How can HIEs access 90/10 and Federal funding and expand their exchange We examined the opportunities to capture funding from CMS to develop core HIE services, public health infrastructure, electronic Clinical Quality Measurement (eCQM) infrastructure, and provider onboarding. This webinar demonstrated how to some innovative HIEs are leveraging these grants and have elected multiple funded activities to boost growth, expand regional interoperability, and upgrade to higher performing technology stacks. George Beckett, Chief Business Development Officer at the Cedar Bridge Group and Orion Health’s Director, Laura Young, about the process to request funding for health information exchange (HIE) infrastructure. In this webinar, we explained: 1. The CMS 90/10 funding opportunities for private and public HIEs 2. The funding strategy used by NDHIN and their 5-year business plan 3- How NDHIN has created a solid data foundation for their data strategy and how they are expanding their infrastructure

1. HOW CAN HIES
ACCESS 90/10 AND
FEDERAL FUNDING
AND EXPAND THEIR
EXCHANGE
WEBINAR SPONSORED BY ORION HEALTH
11/30/2016, 2:00-3:00PM ET

2. AGENDA
• Introduction to Orion Health
• Introduction to Cedar Bridge Group
• Goals for today
• North Dakota HIN presentation
• CMS 90/10 Funding Plan
• Industry trends
• New foundational platform and pop health
applications requirements
• Q&A
GEORGE BECKETT
Chief Business Development Officer,
Member of the board of the state of
Tennessee HIMSS Chapter
LAURA YOUNG
Director of Industry Relations & Solutions Consulting,
Vice Chair of the HIMSS Interoperability
& Health Information Exchange Committee,
President of the board of the Arizona HIMSS Chapter

3. Page 3 • 2016 © Orion Health™ group of companies
Orion Health | Interoperability and PHM Customers Around the World
55 PHM
communities
worldwide
102 million
patient
records
viewed
Over 60 US
health
departments
30+ large
CINs, ACOs,
and HIEs in
the US

4. Page 4 • 2016 © Orion Health™ group of companies
Our People | Global Footprint
1
Mexico
243
United States
16
Canada
5
Spain
2
Italy
1
Greece
1
Turkey
1
Kuwait
34
UK
4
Ireland
4
Belgium
2
Netherlands
3
Denmark
1
Norway
2
Austria
1
Germany
1
Sweden
1
Finland
1
Saudi Arabia
2
Qatar
1
UAE
1
India
1
Thailand
1
Hong Kong
1
Malaysia
1
Singapore
14
Australia
20
New Zealand
73
China
2
Korea
4
Japan
1
Russia
1
Argentina
1
South Africa
4
France
Orion Health | Global Clients & Offices

5. Page 5 • 2016 © Orion Health™ group of companies
Orion Health | Unique Qualifications in the New Era of Healthcare
FUTURE-PROOF
ARCHITECTURE
FOCUS
EXPERIENCE
POPULATION
& PRECISION
HEALTH
END-TO-END
SOLUTION

6. NDHIN FIVE YEAR
BUSINESS PLAN
BUILDINGCAPACITY,USAGE,ANDVALUE.
Presented by George Beckett, Cedar Bridge
Group, for Sheldon H. Wolf, Director of the
North Dakota Health Information Technology

7. North Dakota Facts
42
Hospitals
186
Provider
Organizations
2
Major Payers:
Blue Cross & Sanford Health
880,000
Patients in eMPI
19th
Largest State
36
Critical Access Hospitals

8. North Dakota Critical Access Hospitals & Referral Centers

9. NDHIN Innovative Services Today
Communicate Hub
DIRECT secure messaging
(over 800 messages per week)
Alerts and
notifications
Clinical portal with
claims and clinical data
(500 record look-ups per week)
Prescription
drug-monitoring
program
Longitudinal medical
record with
image viewing
Real-time public health
reporting

10. CedarBridge Group Contract Elements
1) Environmental Scan
3) Future State Brief
2) Best Practices Brief
4)Return on Investment Brief
5) Five-Year Business Plan

11. NDHIN Current State
• NDHIN Public/Private Partnership
• Orion Health Technology Platform
• eMPI, patient matching
• Provider Directory
• Longitudinal Clinical Record
• Image Exchange
• ADT Alerting
• Single Sign-on (SSO)
• PDMP access w/SSO
• Immunization Registry
• Electronic Reportable Labs
• Syndromic Surveillance
• Access to 25-30 out State HIE’s

