Business Agenda - Alaska eHealth Network Shirk, M.D. Valdez Medical Clinic . AeHN Board of Directors...

Mailing: 2440 East Tudor Road PMB 1143 Anchorage, AK 99507

Physical: 4000 Old Seward Hwy, Suite 203 (907) 770-2626

AeHN BOARD OF DIRECTORS

Nancy Merriman President, AeHN Executive Director, Alaska Primary Care Association

Jerry Jenkins Vice President, AeHN CEO, Anchorage & Fairbanks Community Mental Health Services

Chris Emond Treasurer, AeHN Director of Finance & Operations Mat-Su Health Foundation

Jennifer Dahline Secretary, AeHN Premera Blue Cross Blue Shield

Timothy Ballard, M.D. M.S. Director Alaska VA Healthcare System

Connie Beemer Director, Member Services & Operations, Alaska State Hospital and Nursing Home Association

Valerie Davidson Commissioner State of AK, DHSS

Stewart Ferguson, PhD CTO, Alaska Native Tribal Health Consortium

Jan Harris Vice Provost for Health Programs University of Alaska

Erin McArthur, M.D. LaTouche Pediatrics

Sam Shirk, M.D. Valdez Medical Clinic

AeHN Board of Directors Meeting May 17, 2017

11:30 am to 1:00 pm

Location: Alaska eHealth Network 4000 Old Seward Hwy., Suite 203

Dial in: 1-269-220-0254

Business Agenda

1. Call to Order/Nancy Merrimana. Declaration of Conflictb. Approval of Agendac. Approval of Minutes (04/10/2017)

2. Standing Reports• President’s Report/Nancy Merriman• Treasurer’s Report/Chris Emond• Executive Director’s Report/Rebecca Madison• State of Alaska Report/Beth Davidson

3. State Contract/Nancy Merriman4. Board Positions/Nancy Merriman5. Treasurer and Finance Committee/Nancy Merriman6. ED Update/Nancy Merriman7. IAPD Update/Rebecca Madison

a. Possible Budget Revisionsb. Staffing Assumptionsc. Other HIEs

8. Next Meeting – June 6 or June 29, 2017, next regulardate July 19, 2017

9. Board Meeting Adjournment

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pg 1

pg 2

pg 7

pg 14

pg 25

pg 39

AeHN Board of Directors Meeting AeHN Office, 4000 Old Seward Hwy, Suite 203, Anchorage

Monday, April 10, 2017 11:30 a.m.- 1:00 p.m.

Alaska eHealth Network – Board of Directors Meeting Minutes April 10, 2017

Board Members Present P Merriman, Nancy (Vice Pres, Acting Pres) - APCA T Harris, Jan – University of AK (NV) Ad Hoc: P Jenkins, Jerry – Comm. Mental Health Svcs. P McArthur, Erin, MD – LaTouche Pediatrics P Madison, Rebecca -Executive Director A Emond, Chris (Treasurer) –Mat-Su Health P Oswald, Jessica - Providence P Yesmant, Claudette – AeHN Recorder T Dahline, Jennifer – Premera BCBS T Shirk, Sam – Valdez Medical Clinic P Ballard, Timothy – VA Healthcare System P Connie Beemer - ASHNHA X Davidson, Val – DHSS (Proxy-Beth Davidson) P Ferguson, Stewart, PhD - ANTHC P=Present / T=Teleconference / A=Absent / X=Proxy / NV=Non-voting Member (Quorum = 7 Voting Members or Member Proxies) Guests Present (P) Wailand, Heidi – AK Trust Authority (T) Beckett, George – Cedarbridge Group (P) Carney, Darcy – Carney Consulting (P) Kelter, Layla - AFHCP Supporting Documents: TIME AGENDA ITEM – Presenter/Discussion Consensus/Action

11:34AM

CALL TO ORDER • Welcome and Introductions

President Merriman welcomed all attendees. Having determined that a quorum was present the meeting was called to order at 11:34 am.

• Approval of Agenda Ms. Merriman presents a brief overview of the agenda and requests approval. She also asks if any attendee has a conflict of interest to please come forward; none identified. There was a motion by Stewart Ferguson to approve the agenda, seconded by Connie Beemer. Motion approved.

• Approval of Minutes Ms. Merriman presented the meeting minutes from 03/15/2017 and requested approval. There was a motion by Connie Beemer to approve minutes from 03/15/2017, seconded by Jessica Oswald. Motion approved.

• Standing Reports

Motion to approve agenda passed Motion to approve minutes from 03/15/2017 passed

2


President’s Report (Nancy Merriman)

Ms. Merriman gives an overview of the AeHN sponsored stakeholder webinar held on March 29th. She reports there were over 100 participants from across the health care sector statewide. The webinar summarized stakeholder input collected to date, the current state of the health information exchange, and three future options for AeHN; 1. Continue operating as is, 2. Expand onboarding efforts and 3. Expand onboarding efforts and services. She states that the board will be voting on the future direction of AeHN during this meeting.

Treasurer’s Report (Chris Emond)

In the absence of Chris Emond, Darcy Carney gives the Financial Report. She references the new narrative report on page 8 prepared as per board request. Ms. Carney continues by reviewing the Statement of Financial Position report as of February 28, 2017. Cash and money market accounts total $657,759.27. A review of the Statement of Activities ending February 28, 2017 shows a net income of ($87,169.57).

Executive Director’s Report (Rebecca Madison) Rebecca Madison presented the Executive Director’s report as of 02/28/2017. 1. Financial: SOA payments are now up to date. SOA payments for April and June have been removed from the forecast as they are intended to be used as match for HITECH funding. 2. DSM: All DSM accounts have been cleaned up leaving 403 organizations LIVE/5 organizations in process and 4,194 active users 3. HIE: 22 hospitals signed and there are over 620 users. 5. Privacy and Security: HiTrust Certification completion will be in conjunction with Orion Health; they expect to complete their process by December 2017. 6. Resources: AeHN Board is working on a strategy plan and ongoing sustainability plan directives which will include additional resources to ensure AeHN’s ability to provide value based services and build capacity. Hired Help Desk replacement and placed recruitment ads for Data Quality Analyst. There were several comments about the total number of unique patients being reported as 804,400 (graph, page 20). The number seems high for the state of Alaska and it was recommended that the data be rechecked.

State Report (Beth Davidson) Beth states there is no new information to report. There was a motion by Connie Beemer to approve the financial report and standing reports; seconded by Erin McArthur. Motion approved.

• Board Action Items & Required Votes (Nancy Merriman) President Merriman directs board members to page 32; Future Direction Setting. She states there will be five motions presented today that require votes. The votes are mapped to the following three options:

1. Continue operating as is 2. Expand onboarding efforts 3. Expand onboarding and services

The five motions were presented with roll call votes following each. All motions were discussed and modified with approval. They are:

1. DHSS Contract Vote/AeHN Board Members Motion

Motion to approve financial report and standing reports passed Motion to approve DHSS Contract Section 1 and Section 2 – passed by majority vote

3


Move to approve Board signature on the DHSS Contract amendment #11 as two sections requiring separate votes. Section 1: Includes Deliverables number 2, 3, 4 and 5. Section 2: Includes Deliverables number 6 and 7.

2. Strategic Plan Priorities Vote/AeHN Board Member

Motion Move to approve the strategies and priorities presented in the April 10th Board Meeting packet (pages 5 and 12). These represent commitment to value, sustainability and stakeholder engagement and reflect general priorities through FFY 2022. AeHN commits to working on a strategy with DHSS and stakeholders on finalizing the details to support the next HITECH funding request.

3. Staffing Plan Vote/AeHN Board Members

Motion Move to approve the staffing plan presented in the April 10 Board packet, broken out into three sections all of which requiring separate votes.

Section 1: Proceed with the option to contractually engage a subject matter expert as an Interim Executive Director for the immediate term and up to nine months, while the Board conducts a search for a long-term Executive Director. AeHN bylaws establish that the AeHN Board is responsible for the Executive Director search, hiring and termination.

Section 2: Upon securing additional HITECH funds, proceed with the recommendations in the staffing plan, proposed position list and organizational chart, with cost estimates for each position, addressing needs in the immediate, medium-, and long-term future of AeHN. The Executive Director shall oversee the implementation of the staffing plan, in alignment with the trajectory of funding and workload of AeHN and HIE on-boarding and management.

