Exchange HIMSS July 18, 2018 Welcome! HIMSS State Government - - PowerPoint PPT Presentation

Chapter Leader Exchange

HIMSS July 18, 2018

Welcome!

Jeff Coughlin, MPP Senior Director, State and Federal Affairs Evan Dunne Coordinator, State and Federal Affairs

HIMSS State Government Affairs Team

Valerie Rogers, MPH Director, State Government Affairs Alana Lerer, MPH Associate Manager, State Government Affairs

Chapter Advocacy Roundtable Leaders

Kevin Conway Midwestern Region John Ritter Eastern Region

Pam Varhol CAR Chair

Angelique Robateau Southern Region Bonny Roberts Western Region

Today’s agenda

• Advocacy 101

Valerie Rogers, Jeff Coughlin, Josh Roll, HIMSS Government Relations

Morning break (Technology Showcase)

• Strategic Planning with your State

Amy Zimmerman, State Health IT Coordinator, Rhode Island Executive Office of Health and Human Services Respondents: Bonny Roberts and Helen Hill, Chapter Advocates Moderator: Pam Varhol, CAR Chair

Lunch (Technology Showcase)

• Activity: Small group discussions on Strategic Planning
• Activity: Making the Pitch

Mark Stevens, Managing Partner, EnableHealth; President Emeritus, Central Pennsylvania Chapter; Past Advocacy Chair, Delaware Valley HIMSS

• Recap and Looking Forward

Jeff Coughlin and Valerie Rogers, HIMSS Government Relations

Advocacy 101: The How, What & Why of Advocacy and Policy Work

Jeff Coughlin, Senior Director, Federal & State Government Affairs Valerie Rogers, Director, State Government Affairs Josh Roll, Associate Manager, Congressional Affairs

What is Advocacy?

Never doubt that a small group of thoughtful committed citizens can change the world; Indeed it’s the only thing that ever has.

Margaret Mead

HIMSS Chapter Advocacy Roundtable

The HIMSS Chapter Advocacy Roundtable (CAR) supports ‘better health through information and technology’* by informing, empowering and mobilizing HIMSS Chapters to take advocacy action at the state and local level.

• CAR Strategic Aims:

– Connecting federal (national), state and local health IT efforts through active engagement of state officials* – Support a learning health IT policy community by conducting monthly conference calls, regional networking and educational opportunities including webinars and conferences – Leverage existing/future opportunities to further health IT policy

• bjectives by identifying one or more chapter advocates, increasing

participation in National Health IT Week, HIMSS Annual Conference, and the Public Policy Summit in Washington, DC

*(Reference: HIMSS Policy Principles)

2018 HIMSS Public Policy Principles on the Value of Health Information and Technology:

Supporting Care Transformation – Quality, Safety and Outcomes – Clinical & Administrative Efficiency – Interoperability, Health Information Exchange & Infrastructure – Innovation & Research – Information Privacy and Security – Patient Activation and Engagement Expanding Access to High Quality Care – Connected Health – Equity Increasing Economic Opportunity – Workforce Development – Economic Growth Making Communities Healthier – Population Health Management – Public Health

Guiding Questions…

Whom do I advocate to? How will you advocate? What is in your advocacy toolbox? How will you make decisions on what you advocate about? How will you prioritize your advocacy focus amidst so many worthy issues? How do you evaluate effectiveness of your advocacy strategies?

The Importance of Value-based Advocacy

• Chapters should become familiar with both chapter and national HIMSS
• rganizational values and principles and link them to possible policy

directions and state advocacy work that: – Provides a process of consensus on broader concepts (shared values and principles) that builds to agreement on specific advocacy issues – Provides steps along the way that can be approved by larger audiences (board, staff, membership) to insure organizational support for advocacy work – Creates a ‘check’ for long-term/future advocacy – does this advocacy issue reflect our values and principals? – Potentially builds stronger coalitions and engages a wider audience that share values and principles.

What do we Mean by Grassroots Advocacy?

Grassroots advocacy is when you reach out to constituents in legislative districts or congressional districts and have them connect with their legislator

• r member of Congress on an issue they care about. No one is paid for

their action, but resources are often spent reaching out to these constituents.

https://www.thecampaignworkshop.com/grassroots-advocacy-vs-grass-tops-advocacy

What do we Mean by Grasstops Advocacy?

