Janet M. Marchibroda Chief Executive Officer eHealth Initiative and Foundation March 15, 2007

1. The National Landscape and Wisconsin’s RoleeHealth Implementation SummitGovernor Doyle’s eHealth Care Quality and Patient Safety BoardMadison, Wisconsin Janet M. Marchibroda Chief Executive Officer eHealth Initiative and Foundation March 15, 2007 March 15, 2007

2. Congratulations! • For your leadership, within the Governor’s office, the state, and every sector of healthcare in Wisconsin • For the creation of the Wisconsin eHealth Action Plan… • Your long standing history of collaboration around quality and patient safety, and healthcare IT leadership positions you well for enormous success March 15, 2007

3. Overview of Presentation • Emerging National Standards and Policies Offer a Foundation for Health Information Sharing • State Leadership: An Overview of What’s Happening in the Field • Getting to Implementation: Key Insights for State and Community Leaders March 15, 2007

4. National Policies and Standards Offer Foundational Building Blocks for Health IT and HIE • Standards for Health IT and Interoperability: • Outcomes emerging from HITSP process offer guidance; CCHIT for which government has provided seed funding, offers implementation mechanism • Federal government compliance with standards will begin to drive critical mass • President’s Executive Order and DHHS Sec. Four Cornerstones have stimulated private sector purchaser/employer sign-on to requirements for standards for health IT March 15, 2007

5. National Policies and Standards Offer Foundational Building Blocks for Health IT and HIE • Congressional and Executive Branch Actions Signal Changes in Payment Policy • President’s Aug 2006 Executive Order calls for transparency in quality and pricing and directs Federal agencies to “develop and identify approaches that facilitate high quality and efficient care”….Secretary’s Four Cornerstones is driving action by key federal agencies • Principles of “Four Cornerstones” being rapidly “adopted” by the private sector, with over 200 employers having “signed on”, issuing their vote of support….standard “RFI’s” now include expectations for reporting as well as health IT March 15, 2007

6. National Policies and Standards Offer Foundational Building Blocks for Health IT and HIE • Congressional and Executive Branch Actions Signal Changes in Payment Policy • The Tax Relief and Health Care Act of 2006 (H.R. 6111) calls for bonuses to those who report voluntarily on quality measures-- structural measures, such as the use of EHRs and eRx along with reporting of consensus-based measures required in 2008 • Bill also calls for a three year demonstration project on the “medical home” which cannot happen without information mobility and a health IT infrastructure March 15, 2007

7. National Policies and Standards Offer Foundational Building Blocks for Health IT and HIE • Congressional and Executive Branch Actions Signal Changes in Payment Policy • March 2007 MEDPAC recommendations call for changes in payment policy that cannot be achieved without health information mobility, and specifically refers to health IT March 15, 2007

8. National Policies and Standards Offer Foundational Building Blocks for Health IT and HIE • Some Funding Continuing to Emerge to Capitalize Early Efforts, and Technical Assistance Efforts Continue • ONC expected to fund states and communities who will implement “trial implementations” of the Nationwide Health Information Network • AHRQ now reviewing several applications for funding which evaluate use of health IT for quality and safety • A majority of Medicaid Transformation grants focus on HIT • Technical assistance being offered by AHRQ (National Resource Center for Health IT), HRSA (federally qualified community health centers), and CMS (QIO Eighth Scope of Work – support to physician practices) March 15, 2007

9. State Leadership: An Overview of What’s Happening in the Field March 15, 2007

10. State Level ActivityWhat’s Happening? • Over half the states in the country are developing or implementing plans related to health information technology • Emphasis on quality, patient safety and curbing rising healthcare costs rank high as the primary drivers for state leadership around health information technology. March 15, 2007

11. State Level Activity: eHI Survey Results Stage 1 AWARENESS 15% Stage 2 REGIONAL ACTIVITY 17% Stage 3 STATE LEADERSHIP 25% Stage 4 STATEWIDE PLANNING 29% Stage 5 STATEWIDE PLAN 8% Stage 6 STATEWIDE IMPLEMENTATION 6% • Recognition of the need for HIE among multiple stakeholders in your state, region, or community • No coordinated, statewide activity • Regional or community-specific HIE activity • Silos of HIE activity with possibly some cross-over • No coordinated, statewide activity • Either legislation has been passed or an executive order issued • Statewide planning initiative being formulated • Well underway with coordinated, statewide planning • Structures in place have statewide representation • Clear on how to deliver statewide plan • Plan / Roadmap complete and accepted • Plan / Roadmap communicated to the public • Implementation of state plan or Roadmap is well underway, with key milestones completed March 15, 2007