Section 3: Submit staffing plan defined on page 48, medium-term to the SOA to support the next HITECH funding request.

4. FY18 Budget Vote/AeHN Board Members

Motion Move to approve the proposed FY 18 budget presented in the April 10th Board Meeting packet, with the understanding that significant changes to the budget will be presented and considered by the Board throughout the fiscal year. The FY18 budget accounts for the immediate change to the Executive Director position.

5. Sustainability Plan Directives Vote/AeHN Board Members

Motion Move to approve the draft sustainability plan directive as presented in the April 10th Board Meeting packet, which:

• Requires the investment of additional resources into the HIE to increase value to participants • Anticipates CMS federal HITECH funds will be leveraged to support the additional investment • Seeks to move beyond three revenue groups to an expanded contributor model where each sector pays

its fair share based on the proportional value provided to participants • Seeks to achieve a 50/50 payer community/provider community split over time • Budget reflects execution of DHSS proposed Contract Amendment #11; any significant change to the

Motion to approve Strategic Plan Priorities – passed by majority vote Motion to approve Section 1 – passed by majority vote Motion to approve Section 2 – passed by majority vote Motion to approve Section 3 – passed by majority vote Motion to approve FY18 Budget – passed by majority vote Motion to approve Sustainability Plan Directive – passed by majority vote

4


1:40PM

budget or the contract will be submitted to the AeHN Board for review/approval

• Other Business Jessica Oswald states that on behalf of Providence leadership she was asked to inform the AeHN Board of the desire to relinquish board representation. In order to be congruent with their voting distinction, effective immediately, they give up their seat on the board.

• Next Regular Board Meeting – May 17th, 2017; 11:30 am –1:00 pm

• Adjournment

There being no further business to discuss Ms. Merriman asks for the meeting to adjourn. Meeting adjourned at 1:40pm There was a motion by Stewart Ferguson to adjourn, seconded by Jerry Jenkins. Motion approved.

Respectfully submitted by: C. Yesmant

Motion to adjourn passed

5

Board Member 17-Jan 13-Feb 14-Feb 15-Mar 10-Apr 17-May 17-Jul 17-Sep %Ballard, Timothy MD 0 1 1 1 1 80%Beemer, Connie 1 1 1 1 1 100%Dahline, Jennifer 1 1 0 0 1 60%Davidson, Beth (Proxy) 1 1 1 1 1 100%Emond, Chris 0 1 1 0 0 40%Ferguson, Stewart 1 1 1 1 1 100%Harris, Jan (NV) 1 0 0 0 1 40%Jenkins, Jerry 1 1 1 1 1 100%McArthur, Erin MD 0 1 1 1 1 80%Merriman, Nancy 1 1 1 1 1 100%Oswald, Jessica 1 1 1 1 1 100%Shirk, Sam MD 0 0 0 1 25%

*0=Absent 1=Present

Meeting Attendance 2017

6

Alaska eHealth Network Financial Narrative Report

For the period ended 3/31/17 Statement of Financial Position The Statement of Financial Position shows that the ending cash balance at $565,116, a decrease of $92,634 over the prior month. Cash was used to pay down the accounts payable balance, specifically the December 2016 invoice to Orion Health for $225,000 as well as paying other normal operating expenses. The cash balance consists of three cash/bank accounts with $129,311 in the Wells Fargo checking account, $430,773 in the WF High Yield Savings account, and $5,030 in the WF Market Rate Savings account.

Accounts receivable closed at $162,270, a decrease from the prior month of $72,228, which consists of a variety of payments received and new customer invoices created. The last invoice for the State was dated 2/13/17 for $192,500 and payment was received on 3/2/17.

Accounts payable ended at $27,308, a decrease over the prior month of $226,817. The paydown in AP was mostly attributable a payment to Orion for $233,312, which paid the December 2016 invoice, as well as other operational payments. Other current liabilities are the normal charges to the credit card, and the payroll liabilities, which consists mostly of accrued payroll at $55k (paid on the 5th of each month for the previous month) and accrued leave of $40k.

Statement of Activities ‐ YTD with Previous Year Comparison Total Income for the year to date through 3/31/17 is $1,273,181 compared with $1,418,395 from the same time period in FY 16. Direct costs are $735,952 compared with $846,960 for FY 16. Operating expenses for the same period are $645,874, which leaves a loss of $108,645. The net loss for the same period in FY16 was $491,303.

Budget v Actual The fiscal year‐to‐date budget to actual income shows that AeHN is short on budgeted revenue by about $60k, offset by a savings in direct costs by $161k, leaving the gross profit $100k above the budgeted number for the period. Operating expenses are under budget by $20,580, which still leaves a loss to date number of $108,645.

Cash Flow Projection The cash flow projection shows that projected cash at 6/30/17 is expected to end at $442k. Cash at the end of March as shown on this report agrees to the cash balance in the financial report referenced above. The projections for April are expected to be fairly close as the month is now over. The money out projection for May and June is the budgeted expenses for the applicable month, and the money in projections are based on the sales figures for the previous month.

Budget and Forecast – FY17

Total projected income for the year is forecast to end at $1,590,850, a shortfall from budget of $468,291. Most of the shortfall is attributed to the change for the payments from the State of Alaska for the State Participant Fees.

Projected direct costs are expected to end at about $977,953 and total operating expenses at $806,533. This leaves a projected loss for the year of $271,012, which will be funded through prior year earnings.

7

For Management Purposes Only

08Fall

Financial Report

Alaska eHealth NetworkFor the period ended March 31, 2017

Prepared by

Carney Consulting Group

Prepared on

May 12, 2017

8

Alaska eHealth Network 2/4

Statement of Financial Position - ComparativeAs of March 31, 2017

Total

As of Mar 31, 2017 As of Mar 31, 2016 (PY) Change

ASSETS

Current Assets

Bank Accounts

1000 Cash Accounts 565,116.15 643,042.36 -77,926.21

Total Bank Accounts 565,116.15 643,042.36 -77,926.21

Accounts Receivable

1050 Accounts Receivable 162,270.00 74,387.00 87,883.00

Total Accounts Receivable 162,270.00 74,387.00 87,883.00

Other Current Assets

1114 Undeposited Funds 103.00 0.00 103.00

1200 Deposit - Lease 19,843.20 16,454.31 3,388.89

1300 Prepaid Expense 0.00 416,666.75 -416,666.75

Total Other Current Assets 19,946.20 433,121.06 -413,174.86

Total Current Assets 747,332.35 1,150,550.42 -403,218.07

TOTAL ASSETS $747,332.35 $1,150,550.42 $ -403,218.07

LIABILITIES AND EQUITY

Liabilities

Current Liabilities

Accounts Payable

2000 Accounts Payable 102,308.18 505,640.54 -403,332.36

Total Accounts Payable 102,308.18 505,640.54 -403,332.36

Credit Cards

2520 WFB - CC Madison (4258) 9,027.80 16,443.39 -7,415.59

Total Credit Cards 9,027.80 16,443.39 -7,415.59

Other Current Liabilities

2100 Payroll Liabilities 94,572.97 108,539.33 -13,966.36

Total Other Current Liabilities 94,572.97 108,539.33 -13,966.36

Total Current Liabilities 205,908.95 630,623.26 -424,714.31

Total Liabilities 205,908.95 630,623.26 -424,714.31

Equity

3400 Retained Earnings 650,068.76 1,011,230.87 -361,162.11

Net Income -108,645.36 -491,303.71 382,658.35

Total Equity 541,423.40 519,927.16 21,496.24

TOTAL LIABILITIES AND EQUITY $747,332.35 $1,150,550.42 $ -403,218.07

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Statement of Activities - ComparativeJuly 2016 - March 2017