Grasstops advocacy is when you focus narrowly on opinion leaders and folks who have connections to elected officials. For example, reaching out to the office-holder's donors or leaders within their political party.

https://www.thecampaignworkshop.com/grassroots-advocacy-vs-grass-tops-advocacy

Defining your Advocacy Outreach

• Legislative – elected and appointed bodies that vote on policy, law, and public budgets. For example:

Congress, General Assembly, County Commissioners, City Council, School Board and various subcommittees

• r appointed bodies under these groups.
• Administrative – government institutions charged with implementing policy and budgets. For example: US

Department of Health and Human Services, State Health Departments or State Innovation Committees, etc. – A state budget is a true expression of public policy and should create engines of opportunity for improvements in health and wellbeing though the use of information management and technology solutions! – State plans, roadmaps and taskforce recommendations can often drive state priorities and expenditures impacting health and use of health information technology

• And, don’t forget the public!! – responsible for electing our leaders and often voting on referendums that

create policy. For example: K-12 STEM bond referendum.

Key Factors Crucial to your Progress!

Chapter Advocate core responsibilities

1. Create an advocacy action plan and keep members of their Chapter Board and HIMSS staff informed of progress 2. Participate in national and regional CAR Calls held via WebEx 3. Participate in the Chapter Advocacy Recognition Program and corresponding advocacy challenges 4. Attend CAR in-person advocacy workshops 5. Build relationships with and educate state and local policymakers and influencers about HIMSS’ priorities 6. Coordinate at least one advocacy-related Chapter activity per year with state or local policymakers Additional ways to get involved in the CAR Guide posted on CLRA: http://clra.himsschapter.org/user/login

What are the potential Impacts of Advocacy Work?

• Change a law
• Pass a law
• Impact regulations
• Lend a voice to the health information and technology community
• Connect assets – people, funding, etc.

What’s in your advocacy toolbox?

Researching : Including nonpartisan analysis, study, or research, as well as, other information gathering through community conversations and focus groups.

• Ex. Using HIMSS Analytics or CQ State

Educating: Including one-on-one conversations, state HIT Days, community meetings and media messaging. Power Building: This refers to the work needed to involve persons and organize them to leverage individual or collective influence around an issue including nonpartisan political messaging, letter-writing campaigns, building coalitions, and building relationships with elected officials or other community leaders. Monitoring: Watch-dogging institutions, policies, and practices and publicizing results.

Tools for Tracking & Evaluating Progress

Research and Planning Ongoing Monitoring and advocacy activities Evaluating response to your advocacy efforts Policy or legislative changes resulting from your advocacy work  Advocacy capacity assessment  Network mapping (before advocacy)  Review of current reports from national partners (HIMSS, NCSL, NASHP, NGA)  Media tracking  Legislative/policy tracking (e.g. CQ Roll Call Legislative reports)  State policy scorecards  Debriefs with partners  Snapshot surveys  Interviews or focus groups  Network mapping (during or after advocacy)  Research panels  Crowdsourcing  Policy tracking  System mapping (after advocacy)  Legislative/policy tracking (e.g. CQ Roll Call Legislative reports

Setting the stage for success

• Hear from people who are affected – storytelling
• Focus on issues rather than an organizational brand

– Legislators reach out to HIMSS CAR members first regarding any state health information and technology policies/proposed legislation

• Work in coalition

– Exercise network mapping or create a list of both chapter and national partners working at the state/local level

• Non-partisan agenda with clear and simple messages
• Know how federal legislation, budgets and program can impact your state

– Consider the the +/- of all factors

Key Factors Crucial to your Progress!

Lobbying vs Advocacy

Lobbying? This is narrowly defined by federal, state, and sometimes local,

• statute. There are 50 different versions of lobbying laws, but all states and

the territories share a basic definition of lobbying as an attempt to influence government action. Generally, it refers to a person or organization contacting an elected official with a specific support/oppose message on policy currently under consideration. Laws define and regulate lobbying and organizations must adhere to those when engaging in defined lobbying activities. Public policy advocacy? Public policy advocacy is any actions taken to influence government policy. Advocates champion a cause: whether as monumental as women’s suffrage and the civil rights movement or less heralded like safety belt laws and child care subsidies.