12. eHI’s Recent Analysis of Leadership by Governors • Fourteen executive orders were issued by U.S. governors calling for HIT and HIE to improve health and healthcare • Arizona, 2005 • California, 2006 • Florida, 2004 • Georgia, 2006 • Illinois, 2006 • Kansas, 2004 • Mississippi, 2007 • Missouri, 2006 • North Carolina, 1994 • Tennessee, 2006 • Texas, 2006 • Virginia, 2006 • Wisconsin, 2005 • Washington, 2007 March 15, 2007

13. eHI’s Recent Analysis of State Legislative Activity • HIT State Legislative Activity Is on the Rise. State legislatures are increasingly recognizing the importance of IT in driving health and healthcare improvements. • In 2005 and 2006: • 38 state legislatures introduced 121 bills which specifically focus on HIT • 36 bills were passed in 24 state legislatures and signed into law. • In 2007 So Far: • 17 bills have been introduced in 10 states which specifically focus on HIT March 15, 2007

14. eHI’s Recent Analysis of State Legislative Activity Focus of HIT State Legislative Action • The authorization of a commission, committee, council or task force to develop recommendations • The development of a study, set of recommendations, or a plan for HIT • The integration of quality goals within HIT-related activities; or • The authorization of a grant or loan program designed to support HIT March 15, 2007

15. Critical Role of States • Participant in the dialogue • Convener of the dialogue • Providing funds • Commissioning or funding a study • Providing education to stakeholders • Requiring use of standards (a la Four Cornerstones) • Providing financial and other incentives through Medicaid • Providing financial and other incentives in role as purchaser • Integrating other functions of the state with the work of the private sector (e.g. public health, etc.) March 15, 2007

16. State-Wide Dialogue • Establishing policies for information sharing (assuring privacy and confidentiality), Federal government funding initiatives • Removing regulatory barriers • Integration of public health goals into health IT strategy • Facilitating integration with Medicaid program • Education and awareness-building, targeting all stakeholders, including consumers • Sharing of best practices among regions and stakeholders in the state March 15, 2007

17. Insights About Wisconsin’s Plan • Your plan focuses on improving the health and healthcare for the citizens of Wisconsin…which is absolutely the right strategy • Incremental, thoughtful, feasible • Supporting both health IT adoption and health information exchange (we need both) • Recognizing the importance of aligning health IT platform with both value-based purchasing strategies and disease/chronic care management is critical • It’s actionable, it’s measurable….it’s business-like • Positions you well for great success • Congratulations! March 15, 2007

18. Moving From Planning to Implementation: What Next? March 15, 2007

19. Getting to ImplementationSome Key Questions • How should communities leverage the initial capital/grants we’ve received to develop a sustainable business model for health IT and health information exchange? • What should communities do first? What provides the most value? • How do we support clinician adoption? March 15, 2007

20. eHI 2006 SurveyMost Difficult Challenges • Securing upfront funding – (57 percent) • Developing a sustainable business model – (44 percent) • Accurately linking patient data – (30 percent) March 15, 2007

21. eHI 2006 SurveySources for Upfront Funding • Federal Government – (42 percent) • State or Local Government – (29 percent) • Hospitals – (24 percent) • Philanthropic – (23 percent) March 15, 2007

22. eHI 2006 SurveyFunding Sources for Ongoing Operations • Hospitals – (24 percent) • Payers – (21 percent) • Physician practices – (16 percent) • Labs – (13 percent) • Philanthropic (9 percent) March 15, 2007

23. Getting to SustainabilityConnecting Communities Program Background • Provided funding support for 13 learning laboratories in ten communities, related to health information exchange • Engaged an expert panel, including not only healthcare experts, but also experts in economics, business, and financing • Took a very close look at three advanced stage communities in IN, OH and NY March 15, 2007

24. Getting to SustainabilityEarly Key Findings • Sustainability of health information exchange is indeed possible, and probable if certain factors are in place…. • No “one-size-fits-all” approach or silver bullet, it depends on the market’s needs and requirements • Social capital formation is necessary for leaders to identify and coalesce divergent interests in a common cause ….due to fragmentation of our healthcare system and current payment policy • Time, commitment, charisma and honesty are required to keep a large, diverse stakeholder group at the table. Managing an HIE is not a part-time job and consistent execution is necessary to maintain the social capital that has been created as part of the initial endeavor March 15, 2007