Total

Jul 2016 - Mar 2017 Jul 2015 - Mar 2016 (PY) Change

INCOME

4025 Grant Revenue 28,064.73 -28,064.73

4060 Participant Fees 226,077.50 -226,077.50

4061 Provider Participant Fees 79,650.00 79,650.00

4062 Hospital Participant Fees 336,052.00 336,052.00

4063 Payor Participant Fees 58,250.00 58,250.00

4065 Direct Participant Fees 14,062.00 14,062.00

4068 Consulting Services 15,006.32 6,343.75 8,662.57

4301.1 State Participant Fee 770,000.00 1,157,500.00 -387,500.00

4411 Interest Earnings 161.29 409.16 -247.87

Total Income 1,273,181.61 1,418,395.14 -145,213.53

COST OF GOODS SOLD

7600 AK HIE Service (SAAS) 662,500.36 749,999.85 -87,499.49

7601 Participant Onboarding 73,451.75 96,960.50 -23,508.75

Total Cost of Goods Sold 735,952.11 846,960.35 -111,008.24

GROSS PROFIT 537,229.50 571,434.79 -34,205.29

EXPENSES

4490 General Office 18,067.90 27,317.57 -9,249.67

4600 Facilities 48,426.58 47,702.22 724.36

5050 Human Resources 140.00 -140.00

5100 Payroll Expenses 491,409.47 509,847.10 -18,437.63

5200 Professional Fees 66,229.35 65,143.81 1,085.54

5300 Tech Services - Ops. 20,905.68 21,246.64 -340.96

5500 Travel 835.88 6,061.16 -5,225.28

5510 Training/Staff Education 280.00 -280.00

Total Expenses 645,874.86 677,738.50 -31,863.64

NET OPERATING INCOME -108,645.36 -106,303.71 -2,341.65

OTHER EXPENSES

7510 Non-recoverable Revenue 385,000.00 -385,000.00

Total Other Expenses 0.00 385,000.00 -385,000.00

NET OTHER INCOME 0.00 -385,000.00 385,000.00

NET INCOME $ -108,645.36 $ -491,303.71 $382,658.35

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Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Total Total ProjectedActual Actual Actual Actual Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast Budget Variance

Income

Total 4025 Grant Revenue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4062 Hospital Participant Fees 1,800 161,078 2,000 61,430 4,464 103,230 7,475 145,400 66,412 553,289 560,740 (7,451) 4061 Provider Participant Fees 1,900 5,850 54,250 9,250 950 9,500 3,000 1,250 40,000 125,950 250,000 (124,050) 4065 Direct Participant Fees 3,476 1,929 285 185 4,822 946 928 1,100 391 13,785 2,650 2,178 32,675 24,760 7,915 4063 Payor Participant Fees 34,500 23,750 12,638 11,000 11,000 92,888 56,250 36,638 4068 Consulting Revenues 656 312 8,875 944 406 2,781 1,031 438 15,443 11,375 4,068 4200 Donations 0 400 (400) 4250 Misc.Income 0 0 0 4300 State Contract Rev 0 0 0 4301.1 State Participant Fee 192,500 192,500 192,500 192,500 770,000 1,155,000 (385,000) 4411 Interest Earnings 18 15 11 9 9 6 37 28 28 28 20 20 229 240 (11)Total Income 198,550 1,944 7,946 408,334 15,706 299,576 2,321 200,873 137,930 37,364 160,320 119,610 1,590,474 2,058,765 (468,291)

Cost of Goods Sold 7600 AKHIE Service (SaaS) 83,334 83,333 75,000 75,000 75,000 75,000 45,833 75,000 75,000 75,000 75,000 75,000 887,500 1,000,000 (112,500) 7601 Participant Onboarding 6,388 2,446 613 11,812 26,819 25,375 8,500 8,500 90,453 172,500 (82,047)Total Cost of Goods Sold 89,722 85,779 75,613 86,812 101,819 75,000 45,833 100,375 75,000 75,000 83,500 83,500 977,953 1,172,500 (194,547)GROSS PROFIT 108,828 -83,835 -67,667 321,522 -86,113 224,576 -43,512 100,498 62,930 -37,636 76,820 36,110 612,521 886,265 (273,744)

Expenses 4490 General Office 5,965 282 1,761 2,531 1,285 1,349 489 4,215 190 2,201 2,770 320 23,359 38,415 (15,056) 4600 Facilities 5,212 5,212 5,291 5,543 5,795 5,438 5,315 5,329 5,292 4,956 5,365 5,365 64,112 64,190 (78) 5100 Payroll Expenses 56,389 57,595 48,786 53,635 60,507 50,344 62,081 45,231 56,841 46,580 52,732 55,918 646,640 677,120 (30,480) 5200 Professional Fees 4,752 18,389 8,659 9,103 3,553 4,524 2,698 5,566 8,985 8,213 26,400 26,400 127,242 60,800 66,442 5300 Tech Op Services 4,917 167 237 437 487 1,349 137 124 13,053 79 180 180 21,344 29,110 (7,766) 5500 Travel 91 745 836 16,630 (15,794) 5510 Training/Staff Education 0 0 Total Expenses 77,235 81,644 64,824 71,250 71,627 63,749 70,721 60,465 84,362 62,028 87,447 88,183 883,533 886,265 (2,732)

NET INCOME 31,593 -165,479 -132,491 250,272 -157,740 160,827 -114,233 40,033 -21,432 -99,664 -10,627 -52,073 -271,012 0 (271,012)

Alaska eHealth NetworkBudget and Forecast - FY17

July 2016 - June 2017

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Budget vs.ActualJuly 2016 - March 2017

Total

Actual Budget over Budget

INCOME

4061 Provider Participant Fees 79,650.00 137,250.00 -57,600.00

4062 Hospital Participant Fees 336,052.00 371,208.00 -35,156.00

4063 Payor Participant Fees 58,250.00 37,500.00 20,750.00

4065 Direct Participant Fees 14,062.00 5,742.00 8,320.00

4068 Consulting Services 15,006.32 11,375.00 3,631.32

4200 Donations 0.00 300.00 -300.00

4301.1 State Participant Fee 770,000.00 770,000.00 0.00

4411 Interest Earnings 161.29 180.00 -18.71

Total Income 1,273,181.61 1,333,555.00 -60,373.39

COST OF GOODS SOLD

7600 AK HIE Service (SAAS) 662,500.36 750,000.00 -87,499.64

7601 Participant Onboarding 73,451.75 147,000.00 -73,548.25

Total Cost of Goods Sold 735,952.11 897,000.00 -161,047.89

GROSS PROFIT 537,229.50 436,555.00 100,674.50

EXPENSES

4490 General Office 18,067.90 22,965.00 -4,897.10

4600 Facilities 48,426.58 48,095.00 331.58

5050 Human Resources 140.00 -140.00

5100 Payroll Expenses 491,409.47 507,685.00 -16,275.53

5200 Professional Fees 66,229.35 50,600.00 15,629.35

5300 Tech Services - Ops. 20,905.68 23,320.00 -2,414.32

5500 Travel 835.88 13,650.00 -12,814.12

Total Expenses 645,874.86 666,455.00 -20,580.14

NET OPERATING INCOME -108,645.36 -229,900.00 121,254.64

NET INCOME $ -108,645.36 $ -229,900.00 $121,254.64

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Date Prepared: May 12, 2017

Actual Actual Actual Actual Actual Actual Actual Actual Actual Forecast Forecast ForecastJul '16 Aug '16 Sep '16 Oct '16 Nov '16 Dec '16 Jan '17 Feb '17 Mar '17 Apr '17 May '17 Jun '17

Cash On Hand 471,393 404,344 359,852 268,601 272,040 225,182 332,476 920,578 657,750 565,116 618,685 594,020 Cash Out (87,707) (73,832) (92,913) (68,301) (74,872) (100,217) (68,894) (105,826) (69,476) (84,362) (62,028) (87,447)

Cash Out - Orion (195,833) (233,312) (225,000)Cash In 20,658 29,340 1,662 71,740 28,014 207,511 656,996 38,831 210,154 137,930 37,364 160,320

REMAINING CASH 404,344 359,852 268,601 272,040 225,182 332,476 920,578 657,750 565,116 618,685 594,020 441,893

Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast Forecast ForecastJul '17 Aug '17 Sep '17 Oct '17 Nov '17 Dec '17 Jan '18 Feb ' 18 Mar '18 Apr '18 May '18 Jun '18 Jul '18