Source: http://www.ncsl.org/research/ethics/lobbyist-regulation.aspx

Examples of Lobbying vs Advocacy

Advocacy

• Telling a member of Congress how a policy affects constituents
• Using social media to get the word out about a cause/issue
• Meeting with a government official to explain how a particular problem/issue is

affecting a particular group or organization, the environment, etc. Lobbying

• Asking your member of Congress to vote for or against, or to amend or

introduce, particular legislation

• Emailing members of your group asking them to contact their member of

Congress in support of or opposition to legislation or pending regulations

• Generating an online petition asking members of your organization (direct

lobbying) or members of the public (grassroots lobbying) to contact their legislator(s) to support or oppose particular legislation

Source: http://lobbyit.com/advocacy-vs-lobbying-understanding-difference/

Key Federal Health Information and Technology Public Policy Themes

US Federal Public Policy Themes

• Interoperability

– HIMSS Resources – TEFCA – DoD/VA EHR Implementation – Promoting Interoperability Program

• Reducing the Clinician Burden
• Telehealth and Remote Patient Monitoring
• Federal Response to Opioids
• Federal Disaster Response Initiatives

• Demand Integration between the Interoperability Approaches and

Trusted Exchange Frameworks for the Public Good

• Ensure Stakeholder Participation from Across the Care Continuum,

Including Patients and Caregivers

• Identify the “Minimum Necessary” Business Rules for Trusted Exchange

to Enhance Care Coordination

• Educate the Community to Appropriately Implement Existing and

Emerging Standards, Data Formats, and Use Cases to Ensure a Comprehensive, Integrated Approach to Care

• Standardize and Adopt Identity Management Approaches
• Improve Usability for Data Use to Support Direct Care and Research

HIMSS Interoperability Call to Action

Access the Full Call to Action Here!

Nationwide Interoperability Efforts

• July-August 2018

– ONC to release Cooperative Agreement seeking an RCE to lead TEFCA implementation – Looking for a private sector organization to operationalize TEFCA

• September-October 2018

– ONC to announce the RCE Entity – Information Blocking Rule Released

• October-December 2018

– ONC to work with new RCE on finalizing next draft of TEFCA – Stakeholders will likely have opportunity to comment (again)

• December 2018-January 2019

– TEFCA finalized and roll-out plan released

Key Interoperability Dates on the Horizon

DoD/VA EHR Implementation

• DoD initial deployment at 4 Military Treatment Facilities in Pacific NW

complete

• Work continues with the sites in Spring 2018 to incorporate lessons learned

– Wave deployment to all Military Treatment Facilities and Dental Facilities targeted for 2022 – Fairchild Air Force Base – HIMSS Analytics EMRAM moved from Stage 2 in January 2017 to Stage 6 in September 2017

• Cerner contract with VA to modernize its EHR was signed in May 2018

– Achieving interoperability is essential to the DoD and VA’s ability to efficiently improve healthcare – Implications for the entire healthcare system

New Promoting Interoperability Programs and IPPS Rule

• Revamped PI Programs includes fewer measures and less burden

– Reduction of the total number of required measures from 16 to 6

• Removal of eCQMs from CY 2020 Measure Set
• Future State of eCQM Reporting

– Encourage CMS to work to support the development of outcomes-driven eCQMs

• Reaffirming Use of 2015 CEHRT
• Addressing the Opioid Crisis in Medicare Payment Policy

– Change focus on more outcomes-based measures?

• RFI on changing the Medicare and Medicaid CoP to include interoperability

– Would it help to reduce information blocking? – Would it ensure a patient’s right to their information without undue burden? – Would existing portals suffice?

