Missouri Statewide Health Information Organization

MO-HITECHhttp://dss.missouri.gov/hie/

Missouri’s Health Information Exchange:

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Missouri has an unprecedented opportunity to access federal funds to plan, design, implement and support the statewide exchange of electronic health information.

Current state vs. future vision

Labs

Payers

Consumers

Clinics

Hospitals

Pharmacies

Physicians

Government

Health InfoExchange

Labs

Consumers

Payers

Clinics

Hospitals

Pharmacies

Physicians

Government

Current ConfusionEvolving and Competing

Landscape

Future VisionImproved Access and Use of

Health Information

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ARRA and HITECH Act:

Opportunity for Missouri’s Health Care Providers and Consumers

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ARRA & HITECH Funding

HITECH ActHealth Information Technology for Economic & Clinical Health Act

$50 billion section of the stimulus package focused on funding and supporting widespread adoption of health information technology.

ARRAAmerican Recovery & Reinvestment Act

$787 Billion federal stimulus package passed by Congress and signed by President Obama in February 2009.

MO-HITECHMissouri Office of Health Information Technology

$1 billion funding opportunity for Missouri over the next five years.

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$500 Million - $1 Billion

Above $1 Billion

$100-500 Million

Below $100 Million

Missouri:Projected funds from State HIE Program: $13.8 MProjected funds from Medicare Meaningful Use: $442 MProjected funds from Medicaid Meaningful Use: $404 M

Estimated Meaningful Use Funding by State

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Missouri Opportunities Under HITECH:$1 Billion Potential Investment

Program Estimated Amount Timing Purpose

HIE $13,765,040 FY 2011 – 2015 Support HIE infrastructure & implementation

Regional Extension Centers

$6,836,335 2 year awards beginning Q1 of FY 2010

Support providers to achieve meaningful use via technical assistance services

Medicaid Administrative Funding

90% federal match for State expenditures

Available upon approval of application

Implementation of meaningful use payments including promoting interoperability and meaningful use of EHRs

Meaningful Use Payments for Eligible Hospitals & Providers

Up to approx $900MEstimated based on Population Medicaid enrollment

FY 2011 – 2019(meaningful use regulations in progress)

Support provider implementation and meaningful use of EHRs

Broadband & Telehealth

June 2009 – Sept 2010

Provide affordable and quality broadband to greatest number of users

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Support for Missouri’s Health Care providers

Medicare Medicaid

Funding Mechanism(s)

Federal Incentive Payments Federal Incentive PaymentsState matching payments (for admin costs)

Payment Agent Medicare carriers and contractors State Medicaid agencies

Payment Recipients

Hospitals and eligible non-hospital-based providers

Hospitals and eligible certified nurse mid-wives;, nurse practitioners;, physician

assistants and dentists.

Amounts for Hospitals

$2 million base amount $2 million base amount

Amounts for eligible physicians & other health professionals

Up to $44,000 in Medicare reimbursements over five year period

Up to $64,000 over a six year period covering up to 85% of eligible

implementation costs

Timing Incentives begin in Oct. 2010 for hospitals and Jan. 2011 for physicians

Incentives to begin in 2011 for both hospitals and physicians.

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Development of Missouri’s Health Information Exchange:

Goals, Planning and Timelines

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State Goals1. Improve the quality of medical decision-

making and the coordination of care;

2. Provide accountability in safeguarding the privacy and security of medical information;

3. Reduce preventable medical errors and avoid duplication of treatment;

4. Improve the public health;

5. Enhance the affordability and value of health care; and

6. Empower Missourians to take a more active role in their own health care.

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Collaborative Stakeholder Process

The state has overseen and guided an open, transparent and collaborative process to develop a statewide health information exchange strategic and operational plan.

HIE regional listening sessions Advisory Board and Workgroups formed Public invited to review, comment and offer feedback More than 200 stakeholders engaged across the state

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MO-HITECH FrameworkMO-HITECH

Advisory Board

Governance Workgroup

Technical Infrastructure

Workgroup

Finance Workgroup

Business & Technical

Operations Workgroup

Consumer Engagement Workgroup

Legal/ Policy

Workgroup

Manatt & State Employees to Staff & Facilitate Workgroups

Strategic and Operational Plans

Draft Sections of Strategic and Operational Plans

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Barrett A. ToanPrivate Sector Co-Chair Ronald J. Levy, Director, DSS and MO-HITECH CoordinatorDonald BabbCEO, Citizens Memorial Hospital, Bolivar Steve CallowayPharmacy Representative Shalonn Curls Margaret T. DonnellyDirector DHSSKaren Edison, MDMissouri Center for Health Policy Tracy Godfrey, MDFamily Physician, Joplin Tom Hale, MD, PhDSisters of Mercy Health System Sandra Johnson, JD, LL.MEmerita Professor of Law and Health Care

