Workgroup CALL June 9, 2010 & June 16, 2010 (same agenda – two date options for participants) 4:00 pm – 5:00 pm Dial-in:1-866-922-3257; Participant Code.
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Workgroup CALLJune 9, 2010 & June 16, 2010 (same agenda – two date options for
participants) 4:00 pm – 5:00 pm
Dial-in:1-866-922-3257; Participant Code 654 032 36#
North Carolina Health Information Exchange
Finance Workgroup
22
Agenda
Discussion Document – Not for Distribution2
Topic Leads Time
Welcome & Introductions Co-Chairs 4:00 PM - 4:05 PM
Project Background & Approach Co-Chairs & Manatt
4:05 PM - 4:15 PM
Review Charter & Project Plan Co-Chairs & Manatt
4:15 PM - 4:25 PM
Introduction to Modeling Approach and Discussion of Data Collection Requirements
Co-Chairs & Manatt
4:25 PM - 4:55 PM
Next Steps Co-Chairs & Manatt
4:55 PM – 5:00 PM
3
Welcome and Introductions Co-Chairs, Facilitators, and Members
Facilitators• Joseph Ray, Manatt• Brenda Pawlak, Manatt• Allison Garcimonde, Manatt
Members• Mark Bell, NC Hospital Association• Greg Gombar, Carolinas Health Care
System• Brian Harris, Rural Health Group• Yvonne Hughes, Coastal Connect HIE• John Minnich, CSC
Co-Chairs• Maureen O’Connor, BCBSNC• Dr. Dave Tayloe, American Academy of
Pediatrics
• Steve Owens, NC Medicaid• Phred Pilkington, Cabarrus
County Health Dept.• Devdutta Sangvai, MD, Duke
University Medical Center• Beat Steiner, Community Care
of NC at UNC
44
Meeting Objectives – Key Decisions
• Confirm Workgroup charter
• Review project plan and revise based on Workgroup discussion
• Review modeling approach
• Understand data collection requirements and identify next steps/ points of contact
Discussion Document – Not for Distribution4
5
Orientation and Overview
66
Project Background & Approach
Discussion Document – Not for Distribution6
• HITECH Act funding opportunities and incentives have significantly anticipated the HIE financing landscape– To date, no single financing strategy for HIE efforts has emerged
as the clear path to viability
• The state of North Carolina is eligible to receive up to $12.9 million in Federal funds under the State HIE Cooperative Agreement Program– The Finance Workgroup will review and update the proposed
project budget to ensure it reflects the decisions of the NCHIE collaborative process
• The Statewide HIE will be responsible for establishing a sustainability model to ensure that the HIE is viable
7Discussion Document – Not for Distribution
7 7
Definitions – ARRA & HITECH
HITECH ActHealth Information Technology for Economic & Clinical
Health Act
Title XIII and Title IV of the ARRA, the section of the stimulus package focused on supporting the more 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.
