Transcript Slide 1

Stimulus Funding, Meaningful Use
and the Transformation of our
Health Care Delivery System
October 27, 2009
California Center for Connected Health
Five years ago…
“…Within 10 years, every American must have a
personal electronic medical record.
That's a good goal for the country to achieve.
The federal government has got to take the lead
in order to make this happen..”
George W. Bush, Speaking to the American Association of Community Colleges,
April 26, 2004
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Historical Look at Spending in Health IT

Total Federal Health IT Spending (through ONC)
before HITECH:
$300,000,000

Total expected gross outlays through HITECH (up to):
$45,000,000,000

i.e., a 15,000% increase

Put yet another way – it represents a 600% increase
in the EMR market, essentially overnight
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HITECH Overview
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Funding Flows – Entitlements
Entitlement Funds (Up to $45 billion in gross outlays)
Program
Medicare
Payment
Incentives
Medicaid
Payment
Incentives
Distribution
Agency*
CMS
CMS
and states
Use of Funds
Acute Care and
Children’s Hospitals
Incentive Payments
through Carriers
Incentive Payments
through State Agencies
“Meaningful Use”
Physicians and
Dentists
Nurse Practitioners
and Midwives
FQHC
Source: California HealthCare Foundation, 2009
CMS is Center for Medicare and Medicaid Services,
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Funding Flows – Appropriations
Loans
Appropriated Funds ($2 billion in gross outlays)
Distribution
Agency*
Program
HIE Planning and
Development
ONC
EHR Adoption
Loan Program (“may”)
ONC
Health IT
Extension Program
ONC
Use of
Funds
$564 million in
State grants
State-designed
Entity
States
Health Care
Providers
Loan Funds
$598 million - up to 70
competitive grants to
non-profits
Workforce
Training Grants
HHS,
NSF
Medical Health
Informatics & EHR in
Medical School Curricula,
Funding amount unknown
New Technology
Research and
Development Grants
NIST,
NSF
Health Care Information
Enterprise Integration
Research Centers
Indian Tribes
Nonprofits
Least-advantaged
Providers
Higher Education
Medical/Graduate Schools
Source: California HealthCare Foundation. ONC is Office of the National Coordinator, HHS is
Department of Health and Human Services, NSF in National Science Foundation, and NIST is
National Institute of Standards and Technology.
Federal
Government Labs
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Two Programs in Support of
Meaningful Use
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Health Information Exchange
Cooperative Agreement Program
 $564 million Federal program; $38.8 million for California
 States must develop Strategic and Operational Plans:
 Operational plans must address five “domains” identified
by ONC:
Governance, Finance, Technical infrastructure, Business
and technical operations, Legal and policy

 Coordination with Medicaid (Medi-Cal)
 Governance entity
Priority: Support Meaningful Use
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Meaningful Use Priorities
 E-prescribing and medication reconciliation
 Electronic lab ordering and results reporting
 Continuity of care
 Administrative transactions (claims and
eligibility)
 Public health reporting
 Quality reporting
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Regional Extension Center Program
 $598 million in federal funding, 70+ centers funded in three cycles, $30
M max per REC
 ~$500 million for technical assistance
 ~$100 million for core support:
 Three organizations asked to submit proposals to ONC by
November 3rd:
LA Care
 CalOptima
 CalREC (CPCA, CMA, CAPH)
Common governance structure
Centralized “core” services
Decentralized technical assistance services
Coordination with Medi-Cal critical
 Up to $30,000 per provider to support EHR acquisition

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

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REC Core Principles

The REC program should support as many providers as
possible to enable their meaningful use of electronic health
records and maximize their share of the $45 billion in expected
meaningful use incentive payments
 The REC program should maximize California’s collective
receipt of federal funding under the REC cooperative agreement
program
 The REC program should coordinate its activities closely with
the State’s HIE activities, the Medi-Cal meaningful use incentive
program and other relevant programs including telehealth,
broadband and workforce initiatives
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REC Critical Components
Centralized oversight with decentralized services
Centralized Services