Two Components to 2019 PFS/QPP Rule

Physician Fee Schedule Proposal

• Virtual Check-Ins

– Practitioners paid separately for these services

• Telehealth Services

– ESRD – Rural Health Clinics and FQHCs

• Streamlining E/M Documentation

Requirements – Additional options available for reporting

Quality Payment Program Proposal

• Two tracks remain
• Advancing Care Information

– Now known as MIPS Promoting Interoperability Performance Category

• Additional clinician types for 2019

– Physical therapist, social worker

• Low-Volume Threshold remains consistent with

2018, with one addition – ≤ $90K in Part B allowed charges for covered professional services, provide care to ≤ 200 beneficiaries, OR provide ≤ 200 covered professional services under PFS

CMS Adding Several PFS Telehealth Codes

• CMS finalized the addition of several codes to the list of telehealth services, including: HCPCS

code G0296 (visit to determine low dose computed tomography (LDCT) eligibility) and CPT codes 90839 and 90840 (Psychotherapy for Crisis) – Eliminating the required reporting of the telehealth modifier GT for professional claims

• CMS reviewing broader stakeholder comments about additional steps that the agency could take

to expand access to telehealth services within its current statutory authority – Pay appropriately for services that take full advantage of communication technologies

• Medicare payment for telehealth services is restricted by statute

– Establishes the services initially eligible for Medicare telehealth and limits the use of telehealth by defining both eligible originating sites and the distant site practitioners who may furnish and bill for telehealth services

• QPP does not prioritize the use of telehealth or digital technologies in its 2018 Final Rule

– No specific telehealth-related Improvement Activities in this Final Rule’s inventory

Separate PFS Payment for Remote Patient Monitoring

• CMS finalized CPT code 99091 for separate payment in 2018

– For collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, requiring a minimum of 30 minutes of time

• The information must be interpreted by a physician or other qualified health care professional
• Practitioner must obtain advance beneficiary consent for the service and document this in the

patient’s medical record

• CMS is requiring initiation of the service during a face-to-face visit with the billing practitioner, such

as an Annual Wellness Visit or Initial Preventive Physical Exam – This code cannot be reported more than once in a 30-day period

• CMS also alluded to forthcoming coding changes through the CPT process that it anticipates will

better describe the role of RPM

Reducing the Clinician Burden

• HIMSS collaborated with AMDIS on a letter that focused on:

– Leverage information and technology, now and in the future – Addressing burden can result from and contribute to a Learning Health System – Build momentum toward team-based care by placing a greater emphasis on reporting from the entire clinical staff

• Leverage recent guidance on teaching physician and medical student documentation

– Proposed changes in quality reporting and the Promoting Interoperability Programs are a step in the right direction – Reuse and repurpose data from other sources to minimize reporting requirements

• Model after cost reporting under QPP

– Simplify E/M Coding and documentation requirements

• Top priority for HHS

– April, 2017: HHS released 5-step strategy with framework to leverage HHS agencies – SAMHSA, CDC, NIH, FDA, AHRQ are engaged

• White House Response

– President’s Commission on Combating Drug Addiction and Opioid Crisis released recommendations for Federal response. – President Trump unveiled plan on March 19, 2018 that focuses

• n the death penalty for drug dealers and illegal immigration;

little detail on how to decrease frequency of opioids being prescribed

Opioid Epidemic Federal Response

• HHS ASPR creating a Regional Disaster Health Response System

(RDHRS) for States – ASPR funding Disaster Health Response for up to two regional or demonstration sites to build structures, partnerships to meet public health demand during disasters

• Need to leverage or re-channel existing funding streams, interoperability,

and integration of governmental services

• HIMSS providing feedback and continuing to dialogue on building

modern, robust community-based solutions supporting emergency preparedness and response – We’re sharing policy and practice recommendations from Puerto Rico, the US Virgin Islands and Gulf Coast states

State-Local Emergency Preparedness and Response

Questions?

Thank You!

Jeffrey R. Coughlin, MPP Senior Director, Federal & State Affairs Phone: 703.562.8824 Fax: 703.562.8801 E-mail: jcoughlin@himss.org

Congressional Affairs

Josh Roll, CAHIMS Associate Manager, HIMSS Congressional Affairs jroll@himss.org

HIMSS Approach to Congressional Affairs

“Lead with Substance”

• Build relationships based on substance (trusted advisors)
• Be solutions-oriented and forward thinking
• Be advocates for the sector/community as a whole
• Have our finger on the pulse of what Congress cares about
• Effectively use internal & external resources

Washington, DC Engagement

• Technical

Assistance

• Education
• Policy

Development (Asks)

• Building

Champions

• Endorsing

Legislation

• HIMSS AC/NHIT

Week

• Trusted Voices of

Staff/Leadership

• Leading “coalition”

campaigns

• Conduit between

Congress and Agencies Local Engagement*

• Grassroots

Engagement via Legislative Action Center (e.g., NHIT Week Virtual March)