8Discussion Document – Not for Distribution
8
$1.2 B for loans, grants & technical assistance for:
Regional Extension Centers ($640M)
Workforce Training ($80M)
Research and Demonstrations
Medicare & Medicaid incentives for HIT adoption
~$19.1 to $29.8 B total in expected outlays (revised estimate)
$564 M for Statewide HIE Development
States receive between $4M & $40M
$220 M for “Beacon” Community Program
15 HIEs receiving between $10-$20M
$4.3 B for broadband & $2.5 B for distance learning/ telehealth grants
$1.5 B in grants through HRSA for construction, renovation and
equipment, including acquisition of HIT systems
New Incentives for Adoption Funding for Health IT
Funding for HIE
Broadband and Telehealth
Community Health Centers
HITECH FundingHIT & HIE infrastructure
9Discussion Document – Not for Distribution
9
North Carolina Health IT Awards
ARRA:
•State HIE Cooperative Agreement: $12.9 million
•Medicaid Meaningful Use Planning: $2.29 million
•Regional Extension Center: $13.9 million NC AHEC (North Carolina Area Health Education Centers Program @ UNC Chapel Hill)
•Beacon Community: $15.9 million Southern Piedmont Community Care Plan
•Health IT Workforce Community College Consortia Program (non degree programs): $10.9 million Pitt Community College
•Health IT Curriculum Development: $1.8 million Duke University
•University-level Health IT Workforce Training (degree programs): $2.1 million Duke University
•Broadband: $28.8 million MCNC / North Carolina Research and Education Network (NCREN)
•CHIPRA (non-ARRA): $9.2 million (one of 10 state awards)
–Testing medical home for children with special health care needs through three provider-led community-based models
–Implementing a model electronic health record format for children
10
Overview of Workgroup Process and Tasks
11
State HIE Cooperative AgreementGoals and Planning Requirements
Domains toAddress
Domains toAddress
RequiredPlans
RequiredPlans
Goal: Plan and develop the HIE infrastructure to ensure• Widespread interoperability across entire state• Providers and hospitals can achieve meaningful use
Goal: Plan and develop the HIE infrastructure to ensure• Widespread interoperability across entire state• Providers and hospitals can achieve meaningful use
- Strategic Plan: State’s vision, goals, objectives and strategies for statewide HIE; including plans to support
provider adoption( Submitted to ONC Oct. 09 , to be
verified via Operational Plan process)
- Operational Plan: Detailed explanation, targets, dates for
execution of strategic plan
-Governance-Finance-Technical infrastructure-Business & Technical Ops-Legal and Policy
Types of Exchange
Types of Exchange
– Eligibility & claims transactions
– eRx & refill requests– Lab ordering & results
delivery– Public health reporting– Quality reporting– Rx fill status/med fill Hx– Clinical sum for care
coordination & patient engagement
Discussion Document – Not for Distribution12
Workgroup Deliverables for Operational Plan
Workgroup Deliverables
Governance • Recommendation on public-private partnership structure and functions of the governing body• Recommendation on bylaw-related issues for governing body• Recommendation on approach to statewide HIE• Recommendations to ensure alignment with Medicaid and state programs• Recommendations to ensure alignment with ARRA funded HIT and HIE activities in North Carolina• Components of a consumer engagement and outreach plan
Finance • Environmental data collection / provider landscape • 2-3 financial model scenarios• Payment flow models• Finance section of NC HIE Operational Plan• Workplan for ongoing sustainability effort
Clinical & Technical Operations
• Landscape survey of relevant health IT assets across key stakeholders• Clinical opportunity analysis as relates to NC HIE meaningful use and operational goals• Selected use cases• Straw technical architecture and approach based upon use cases• Description of how the technical architecture will align with NHIN core services and specifications
Legal/Policy • Recommendation on statewide policy framework that protects the privacy and security of health information and that allows for incremental development of polices over time.
• Process to harmonize federal and state legal and policy requirements to support HIE.• Recommendations on operational processes to support privacy and security policies and ensure
implementation and evaluation of policies• Process to develop a consumer and stakeholder outreach, education and engagement plan.• NC state law scan
13Discussion Document – Not for Distribution
13
Work Group MethodologyIntegration of Key Deliverables
Clinical & Tech Operations Work Group
Clinical & Tech Operations Work Group
Legal &Policy
Work Group
Legal &Policy
Work Group
Finance Work Group
Finance Work Group
•Identify clinical/business objectives
•Define architecture•Identify services•Detail functions, options•Develop high-level costs
•Identify privacy issues•Define options•Identify policy/tech requirements
•Collect relevant environment data
•Define revenue sources •Identify funding constraints and timing considerations
Implementation Requirements
•Technical specifications•Implementation sequencing
•Detailed cost estimates•Detailed, 4 yr budget•Evaluation strategy
Governance Work GroupGovernance Work Group
•Define roles, decision making authority
•Identify goals•Define measures
1414
Finance Workgroup Charter
Co-Chairs •Maureen O’Connor•Dave Tayloe
Staff •Joseph Ray•Brenda Pawlak•Allison Garcimonde
Members See Member List.