Cash On Hand 441,893 473,320 395,279 331,786 31,670 149,056 (123,888) (287,532) (354,548) (452,604) (417,107) (469,526) (624,725)Cash Out (88,183) (84,091) (65,437) (83,062) (98,448) (63,650) (70,720) (69,337) (73,929) (102,433) (89,783) (90,519) (77,565)

Cash Out - Orion (225,000) (225,000) (225,000) (225,000)Cash In 119,610 6,050 1,944 7,946 215,834 15,706 -92,924 2,321 200,873 137,930 37,364 160,320 145,498

REMAINING CASH 473,320 395,279 331,786 31,670 149,056 (123,888) (287,532) (354,548) (452,604) (417,107) (469,526) (624,725) (556,792)

Jul '17 Aug '17 Sep '17 Oct '17 Nov '17 Dec '17 Jan '18 Feb ' 18 Mar '18 Apr '18 May '18 Jun '18 Jul '18Cash On Hand 441,893 477,881 319,840 1,414,086 864,784 686,826 752,932 567,776 822,749 576,835 407,466 260,481 37,388

Cash Out (83,622) (164,091) (261,748) (332,248) (393,792) (254,600) (282,880) (277,348) (221,787) (307,299) (269,349) (181,038) (155,130)Cash Out - Orion (225,000) (225,000) (225,000) (225,000)

Cash In 119,610 6,050 1,355,994 7,946 215,834 545,706 97,724 532,321 200,873 137,930 122,364 182,945 145,498

REMAINING CASH 477,881 319,840 1,414,086 864,784 686,826 752,932 567,776 822,749 576,835 407,466 260,481 37,388 27,756

Unknowns Not IncludedSt Elias 26,680 Manilaq 7,457

Samuel Simmonds 7,475 Cordova 4,753

Sitka 4,753 51,118

Assumptions Included in Forecast

SOAOther Contractuals New Help Desk Hire

Alaska eHealth Network

Cash Flow Projection ‐ Presented with February 2017 Financials

Expense starts in March

PROJECTED CASH FLOW FY17

PROJECTED CASH FLOW FY18 without/State Contract

Removed SOA income for April and JuneIncludes Cedarbridge $13K and Interim ED $59K

PROJECTED CASH FLOW FY18 with/State Contract

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Alaska eHealth Network Dashboard as of 03/31/2017

Financial:

Objective: Balanced budget with consistent monthly income that supports HIE for all Alaskans; measurement is positive income and expenses within budget

Notes: Signed no-cost extension on State Contract; awaiting new State contract for additional onboarding.

(300,000.00)

(200,000.00)

(100,000.00)

-

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Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Income

FY14

FY15

FY16

FY17

$0.00

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$50,000.00

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Expense

Budget

FY15

FY16

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Additional HIE Data:

7/16 8/16 9/16 10/16 11/16 12/16 1/17 2/17 3/17 4/17 5/17 6/17 ** PRODUCTION ENVIRONMENT UPTIME (Percent) ** Uptime Against Scheduled Maintenance

99.13 99.43 99.75 99.67 99.75 98.34 98.62 99.99 99.99

Unscheduled Outages

0.42 0.00 0.19 0.00 0.00 0.08 0.18 0.00 0.00

** TOTAL PRODUCTION INTERFACES BY DATA TYPE (I/O) ** ADT (Demo) 16 19 19 19 19 21 24 24 28 ORU (Results) 11 12 12 12 12 12 14 15 15 ORM (Orders) 1 1 1 1 1 1 2 2 VXU (Immuniz) 7 8 8 8 8 8 8 8 8 CCD (Complete) 5 5 5 5 5 5 6 8 8 BioSense (Syndrom) 8 11 11 11 11 12 13 14 14 ELR (Lab to SOA) 7 7 7 7 7 7 8 8 8 ** RHAPSODY TRANSACTIONS (In Millions)** All Types (4 weeks) 26.972 28.838 27.809 28.005 26.636 26.686 28.318 27.351 28.224 ** HIE USERS (All Types – Level 1-5) ** Total Accounts 642 639 640 656 663 668 705 730 726 Active Unique User Logins/mo

184 149 265 249 239 242 283 298 288

Break the Glass/mo 96 75 36 125 134 133 135 121 125 ** Enterprise Master Patient Index (EMPI) ** Total Unique Patients (1,000s)

546.3 688.8 682.0 706.5 714.2 717.8 796.3 804.4 810.1

Total MRNs (1,000s)

894 987 998 1,033 1,045 1,051 1,246 1,268 1,279

Total Facilities 22 24 25 26 28 29 29 29 31 ** EHRs RECEIVING DATA ** ORU (Results) 1 1 2 2 2 3 4 4 4 ORM (Orders) 1 1 1 1 1 1 2 2 ** PATIENT Portal ** Patient Invites/mo 42 38 54 36 48 36 39 35 32 Patient Logins/mo 8 10 12 16 14 12 9 12 14

15


Health Information Exchange:

Objective: Increase Meaningful Use of EHRs through increased HIE use; measurement is number of users by facility and community

Notes: 22 hospitals signed (92% of hospital beds); over 720 individual users

Direct Secure Messaging:

Objective: Increase Meaningful Use of EHRs through exchange of data via DSM; measurement is number of providers using DSM.

Notes: Over 55,000 messages sent monthly

0

500

1000

Qtr 2 '15 Qtr 3 '15 Qtr 4 '15 Qtr 1 '16 Qtr 2 '16 Qtr 3 '16 Qtr 4 '16 Qtr 1 '17 Qtr 2 '17

HIE Users

Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17ADT/Live 10 11 14ADT/Onboarding 4 3 5ADT/In Queue 4 4 3

Syndromic/Live 12 13 14Syndromic/Onboarding 4 3 5Syndromic/In Queue 4 4 3

ORU/Live 7 7 7ORU/Onboarding 7 7 7ORU/In Queue 4 4 4

ELR/Live 8 8 8ELR/Onboarding 6 6 6ELR/In Queue 4 4 4

HOSPITAL STATUS

0

10000


DSM Users by MonthFMarch 2017 (n=3,947)

FY15 FY16 FY17

16


Help Desk:

Objective: Timely resolution of help desk issues; measurement is volume/type of calls and time to resolution

Notes: No unscheduled downtime

Outreach

FY17 HIE OUTREACH ACTIVITIES

7/16 8/16 9/16 10/16 11/16 12/16 1/17 2/17 3/17 4/17 5/17 6/17

Participant Visits 38 49 76 76 88 48 61 49 66 Potential Participant Visits

17 20 23 40 52 25 26 38 38

Professional Conferences

1

1

1 1

Presentations 1 0 3 4 8 6 4 2 1 Seminars 1 Email Outreach 2040 2720 2040 2040 2460 0 2460 820 3280 Newsletters 1 0 0 0 0 0 0 0 0 Website Updates 8 10 12 6 4 2 12 8 10

FY17 HIE ONBOARDING GOALS

1st QTR Goal

1st QTR

Actual

2nd QTR Goal

2nd QTR

Actual

3rd QTR Goal

3rd QTR

Actual

4th QTR Goal

4th QTR

Actual Hospitals 19 18 21 18 21 22 21 Providers (Level 1) 640 640 700 668 820 726 940 Payers 1 1 1 1 1

New & Potential Participant Update:

Payors: Moda, Aetna initial contact established; developing payor list by priority

Pinnacle: contract signed for Alaska Women’s Health Alaska Center for Pediatrics and Medical Park, all on athenahealth EHR ( providers)

0

100

200

LOGIN ISSUES ERROR TRAINING OTHER

Help Desk Calls (n=380)

Mar-17 Feb-17

17


ONBOARDING OBSTACLES MITIGATION STRATEGIES Reduced funding and corresponding staff reductions

· Reduce all expenses and re-valuate budget to identify resources

· Begin investigation of new funding sources and new participant types

Provider value · Survey current providers on value and perceived need

· Define uses cases and distribute · Pursue referral and notification upgrades · Market single sign on to keep HIE in provider

workflow EHR interface costs and constraints · Pursue group purchasing for interface

development; hub and spoke design · Leverage existing provider interfaces

State of Alaska Contract:

Objective: Meet SOA deliverables on time; measurement is deliverables, time and revenues

Notes: Current Contract: 0610079, Amendment 11 (no-cost extension)

Deliverables Status/Note #10-1-7 No issues; continue to provide service as required

#10-8 HIE Reporting Weekly activity and onboarding status report continues to be sent to DHSS.