13. NDHIN Future State Additions
Infrastructure
• Orion Health Amadeus
Platform Upgrade
• Provider Directory Upgrade
• Medications
• Additional Single Sign-on
• C-CDA Discrete Data
• Genomic Data
State Systems
• Cancer Registry
• Enhanced Immunization System
• Behavioral Health EHR
• Developmental Disabilities EHR
• Corrections EHR
• State Vets Home EHR
• University Health systems EHR
Federal Systems
• VA, IHS, DOD
• South Dakota
• Snow Bird aStates
• 40 additional States
& HIEs

14. NDHIN Future State Additions
Payer
§ Access
§ Data contribution
§ All Plans
• Medicaid
• Medicare
• Commercial
• Large Employer
• Workman’s Comp
Patient
§ Global Personal Health Record
§ Patient Reportable Data,
Telehealth, Wearables
MU Providers
§ Hospitals
§ Clinics
• Traditional
• Urgent Care
• Pharmacies
§ Large Reference Labs
§ Chiropractors
§ Optometrists
§ Dentists

15. NDHIN Future State Additions
Non MU Providers
§ Long Term Care
• Assisted Living
• Basic care
§ Behavioral Health
§ Residential Treatment Centers
§ Home Health Care
§ Hospice, Palliative Care
§ EMS
§ Pharmacies
§ DME
§ Audiology
§ Podiatry
§ Prosthetics
§ New Born Screening
§ Local Health Departments
• K-12 Schools

16. NDHIN Future State Additions
Strategic Statewide Applications
Care Coordination
Coordinate integrates with Engage - Social Services Referrals - Risk Scores
Gaps in care - Clinical & Claims Data
Analytics, Population Health
Statewide Credentialing
Advance Directives, POLST/MOLST Registry

17. NDHIN- Tools
Patient-centered
care
Shared care
plans
Collaborative
worklists
Referral
management
Risk
calculators
Patient
engagement
Medication
management
Assessments
Hospitals Clinics
Behavioral Health
Long Term Care
Local Public Health
Ø K-12 school nurses
ND Developmental
Disabilities
VA
Home Health
ND University
System
IHS
Medicaid
ACOs
NDPERS/ state
employees health plan
Commercial
SNAP
Foster care Child care
assistance
TANF
Autism services
Special-needs
adoption
LIHEAP
Transportation
Job programs
Housing Assistance
Department of
Corrections
ND Veteran’s
Home
Care Coordination
Partners
Future State: Data Integration and Care Coordination
Clinical Care - Behavioral Health - Social Services
Key
Providers
Payers
Human Services
Community Services
Medicare
Self-insured Employers
VA
DOD
SSA
Chiropractors
Optometrists Hospice
EMS
Labs
Pharmacies
University Health
DMS
Audiology
Podiatry
New Born Screening
Prosthetics

19. CMS 90/10 FUNDING
PLAN FOR NORTH
DAKOTA HIN
GEORGE BECKETT
Chief Business Development Officer
CedarBridge Group

20. NDHIN Five Year Budget/R.O.I.
Get Big or Get Out

21. Get Big or Get Out
NDHIN Five Year Budget/R.O.I.
It’s a moon shot

22. NDHIN Five Year Budget/R.O.I.
Patient “Look up” won’t cut it

23. Facts
NDHIN Five Year Budget/R.O.I. 23
Population of
740,000
42
Hospitals
36
Critical Access
Hospitals
2
Major Payers
Blue Cross & Sanford Health
880,000
Patients in eMPI
19th
Largest State
47th in
population density

24. NDHIN 5 year Development Plan
Amount
spent in 3
years to
date: $8.8M*
Budget for
the next 5
years: $47M
Total NDHIN
investment:
$55.8M
*Total stakeholder investment to date: $0

25. NDHIN 5 year Development Plan
85% 15%
Federal
Contribution
*Stakeholders only share $4.7M (8.5%)
$47m
North Dakota
$7m
State
ContributionProviders
Contribution
Payer Contribution
$2.33m $2.33m
$2.33m

26. CMS 90/10 Match Funding Opportunity
§ Funding is available through Sept. 30, 2021
§ Non-competitive, No limit in funding amount
§ You do not have to be a “State” HIE to receive monies
CMS offers states 90/10 matching
funds for building HIE infrastructure
to support Meaningful Use initiative.
Some categories of technology
qualify for 75/25 and 50/50 matches.

