March 15, 2007 Page 1

The National Landscape and Wisconsin’s Role

eHealth Implementation SummitGovernor Doyle’s

eHealth Care Quality and Patient Safety BoardMadison, Wisconsin

Janet M. MarchibrodaChief Executive Officer

eHealth Initiative and FoundationMarch 15, 2007

March 15, 2007 Page 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 Page 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

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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 Page 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

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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

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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 Page 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 Page 9

State Leadership: An Overview of What’s Happening in the Field

March 15, 2007 Page 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 Page 11

State Level Activity: eHI Survey Results

Recognition of the need for HIE among multiple stakeholders in your state, region, or community

No coordinated, statewide activity

Stage 1AWARENESS15%

Stage 2REGIONALACTIVITY17%

Stage 3STATE LEADERSHIP25%

Stage 4STATEWIDE PLANNING 29%

Stage 5STATEWIDEPLAN 8%

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

Implementation of state plan or Roadmap is well underway, with key milestones completed

Stage 6STATEWIDEIMPLEMENTATION6%

Plan / Roadmap complete and accepted

Plan / Roadmap communicated to the public

March 15, 2007 Page 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 Page 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 Page 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 Page 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 Page 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 Page 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 Page 18

Moving From Planning to Implementation:

What Next?

March 15, 2007 Page 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 Page 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 Page 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 Page 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 Page 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

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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

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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 revenue to 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

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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.

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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 Page 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 Page 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 Page 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 Page 31

Taking a Harder Look at the Use of Health Information Exchange to

Support Quality Improvement and Performance Reporting

March 15, 2007 Page 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 Page 33

You Really Need Clinical and Claims Data to Make This all Work

Health Information Exchange

Claims Data Aggregation

Plan A

Plan B

Plan C

Medicaid

Medicare

March 15, 2007 Page 34

eHI’s Parallel Pathways Framework requires alignment

You Can’t Get There Without Building the Information Foundation

Quality and Value

Quality Expectations Quality Expectations

Physician Practice HITCapabilities

Physician Practice HITCapabilities

Health Info Exchange Capabilities

Health Info Exchange Capabilities

Financial IncentivesFinancial Incentives

March 15, 2007 Page 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 effectively and 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

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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 Page 37

Congratulations and Thank You

March 15, 2007 Page 38

Janet M. MarchibrodaChief Executive Officer

eHealth Initiative and Foundation

www.ehealthinitiative.org818 Connecticut Avenue, N.W., Suite 500

Washington, D.C. 20006202.624.3270

Janet.marchibroda@ehealthinitiative.org