Charge Make recommendations to the Board of NC HIE regarding:• Budget to support implementation of NC HIE Strategic Plan• Analysis of costs and ongoing funding streams (existing and potential)
associated with statewide HIE• Value and business case/return on investment (ROI) of investments at the
state, regional, and institutional levels• Financing strategies to support adoption of HIE
Deliverables •Environmental data collection/provider landscape•2 – 3 financial model scenarios•Payment flow models•Finance section of NC HIE Operational Plan•Workplan for ongoing sustainability effort
1515
Finance Workgroup Project Plan
WG Meeting
Action Items & Key Workgroup Deliverables Reach Agreement On
June 9th
Initial Workgroup Meeting Option 1• Review and adopt Workgroup charter and Project Plan • Initiate collection of relevant environmental data necessary for the
calculations of cost and revenue
• Workgroup charter• Project plan • Data collection needs, assignments and expected
sources
June 16th
Initial Workgroup Meeting Option 2 – Same Agenda as 6/9 Mtg. (See Above)
Board Meeting – June 15, 2010 – Finance Workgroup to present:• Key assumptions of financial modeling approach• Environmental data collection process
See above.
June 23rd
Workgroup Meeting 2• Review HIE financial modeling approach, key assumptions, and drivers• Discuss characteristics specific to North Carolina that may impact modeling
• Financial model approach summary• Financial model key assumptions and drivers• North Carolina characteristics that impact modeling
Week of June 28th
No Workgroup Meeting N/A
July 8h
Workgroup Meeting 3• Review initial draft of financial model components and adoption
assumptions• Review sources, guiding principles, and approach for ongoing revenue
• Provider environment assumptions and next steps• Next steps and adjustments to financial model and
adoption assumption components • Ongoing revenue guiding principles, prioritized sources
and approach for modeling
1616
Finance Workgroup Project Plan
WG Meeting
Action Items & Key Workgroup Deliverables Reach Agreement On
Week of July 12th
No Workgroup MeetingBoard Meeting – July 13, 2010 – Finance Workgroup to present• Findings of environmental data scan• Recommended financial model components
N/A
July 22nd
Workgroup Meeting 4• Harmonize financial model with operational planning activities,
assumptions, and key decisions of other Workgroups• Initiate development of payment flow models• Initiate finalization of financial models for inclusion in Operational Plan
Draft
• Updates to financial model• Payment model flows draft for Operational Plan• Determination of financial models to be included in
Operational Plan
Week of July 26th
No Workgroup Meeting N/A
Aug 4th
Workgroup Meeting 5• Review and finalize recommended financial models for inclusion in draft
Operational Plan • Develop work plan for ongoing sustainability effort
• Operational Plan input• Recommend financial models• Initial payment flow models• Work plan for ongoing sustainability effort post-
Operational Plan submission
Week of Aug 9th
No Workgroup Meeting – Workgroup calls to be scheduled as necessary • Ongoing review of Draft Operational Plan
N/A
Week of Aug 16th
Full Workgroup Conference Call - to be scheduled as necessary • Ongoing revisions to Draft Operational Plan
N/A
1717
Introduction to Modeling Approach
18Discussion Document – Not for Distribution
18
Progress in North CarolinaFinancing
Considerations Status Discussion, Remaining Questions to Address
Environmental data
In January of 2009, significant initial work was completed by NCHICA as part of their NHIN Trial Implementation Contract to develop a sustainability and business plan for North Carolina.
Additional work required to update inventory of revenue resources and mechanisms including providers, payers, population, boarder states, existing HIOs, etc.
Cost modelDevelop total cost of ownership model (over four year period) based on selected HIE services.
Revenue modelDevelop revenue models for the state based on environmental data and high-level assumptions.