27. CMS 90/10 Match Funding Opportunity
n Where do we get the 10% Match?
o States- free-up current expenses
u State Payroll
u State HIE Infrastructure (Maturity)
u Office, Travel, IT, etc.
u On-boarding
o Outside Fees
u Incremental Charge-backs
u CMS Open to discussions

28. CMS 90/10 Match Funding Opportunity
n What can it pay for?
o Operations
u Staffing
u HIE Core
u Expenses

29. CMS 90/10 Match Funding Opportunity
n Interfaces
o Bundle Hub & Spoke Offerings
o Negotiate with Vendors of
state-wide
n On-boarding
o HIT/HIE Combination
u Awareness, Marketing
u Contracting, Training
n Connectivity Projects
o Diagnostic Image Exc.
o Cancer Registry
o Indian Health Services
o Department of Defense
o Intra-state Exchange
o Personal Health Record
u Wearable reporting

30. CMS 90/10 Match Funding Opportunity
n Participants & Data
o Clinical Data
o Behavioral Health
o Social Determinates
o Genomic
o Payer Data
u Claims
u Risk Scores
u Gaps in care
n State-wide applications
o Care Coordination
o POLST/MOLST Registry
o PDMP Integration
o Credentialing
o Analytics
n Roll-outs!!!

31. CMS 90/10 Match Funding Opportunity
n State systems
o Corrections
o Developmental Disabilities
o Foster Children Services
n MU Providers
o Hospitals
o Clinics
o Chiropractors
o Dentists
o Optometrists
n Non-MU Providers
o Local Health Departments
o New Born Screening
o K-12 Schools
o University Health Services
n Non-MU Providers
o Long Term Care
u Assisted Living
u Basic care
o Behavioral Health
o Residential Treatment Centers
o Home Health Care
o Hospice, Palliative Care
o EMS
o Pharmacies
o DME
o Audiology
o Podiatry
o Prosthetics

32. CMS 90/10 Match Funding Opportunity
n What about on-going funding?
o State-run – Combining with MMIS enterprise
u 75/25 match for Medicaid percentage of the pop.
o Non-profits and others
u 50/50 match for Medicaid percentage of the pop

33. Stakeholder Value Propositions
Where’s the
value for
stakeholders?
Where’s
the value
for HIE?
Where’s the
value for
your state?

34. R.O.I. Calculators
n Three categories
o Initial Investment
u HIE Core/Operations
u Interfaces/Maint.
o Strategic Applications
o Specific savings
u Provider
u Payer

35. POPULATION HEALTH
FOUNDATION &
APPLICATIONS

36. Page 36 • 2016 © Orion Health™ group of companies
Industry Trends | Precision Medicine: The Right Treatment at the Right Time
FUTURE PROOF
ARCHITECTURE
A vast amount of untapped data could have a great impact on our health
Source: Health Aff (Millwood). 2002 Mar-Apr;21(2):78-93. The case for more active policy attention to health promotion.
McGinnis JM, Williams-Russo P, Knickman JR.

37. Page 37 • 2016 © Orion Health™ group of companies
Industry Trends | Healthcare Data Explosion
2012
500 Petabytes
=
10 billion
Four drawer
cabinets
2020
25,000 Petabytes
=
500 billion
Four drawer
cabinets
The amount of
healthcare data worldwide is expected to grow
by 50 times in 8 years

38. Page 38 • 2016 © Orion Health™ group of companies
New Platform Requirements | Handling Data Complexity
Healthcare is changing from a closed community into an ecosystem centered around
the patient and their record which will include many elements not traditionally captured.

39. Page 39 • 2016 © Orion Health™ group of companies
Orion Health | Market Evolution

40. Page 40 • 2016 © Orion Health™ group of companies
Population Health Management | Maturity Model

41. Page 41 • 2016 © Orion Health™ group of companies
Orion Health Amadeus | Addresses Key Pop Health Needs in one solution
Quality and Compliance
Reporting
Managing Revenue and
Costs
Coordinating Care
‣ Monitor and manage key
performance metrics under value
based contracts:
‣ Pay for Performance
‣ Shared Savings
‣ Bundled Payments
‣ Give practices and providers the
tools required to identify and close
care gaps.
‣ Population exploration tools for
care coordination staff
‣ Patient risk stratification tools
‣ High risk discharge and medication
adherence analysis
‣ Tools to identify key
contributors to costs:
‣ Readmissions
‣ Utilization
‣ PMPM
‣ Manage network leakage and
referrals.

43. Page 43 • 2016 © Orion Health™ group of companies
Orion Health Amadeus| Population Level

44. Page 44 • 2016 © Orion Health™ group of companies
Orion Health Amadeus | Integration of Analytics & Care Coordination

45. Page 45 • 2016 © Orion Health™ group of companies
Orion Health Amadeus | Drill down to Patient-Centric Longitudinal Health Record
+ Gaps in Care

46. Q&A
Contacts:
George Beckett
Chief Business Development Officer
George@cedarbridgegroup.com
Laura Young
Director of Industry Relations &
Solutions Consulting
Laura.Young@orionhealth.com