• In-District/State

Events with Members of Congress Appropriations*

• Friends of AHRQ
• Coalition for

Health Funding

• NDD United

Alignment with HIMSS Foundation IeHP

• Content

Development/ Alignment with HIMSS Policy Priorities

• Capitol Hill

Steering Committee

• Education/

Infrastructure Support for Senate/House Offices, Caucuses, Committees

Congressional Affairs Pillars of Engagement

* Indicates new or growing portfolio

2017-2018 Congressional Asks

• Congressional Ask #1: Create an HHS Cyber Leader Role

–

• Rep. Billy Long (R-MO) and Rep. Doris Matsui (D-CA) introduced H.R. 4191, the HHS

Cybersecurity Modernization Act. – Gives the HHS Secretary the authority to reorganize cybersecurity personnel within the Department, including elevation of the HHS Chief Information Security Officer

• Congressional Ask #2: Pass the Connect for Health Act of 2017

– Bill reintroduced, CBO remains a challenge – Passage of the Chronic Care Act (S.870)

• Congressional Ask #3: Invest in Infrastructure to Support 21st Century Healthcare.

– Under Pressure from Congress, the FCC raised the Rural Health Care Program subsidy from $400 million to $571 million – Program funding unchanged since 1997

Congressional Affairs Highlights

• Congress raised the budget caps – February Budget Deal

– First to the table representing health I&T community. – Result of more than two years of collaboration with NDD United and Coalition for Health Funding.

• Telehealth legislation (finally) enacted into law.

– Result of four years of bipartisan collaboration starting with 21st Century Cures leading to CONNECT for Health Act. – February Budget deal included the provisions of the CHRONIC Care Act. – Additional flexibility/waived 1834(m) requirements for ACOs, Medicare Advantage, Stroke and Dialysis. Narrow to stay budget neutral.

Congressional Affairs Highlights Cont.

• Congress has moved “beyond Meaningful Use”

– “Escalator clause” removed in budget deal. Provides flexibility to CMS but full repeal would have budget implications. – Focus now on what Congress believes MU didn’t move the needle on - interoperability, cybersecurity and patient access to their health information.

• Opioids, Opioids, Opioids!

– $6 billion in new funding to combat the Opioid crisis. – House and Senate advancing comprehensive Opioid legislation.

Congressional Affairs Highlights Cont.

• FY2019 Appropriations process in full swing.
• Continued focus on VA/DoD EHR implementation.
• Investment in rural broadband.
• Oversight of 21st Century Cures Implementation.

Opioids, Opioids, Opioids!

• In June the House Passed H.R.6 – SUPPORT for Patients and

Communities Act

• Comprehensive bi-partisan bill follows months of work at the

committee level

• Contains HIMSS supported positions:

– e-prescribing of controlled substances under Medicare part D – Waives certain Medicare telehealth restrictions for opioid / substance abuse treatment.

Opioids, Opioids, Opioids cont.

• Senate Finance Committee & Senate HELP Committee have led

efforts in the Senate.

• HELP: Opioid Crisis Response Act of 2018 (S.2680)

– Combination of a number of provisions and ideas from HELP committee members, federal agencies, governors and various technical experts. – Calls for greater use of PDMPs, incentivizes the sharing of data collected from PDMPs, and seeks to promote PDMP interoperability with other health IT systems.

Opioids, Opioids, Opioids cont.

• Finance: The HEAL Act (S.3120)
• Culmination of over 22 bills from Finance Committee Members
• Contains HIMSS supported positions:

– E-prescribing of controlled substances under Medicare part D – Waives certain Medicare telehealth restrictions for opioid / substance abuse treatment.