Updated budget Update ONC State HIE Cooperative Agreement budget.
Issues and risk mitigation strategies
Develop as required by ONC State HIE FOA.
Controls and reporting Develop as required by ONC State HIE FOA.
1919
Financing Approach and Key Assumptions
Discussion Document – Not for Distribution19
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
Cos
t Inp
uts
Revenue Inputs
Key
Sou
rces
and
Driv
ers
of
Cos
t
Sources and D
rivers of
Up Front Financing &
Ongoing R
evenue
Key
Sou
rces
and
Driv
ers
of
Cos
t
Sources and D
rivers of
Up Front Financing &
Ongoing R
evenueFinancing
Model
Framework
2020
HIE Model Approach Steps
Step 1: HIE Modeling Approach and Key Assumptions
Review HIE modeling approach, key assumptions and drivers with Finance Workgroup and modeling sub committee. Update key assumptions and drivers as required to customize the model for North Carolina.
Step 2: Environment Data Collection
Collect relevant environment data necessary for the calculations of cost and revenue. Data includes: providers, payers, population, boarder states, existing HIEs, etc.
Step 3: Initial Cost and Revenue Models
Develop initial draft of overall costs and revenue for the state based on environmental data and high-level assumptions.
Step 4: Harmonize Model with Strategic Plan and Operational Plan Draft
Harmonize the assumptions with the Strategic Plan and initial draft of the Operational Plan. Perform additional data collection as20 required to produce a second draft of the model.
Step 5: Iterate Model with Operational Planning Activities
Continue to iterate versions of the model to incorporate operational planning activities, assumptions and decisions. This step will ultimately lead to a final version of the model.
21 21For discussion purposes only - Not for distribution
NHIN
MiHIN Backbone
CommunityHIE
CommunityHIE
OtherCommunityProviders
PhysicianOffices
ExternalData Source
ExternalData Consumer
ReferenceLabs
Hospital
SecurityServices
PublicHealth
ReportingService
OtherCommunityProviders
PhysicianOffices
Hospital
PrivateHIE
PhysicianOffices
PhysicianOffices
PhysicianOffices
Personal HealthRecord System
Private HIE (Hosp)
PhysicianOffices
Hospital OtherCommunityProviders
MiHIN Conceptual Architecture
Query forDocuments
Service
StandardProtocols
LocalProtocols Local
Protocols
EMPI/RLS StandardProtocols
StandardProtocols
(Paid Connection)
StandardProtocols
(Paid Connection)StandardProtocols
StandardProtocols
StandardProtocols
(Paid Connection)
DataWarehouse
MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services
Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards
MessagingGateway
Public ServiceRegistry
Payers
ProviderIndex
MedicationManagementPharmacies
Medicaid
Other State Agencies
EHR/CIS Implementers and Remediators
NHIN
MiHIN Backbone
CommunityHIE
CommunityHIE
OtherCommunityProviders
PhysicianOffices
ExternalData Source
ExternalData Consumer
ReferenceLabs
Hospital
SecurityServices
PublicHealth
ReportingService
OtherCommunityProviders
PhysicianOffices
Hospital
PrivateHIE
PhysicianOffices
PhysicianOffices
PhysicianOffices
Personal HealthRecord System
Private HIE (Hosp)
PhysicianOffices
Hospital OtherCommunityProviders
MiHIN Conceptual Architecture
Query forDocuments
Service
StandardProtocols
LocalProtocols Local
Protocols
EMPI/RLS StandardProtocols
StandardProtocols
(Paid Connection)
StandardProtocols
(Paid Connection)StandardProtocols
StandardProtocols
StandardProtocols
(Paid Connection)
DataWarehouse
MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services
Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards
MessagingGateway
Public ServiceRegistry
Payers
ProviderIndex
MedicationManagementPharmacies
NHIN
MiHIN Backbone
CommunityHIE
CommunityHIE
OtherCommunityProviders
PhysicianOffices
