Workgroup CALL June 9, 2010 & June 16, 2010 (same agenda – two date options for participants) 4:00 pm – 5:00 pm

1. 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 654 032 36#

2. Agenda 2 2 Discussion Document – Not for Distribution

3. Welcome and Introductions Co-Chairs, Facilitators, and Members • Co-Chairs • Maureen O’Connor, BCBSNC • Dr. Dave Tayloe, American Academy of Pediatrics • 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 • 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

4. Meeting Objectives – Key Decisions 4 • 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 4 Discussion Document – Not for Distribution

5. Orientation and Overview

6. Project Background & Approach 6 6 • 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 Discussion Document – Not for Distribution

7. Definitions – ARRA & HITECH ARRA American Recovery & Reinvestment Act $787 Billion federal stimulus package passed by Congress and signed by President Obama in February 2009. HITECH Act Health 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. 7 7 Discussion Document – Not for Distribution

8. HITECH FundingHIT & HIE infrastructure New Incentives for Adoption Funding for Health IT • $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) Funding for HIE Community Health Centers $1.5 B in grants through HRSA for construction, renovation and equipment, including acquisition of HIT systems • $564 M for Statewide HIE Development • States receive between $4M & $40M $220 M for “Beacon” Community Program • 15 HIEs receiving between $10-$20M Broadband and Telehealth $4.3 B for broadband & $2.5 B for distance learning/ telehealth grants 8 Discussion Document – Not for Distribution

9. North Carolina Health IT Awards • ARRA: • State HIE Cooperative Agreement: $12.9 million • Medicaid Meaningful Use Planning: $2.29million • 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: $28.8million 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 9 Discussion Document – Not for Distribution

10. Overview of Workgroup Process and Tasks

11. State HIE Cooperative AgreementGoals and Planning Requirements • Goal: Plan and develop the HIE infrastructure to ensure • Widespread interoperability across entire state • Providers and hospitals can achieve meaningful use Required Plans Domains to Address Types of Exchange • 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 • 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 • -Governance • -Finance • -Technical infrastructure • -Business & Technical Ops • -Legal and Policy

12. Workgroup Deliverables for Operational Plan 12 Discussion Document – Not for Distribution

13. Work Group MethodologyIntegration of Key Deliverables Governance Work Group Legal & Policy Work Group Clinical & Tech Operations Work Group Finance Work Group • Identify privacy issues • Define options • Identify policy/tech requirements • Identify clinical/business objectives • Define architecture • Identify services • Detail functions, options • Develop high-level costs • Collect relevant environment data • Define revenue sources • Identify funding constraints and timing considerations • Define roles, decision making authority • Identify goals • Define measures ImplementationRequirements • Technical specifications • Implementation sequencing • Detailed cost estimates • Detailed, 4 yr budget • Evaluation strategy 13 Discussion Document – Not for Distribution

14. Finance Workgroup Charter 14

15. Finance Workgroup Project Plan 15

16. Finance Workgroup Project Plan 16

17. Introduction to Modeling Approach 17

18. Progress in North CarolinaFinancing 18 Discussion Document – Not for Distribution

19. Financing Approach and Key Assumptions Refinement Cycle Up Front Financing Ongoing Connectivity Core Services / MU Use Cases Revenue Inputs Sources and Drivers of Sources and Drivers of Up Front Financing & Up Front Financing & Ongoing Revenue Ongoing Revenue Value Added Services Fees or Assessments Financing 6 YR Model Participants, Connectivity and Use Cases Model Framework Value Added Services Key Sources and Drivers of Key Sources and Drivers of Cost Inputs Cost Cost Core Services Governance and Operations Refinement Cycle 19 19 Discussion Document – Not for Distribution

20. HIE Model Approach Steps 20

21. EHR/CIS Implementation and Remediation Boundaries PrivateHIE Community HIE EHR LiteConsumers EHR/CIS Implementers and Remediators State HIE Medicaid Other State Agencies For discussion purposes only - Not for distribution 21

22. Financing Approach and Key Assumptions • Governance and operations costs will focus on the statewide HIO, not the individual governance and operations of any regional or local HIOs. • 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). • 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. • 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. • 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). 22 22 Discussion Document – Not for Distribution

23. Environment Data Collection 23

24. Environment Data Collection 24

25. Environment Data Collection 25

26. 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 Same agenda as 6/9 call for those not able to attend Finance Workgroup – June 21st Questions or Comments? Contact anita.massey@nc.gov. 26 26 Discussion Document – Not for Distribution