• Next Step – Final Senate Package

Governing By Deadline

• Pandemic and All-Hazards Preparedness Act Reauthorization
• 12 FY19 Spending Bills

– Labor-HHS Appropriations Bill

• Funding for AHRQ,CDC HRSA, ONC, NIH, etc.
• September 30th Deadline
• Likely to see a continuing resolution
• Possible “shutdown showdown”

Get Involved – Federal Advocacy

• HIMSS Legislative Action Center

– Use the HIMSS Legislative Action Center as your personalized electronic tool to communicate directly with your elected Federal and State officials to request support for HIMSS Policy Positions – National Health IT Week – Tweet your legislator Campaign

• 2019 HIMSS Congressional Asks

– 2019 Asks will be released next year in the new Congress

• In-District Site Visits

– HIMSS facilitates visits to in-patient and out-patient facilities to demonstrate “health IT in action”

Q&A

Morning Break with Chapter Leaders

Technology Showcase

Strategic HIT Planning

HIMSS Chapter Leader Exchange July 18, 2018

Amy Zimmerman, MPH State HIT Coordinator RI Executive Office of Health and Human Services

Overview

• Questions to Consider
• Rationale for a Statewide HIT plan
• Historical Approach to Statewide Planning Efforts
• Understanding the State and Federal Environment
• Example HIT Planning process
• Stakeholder Involvement
• Key State HIT Colleagues
• Challenges
• Questions and Discussion

Some Questions for HIMSS Chapter Advocates:

• Is there a State HIT plan(s) for your state?
• Is there Governance for HIT efforts in your state? Is your

HIMSS Chapter part of the Governance?

• Are your members contributing to sustainability of

HIT/HIE efforts? If not, under what conditions would they?

• Do you know who are the appropriate state officials in

your state to reach out to in order to provide input ?

• Are there specific messages you/your chapter want to

have considered in the development of a plan?

• Are there projects underway to develop, implement and

sustain shared services? Does your Chapter/Members support this type of approach?

Rationale For Statewide HIT Plan

• Articulate the State’s priorities
• Align efforts across state government and private sector
• Align efforts with Federal government and national trends (e.g.

Trusted Exchange Framework and Common Agreement, TEFCA)

• Create strong governance; identify public vs private roles
• Reduce duplication and redundancy; break down data silos (try to

do in manner that minimizes creating new integrated date silos)

• Maximize resources and sustainability (identify whether and how

to leverage investments)

• Reduce provider burden;
• Engage/Empower Patients in own health care

Evolution of Statewide HIT Plans

• Early work by some states to promote EHR adoption and HIE (early

2000’s); AHRQ HIE grants

• HITECH implemented (2010):
• EHR incentive program initiated: needed a state Medicaid HIT

plan (SMHP)

• ONC provide HIE grants to all states: required a State HIT

Coordinator and a HIE operational plan; states could designated an HIE entity to receive funding directly

• Other relevant grants: Regional Extension Centers, Beacon, etc.
• ONC and CMS focus on HIT and HIE in various grant

requirements; seeking to coordinate efforts

• State Innovation Model grants (2012):
• CMMI requires a SIM HIT plan to support value based

purchasing

• ONC and CMS actively coordinate the review of these plans to help

promote consistency and alignment

Historical Approach to Statewide HIT Planning

• States vary widely in how they approached

development of these plans ?

• Some states were legislated to develop a state wide

plan (as a result of HITECH)

• Some states created separate and distinct plans:
• Medicaid and or State HIT Coordinator developed SMHP
• State Designated Entity developed the HIE operational

plan

• SIM staff developed SIM plan

Which of these plans has your state created? Are they aligned?

Historical Approach to Statewide HIT Planning

Without a single Statewide HIT Plan, there is potential for:

• Numerous different governing bodies
• Building of various component pieces that

may or may not fit well together

60 HIT Governing Board (Proposed)

Health Information Technology State Governance Diagram

SIM Steering Committee HIT Advisory Committee

(Advisory to Director of Health)

Ecosystem Governing Board APCD Interagency Staff Workgroup Ecosystem Data Governance Committee (Proposed) APCD Data Release Review Board

(Advisory to Director of Health)

HIE Advisory Commission

(Advisory to Director of Health)

SIM Technology Reporting Workgroup RIQI Provider Directory Advisory Committee Provider Directory Workgroup

(State/RIQI)

Internal to State/ Vendor Community Involvement Ecosystem Team State RHIO/RIQI Principals Group (Proposed) RIIPL Governing Board Required by Law

61

Understanding the Environment: State and Federal

Strategic Areas:

• Opioid Epidemic
• System and Practice Transformation to support Value

Based Payment models

• Integration of Behavioral Health (with Physical Health)
• Improve Population and Public Health
• Address Social Determinants of Health
• Reduce Provider Burden/Burnout; Support Workforce
• Patient Engagement

Are these similar in your state?

