MiHIN Work Group Kick Off

1. MiHIN Work GroupKick Off November 10, 2009

2. Agenda

3. Opening Remarks Ken Theis, CIO, State of Michigan Jennifer M. Granholm, Governor, State of Michigan

4. Welcome to Attendees Governor Jennifer Granholm “We will help our health care industry stop depending on your memory and their paper records as databanks. We are going to use technology to vastly improve the system. In the future, you will be able to give your pharmacist, your doctor, or the emergency room immediate access to your information, but you will control who sees it and what it is used for.” ~Governor Jennifer Granholm, 2006 State of the State Address

5. Conduit To Care Vision & Goals Remain Unchanged MiHIN Vision “The MiHIN will foster development of HIE that will reduce the overall cost of care while at the same time increasing the quality of care and patient safety.” -Conduit to Care, 2006

6. Conduit To Care Vision & Goals Remain Unchanged MiHIN Goals • Improve the quality and efficiency of health care delivery for Michigan citizens by accelerating the adoption and use of a collaborative model including health information technology (HIT) and health information exchange (HIE). • Minimize redundant data capture and storage, inappropriate care, incomplete information and administrative, billing and data collection costs. • Promote evidence-based medical care to improve patient safety and quality. • Encourage patient-centered care: Connect health care providers – clinicians and facilities to ensure continuity of care for every patient. • Increase patient understanding and involvement in their care. • Enhance communication between patients, health care organizations and clinicians. • Promote national standards to guide the sharing of information and electronic data interoperability. - Conduit to Care, 2006

7. Strategy For Ongoing Stakeholder Involvement A wide array of stakeholders must be engaged to give input throughout all aspects of the project • Engage the MiHIN Regional entities to build on their significant progress • Form structured workgroups to get focused, detailed input • Hold public review and input sessions to ensure consideration of all perspectives • Utilize tools for transparency such as an online work space where all documents and information are readily available

8. MiHIN Timeline 2006 Through 2015 Today marks the start of the next phase of the MiHIN project

9. MiHIN Project Coordination Federal Administrative Office of the State HIE Cooperative Agreement Program Office of the National Coordinator for HIT Applicant HIT Coordi-nator MDCH & MDIT Program Office HIT Commission Project Control Office Support Structure

10. Background Michigan HIE / HIT and the State Cooperative Agreement Program Beth Nagel, HIT Coordinator

11. Current State Of HIE Capacity In Michigan • Michigan created a landmark roadmap with the MiHIN Conduit to Care and invested $10 million to implement it • Michigan has a strong foundation of HIE capacity: • Michigan HIT Commission • HISPC • Broadband (FCC and ARRA) • MiHIN Grant Program • 9 MiHIN Regions • MiHIN Resource Center • Community HIEs • Electronic eligibility & Claims • E-Prescribing • Public Health Reporting • MCIR • Quality, Care Coordination & Patient Engagement • Michigan Primary Care Consortium

12. American Recovery & Reinvestment Act of 2009 HIT Opportunities State HIE Cooperative Agreement EHRIncentives Regional HIT Extension Center Workforce Development Michigan’s Corresponding Initiatives M-CEITA MCHIT MiHIN Michigan Medicaid EHR Incentives

13. State HIE Cooperative Agreement • Strategic & Operational Plans • First Milestone of Cooperative Agreement • Due April 2010 • Must finalize Strategic & Operational Plans before receiving implementation funding • Must work through specific milestones in five domains: • Governance • Technical Architecture • Business and Technical Operations • Finance • Legal/Policy

14. Dewpoint & s2a • Dewpoint - Recently named part of Michigan’s 50 Companies To Watch, is a long-standing tenant of Michigan’s technology corridor. Dewpoint has had a successful track record providing both consulting and implementation services to state government. Founded in 1996, Dewpoint has become a systems integration partner for major companies and governments throughout the Midwest. Dewpoint is headquartered in Lansing, Michigan, and has grown over the past 12 years to also support Ohio, Kentucky, Indiana and Tennessee. • s2a - s2a’s primary goal is to offer clients substantial expertise in the development and implementation of state-wide and community-based HIEs and RHIOS. s2a tailors an approach to HIE which meets the specific needs of each individual client by utilizing a proven methodology based on six successful components of HIE: clinical informatics; stakeholders/governance; financial sustainability; health information technology and technical architecture; performance measurement, and project management.

