2007 Ambulatory spend $448B on Communication, Technology, Information Systems Market View: Total Healthcare Spend Healthcare presents a sizable.

2007 Ambulatory spend

$448B on Communication, Technology, Information Systems

Market View: Total Healthcare SpendMarket View: Total Healthcare Spend

Healthcare presents a sizable growth market offering future opportunities

The American Medical Association, National Health Insurer Report Card www.ama-assn.org

2007 U.S Total Healthcare Expenditures = $2.1 trillion(~$7,500 per resident)

$448B Communication, Tech, & IS Spending

~ $3B Software & Services Spending Need to size the $3B

plus ARRA $:

• EHR

•Practice Mgmt

• EMR

• HIE

• CHC

• etc.

Prevention

& WellnessEducation

& TrainingTelemedicine

SCHIP

Infrastructure, HIE, CHC, Indian Health

Research

EHR IncentivesEHR Incentives

In Billions

What is the Impact of ARRA/HITECH Act?The American Recovery and Reinvestment Act contains bonus payments of $44,000 to $64,000 to physicians who adopt and use EHRs “in a meaningful way”, beginning in 2011 and continuing through 2015 after which doctors who do not use EHRs will be penalized.

HHS - $167 Billion in ARRA Funding• ONC Funding

– Privacy and Security – $24.3 million – NIST – $20 million – Regional HIT Exchange – $300 million – Unspecified – $1.65 billion – Total, HIT - $2 billion

• CMS Funding:

– State Medicaid Administration – $1.05 billion – Medicare Administrative Costs – $745.0 million – Medicaid Administrative Costs – $300 million – Medicare Incentives – $23.1 billion (available

starting in FY11) – Medicaid Incentives – $21.6 billion (available

starting in FY11) – (Total Mandatory Recovery Act HIT Funds $46.8

billion)

• HRSA – CHC Funding– Capital Improvement Grants- $850 million

for use on capital improvements, including EHR adoption (will be spent in FY09)

– Health Information Technology Systems/Networks Grants- $125 million (will be spent in FY09)

– Facility Investment Grants- $512.5 million (will be spent in FY 2010)

– (Total: $1.5 billion)

HRSA – Workforce Training– Loan Forgiveness - $300 million– Workforce Training - $200 million

HHS - $167 Billion in ARRA Funding• Indian Health Service (IHS)

Funding for IT Adoption

– Certified Electronic Health Record Adoption - $61.7 million (34.8 in FY09 and 26.9 in FY10)

• CPOE • Clinical Decision Support • Quality Reporting • Health Information Exchange • Certification • Deployment

– Personal Health Record Adoption - $2.5 million ($1.7 million in FY09 and $0.8 million in FY10)

– Telehealth and Network Infrastructure - $16.7 million ($12.7 million in FY09 and $4.0 million in FY10)

– Administration Costs- $4.1 million

• HHS, AHRQ, and NIH Comparative Effectiveness Research

– HHS Discretionary Funding- $400 million – AHRQ- $300 million – NIH- $400 million

• HHS Information Technology Security

– HHS Information Technology Security-$50 million ($31.9 million in FY09, $18.1 million in FY10)

Non-HHS Funding of Note:

FCC, USDA and Commerce – Broadband– $7.3 billion for broadband

How is Sage preparing?How is Sage preparing?

Staying plugged in• Actively monitoring legislative and regulatory changes

• Ongoing employee and business partner education

Products & Certification• Sage Intergy EHR v6 – our “meaningful use version”

• ONC-required Meaningful Use certification

• CCHIT 2011 certification

How is Sage preparing?How is Sage preparing?