Ethics, St. Louis University School of Law

Herb B. Kuhn

President & CEO, Missouri Hospital Association Ian McCaslin, MDDirector, MO HealthNet Division Joe Pierle, CEOMissouri Primary Care Association Verneda RobinsonCEO, Swope Health Systems Andrea RouthHealth Advocacy Alliance Senator Eric Schmitt Mahree SkalaMissouri Association of Local Public Health

Agencies Steven C. WalliPresident & CEO, United Healthcare MO David Weiss, CIOBJC Healthcare Karl WilsonPresident & CEO, Crider Health Center

MO-HITECH Advisory Board

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Workgroup Co-Chairs Technical Infrastructure

◦ Mitzi Cardenas, CIO, Truman Medical Center

◦ Doug Young, CIO, Information Technology Services Division

Legal/Policy◦ Sandra Johnson, Professor Emerita

of Law and Health Care Ethics, St. Louis University School of Law

◦ Doug Nelson, Deputy Chief of Staff, Governor Jay Nixon

Finance◦ John M. Huff, Director, Department

of Insurance ◦ Donna Checkett, Senior Vice

President, Aetna Medicaid

Governance◦ Steve Roling, Healthcare

Foundation of Greater Kansas City ◦ Ronald J. Levy, Director,

Department of Social Services Consumer Engagement

◦ Scott Lakin, Lakin Consulting ◦ Margaret T. Donnelly, Director,

Department of Health and Senior Services

Business and Technical Operations◦ Karl Kochendorfer, MD, University

of Missouri - Columbia ◦ Ian McCaslin, MD, Director, MO

HealthNet Division

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6 Coordinated Planning Tracks Establish governance and

decision-making process Develop privacy and security plan Develop technology plan Develop financing plan Develop EHR adoption plan Develop consumer engagement

plan

3 Key Work Products State HIE Plan

◦ Strategic◦ Operational

State Medicaid Plan Regional Extension

Center◦ EHR adoption plan

Health IT is the enabler, not the result

Missouri’s Action Plan

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Operational PlanStrategic PlanState HIE Grant

ApplicationLetter of Intent Submitted

Sept Oct Nov Dec Jan 2010 Feb Mar April May June

Project Initiation

Begin Landscape Assessment & Interviews

Submit Application to HHS

• Support State application process

• Conduct stakeholder interviews

• Establish MO-HITECH

• Establish Advisory Board

• Convene Workgroups

• Draft Strategic Plan

• Publish Draft Strategic Plan for Review

• Develop detailed project timeline and work plan

• Engage and educate stakeholders

Submit Strategic Plan to HHS

• Convene Advisory Board & Workgroups

• Draft Operational Plan

• Publish Draft Operational Plan for Review

• Update project timeline and work plan

• Engage and educate stakeholders

Submit Operational Plan to HHS

Publish Draft Strategic Plan for Review/Comment

Publish Draft Operational Plan for Review/ Comment

Statewide Kickoff Meeting

Executive Order 09-27

Funding Announcemen

t

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Missouri’s Health Information Exchange:

A Strategic and Operational Roadmap

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MO-HITECH Approach to Statewide HIE

Range of “qualified organizations” pursuing regional or localized exchange are core structure

Statewide HIO provides statewide policy guidance, core services to enable interoperability

Statewide HIO leads collaborative governance with Qualified Organizations

Statewide Network Comprised of

Diverse Qualified Organizations

Abandon core services focus, leaving the private market to address interoperability

Provide backfills where market fails to assure ‘No provider left behind’

Focus on education, convening, and statewide policy guidance

Market Determines Structure –

Statewide HIO Backfills

Statewide HIO is primary vehicle for HIE

Statewide HIO builds infrastructure, consolidates HIOs for economies of scale

MO HIOs focus on local governance, adoption

Statewide HIO is the Market

Divide Missouri into markets/territories assigned to existing HIOs, new HIOs or the Statewide HIO

Statewide HIO provides governance, manages monopolies for public good

Statewide HIO may provide core services to Qualified Organizations

Qualified HIOs given Exclusive Territories

– Statewide HIO Provides

Governance, Outreach

Approach

Given the relatively nascent HIE market in Missouri and the desire to pursue an effective public-private governance model, Missouri intends to develop a

“Statewide Network Comprised of Diverse Qualified Organizations.”