15. Dewpoint/s2a Health Information Exchange Planning & Implementation Engagements • Michigan • First statewide HIT/HIE plan for MiHIN • HIE feasibility plan for 12 hospitals – HIE of Northern Michigan • Current 5yr HIE planning and implementation • New York • HEAL NY Phase 3 and 5 • CCITI NY 2 yr HIE implementation • HIPAA Privacy and Security plan • Public Health Registry • North Country HIE • Vermont • Led development of statewide rural HIE – VITL • HISPC project • Terminology normalization • New Hampshire • Roadmap for statewide HIT and HIE • Kansas • Statewide HITand HIE roadmap for Kansas HIT/HIE Commission • Massachusetts • EMR impact measurement (for MHQP and MAeHC) • Terminology normalization • Arkansas • Statewide HIT/HIE plan for Arkansas Foundation for Medical Care • San Antonio • Public Health Surveillance system

16. Project Work Initiated in August • Project team started due diligence • Included early adopter analysis • Technical assessment of early adopters and other stakeholders • HIE region and non-HIE region interviews • State of MI technical system technical analysis HIE Cooperative Agreement Grant • Preliminary architecture • Preliminary budget • Drafted grant application submitted 10/16

17. Grant Application Process Update Conduit to Care report (Strategic Plan) and develop plan for implementation (Operational Plan) by April 15, 2010

18. Next Steps • Build work groups • Gain critical stakeholder involvement • Leverage other programs and resources • Execute on the plan Thank you for your interest and for being here.

19. Integration of MI HIN and Medicaid EHR Incentive Program Efforts Sue MoranDirector, Medicaid Program Operations Bureau

20. Medicaid ARRA Provisions

21. Section 4210 • Establishes a program for payment to providers who adopt meaningful use of electronic health records • Provides both Medicaid and Medicaid incentives • Before states can make payments, a range of regulatory, policy, and planning activities must take place

22. State’s Role • Administer the Medicaid incentive payment to eligible professionals • Conduct adequate oversight of the program, including tracking meaningful use • Pursue initiatives to encourage adoption of certified EHR technology to promote health care quality and exchange of health care information

23. What CMS Medicaid Funding Is Available? Two funding sources under ARRA: • 100% FFP Incentive Funds to Providers • Eligible Professionals: up to a maximum of $63,750 over a 6 year period based on historical cost studies • Hospitals: amounts determined through a formula • 90% FFP Administrative Funds to Medicaid State Agencies – 3 Purposes • Administer the incentive payments • Conduct oversight including tracking meaningful use attestations and reporting mechanisms • Pursue initiatives to encourage adoption of EHR technology to promote HC quality and exchange data

24. 100% FFP Medicaid Incentive Funds to Providers

25. Criteria To Receive Medicaid Provider Incentive Payments 1. Be an “eligible” provider 2. Use “certified” EHR technology Definition to be published by ONC by 12/31/2009 3. Meet the “meaningful use” criteria in the employment of the certified EHR technology Definition being developed by ONC + CMS

26. Focus On “Meaningful Use” • Recognition that better health care does not come solely from the adoption of technology itself • Rather, it comes from the exchange and use of health information to better inform clinical decisions at the point of care • Defined by CMS with help from ONC, HIT Policy and Standards Committees and others See www.healthit.hhs.gov for more information on MU

27. Differences Between Medicaid & Medicare Incentive Payments • Medicaid participation is voluntary • Provider types significantly broader • No Medicaid financial penalties to Medicaid providers for not adopting • Incentive payments are potentially higher than for Medicare • Time period for which incentives are available extend to 2021 (compared to 2015 for Medicare EPs) • No “meaningful use” required in Year One – Adopt, Implement or Upgrade