ExternalData Source
ExternalData Consumer
ReferenceLabs
Hospital
SecurityServices
PublicHealth
ReportingService
OtherCommunityProviders
PhysicianOffices
Hospital
PrivateHIE
PhysicianOffices
PhysicianOffices
PhysicianOffices
Personal HealthRecord System
Private HIE (Hosp)
PhysicianOffices
Hospital OtherCommunityProviders
MiHIN Conceptual Architecture
Query forDocuments
Service
StandardProtocols
LocalProtocols Local
Protocols
EMPI/RLS StandardProtocols
StandardProtocols
(Paid Connection)
StandardProtocols
(Paid Connection)StandardProtocols
StandardProtocols
StandardProtocols
(Paid Connection)
DataWarehouse
MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services
Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards
MessagingGateway
Public ServiceRegistry
Payers
ProviderIndex
MedicationManagementPharmacies
NHIN
MiHIN Backbone
CommunityHIE
CommunityHIE
OtherCommunityProviders
PhysicianOffices
ExternalData Source
ExternalData Consumer
ReferenceLabs
Hospital
SecurityServices
PublicHealth
ReportingService
OtherCommunityProviders
PhysicianOffices
Hospital
PrivateHIE
PhysicianOffices
PhysicianOffices
PhysicianOffices
Personal HealthRecord System
Private HIE (Hosp)
PhysicianOffices
Hospital OtherCommunityProviders
MiHIN Conceptual Architecture
Query forDocuments
Service
StandardProtocols
LocalProtocols Local
Protocols
EMPI/RLS StandardProtocols
StandardProtocols
(Paid Connection)
StandardProtocols
(Paid Connection)StandardProtocols
StandardProtocols
StandardProtocols
(Paid Connection)
DataWarehouse
MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services
Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards
MessagingGateway
Public ServiceRegistry
Payers
ProviderIndex
MedicationManagementPharmacies
NHIN
MiHIN Backbone
CommunityHIE
CommunityHIE
OtherCommunityProviders
PhysicianOffices
ExternalData Source
ExternalData Consumer
ReferenceLabs
Hospital
SecurityServices
PublicHealth
ReportingService
OtherCommunityProviders
PhysicianOffices
Hospital
PrivateHIE
PhysicianOffices
PhysicianOffices
PhysicianOffices
Personal HealthRecord System
Private HIE (Hosp)
PhysicianOffices
Hospital OtherCommunityProviders
MiHIN Conceptual Architecture
Query forDocuments
Service
StandardProtocols
LocalProtocols Local
Protocols
EMPI/RLS StandardProtocols
StandardProtocols
(Paid Connection)
StandardProtocols
(Paid Connection)StandardProtocols
StandardProtocols
StandardProtocols
(Paid Connection)
DataWarehouse
MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services
Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards
MessagingGateway
Public ServiceRegistry
Payers
ProviderIndex
MedicationManagementPharmacies
NHIN
MiHIN Backbone
CommunityHIE
CommunityHIE
OtherCommunityProviders
PhysicianOffices
ExternalData Source
ExternalData Consumer
ReferenceLabs
Hospital
SecurityServices
PublicHealth
ReportingService
OtherCommunityProviders
PhysicianOffices
Hospital
PrivateHIE
PhysicianOffices
PhysicianOffices
PhysicianOffices
Personal HealthRecord System
Private HIE (Hosp)
PhysicianOffices
Hospital OtherCommunityProviders
MiHIN Conceptual Architecture
Query forDocuments
Service
StandardProtocols
LocalProtocols Local
Protocols
EMPI/RLS StandardProtocols
StandardProtocols
(Paid Connection)
StandardProtocols
(Paid Connection)StandardProtocols
StandardProtocols
StandardProtocols
(Paid Connection)
DataWarehouse
MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services
Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards
MessagingGateway
Public ServiceRegistry
Payers
ProviderIndex
MedicationManagementPharmacies
EHR LiteConsumersNHIN
MiHIN Backbone
CommunityHIE
CommunityHIE
OtherCommunityProviders
PhysicianOffices
ExternalData Source
ExternalData Consumer
ReferenceLabs
Hospital
SecurityServices
PublicHealth
ReportingService