Understanding the Environment: State and Federal

Technology Themes:

• Interoperability
• Modularity
• Shared Services
• Reuse
• Open source
• APIs
• Privacy and Consent
• Cyber Security

Are these similar in your state?

Understanding the Environment: State and Federal

Funding:

• SIM in its last year of funding; focus on sustainability
• Promoting Interoperability Programs (EHR Incentive) ending

in 2021:

• Can use 90/10 funding if helping providers meet Meaningful

Use; need to cost allocation if “others” use/benefit from system ; state needs state match dollars

• States start shifting to include HIT projects as part of Medicaid

Information Technology Architecture (MITA), then can still get enhanced match (90/10 or 75/25) Multi-payer/Multi-stakeholder sustainability models

Understanding the Environment: State and Federal

Role of the State:

• Convener and Facilitator
• Funder
• Provider
• Regulator and Policy Maker
• Enforcer
• Arbiter
• Other?

Example HIT Planning Process

1. Document Current HIT Environment

• Internal and External to state government
• Infrastructure, products, services
• Policy: legislation, regulation, policy levers

2. Identify Needs:

• To support system and practice transformation (care management, analytics,

etc.)

• Engage Stakeholders (providers, consumers, vendors, academia, others) to

seek their input

• Determine if legislative, regulatory or policy changes needed
• Identify Funding/Sustainability needs
• 3. Gap analysis
• Identify Gaps in ability for existing HIT to meet state and stakeholders needs

Stakeholder Involvement

Community Partners:

• Providers
• Hospital Systems
• Payers
• Health Information Exchanges
• Quality Improvement

Organizations

• Consumers
• Professional Associations
• Academia
• Vendors

Are there others that need to be involved ?

State Partners:

• EOHHS
• Medicaid
• Dept. of Health
• Dept. of Behavioral Health
• Health Insurance Exchange
• Dept. of Insurance
• Dept. of Information

Technology

• Governor’s office
• Legislators

Example HIT Planning Process

• 4. Possible Strategic HIT Plan Components:
• Vision, goals
• Principles for Statewide HIT efforts
• Overarching aims
• Priorities and Policy Context for HIT efforts
• Recommended HIT modular stack to support needs and

roles of the components:

• Shared services, interoperability, integration, interfaces,
• Recommended Governance Structure
• Role and Responsibilities
• State agency/staffing structure required to support

effective role

• Financing strategy

Others sections? What would you want to see in the plan ?

Possible Key State HIT Colleagues:

• State CIO
• State HIT Coordinator
• Medicaid Director
• Medicaid (or OHHS)

CIO

• Medicaid EHR program

Director

• HIE Director ( if HIE run

by State)

• Public Health Informatics

Coordinator

• Public Health Meaningful

use Coordinator

• SIM Director
• SIM HIT staff
• Governor’s Office Health

Policy Staff

• Legislators

Challenges

• Weaving and aligning existing HIT efforts and plans into
• ne cohesive plan
• Development of an HIT plan as part of conducting overall

health planning processes

• Competing strategic planning processes: (State

Designated HIE Entity plan, provider and payer strategic plans, vendor business models vs State HIT Plan)

• Balancing state agencies and stakeholder needs which

could reflect different priorities

• Time and availability of state staff to mange process
• Changes in Leadership (need overall buy in)
• Timing of Legislative Session
• Funding overall; funding to vendor to assist with planning

process and serve as neutral third party

Questions and Discussion

Networking Lunch with Chapter Leaders

Technology Showcase

State Health IT Strategic Plans

Valerie Rogers Director, State Government Affairs, HIMSS

Key State Policy Levers for Advancing Health Information & Technology

Healthcare/Population Health Topics

Opioid Crisis/Substance Abuse Behavioral Health Broadband Social Determinants Access to Care Chronic Disease Management Medicaid & Medicare Emergency response and Disaster Preparedness Healthcare Transformation and budgets Public Health/Prevention State Health IT Roadmap State Medicaid IT Plan State Plan Amendments (Medicaid) State HIE Plans State Innovation Plan State Health Improvement Plan State Emergency Preparedness Plan

State Policy Levers

Coordinating Bodies

Governor’s Office/Taskforce State HIT Coordinator Local Health Department State Health Department State Medicaid Department State Legislative Taskforce Mayor’s Office/Taskforce State Health Information Exchange HIMSS Chapters!!!