#10-8 Outreach Plan, Sustainability Plan and Participant Fees

Ongoing activities include: · Revisions to Roadmap · Revisions to Budget and Priorities · Staffing/Budget Forecast · Revisions and additions to Sustainability Plan

#10-8 Contract Negotiations Recurring monthly meeting established with Orion/DHSS. Orion: Orion Health Contract renewal for FY2017 and FY2018 completed and copy provided to DHSS. DHSS: Negotiations for DHSS contract and participation fees complete; awaiting final contract.

#10-8 Activities and Tasks Associated with SB74

AeHN staff and board members are participating in SB74 Workgroups as follows: Telehealth Workgroup – Georgiana Page, Data Quality Measures Workgroup – Rebecca Madison, Information Infrastructure Workgroup – Erin Aklestad

#10-8 Activities and Tasks Associated with Medicaid Director’s Letter #16-002

Provisioned and trained 39 DHSS staff in Public Health; staff reported travel and cost savings in relation to record review for Cancer and Birth Defects Registries.

#10-8 Reduction in Interfaces to Public Health

Completed; now sending a single feed for BioSense Syndromic Surveillance and Electronic Lab Reporting (ELR).

#10-9 HIE Budget FY18 Budget completed, board approved and submitted to DHSS, a revised budget will be submitted if additional funding becomes available

18


Privacy and Security:

Objective: Ensure patient confidentiality

Total Opt-Outs: Full (no access) – 74, Partial (emergency only) – 114

Notes: No reported issues. HiTrust certification work continues.

Incidents FY15 Reported Resolved Time to Resolution Privacy Complaints 0 NA Security Issues in Audit 0 NA Security Incident DSM 0 NA Breach FY15 Attempted Successful Resolution Breach Attempts 0 NA

Risks/Mitigations: AeHN staff and Board of Directors utilize the following to minimize risk:

· Monthly review of financial status; · Annual review and adjustment of fees; · Monitoring key trigger points to ensure timely response to issues; · Seek endorsements from provider and consumer groups; and · Use the media to share success stories and testimonials.

Risks and mitigations are being reviewed and updated as part of the strategic planning process with the AeHN Board.

#10-10 Sustainability Plan Under revision – includes incorporating board approved priorities, staffing and long-term strategies

#10-11 -13 No issues; continue to provide support as required #5-5 DSM V2 Web CCD Requested removal; no longer desired #5-6 Medicaid Claims Data DHSS not ready; will remove from contract #5-7 Blue Button No demand; DHSS will remove contract #5-9 Disease Management Requested extension or removal until such time as there is

sufficient onboarding, data and funding to proceed. #5-11 Privacy and Security Certification (HiTrust)

Completed HiTrust audit of AeHN security practices. HiTrust added a requirement for an audit of Orion security processes. Orion is currently engaged in the HiTrust audit process and reports this is scheduled for completion by December 2017. The Orion audit can then be added to the AeHN application to complete the certification process. Requested extension to 12/2017.

#5-14 Business Intelligence Requested extension or removal until such time as there is sufficient onboarding, data and funding to proceed.

19


POTENTIAL RISK

STAKEHOLDER

GROUP MITIGATION STRATEGIES

Revenue is insufficient or tapers off; costs outstrip available economic resources

All AeHN Stakeholders

· Monthly review of finances and revision of fees as necessary

· Pursue additional federal, state and private sources of grants and endowments

· Maintain line of credit for short term cash flow

· Partner with other data analysis initiatives as they are conceived and developed to reduce costs by sharing systems and resources

· Pursue additional HIE participants not previously considered in outreach and marketing plans

· Aggressively communicate and marketing HIE capabilities

Healthcare practitioners or consumers lose faith in the AeHN ’s ability to make HIE a reality; bad press from other states bleeds over to taint Alaska HIE

Board of Directors

Hospitals

Providers

Payors

· Identify a champion (entertainer, politician, clinician) who will speak on the AeHN ’s behalf and who will endorse the concepts

· Tout AeHN’s successes in news and media

· Document connectivity implementation guidelines to inspire confidence that technological obstacles can be overcome

· Document the achievements to date that speak to AeHN ’s strengths thru the Newsletter and the website

Program alternatives are offered by competing organizations

Board of Directors

· Carefully distinguish AeHN ’s products and services from those of any competitor(s) and conduct extensive marketing campaign

· Cite AeHN ’s position as a neutral third party

· Work with key stakeholders to gain early participation and acceptance eliminating or reducing potential competition

Privacy or security incidents undermine faith in PHRs and healthcare data exchange

Consumers

Providers

Hospitals

· Remain open and transparent with regard to privacy and security policies and procedures

· Create a marketing program which highlights the patient- centric model

· Demonstrate how AeHN, working with providers, payors and community members, has adopted national standards for privacy and security to prevent improper or accidental disclosure in order to protect consumers and clinicians

Computer viruses or other breaches compromise the data

Consumers

Providers

· Adopt national standards for privacy and security and implement best practices for data control and access

· Maintain disaster recovery procedures and “lock down” emergency policies for detection of intrusion

Clinical errors occur and AeHN is blamed

Providers

Consumers

· Adopt national best practices for RHIOs including audit trails, testing and monitoring

Delay of onboarding due to third party vendors

Hospitals

Providers

Payors

· Adopt best practices for project management to ensure optimum onboarding timeline

· Escalate onboarding issues timely to appropriate venues

20

AeHN Executive Director Report

May 17, 2017

1) Participant Status:

a) Biweekly meeting with Acting State HIT Coordinator to review issues related to the AeHN/SOA contract; waiting for FY18 contract; behavioral health interface requirements; MU public health reporting requirements, legislative and/or regulatory action necessary for mandatory reporting; contract reporting requirements; onboarding updates

b) Healtheway (NwHIN/eHealth Exchange) –VA connection back in Test; VA is converting from C32 to CCD; DoD testing not started; SSA meeting to discuss connections ongoing

c) HIE Participant Status: See table at the end of this report.

2) Privacy and Security/Risk Assessment a) No security incidents b) Completed reports to Digital Securus for security assessment. Final report to be delivered in

May. c) HiTrust Certification – will coordinate Orion and AeHN applications for HiTrust at HiTrust

recommendation; new date for completion December 2017.

3) Resources a) Hired Help Desk replacement; started March 6, 2017 b) Interviews are ongoing to replace vacant positions (Data Quality Analyst) c) Interim ED CVs provided to Board President, ED position posted d) Increase in participants will require additional staffing by the end of FY2017; need to add Project

Manager, Privacy/Security Officer, Data Quality Analyst and other positions as defined in Staffing and Priorities planning approved by Board in April; waiting for DHSS contract before hiring

4) Direct Secure Messages

a) DSM v2: 411 organizations LIVE / 3 organizations in process; 3,947 active users

5) Policies and Procedures a) Link to all policies: https://www.ak-ehealth.org/privacy-and-security-policies/. b) Policies for review in July:

1.100 Conflict of Interest (board) Policy 1.105 Conflict of Interest (staff) Policy 1.200 Record Retention Policy 1.300 Transparency Policy 1.400 Board Nomination Policy 1.500 Policy on Policies 1.600 Grievance Policy 3.100 HIPAA Privacy & Permitted Disclosures Policy 4.100 Workgroup Policy 4.200 External HIE Policy 4.300 HIE Maintenance Policy 4.900 HIE DSM Provisioning Policy 6.100 Personnel Policies 6.600 Benefits Policy

21

AeHN Executive Director Report

May 17, 2017

6.200 AeHN Fraud and Abuse Policy 7.100 Financial Policy 7.200 Program Monitoring and Grant Reporting Policy 8.100 AeHN Procurement Policy

c) Awaiting PSC review for substance abuse to adjust consent policies accordingly d) Patient Portal access policy under review for age considerations

6) Financial:

a) Remain within adjusted budget and no major cash flow issues b) Sustainability plan, FY 18 Budget and 10 Year budget revised c) New revenue areas being investigated – analytics, referrals, case management, and behavioral

health

7) Meetings a) Bi-weekly SOA meeting with HIT Coordinator, monthly with PH b) Board workgroup meetings: Finance Committee c) Weekly onboarding meeting with: onboarding clients d) Weekly Orion meeting for status on UAT testing, system upgrades, and any other issues