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Governance: Board of Directors

Not-for-profit – 501c3 – public/private partnership 15-member MSHIO Board appointed by MO-HITECH

Advisory Board June 30◦ 13 private sector representatives◦ 2 state representatives

Consumer advocates and providers must be represented on the Board at all times

Draft articles of incorporation and bylaws completed

Statewide HIE in Missouri will be governed by a collaborative multi-stakeholder organization – the Missouri Statewide Health Information Organization (MSHIO).

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Governance: Qualified Organizations

Missouri Statewide Health Information Organization (MSHIO) will be comprised of “qualified organizations” as participating members. A qualified organization is a health care organization or

aggregator of health care providers that is capable of fulfilling certain obligations and requirements:

Technical, legal, policy and procedural obligations as defined by MSHIO

Willing to enter into a binding contract with MSHIO

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Governance: Qualified Organizations

Qualified organizations may be, but are not limited to: Provider networks:

Hospitals, health systems, provider groups, FQHCs/RHCs, regional HIOs, etc.

Private, non-provider networks: Clearinghouses, payors, vendors

Medicaid and Missouri State Employee Health Plans

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Statewide Network Comprised of Diverse Qualified Organizations

Missouri Statewide Health Information Exchange Network

RHIO RHIO

Lab Enterprise

ProviderConsortium

HospitalRural Health

CenterFQHC Labs

PrivateNetwork

PayersPublic Health

Clinic Clinic Labs

Long TermCare

EHR Light

Medicaid

MMIS Clinical EligibilityPaid

ClaimsHospital Lab RHC FQHC

HospitalsPhysicianGroups

Clinics

NHIN GatewayInterstate Connectivity

Hospital Lab RHC

Hospital System

Cyber Access

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Consumer Engagement

Consumer advocates will be represented on the MSHIO Board

Consumer Advisory Council will be established Consumer engagement and information strategy will

be developed

MSHIO is committed to utilizing health information exchange to empower Missourians to take a more active role in their own health care.

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Technical Infrastructure: Principles

Principles◦ No provider left behind◦ Alignment with meaningful use◦ Interoperability and accessibility ◦ Leverage resources – public and private ◦ Consistency with national standards

MSHIO will support the development of regional HIE (qualified organizations) efforts while linking those networks together to enable statewide exchange of health information.

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Technical Infrastructure: Services

Core infrastructure and services: Provider registries and Master Patient Index (MPI) Secure messaging and clinical information exchange Consent management Electronic access to Medicaid data Reporting services

Potential value-added services: Electronic lab ordering and results delivery Electronic prescribing (e-prescribing) “EHR Lite” web viewers for providers without EHRs

MSHIO will provide core infrastructure services to support health care transactions, information exchange and help meet meaningful use requirements for providers.

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Legal/Policy: Patient Consent Model

Consumer and provider trust State and federal requirements Clinical value of the information Technical feasibility and cost Administrative burden and implementation cost

Evaluation and final decision related to an opt-in versus opt-out model is complex and must consider the following:

Preliminary recommendation is that MSHIO utilize an opt-in patient consent framework.

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Finance: Funding and SustainabilityTo date, Missouri has received notice of federal funding for $22.3 million:

$13.8 million planning and implementation grant $1.7 million Medicaid IT planning grant $6.8 million for Regional Extension Center

These funds represent “seed money” for the planning and implementation of statewide HIE and provides for meaningful use and adoption of EHRs.

A model and plan is being developed to ensure there is long-term financial sustainability for operating the MSHIO.

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FinanceA six year all-in cost model for statewide HIE

Refinement Cycle

Refinement Cycle

Up Front Financing

Value Added Services

Participants, Connectivity and Use Cases

Core Services

Governance and Operations

Ongoing Connectivity

Core Services / MU Use Cases

Value Added Services

Fees or Assessments

6 YR

Model

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Revenue Inputs

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Sources and D

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Up Front Financing &

Ongoing R

evenue

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Sources and D

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Up Front Financing &

Ongoing R

evenueFinancing

Model

Framework

Finalize and submit MSHIO Operational Plan to ONC (June 30) Appoint MSHIO Board of Directors (June 30) Incorporate MSHIO (July) Recruit executive staff (July-October) Develop and release Request for Proposal (RFP) for technical

infrastructure and core services (July-October) Coordinate with Missouri HIT Assistance Center, Medicaid and

Missouri’s border states (ongoing)

Visit http://dss.mo.gov/hie/ for more information

Next Steps

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