National eHealth Collaborative Board of Directors Meeting Ruth T. Perot Managing Director

1. Presentation National eHealth Collaborative Board of Directors Meeting Ruth T. Perot Managing Director August 13, 2009

2. Introducing NHIT Our Vision An interconnected public and private health system where all consumers have access to high quality, affordable care and to the information and technology resources required to maximize their access and effective use of health care services. Our Purpose Convene community, public and private sector leaders and experts to leverage advances in health IT to expand access, improve quality and reduce and ultimately eliminate health disparities experienced by communities of color and other underserved populations.

3. NHIT’S GOALS Ensure HIT needs of underserved are met through policies, programs and research Establish effective partnerships to support NHIT goals Reach, inform and educate consumers and providers who serve them to encourage HIT adoption, using culturally and linguistically appropriate strategies Serve as a widely recognized source of innovative HIT-related models Establish an effective organizational structure

4. NHIT Overview Official Launch of NHIT – June 12, 2008 Initiators/Management Committee Apptis Association of Clinicians for the Underserved eHealth Initiative Foundation Institute for E-Health Policy, HIMSS Foundation Office of Minority Health, DHHS Summit Health Institute for Research and Education, Inc. Workgroups with 100+ Volunteers Education and Outreach, Policy, Workforce Development and Training, Finance and Sustainability Program Management Office (SHIRE)

5. NHIT’s Focus Appropriate educational/outreach strategies, public policies, workforce development/training and finance and sustainability initiatives must be made available as essential tools, along with health information technology, in order to achieve improved health quality, equity and access, and these tools must benefit all. With regard to HIT, we must leave no community behind!

6. Who Are the Underserved? Uninsured U.S. residents – 47 million - Less likely to have usual course of care - More likely to have gone without needed care Residents in Health Professional Shortage Areas (HPSAs) – urban and rural areas having a shortage of certain providers - 6,080 Primary Care HPSAs – 65 million residents – 16,585 practitioners needed to meet their need - 4,091 Dental HPSAs – 49 million residents – 9,579 practitioners needed - 3,132 Mental Health HPSAs - 80 million residents – 5,352 practitioners needed

7. Who Are the Underserved? Communities of Color Population percentage in 2008 = 34%; est. percentage in 2050 =54% AHRQ National Healthcare Disparities Report: “For Blacks, Asians, American Indians/Alaska Natives, Hispanics, and poor people, at least 60% of measures of quality care are not improving (either stayed the same (2001/2006) or worsened.)” “Racial and ethnic minorities…..are disproportionately represented among individuals with access problems, such as insurance. “SES explains some but not all of the differences in the health insurance coverage of racial and ethnic groups under age 65.”

8. Defining the Safety Net Institute of Medicine: “Those providers that organize and deliver a significant level of health care and other health-related services to uninsured, Medicaid and other vulnerable patients.” Core safety net providers – public hospitals, FQHCs, local health departments - Teaching and community hospitals, ambulatory care sites Free clinics, oral health, behavioral health, AIDS, school-based clinics that are often not Federally qualified - Private physicians IOM, 2000

9. Private Physicians - Safety Net’s Invisible Giant “Private physicians may well be the invisible giant of the nation’s health care safety net….the data that does exist suggests that most of the health care received by the poor and uninsured in provided in doctors’ offices.” W.K. Kellogg Foundation, 2006 For patients with either Medicaid or no insurance, 78% of primary care visits take place in private physicians’ offices. For ethnic minority patients, 63% of primary care visits occurred in private physicians’ offices. Most of these physicians are in solo or small group practice. In 2008, practices with three or fewer providers served almost 50% of Medicaid beneficiaries in Arkansas, Michigan and Southwest Pennsylvania.

10. NHIT’s Assessment of ARRA/HITECH Meaningful Use and the Underserved “Improve quality, safety, efficiency and reduce health disparities” is lead Health Outcomes/Policy Priority” statement in recent ONC definition. Collection of race, ethnicity, primary language data to aid monitoring and reporting of patient outcomes in early years of adoption Other important goals – engage patients and families; improve population and public health; ensure adequate privacy and security protection for personal health information

11. Other ARRA/HITECH Provisions Benefiting the Underserved Medicare and Medicaid “eligible providers could receive up to $44,000 and $64,750 over 5 years, respectively. Many “safety net” providers are potentially eligible, and an increase of 10% can be made for these eligible professionals furnishing services in HPSAs. Exemptions from application of payment downward adjustments can be made by the Secretary for eligible professionals and hospitals if meaningful EHR use would result in a significant hardship.

12. ARRA/HITECH Challenges/Potential Solutions Challenge: Exclusion of certain safety net providers (e.g., “free clinics”, behavioral health clinics) from eligibility for “meaningful use” incentives Potential Solutions: Legislation may be needed to broaden eligibility criteria for CMS incentives. Eligibility for HIT funding should be based on a broader definition – at least 30 percent of patient volume is attributable to needy individuals.

13. ARRA/HITECHChallenges/Potential Solutions Challenge: Low adoption rates among potentially eligible providers/health professionals, for example: In California, estimated 13% physician practices use EHRs, as well as 3% of community clinics and 13% of hospitals; - NCHS 2-yr study – uninsured and underinsured Hispanic and African American patients are more likely than whites to be treated by physicians who do not use EHRs. Potential Solutions Targeted culturally/linguistically appropriate community-based campaigns to inform safety-net providers about CMS incentives for “meaningful use” of EHRs. - Continuum of technical assistance and other services for under-resourced providers, including practice analysis, decision support, workforce training, development, telemedicine applications, to enable effective EHR use.

14. ARRA/HITECH Challenges/ Possible Solutions Challenge: Role of consumers in HIT not addressed. In statute. Yet, in California study, 70% of consumers say physicians having HIT is important. Possible Solutions Federally-funded consumer outreach campaign on availability of EHR incentives for eligible providers - Regional Extension Centers mandated to ensure community awareness and engagement in planning, implementation and evaluation of activities

15. ARRA/HITECH Challenges/Possible Solutions Challenge: Need for strategies to determine “meaningful use” EHR participation of safety net providers, including physician practices Possible Solutions ONC monitors number/percentages of safety net providers/hospitals compared to representation in total population of potentially eligible. ONC plans interventions if required to rectify under-representation of safety net providers in CMS incentive program.

16. Thank You! For more information, contact: Ruth Perot, Managing Director rperot@shireinc.org www.shireinc.org/nhit