WORKGROUP UPDATES

Clinical and Informatics – No meeting scheduled

Privacy, Security, and Compliance – No meeting scheduled

Imaging sub-group met: developing criteria for sharing images

22

ContractPublicHealth Admits Discharges

Patient Complaint Allergies Diagnosis Procedures

Lab Results

Radiology Reports Transcription3 CCD4 Insurance

HOSPITALSAlaska Native Medical Center O S B/E T T T T T T T T T TAlaska Regional Hospital O SBartlett Regional Hospital O SBristol Bay Area Health Corporation (FQHC) L S B L L L L L L L L LCentral Peninsula General Hospital L S B/E L L L L L L L L L LCordova Community Medical Center NS SFairbanks Memorial Hospital L S B/E/I L L L L L L L L L LKetchikan Medical Center O SManiilaq Medical Health Center (FQHC) NS SMatSu Regional Medical Center L S B/I L L L L L L T T T LNorton Sound Health Corporation (FQHC) O S TPetersburg Medical Center L S B/I L L L L L L T T T LProvidence Alaska Medical Center L S B/E L L L L L L L L L LProvidence Kodiak Island Medical Center L S B/E L L L L L L L L L LProvidence Seward Medical Center L S B/E L L L L L L L L L LSamuel Simmons Memorial Hospital O SSitka Community Hospital NS SSouthEast Alaska Regional Health Consortium (FQHC) NS S T T T T T T T T TSouth Peninsula Hospital L S B/I L L L L L L L L L LValdez Community Hospital L S B/E L L L L L L L L L LWrangell Medical Center L S B/I L L L L L L L L L LYukon Kuskokwim Health Corp (FQHC) PHO S B/E

PROVIDERS/CLINICSAdventures in Pediatrics NS SAlaska Children's Heart Center NS SAlaska Family Care Associates L S L L L L L L L L LAlaska Innovative Medicine NS/QRY SAlaska Island Community (FQHC) L S I L L L L L L L LAlaska Women’s Health PC NS SAllergy, Asthma, and Immunology Center of Alaska NS SAnchorage Medical and Surgical Clinic NS SAnchorage Neighborhood Health Center (FQHC) NS SANP Family Care NS SBethel Family Clinic (FQHC) O S I T T T T T T T TCamai Community Health Center (FQHC) NS SChena OB/GYN O SCook Inlet Tribal Council NS SCornerstone Clinic Medical Center NS S

ADT Event Types1 Additional Data2

Status

L=Live NS=Not Started T=Test QRY=Query Access S=Signed O=Onboarding B=BioSense E=Electronic Lab Reporting I=Immunizations CR=Cancer Registry PHO=Public Health Reporting Only

23

ContractPublicHealth Admits Discharges

Patient Complaint Allergies Diagnosis Procedures

Lab Results

Radiology Reports Transcription3 CCD4 Insurance

ADT Event Types1 Additional Data2

Status

L=Live NS=Not Started T=Test QRY=Query Access S=Signed O=Onboarding B=BioSense E=Electronic Lab Reporting I=Immunizations CR=Cancer Registry PHO=Public Health Reporting Only

Copper River Native Association NS SDahl Memorial Clinic (FQHC) O S I T T T T T T T TDenali OB-GYN Clinic NS SEastern Aleutian Tribes (FQHC) NS/QRY SFairbanks Cancer Care L S L L L L L L L L L LGirdwood Health Clinic Inc. (FQHC) O S T T T T T T T THomer Medical Clinic PHO S IIliuliuk Family and Health Services Inc. (FQHC) NS SInterior Community Health Center (FQHC) PHO S IInterior Women's Health NS SKenaitze Indian Tribe NS SKilby, Catherine MD NS SLaTouche Pediatrics L S L L L L L L L LMat-Su Health Services (FQHC) NS SNative Village of Eklutna NS SNimmo, Eric A. MD, APC NS SNinilchik Traditional Council L S L L L L L L L L LNorthern Neurology Consultants NS SPatients First Medical Clinic NS SPeninsula Community Health Services (FQHC) NS SPeninsula Internal Medicine L S L L L L L L L L LSeldovia Villiage Tribe (FQHC) L S L L L L L L L L LSouthcentral Foundation (FQHC) O S T T T T T T T T T T TTanana Chiefs Conference (FQHC) O S T T T T T T T T TTanana Valley Medical Surgical Group L S L L L L L LValley Medical Care NS S

Payors/Care ManagementPremera L S L L L L L L L L L L L

3Transcription - Facilities may send multiple transcribed reports for a variety of services.4CCD - continuity of care document, transition of care document or summary of care document.

2Additional Optional Fields – Facilities marked as providing these fields have successfully demonstrated the ability to send messages containing these fields to the HIE in test. This is not a guarantee that all notifications generated from these facilities will contain all of these fields.

1Admits - This represents inpatient, outpatient and emergency registrations. Discharges - This refers mainly to inpatient discharges.

24

Alaska HIT Project Monthly Status Report – Week of May 12, 2017 1 - of - 14

Alaska HIT Monthly Status Report Reporting Period: Week of May12, 2017 State HIT Coordinator: Beth Davidson

Legend Conditionally Approved Rejected or Late

Schedule Deliverable has been conditionally approved: may just need to make adjustments or changes and provide an updated deliverable to State that addresses comments

Deliverable has been rejected: revised submission of deliverable is needed or the deliverable is late for submission

Deliverables under DHSS HIE Participation Fee Contract Amendment #

Deliverable #

Deliverable Name Status Contract Due Date

State Deliverable Review Status

Conditionally Approved/ Rejected Updates Due Date

Needs AeHN Board Approval

Comments

10 1 Direct Secure Messaging Webmail

Ongoing N/A N/A N/A • AeHN will provide DSM webmail accounts for any/all identified State of Alaska users.

10 2 Public Health Reporting Interface

Ongoing N/A N/A N/A • Interface costs for immunization registry reporting, maintenance and operations for established Public Health interfaces.

10 3 DHSS HIE Query Users

Ongoing N/A N/A N/A • AeHN will provide HIE query access to all identified State of Alaska users with receipt of completed user access form.

• Access to be granted to users and training scheduled as needed within one (1) business day of request.

10 4 Patient Portal Access

Ongoing N/A N/A N/A • DHSS is not currently utilizing Patient Portal access. This is not a piece of functionality that DHSS has found to be valuable.

• AeHN will provide patient portal access to any DHSS identified clients/ recipients with receipt of completed user access form.

• Patient portal access to be granted for up to 100 clients per

25



Deliverable #





Comments

day within one (1) business date of request.

10 5 Notifications

Ongoing N/A N/A N/A • DHSS is not currently utilizing Patient Portal access. This is not a piece of functionality that DHSS has found to be valuable.

• AeHN will provide Clinical Portal notification functionality (for hospital admissions, hospital discharges, ER admissions, lab results and radiology results) to all identified State of Alaska users as requested by DHSS.

• Train the Trainor and user training is available for groups up to 25 users with advance scheduling notice.

• To be granted within one (1) business date of request.

10 6 Audit Logs

Ongoing monthly

N/A N/A N/A • AeHN will provide copies of State of Alaska related audit logs.

10 7 Help Desk

Ongoing N/A N/A N/A • AeHN will provide help desk services during normal business hours, Monday through Friday from 8:00 AM – 5:00 PM, excluding holidays.

• AeHN will meet the State of Alaska DHSS standards for Help Desk response time during normal business hours: Urgent: 6 hours, Elevated: 9 hours, Standard: 24 hours.

10 8 HIE Reporting Monthly Not a deliverable that will be “approved”,

Usually received monthly but there have

N/A • AeHN was asked to ensure reports were submitted timely to DHSS and contained all required items per contract via a Notice to

26



Deliverable #





Comments

“conditionally approved” or “rejected” but several areas of required reporting have never been submitted by AeHN since contract amendment #9 and #10 signatures

been long stretches of time where DHSS has not received the HIE report(s). There are several areas of reporting that have never been submitted by AeHN

Cure letter sent to the AeHN board on January 12, 2017.