Comprehensive Approach Across States

Courtesy of The National Association of County and City Health Officials (NACCHO)

Example State Health plans/State Health IT Roadmaps

– CA State Health Care Innovation Plan, 2014

• Maternity Care
• Health Homes for complex patients
• Palliative Care (end of life care)
• Accountable Care Communities

– Supported by

• Center for Medicare and Medicaid Innovation
• Blue Shield of California Foundation and The California Endowment
• California State Innovation Model (CalSIM) stakeholder group
• California HealthCare Foundation

Example State Health plans/State Health IT Roadmaps

CA State Health Care Innovation Plan, 2014

• Maternity Care
• Health Homes for complex patients
• Palliative Care (end of life care)
• Accountable Care Communities

Supported by:

• Center for Medicare and Medicaid Innovation
• Blue Shield of California Foundation and The California Endowment
• California State Innovation Model (CalSIM) stakeholder group
• California HealthCare Foundation

Example State Health plans/State Health IT Roadmaps Cont’d

2017 Colorado State HIT Roadmap – 16 recommendations across six domains 1. Stakeholder Engagement 2. Governance 3. Resources/Financial 4. Privacy & Security 5. Innovation 6. Technology Supported by: – The Colorado Office of eHealth Innovation lead efforts to implement the state’s health IT strategy and interoperability objectives – Set goals for health IT programs and create a process for developing common policies and technical solutions – Engaged stakeholders across the community

HIMSS Chapter Advocates Have a Role…

HIMSS Chapter Advocates State HIT Coordinator Governor’s Office State Health Officer/State Medicaid Officer State Legislators (Health Committee Leads)

Activity: Strategic Planning with Your State

Small group discussions led by CAR Leaders and HIMSS Staff

Discussion on State Plans

• Describe your state’s health HIT plan/roadmap

– Did you receive special funding to create the plan? – Were state executive leaders (Governor’s Office, State Health Officer, etc.) involved and supportive of the initiative? If so, who/how? – Does the effort drive other health information and technology related programs in your state?

• Did State Health Assessments/Health Improvement priorities factor into the making of the roadmap?

– What was your involvement in developing the plan/roadmap? – Who are the community partners you engaged at the state/local/national levels?

• What are the key advocacy and organizing tactics that can help your state develop a state health IT plan/roadmap?

– Existing policy and funding opportunities?

• Describe success stories (outcomes/outputs) or lessons learned as a result of having the strategic plan/roadmap?
• What can be the role of HIMSS Chapter leaders and advocates?

– Describe thoughts on the current opportunities for HIMSS Chapters, State HIT Coordinators and other community stakeholders to work together/advocate for state health IT planning.

• Prepare for next activity: Making the Pitch

– Select 2-3 volunteers to role play asking your state official/legislator to work together and create/revise a state Health IT plan

Activity: Making the Pitch

Moderator: Alana Lerer, Associate Manager, State Government Affairs Role as state official: Mark Stevens, President Emeritus, Central Pennsylvania Chapter; Managing Partner, EnableHealth; Past Advocacy Chair, Delaware Valley HIMSS

Recap and Looking Forward

Pam Varhol, Chapter Advocacy Roundtable Chair Alana Lerer, Associate Manager, State Government Affairs, HIMSS Valerie Rogers, Director, State Government Affairs, HIMSS Jeff Coughlin, Senior Director, Federal and State Government Affairs, HIMSS

Chapter Advocate Recognition Opportunities

• 1. Chapter Level of Advocacy Award – Awarded at end of Fiscal Year

– Presidential – Ambassador – Advocate **Take advantage of Advocacy Challenges: National Health IT Week, Non-Stop November, and Action Awareness!**

• 2. Chapter Advocate of the Year Award – Awarded at HIMSS Global Conference

• Advocacy Challenge and Award
• State Official of the Year

Upcoming

Next National CAR call: August 17, 2018 from 12:00 – 1:00pm EDT

(Every Third Friday at 12pm EDT except December and February)

Next Regional Call invitations to be announced shortly

What did we learn?

Thank you for volunteerism and we look forward to hearing your progress!