Advocacy• Participation in industry groups shaping the dialog with the federal

government• Written responses to the proposed rules per public comment provision

Readiness• Education

– Meaningful Use White Paper– Meaningful Use Summits– Educational webinars– Updated stimulus information on www.SageHealth.com– Articles in Sage CheckUp and Sage e-briefs

• Developing practical tools and resources for customers• Consultative discussions with Sage customers about reaching meaningful

use

The Coming Months

State HIE Procurements from ONC could be released as early as mid-August

July 2009 August October December January 2010 April Oct 2010

ONC releases HIE implementation plans and Regional Extension Center definitions and procurement

HIT Policy & Standards Committees deliver and approve Meaningful Use Recommendations

State funding applications likely due; ONC to issue guidance on EHR loan program; ONC to craft Meaningful Use definition

•ONC to release Meaningful Use definition and CMS to issue proposed rule by end of December 2009

•60 day public comment period

•First round of administrative HIT payments could be released in Q1 2010

Final Rule issued on Meaningful Use

Earliest Medicare payments will be made available

Meaningful Use OverviewMeaningful Use OverviewPolicy Vision & Goals*Policy Vision & Goals*

VisionEnable significant and measurable improvements in population health through a transformed health care delivery system.

Goals• Improve quality, safety, and efficiency

• Engage patients and their families

• Improve care coordination

• Improve population and public health • Ensure privacy and security protections

*Source: Health IT Policy Committee Meaningful Use Workgroup’s June 23, 2009 presentation

Meaningful Use Overview Meaningful Use Overview Regulatory DefinitionRegulatory Definition

In HITECH, Congress specified three types of requirements for meaningful use:

1. use of certified EHR technology in a meaningful manner (e.g. Electronic Prescribing);

2. that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and

3. that, in using certified EHR technology, the provider submits to the Secretary information on clinical quality measures and such other measures selected by the Secretary.

To be a “meaningful user,” EPs must use a certified EHR to satisfy all Criteria and all Measures.

CMS Vision for StagesCMS Vision for StagesRequirements Scaling Up Over TimeRequirements Scaling Up Over Time

Stage 1 Stage 2 Stage 3

1. Capturing health information in a coded format

2. Using the information to track key clinical conditions

3. Communicating captured information for care coordination purposes

4. Reporting of clinical quality measures and public health information

1. Disease management, clinical decision support

2. Medication management

3. Support for patient access to their health information

4. Transitions in care

5. Quality measurement

6. Research

7. Bi-directional communication with public health agencies

1. Achieving improvements in quality, safety and efficiency

2. Focusing on decision support for national high priority conditions

3. Patient access to self-management tools

4. Access to comprehensive patient data

5. Improving population health outcomes

For Stage 2, CMS may also consider applying the criteria more broadly to both the inpatient and outpatient hospital settings. CMS expects to propose Stage 2 criteria by the end of 2011.

CMS expects to propose Stage 3 criteria by the end of 2013.

Meaningful Use Measures – Stage 1Meaningful Use Measures – Stage 1

Measures are grouped into two categories:

Each measure is linked to a related Meaningful Use Objective

18

Electronic Health Record Technology Functionality Measures (8)

Clinical Quality Measures (17)

Immediate Action for Practices!Immediate Action for Practices!• Decide if you will participate• Pick your program• Develop detailed implementation plan

– Set goals & detailed timelines– Set expectations– Gain “buy in”– Plan for the unexpected

• Make EHR selection• Keep your end goal in mind• Process Redesign!Process Redesign!

Process Redesign | Bottom Line ResultsAutomating current manual processes will provide simple efficiencies like finding a patient’s chart in seconds to complex situations such as patient flow monitoring and clinical treatment plan effectiveness.

The key is to understand the process before and after the introduction of technology into your practice.

Our staff collaborates with your team to assess workflows and design a system to streamline the unique needs of your practice.

Sage Value in Partnership – our program is growing and offering multiple opportunities to partner in select areas and/or segments – Referral, Reseller and Channel Partner Arrangements

Multi-Year ContractsNo Admin FeeChannel Partner PortalAttractive MarginsCustom Training

Brian MuckVice President - Indirect DistributionSage Healthcare Division4301 W. Boy Scout Blvd. Suite 800Tampa, FL 33607Mobile: 610-334-6165Fax: [email protected] us at: www.sagehealth.com