• HIE Reporting must include: o Weekly status report from

Orion Health for their activities related to Alaska HIE.

o Outreach and marketing plan for new participants including payers and Medicare. Update must include a list of potential participants AeHN has identified.

o Onboarding status for all participants must include a status update for each participant describing their progress towards the goals for HIE participation and identify any obstacles to be addressed if goals are not obtained.

o Updated regarding HIE sustainability and participation fee structure changes.

o Updates about contract negotiations with Orion Health.

o Overall risk and issue list from AeHN’s perspective.

o Updates about activities and tasks associated with Senate Bill 74 initiatives.

o Updates about activities and tasks associated with State Medicaid Director’s letter #16-002 (Tribal FMAP).

o Migration plan and updates for reducing the number of Public Health reporting interfaces.

27



Deliverable #





Comments

10 9 HIE Budget Annual or on DHSS request

N/A N/A Yes • AeHN is working on strategic planning. Updated budget will be requested in a response letter to AeHN’s response to the Notice to Cure letter.

• DHSS has conditionally approved the budget with the understanding that it will be updated and submitted for DHSS review and approval at a minimum on an annual basis, anytime the AeHN Board reviews and makes changes, or any time DHSS requests.

10 10 HIE Sustainability Plan Annual or on DHSS request

N/A N/A Yes • AeHN is working on strategic planning. Updated budget will be requested in a response letter to AeHN’s response to the Notice to Cure letter.

• DHSS has conditionally approved the budget with the understanding that it will be updated and submitted for DHSS review and approval at a minimum on an annual basis, anytime the AeHN Board reviews and makes changes, or any time DHSS requests.

• DHSS does not feel that there is good critical thinking that was applied to this plan. While requested changes have been made to the document, there is still a fundamental problem with HIE sustainability. The plan does not adequately outline the future of the HIE and how risks will be mitigated if the return on investment is not realized. There

28



Deliverable #





Comments

does not appear to be any analysis and assessment of HIE data and sustainability to keep DHSS and other stakeholders regularly informed. DHSS is concerned about AeHN’s (including the board members) ability to manage a successfully and financially sustainable HIE that will support Alaska’s future system of care.

10 11 Engagement, support, active participation in all Senate Bill 74 activities

Ongoing N/A N/A N/A • AeHN has been engaged in conversations related to SB 74 activities when requested by DHSS.

• On-boarding of participants to the HIE as identified by DHSS and other Senate Bill 74 stakeholders. Including the development of performance measurements agreed to by AeHN and DHSS that AeHN will need to meet for on-boarding stakeholders and AeHN’s active involvement in the on-boarding processes.

10 12 Engagement, support, active on-boarding of stakeholder to the HIE to support State Medicaid Director’s letter #16-002

Ongoing N/A N/A N/A • AeHN has been engaged in conversations related to SB 74 activities when requested by DHSS.

3

Survey Results

3/15/2017 N/A N/A N/A • New participant survey is scheduled to be completed by 3/15/17.

• AeHN will provide DHSS access and copies of all survey results conducted about stakeholder engagement and surveys documenting value proposition

29



Deliverable #





Comments

and projected value of HIE participation.

Design, Development and Implementation AeHN/DHSS Contract Deliverables Contract Amendment #

Deliverable #





Comments

5 5 DSM V2 Web

12/30/2016 Late • DHSS will be removing this deliverable in next contract amendment.

5 6 Medicaid Claims Data into the CDR

6/30/2017 • DHSS will be removing this deliverable in next contract amendment.

5 8 Blue Button

6/30/2017 • DHSS will be removing this deliverable in next contract amendment.

5 9 Disease Management


5 11 Security Certification

12/31/2016 Late • AeHN has requested an extension until January 2018 to allow time for implementation. DHSS will be requesting further documentation to support this extension. Due February 28, 2017

5 14 Business Intelligence


30


Critical Active Issues Summary - Current Reporting Period and Unresolved from Prior Reporting Period(s) Date Project Issue Title Description Discussion Comments Status Trend

9/7/2016 HIE Governance

AeHN Board Role and Responsibilities

DHSS has concerns about AeHN Board and ability for the board to ensure the success and sustainability of the HIE.

DHSS is concerned the members of the AeHN Board do not appear to understand their role and responsibilities as a HIE board member. DHSS is concerned that AeHN board members are not fully in support of the HIE, do not understand the value proposition of the HIE, do not market and outreach for the benefit of the HIE, and members are not actively engaged in the board responsibilities. DHSS is unsure if this is a training issue or there are other factors that are preventing board members from fulfilling their board duties. The State HIT Coordinator has suggested to the AeHN Executive Director to seek out grant funding from Rasmussen to support board training for AeHN board members

Active No Change


AeHN Staffing Lack of quantity and quality staff within AeHN

DHSS is concerned that AeHN is lacking the necessary and qualified staffing in order to ensure the success and sustainability of the HIE.

3/7/2015: Wendy Tucker has resigned employment from AeHN. AeHN has hired a new staff person to be the Help Desk staff person. Resume was sent to HIT Coordinator AeHN does not have a dedicated privacy/security officer. AeHN does not have dedicated staff to research and support business process improvement consultation to health care providers. DHSS is concerned that AeHN does not have enough staff to onboard participants and also be able to support the infrastructure needs and business intelligence that an HIE can provide to support Alaska's system of care moving into the future.

Active Worsening

31


Date Project Issue Title Description Discussion Comments Status Trend


Sustainability HIE Sustainability Plan Current HIE Sustainability Plan has been conditionally approved but DHSS is concerned that there is no "plan" in the Sustainability Plan.

DHSS does not feel that there is good critical thinking that was applied to the latest version of the HIE Sustainability Plan. While requested changes have been made to the document, there is a fundamental problem with the HIE sustainability that needs to be addressed. The plan does not adequately outline the future of the HIE and how risks will be mitigated if the return on investment is not realized. DHSS is also concerned that there has been little to no direct board member involvement in the development of the Sustainability Plan.

Active Worsening

9/7/2016 HIE Governance Bottom of Form

HIE Funding- DHSS and other Participant Fees

Current participation fees will not allow the HIE to be financially sustainable.

The current HIE budget AeHN has developed has DHSS paying a participation fee that is significantly more than DHSS's fair share for the actual services being received. This may be true for other participants.

Long-term participant fees are intended to support the bulk of operational expenses of the Alaska HIE. That becomes a more feasible plan if the numbers and types of providers increase dramatically, which will be accomplished by resolving the current back-log and on-boarding of the 150 new organizations currently identified as potential participants. AeHN needs to develop a budget that is reasonable for the current economy. AeHN needs to identify opportunities for other funding sources to support the HIE. DHSS has informed the AeHN Executive Director that AeHN will need to plan for a 25% reduction in the DHSS participation fee for State Fiscal Year 2018. AeHN has not experienced the cut in funding that other state programs have faced in recent fiscal years.

Active Worsening

32


Date Project Issue Title Description Discussion Comments Status Trend


Notice to Cure Letter

Issues Pertaining to Health Information Exchange

5/11/17 Received AeHN HITECH budget forecast response to DHSS Letter to Cure. 5/4/17: DHSS leadership made decision to continue contract with AeHN. 4/03/17: Nancy Merriman of the AeHN board sent DHSS Board Packet response to DHSS Notice to Cure. 1. DHSS Contract Vote 2. Strategic Priorities Vote 3. Staffing Plan Vote 4. FY18 Budget Vote 5. Sustainability Strategy Vote See Board Packet for further details. 2/15/17: Nancy Merriman of the AeHN board sent DHSS response to DHSS response for Cure letter. Notice to Cure letter and subsequent DHSS response letter address several issues. See letters for details.

Active First Report

33


Risk Report Summary Date Project Risk Title Description Comments Status Severity Probability Impact Strategy 9/7/2016 HIE

Governance AeHN Board Role and Responsibilities

If the AeHN Board cannot learn and function for its roles and responsibilities the HIE could fail to be success and be sustainable.

