Missouri Statewide Health Information Organization MO-HITECH http://dss.missouri.gov/hie/
Oct 30, 2014
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
Key
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Sources and D
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Up Front Financing &
Ongoing R
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Key
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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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