28. 90% FFP Administrative Funds To Medicaid State Agencies

29. Three Purposes of 90% FFP ARRA State Admin Match The State Medicaid Agency must: 1. Administer the incentive payments to eligible professionals and hospitals; 2. Conduct oversight of the program, including tracking meaningful use by providers 3. Pursue initiatives to encourage the adoption of certified EHR technology to promote health care quality and the exchange of health care information

30. Medicaid - Planning • Develop a State Medicaid HIT Plan (SMHP) describing the State’s Medicaid incentive program and how it will integrate current and planned Medicaid HIT assets and fit within the larger State HIT/HIE roadmap • Work collaboratively with other stakeholders involved with HIT adoption

31. State Medicaid HIT Plan (SMHP) • Current HIT Landscape Assessment • “As-Is” Environment • Vision of the HIT Future • “To-Be” Environment • Specific Actions Necessary to Implement the EHR Incentive Program • HIT Road Map • Vision for Medicaid to become part of existing or planned Federal, regional, statewide, and/or local health information exchanges (HIE)

32. Integration of Efforts

33. Collaboration • EHR Incentive Workgroup is working collaboratively with the other ARRA HIT projects, including: • State HIE • Regional HIT Extension Center, M-CEITA • Since these projects are interrelated, the plan is to leverage the activities to advance all the projects, including: • Shared public meetings • Collaborative efforts on planning documents, surveys and outreach

34. Multi-Stakeholder Outreach • In order to insure success the EHR Incentive Workgroup is seeking input from all stakeholders • Public informational and listening sessions are planned • Both broad (to all Medicaid providers) and targeted (to likely incentive participants) outreach is planned • These activities will continue through planning and implementation

35. Questions? Contact Information: • morans@michigan.gov • 517-241-8055

36. Regional HIT Extension Center –Michigan Center for Effective IT Adoption(M-CEITA) Kimberly Lynch, Altarum

37. Regional Extension Centers • Health IT Regional Extension Centers will provide technical assistance and disseminate best practices to support and accelerate efforts to adopt, implement, and effectively utilize health information technology. (ARRA Sec. 3012(c)) • Michigan’s REC applicant is M-CEITA – the Michigan Center for Effective IT Adoption (www.mceita.org) • M-CEITA will advance the meaningful use of HIT across Michigan promoting improvements in quality and enabling patient-centered medical home.

38. M-CEITA Development • Full application submitted to ONC on November 2, 2009 • Over 1,500 priority provider commitments; nearly 5,000 provider commitments total • $3,383,629 in total matching funds September 8 Preliminary Application February M-CEITA Collaborative Formed December 11 Awardee Selection September 28 Preliminary Approval August 20 FOA Released November 2 Full Application M-CEITA Planning M-CEITA Roll Out

39. Activities In Progress Current Planning Activities M-CEITA Workgroups • Finalize Organizational Structure • Alignment with other HIT efforts • Effective governance • Project execution • Operationalize Scope of Services • Direct Assistance • Core Support • Implement Sustainability Plan • Grant funding • Matching funds • Provider payments Governance Operations Sustainability

40. Governance M-CEITA Structure • Executive Committee (EC) members comprised primarily of nonprofit organizations providing core and direct services • Steering Committee (SC) representing the user community and other key stakeholders to ensure M-CEITA’s responsiveness to its core constituency • Advisory Committee (AC) comprised of experts with national stature who can assist M-CEITA in designing and coordinating activities in line with best practices of HIT • Program Management includes project oversight, management of sub-contracts, and meeting federal / grant reporting requirements M-CEITA Executive Committee M-CEITA Steering Committee M-CEITA Advisory Committee M-CEITA Program Management