Active 1 - High; probably project failure

2 - Expected; could occur (75%)

3 - Moderately Controllable

5/11/17 Received AeHN HITECH budget forecast response to DHSS Letter to Cure. 5/4/17: DHSS leadership made decision to continue contract with AeHN. 4/3/17: Nancy Merriman of the AeHN board sent DHSS Board Packet response to DHSS Notice to Cure. 1. DHSS Contract Vote 2. Strategic Priorities Vote 3. Staffing Plan Vote 4. FY18 Budget Vote 5. Sustainability Strategy Vote See Board Packet for further details. 2/15/17: Nancy Merriman of the AeHN board sent DHSS response to DHSS response for Cure letter. See response letter for details. 2/3/17: DHSS sends a response to AeHNs response to Notice to Cure. See response letter for details. 1/27/17: AeHNs send response to Notice of Cure to DHSS. See response letter for details. 1/12/17: DHSS sends Notice to Cure to AeHN. See Notice for details. 9/7/16: DHSS recommends board training for the current AeHN board so members 34


Date Project Risk Title Description Comments Status Severity Probability Impact Strategy understand their role and responsibilities.


AeHN Staffing AeHN currently has a minimal staffing structure, with the Executive Director holding full responsibility for coordination and communication with the subcontractor, conducting much of the technical work, and holding most of the institutional knowledge.

Active 2 - Significant; affecting all performance and budgets



5/11/17 Received AeHN HITECH budget forecast response to DHSS Letter to Cure. 5/4/17: DHSS leadership made decision to continue contract with AeHN. 4/3/17: Nancy Merriman of the AeHN board sent DHSS Board Packet response to DHSS Notice to Cure. 1. DHSS Contract Vote 2. Strategic Priorities Vote 3. Staffing Plan Vote 4. FY18 Budget Vote 5. Sustainability Strategy Vote See Board Packet for further details. 3/7/2015: Wendy Tucker has resigned employment from AeHN. AeHN has hired a new staff person to be the Help Desk staff person. Resume was sent to HIT Coordinator. 2/15/17: Nancy Merriman of the AeHN board sent DHSS response to DHSS response for Cure letter. See response letter for details. 2/3/17: DHSS sends a response to AeHN's response to the Notice to Cure. See response letter for details. 1/27/17: AeHN sends response 35


Date Project Risk Title Description Comments Status Severity Probability Impact Strategy to Notice of Cure to DHSS. See reponse letter for details. 1/12/17: DHSS sends Notice to Cure to AeHN. See Notice for details.


HIE Sustainability

If a reasonable sustainability plan is not developed that can be marketed and easily explain the value proposition of the HIE it is likely the HIE will not be success.




5/11/17 Received AeHN HITECH budget forecast response to DHSS Letter to Cure. 5/4/17: DHSS leadership made decision to continue contract with AeHN. 4/3/17: Nancy Merriman of the AeHN board sent DHSS Board Packet response to DHSS Notice to Cure. 1. DHSS Contract Vote 2. Strategic Priorities Vote 3. Staffing Plan Vote 4. FY18 Budget Vote 5. Sustainability Strategy Vote See Board Packet for further details. 1/27/17: AeHN is working with the Alaska Mental Health Trust Authority to develop a roadmap and strategic document that will include a sustainability plan.

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Date Project Risk Title Description Comments Status Severity Probability Impact Strategy 9/7/2016 HIE

Governance HIE Funding Alaska is facing a

significant fiscal crisis and AeHN needs to aligns its budget in accordance with this crisis. To date DHSS has been paying the majority of the operating costs of the HIE. If AeHN cannot develop a sustainable budget it is likely the HIE will fail.

2/7/17: Participation fees need to be re-evaluated to apply a consistent methodology for all participants and future participants that is based on a fair usage model.




5/11/17 Received AeHN HITECH budget forecast response to DHSS Letter to Cure. 5/4/17: DHSS leadership made decision to continue contract with AeHN. 4/03/17: Nancy Merriman of the AeHN board sent DHSS Board Packet response to DHSS Notice to Cure. 1. DHSS Contract Vote 2. Strategic Priorities Vote 3. Staffing Plan Vote 4. FY18 Budget Vote 5. Sustainability Strategy Vote See Board Packet for further details. 2/15/17: Nancy Merriman of the AeHN board sent DHSS response to DHSS response for Cure letter. See response letter for details. 2/3/17: DHSS sends a response to AeHN's response to the Notice to Cure. See response letter for details. 1/27/17: AeHN sends response to Notice to Cure to DHSS. See response letter for details. 1/12/17: DHSS sends Notice to Cure to AeHN. See Notice for details.

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Date Project Risk Title Description Comments Status Severity Probability Impact Strategy 1/12/2017 HIE

Governance Notice to Cure Letter

DHSS issues a Notice to Cure letter to AeHN on 1/12/17 that covered several issues relates to the AeHN organization.




5/11/17 Received AeHN HITECH budget forecast response to DHSS Letter to Cure. 5/4/17: DHSS leadership made decision to continue contract with AeHN. 4/03/17: Nancy Merriman of the AeHN board sent DHSS Board Packet response to DHSS Notice to Cure. 1. DHSS Contract Vote 2. Strategic Priorities Vote 3. Staffing Plan Vote 4. FY18 Budget Vote 5. Sustainability Strategy Vote See Board Packet for further details. 2/15/17: Nancy Merriman of the AeHN board sent DHSS response to DHSS response for Cure letter. See response letter for details. 2/3/17: DHSS sends a response to AeHN's response to the Notice to Cure. See response letter for details. 1/27/17: AeHN sends response to Notice to Cure to DHSS. See response letter for details. 1/12/17: DHSS sends Notice to Cure to AeHN. See Notice for details.

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Alaska eHealth Network

Budget Decisions Associated with Future HITECH Funding

May 17, 2017

Based on DHSS and CMS discussions, Alaska is now eligible for a 90/10 match versus an 82/18 match acquired in former years provided all funds are used to serve Medicaid providers. Non-Medicaid provider connectivity would have to be provided utilizing annual subscription fees however since these represent only 9% of all provider fees at this time. This provides both the State of Alaska and AeHN the ability to bring in substantially more federal funding over the next four year time period. The projected HITECH numbers requested could be increased in several categories. This has the potential to almost double the available funding originally thought to be available:

Options which could be considered with the additional funding include:

1. DHSS other internal unmet needs (to be defined by DHSS). 2. Pay more upfront in software/SaaS fees identified in the Priorities (attached) with lower annual

core product costs. Pros: ongoing costs remain lower; more functionality available sooner for end user; provides more flexibility to meet AeHN goals Cons: costs may go up anyway; healthcare requirements may change causing a shift in interoperability priorities; require guarantees from Orion and/or other vendors

3. Add additional funds for providers to be used for staff training and workflow analysis/optimization. Pros: increase HIE and DSM usage; rapidly meet provider requirements; assist already stressed providers with additional support Cons: time constraints on provider staff time

4. Add other core products not defined in the Priorities (attached) that fit within the goals and objectives defined by the AeHN board and that would not increase the 2022 sustainable budget. Pros: provide a more robust core set of services for AeHN; may be an incentive for providers Cons: may require additional support in unfunded years beyond 2021

5. Add additional contractors and technical assistants beyond the Priorities (attached) to speed up onboarding processes. Pros: increase onboarding capacity and increase value to participants Cons: there is a natural limit to onboarding and the existing Priorities funding may already have maxed the onboarding capacity

Decisions required today:

1. A) Access additional funds by using the 90/10 with the existing match or B) Reduce the match requirement to keep the total ask at $24M.---

2. If A), AeHN staff recommends investigating and possibly including 1 through 3 above in the HITECH application. What are the board recommendations from the above list of options?

3. If A), Authorize Rebecca Madison and Beth Davidson to complete the application based on the recommend options?

2018 2019 2020 2021 TotalOriginal 82/18 7,213,542$ 7,213,542$ 4,812,500$ 4,812,500$ 24,052,084$ Revised 90/10 12,984,375$ 12,984,375$ 8,662,500$ 8,662,500$ 43,293,750$

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Business Agenda - Alaska eHealth Network Shirk, M.D. Valdez Medical Clinic . AeHN Board of Directors...

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Transcript of Business Agenda - Alaska eHealth Network Shirk, M.D. Valdez Medical Clinic . AeHN Board of Directors...