OtherCommunityProviders
PhysicianOffices
Hospital
PrivateHIE
PhysicianOffices
PhysicianOffices
PhysicianOffices
Personal HealthRecord System
Private HIE (Hosp)
PhysicianOffices
Hospital OtherCommunityProviders
MiHIN Conceptual Architecture
Query forDocuments
Service
StandardProtocols
LocalProtocols Local
Protocols
EMPI/RLS StandardProtocols
StandardProtocols
(Paid Connection)
StandardProtocols
(Paid Connection)StandardProtocols
StandardProtocols
StandardProtocols
(Paid Connection)
DataWarehouse
MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services
Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards
MessagingGateway
Public ServiceRegistry
Payers
ProviderIndex
MedicationManagementPharmacies
NHIN
MiHIN Backbone
CommunityHIE
CommunityHIE
OtherCommunityProviders
PhysicianOffices
ExternalData Source
ExternalData Consumer
ReferenceLabs
Hospital
SecurityServices
PublicHealth
ReportingService
OtherCommunityProviders
PhysicianOffices
Hospital
PrivateHIE
PhysicianOffices
PhysicianOffices
PhysicianOffices
Personal HealthRecord System
Private HIE (Hosp)
PhysicianOffices
Hospital OtherCommunityProviders
MiHIN Conceptual Architecture
Query forDocuments
Service
StandardProtocols
LocalProtocols Local
Protocols
EMPI/RLS StandardProtocols
StandardProtocols
(Paid Connection)
StandardProtocols
(Paid Connection)StandardProtocols
StandardProtocols
StandardProtocols
(Paid Connection)
DataWarehouse
MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services
Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards
MessagingGateway
Public ServiceRegistry
Payers
ProviderIndex
MedicationManagementPharmacies
PrivateHIE
NHIN
MiHIN Backbone
CommunityHIE
CommunityHIE
OtherCommunityProviders
PhysicianOffices
ExternalData Source
ExternalData Consumer
ReferenceLabs
Hospital
SecurityServices
PublicHealth
ReportingService
OtherCommunityProviders
PhysicianOffices
Hospital
PrivateHIE
PhysicianOffices
PhysicianOffices
PhysicianOffices
Personal HealthRecord System
Private HIE (Hosp)
PhysicianOffices
Hospital OtherCommunityProviders
MiHIN Conceptual Architecture
Query forDocuments
Service
StandardProtocols
LocalProtocols Local
Protocols
EMPI/RLS StandardProtocols
StandardProtocols
(Paid Connection)
StandardProtocols
(Paid Connection)StandardProtocols
StandardProtocols
StandardProtocols
(Paid Connection)
DataWarehouse
MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services
Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards
MessagingGateway
Public ServiceRegistry
Payers
ProviderIndex
MedicationManagementPharmacies
State HIE
NHIN
MiHIN Backbone
CommunityHIE
CommunityHIE
OtherCommunityProviders
PhysicianOffices
ExternalData Source
ExternalData Consumer
ReferenceLabs
Hospital
SecurityServices
PublicHealth
ReportingService
OtherCommunityProviders
PhysicianOffices
Hospital
PrivateHIE
PhysicianOffices
PhysicianOffices
PhysicianOffices
Personal HealthRecord System
Private HIE (Hosp)
PhysicianOffices
Hospital OtherCommunityProviders
MiHIN Conceptual Architecture
Query forDocuments
Service
StandardProtocols
LocalProtocols Local
Protocols
EMPI/RLS StandardProtocols
StandardProtocols
(Paid Connection)
StandardProtocols
(Paid Connection)StandardProtocols
StandardProtocols
StandardProtocols
(Paid Connection)
DataWarehouse
MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services
Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards
MessagingGateway
Public ServiceRegistry
Payers
ProviderIndex
MedicationManagementPharmacies
Community HIE
EHR/CIS Implementation and Remediation Boundaries
2222
Financing Approach and Key Assumptions
Discussion Document – Not for Distribution22
1. Governance and operations costs will focus on the statewide HIO, not the individual governance and operations of any regional or local HIOs.