41. Governance M-CEITA Executive Committee Organizations that participated in full application development and are moving M-CEITA into execution: • Altarum Institute (prime applicant & program management) • Michigan Public Health Institute (MPHI) • Michigan Peer Review Organization (MPRO) • Michigan State Medical Society • Michigan Osteopathic Association • Michigan Health & Hospital Association • Alliance for Health • Michigan Primary Care Association (MPCA) • University Research Corridor: MSU, U of M, Wayne State • Central Michigan University Research Corp (CMU-RC) • Upper Peninsula Health Care Network

42. Governance M-CEITA Operational Model The M-CEITA operational model is based on the agricultural regional extension service model, and will meet the needs of priority and other participating providers across Michigan. M-CEITA Administration Executive, Steering and Advisory committees Program Management M-CEITA Program Manager, Subject Matter Experts and Core Support team Regional Managers – Coordinate and implement the EHR adoption program through direct services delivered to provider offices; one manager will be assigned to each of Michigan’s 9 Medical Trading Areas and will manage multiple Implementation Teams. Implementation Teams – Multidisciplinary implementation teams of process engineers and clinical information technologists will provide direct EHR support services within provider offices

43. Operations M-CEITA Scope of Services • The service area for M-CEITA is the entire state of Michigan • Around 18,000 PCPs; 7,000 priority PCPs; Over 200 Federally-supported practice networks; 14 HIE efforts • FOA Requirements • Each Regional Center will provide assistance to a minimum of 1,000 priority PCPs in the first two years (serve at least 20% of the PCPs in the area) • M-CEITA’s goal is to reach 4,000 priority PCPs and 6,000 providers total over the first 2 years • Core Support • Available to all participating providers • Education and outreach • Local workforce support • Participation in peer-learning and knowledge transfer activities, facilitated by the national Health Information Technology Resource Center / National Learning Consortium Direct Assistance Support Prioritized to priority primary care providers - Vendor selection and group purchasing - Implementation and project management - Practice and workflow redesign - Functional interoperability and health information exchange - Privacy and security best practices - Progress towards meaningful use

44. Operations Primary-Care Providers • MDs, DOs, NPs, CNMs & PAs who practice family, general internal or pediatric medicine or obstetrics and gynecology Priority PCPs • Individual and small group practices (<10) primarily focused on primary care • Public and Critical Access Hospitals • Community Health Centers and Rural Health Clinics • Settings that serve uninsured, underinsured, and medically underserved populations

45. Operations Direct Assistance Approach M-CEITA will provide a variety of individualized services to priority providers supporting effective IT adoption and use

46. Operations Core Support Approach M-CEITA will ensure all Michigan providers have access to current best practices and federal guidance in HIT adoption and use

47. Sustainability Sustainability Plan • Total amount of funding available: $598,000,000; approximately 70 awards • M-CEITA is prepared to execute in either round 1 or 2 of ONC’s funding cycles • Project period length: four-year project period with two separate two-year budget periods • Funding is distributed upon milestone completion which includes signed provider contracts, EHR “go live” and meaningful use achievement including e-prescribing and quality reporting • Self-sustaining business plan included in full application, and must be executed to support REC activities beyond Federal funding • Sustainability plan includes award funding, matching funds and direct provider payments

48. Next Steps • M-CEITA eagerly participating in MiHIN Work Groups and Medicaid EHR planning • Ideas / assistance in obtaining provider commitments, Steering and Advisory committee membership • Provider commitments are still needed and letter templates can be found at www.mceita.org • Steering or Advisory Committee may be submitted to mceita.info@altarum.org • Use of your communication channels to spread the word about M-CEITA and its services to providers • Contact: mceita.info@altarum.org

49. HIE Planning Approach John Evans, Dewpoint/s2a

50. MiHIN Project Goals • Support the implementation of the ONC priorities for health information exchange including NHIN connection • Establish Long-term Governance Structure • Establish a Financial Sustainability Plan • Develop a statewide infrastructure for the secure exchange of health information • Create an incremental plan for implementing HIE over the next four years across Michigan • Ensure interoperability of disparate systems by developing and implementing technical standards that address privacy and security • Develop measures for success