li>Leveraging existing programs, expertise </li></ul><ul><li>Targeting interface of HIT with Health Care Reform </li></ul><ul><li>[email_address] </li></ul><ul><li>Thank you! </li></ul>Dierker