2. The cost of participants’ connectivity to the HIE will be based on adoption estimates that may vary by participant type (e.g. solo provider, critical access hospital, FQHC).
3. The cost for participants to implement new EHRs or remediate existing clinical information systems (CIS) is not included in the cost of statewide HIE, with the exceptions of: Medicaid system implementation or remediation required for
statewide HIE; and Estimated costs and revenues generated by providers that
connect to the statewide HIE using an HIE-provided EHR lite.4. Value-added HIE products and services that can help providers
meet meaningful use requirements and generate revenue to support sustainable HIE will be identified, including any potential added costs for incremental development and/or delivery of such products and services.
5. The finance and revenue model does not include a return on investment (ROI) calculator; only direct sources of revenue are included in the model (ROI and cost avoidance are not included).
2323
Environment Data Collection
Category Statistic(s) Potential Source(s) Complete
General Information
• Residents• Medicaid Enrollment• Medicaid status • Public health departments• Other state agencies• Border States
• Kaiser Family Foundation• Census Data• Medicaid Agency
Physicians • Primary care physicians• % PCP practicing• Nurse practitioners• Physician assistants• % eligible professional (EPs) for Medicaid
and Medicare incentives • EHR adoption among small, medium,
large practices
• Kaiser Family Foundation• Medical Society/Association• Academy of Family
Physicians• Licensing Board
Hospitals • Total hospitals• State/local government owned hospitals• Not-profit hospitals• For-profit hospitals• EHR adoption among small, medium, and
large hospitals• Large hospital system demographics
• Hospital Association
2424
Environment Data Collection
Category Statistic(s) Potential Source(s) Complete
Federally Qualified Health Centers (FQHCs)
• Total FQHCs• Size breakdown (small, medium, and
large)• EHR adoption among small, medium, and
large practices
• Primary Care Association
Rural Health Clinics (RHCs)
• Total RHCs• Size breakdown (small, medium, and
large)• EHR adoption among small, medium, and
large practices
• Rural Health Clinic Association
Payers • Total – Self-insured– Employer-based– Medicare– Medicaid/S-CHIP– Uninsured/Charity care– Cash
• Claims (by payer)• Associated PBMs (by payer)• Surescripts connectivity (by payer)
• Medicaid Agency • Payers • Department of Insurance
2525
Environment Data Collection
Category Statistic(s) Potential Source(s) Complete
Pharmacies • Total pharmacies• Chain v. independent pharmacies• Surescripts connectivity • Pharmacy benefit mangers
• Pharmacy Association• Medicaid Agency• Surescripts
Labs • Total labs• Hospital-based labs• Independent labs • Labs affiliated with large chains
• Medicaid Agency• LabCorp• Quest
Radiology Centers
• Total radiology centers• Hospital-based centers• Independent centers
Regional HIOs
• Demographic data • Technology model• Business/sustainability model• Complexity of connectivity
• NC HIE Strategic Plan
Border States
• Medical trading areas • Expected complexity • Data/services to coordinate
(South Carolina, Georgia, Tennessee, Virginia)
2626
Next Steps
• Initiate data collection and report on progress• Develop provider environment assumptions to inform
financial model• Discuss approach to develop initial cost and revenue
models
Upcoming Meetings– Board of Directors– June 15th – Finance Workgroup Kick-Off Call – June 16th
o Same agenda as 6/9 call for those not able to attend– Finance Workgroup – June 21st
Questions or Comments? Contact anita.massey@nc.gov.
Discussion Document – Not for Distribution
26
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