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
Group Purchasing of 2-5 EHR
Products
List of vetted/approved products and
consultants, standardized EHR
contracts, hardware group purchasing,
etc.
Online support, educational materials,
and learning collaboratives
Evaluation of services and Federal
reporting
Coordination with EHR Loan Fund
Coordination and management of HIT
consultant certification and Internships
Development of standardized
processes used by RECs
Local Services
 On-site and off-site services
tailored to individual providers
 HIE Support
 Identification of potential
candidates for funding support
 Documentation and dissemination
of training materials and best
practice data
 Coordination with workforce and
training programs
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Overall Timeline
State HIE Grant Application
Anticipated
Award
Announcements
ONC releases
State HIE
Procurement
• 60 day public comment period
Oct
Nov
ONC to issue guidance
on EHR loan program;
ONC to craft Meaningful
Use definition
Dec
Jan
2010
Feb
Marc
h
Full applications
due by Nov 3rd
Preliminary applications
under 1st cycle due by Sept
8th
ONC releases REC
Procurement
Earliest Medicare
payments will be
made available
• First round of administrative HIT payments could be
released in Q1 2010
Application due
by 5pm EST on
October 16th
Sept
Final Rule issued
on Meaningful
Use
• ONC to release Meaningful Use definition and CMS to issue
proposed rule by end of December 2009
Letter of Intent
due 5pm EST
on Sept 11th
Augu
st
2009
Anticipated
Project Start
Date
Preliminary
applications under
2nd cycle due by
Dec 22nd
Awardee
Selection
April
May
June
July
Augu
st
Sept
Oct
2010
Full applications
due by Aug 3rd
Full applications
due by March 2nd
Preliminary applications
under 3rd cycle due by June
1st
Awardee
Selection
Regional Extension Center Application
Awardee
Selection
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…A Foundation for Health Reform
“…investments in electronic records and preventive care are just
preliminary steps. They will only make a dent in the epidemic of
rising costs in this country…
But what accounts for the bulk of our costs is the nature of our
health care system itself – a system where we spend vast amounts
of money on things that aren't making our people any healthier;
A system that automatically equates more expensive care with
better care…
Health care reform is the single most important thing we can
do for America's long-term fiscal health..”
Barack Obama, Speaking to the American Medical Association, June 15, 2009
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Coronary Bypass Procedures
per 100,000 Population, 2006
*2005
**2004
Data: OECD Health Data 2008 (June 2008).
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CABG Procedure Variation in CA
per 100,000 Population, 2007
350.0
CABG
300.0
Laminectomy
250.0
200.0
150.0
100.0
50.0
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a
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i
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sc
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0.0
Data: OSHPD
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International Comparison of Health Spending
Average spending on health per capita 1980 – 2007 ($U.S. PPP)
8000
7000
6000
5000
4000
3000
2000
1000
06
20
04
20
02
20
00
20
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
0
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Per Capita Spending
$7,290
Australia
Canada
France
Germany
Japan
United Kingdom
United States
Source: OECD Health Data 2007.
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International Comparison of Health Spending
Average spending on health per capita 1980 – 2007 ($U.S. PPP)
Poverty level = $10,294
Minimum wage = $13,624
Median income = $26,036
20% of GDP
8000
Australia
Canada
France
Germany
Japan
United Kingdom
United States
6000
5000
4000
3000
2000
1000
06
20
04
20
02
20
00
20
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
0
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Per Capita Spending
7000
$7,290
$11,045
Source: OECD Health Data 2007.
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Timely Preventative Care?
Percentage of Recommended Care Received
Breast Cancer
76%
Prenatal Care
73%
Low Back Pain
69%
Coronary Artery Disease
68%
Hypertension
65%
Congestive Heart Failure
64%
Depression
58%
Orthopedic Conditions
57%
Colorectal Cancer
54%
Asthma
54%
Benign Prostatic Hyperplasia
53%
Hyperlipidemia
49%
Diabetes Mellitus
45%
Headache
45%
Urinary Tract Infection
41%
Ulcers
33%
Sources: The World Factbook (ISSN 1553-8133; also known as the CIA World Factbook). Wal-Mart 2006 Annual Report.
Hip Fracture
23%
Alcohol Dependence
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11%
Columbia Basin Health Association
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Demographics
 24,991 Patients
 75% Hispanic or Latino
 57% of Patients Best Served in a Language other than
English
 47% Migrant/Seasonal Agricultural Workers
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Patient Income
> 200%
4%
151 - 200%
12%
101 - 150%
31%
< 100%
53%
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Payer Mix
Medicare
6%
Private
Insurance
21%
Public
Insurance
12%
Uninsured
26%
Medicaid
35%
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Outcomes Measurement
DM Foot Exams and M icroalbumin
80% o f patients have had fo o t exam and micro albumin within last 12
mo nths
87.6%
100%
55.8%
79.9%
65.9%
60%
90th percentile –
national HMO
commercial
plans
40.8%
40%
30.6%
31.1%
20%
08
`
M
ay
-
08
Ap
r-
08
M
ar
-
Fe
b08
Ja
n08
0%
EMR
Go-Live
83.8%82.80%
Ju
l-0
8
55.7%
69.0%
61.2%
Ju
n08
80%
88.2% 87.10%
DM Foot Exams
Annual Microalbumin
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Outcome Measures, Continued
PHQ Screening
67.0%
60.7%
59.5%
EMR
Go
Live
Ju
l-0
8
Ju
n08
08
M
ay
-
08
Ap
r-
M
ar
-
08
34.2%
Fe
b08
30.5%
Ja
n08
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
85% PHQ-9 Screening Completed for Chronic Care
Patients
93.0%
87.1%
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“If we can measure it, we can manage it."
- Greg Brandenberg, CEO, Columbia Basin Health Association
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Pediatric Partners Medical Group - Temecula
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Data-Driven Processes
 Revenue cycle management services in 2001
 Significantly reduced days in A/R
 Payor dashboard – allows deep level of analysis
 EHR implemented in 2006
 Productivity reports:
 By provider
 By staff
 No more faxes
 Electronic lab results and e-Prescribing
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Pediatric Partners Growth
80
76
12,000,000
70
50
40
12,000,000
MDs
60
14,000,000
10,000,000
Revenue
8,000,000
6,000,000
30
22
20
20
4,000,000
1,800,000
10
2,000,000
3
-
0
2001
2007
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NASA’s Mission to the Moon
“We choose to go to the moon in this decade and do the other things,
not because they are easy,
but because they are hard,
because that goal will serve to organize and measure
the best of our energies and skills,
because that challenge is one that we are willing to accept,
one we are unwilling to postpone,
and one which we intend to win.”
- John F. Kennedy, Rice University, Houston Texas, May 25, 1962
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A Final Word
“The power of space was to raise our
aspirations to those things that are possible,
IF WE WILL COMMIT.”
-NASA flight director Eugene F. Kranz
Mr. Kranz is not just making a statement.
He’s asking a question —
Will we commit?
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Thank you
Jonah Frohlich
Deputy Secretary for Health Information Technology
California Health and Human Services Agency
[email protected]
Sign-up for regular updates, get involved:
HIT&[email protected]
Up-to-date information on State and Federal activities:
www.hie.ca.gov
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