25. Getting to SustainabilityEarly Key Findings • Social capital will help communities build trust and develop consensus on policies for information sharing • Strong leadership team with good business acumen is one of the key criteria for success as communities move to the implementation stage • Rigorous analysis of the value that potential services provide to each customer is crucial… • Need to better understand how value for each customer translates to revenueto cover the costs of the endeavor. This takes time and discipline…and business orientation • Today, while many community leaders understand this concept, it is often not well executed March 15, 2007

26. Exploring Areas of Value • Highlights of 2006 eHI Survey of Health Information Exchange at State and Local Levels • Fielded in May 2006 • Includes 165 responses from health information exchange (HIE) initiatives located in 49 states, the District of Columbia and Puerto Rico. March 15, 2007

27. eHI 2006 Survey: Who’s Involved Stakeholder Engagement • Engagement of the multiple stakeholders in healthcare is expanding considerably. • Largest increases in: • Hospitals – 96% • Health plans – 69% • Employers – 54% • Primary care physicians – 91% • What does this mean for the value proposition? March 15, 2007

28. eHI 2006 SurveyTypes of Data Exchanged • Laboratory – (26 percent) • Claims – (26 percent) • ED Episodes – (23 percent) • Dictation – (22 percent) • Inpatient Episodes – (22 percent) • Outpatient Lab – (22 percent) • Radiology – (20 percent) • Outpatient Prescriptions – (18 percent) March 15, 2007

29. eHI 2006 SurveyServices Provide Value that Focuses on Care Delivery for Providers • Clinical documentation (26 percent) • Results delivery (25 percent) • Consultation/referral (24 percent) • Electronic referral processing (23 percent) • Alerts to providers (20 percent) March 15, 2007

30. eHI 2006 SurveyNew Valuable Services are Emerging • Chronic or Disease Management – (20%) • Quality Performance Reporting for Purchasers or Payers – (11%) • Quality Performance Reporting for Clinicians – (10%) • Public Health Surveillance • Consumer Access to Information (in light of rapidly emerging PHR initiatives) March 15, 2007

31. Taking a Harder Look at the Use of Health Information Exchange to Support Quality Improvement and Performance Reporting March 15, 2007

32. BTE-Funded Towers Perrin Study Identifies Measures That Produce Improvements in Cost and Quality • HTN 42 BP<140/90 • HTN 43 SBP<140 • HTN 44 DBP<90 • DM 23 BP<140/90 • DM 21 HbA1c>9% • DM 22 HbA1c<7% • DM 25 LDL<100 • DM 26 LDL<130 • CAD 6 LDL<100 after discharge for AMI, CABG, PCI • CAD 7 LDL<130 after discharge for AMI, CABG, PCI • CAD 8 LDL<100 any CAD • CAD 9 LDL<130 any CAD March 15, 2007

33. You Really Need Clinical and Claims Data to Make This all Work Plan A Plan B Health Information Exchange Claims Data Aggregation Plan C Medicaid Medicare March 15, 2007

34. You Can’t Get There Without Building the Information Foundation • eHI’s Parallel Pathways Framework requires alignment Quality and Value Quality Expectations Health Info Exchange Capabilities Physician Practice HIT Capabilities Financial Incentives March 15, 2007

35. Points of Intersection:Health IT and Value-Driven Healthcare • Both require leadership and multi-stakeholder collaboration at the market level • Value driven healthcare needs a health IT infrastructure to effectivelyand efficiently measure quality (particularly as we look at 2008 expectations) • Health IT facilitates quality improvement at the same time as performance measurement…which is critical • Health IT enables care coordination which is a necessary component of value-driven healthcare • Health IT provides necessary linkages to clinical data for consumer engagement strategies to support consumer activation for healthcare improvement • So…..incentives should support process, structure and outcomes…and all align with health IT March 15, 2007

36. We’re at a Unique Point in Time • The confluence of efforts surrounding not only health IT but also value-driven healthcare and consumer activation, create an enormous opportunity for transformation in Wisconsin and across the U.S. healthcare system. March 15, 2007

37. Congratulations and Thank You March 15, 2007

38. Janet M. Marchibroda Chief Executive Officer eHealth Initiative and Foundation www.ehealthinitiative.org 818 Connecticut Avenue, N.W., Suite 500 Washington, D.C. 20006 202.624.3270 Janet.marchibroda@ehealthinitiative.org March 15, 2007