eHealth Exchange Transition UpdateOctober 2, 2012

Mariann YeagerInterim Executive Director

Healtheway, Inc.703-623-1924

myeager@healthewayinc.org

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Discussion Topics• Context• eHealth Exchange• eHealth Exchange Strategic Road Map• State engagement

• Transition Strategy• Healtheway• eHealth Exchange Anchor Participants• Healtheway Members• Cross-industry Collaborative Initiatives

• Harmonized testing program with HER HIE Interoperability Workgroup

• Q&A 2

Context

• Nationwide Health Information Network (NwHIN): A set of standards, services and policies deemed by ONC as NwHIN.

• eHealth Exchange: A community of exchange partners who, via a contractual relationship, share information using NwHIN or other standards, services and policies. • Started as an NwHIN program initiative in 2007• Transitioning to public-private partnership in 2012• Rebranded as eHealth Exchange• Healtheway assuming operational support, starting Oct 2012

• Healtheway: non-profit organization chartered to support the eHealth Exchange

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eHealth Exchange Strategic Road Map

Initial Rollout(2009 – 2011)

Mature, Grow, Scale

2012-2013

Sustainability2014

Phase 1 Phase 2 Phase 3

• Early adopters• Federal business cases• Shared infrastructure• Early lessons learned• Success / viability• ONC program pilot

concludes• Production ramps up

• Transition to public-private model

• Grow participation and transactions

• Refine and scale• Expand value cases• Align with NwHIN

governance• Implement

sustainability model

• Continued growth in participant and transactions

• Revenue model sustains operations

• Nationwide deployment

• Interoperable exchange among private entities

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eHealth Exchange Vision / Mission

• Vision • To serve as a critical element of the nationwide health

information infrastructure; and• To improve the health and welfare of all Americans through

health information exchange that is trusted, that scales, and enhances quality of care and health outcomes by supporting comprehensive longitudinal health records.

• Mission• To expand trusted, secure and interoperable exchange of health

information across the nation by providing shared governance and necessary shared service to public and private organizations who wish to interconnect as a network of networks.

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eHealth Exchange Participants and Technology Partners• eHealth Exchange Participants: • Rapidly growing community of exchange partners• Facilitate and govern exchange, meet eligibility criteria and

successfully complete production readiness testing of Exchange-Ready system

• 34 organizations in production, representing hundreds of hospitals, thousands of providers and millions of patients

• Another two dozen organizations in the pipeline• Dramatic growth, primarily in private sector

• Technology Partners• Provide Exchange-Ready technology solutions to eHealth Exchange

Participants• Approximately 20 solutions support participants, with rapid growth 6

eHealth Exchange Participants* • Alabama One Health Record• Centers for Medicare and Medicaid Services

(CMS)• Childrens’ Hospital of Dallas• Community Health Information Collaborative

(CHIC) • Conemaugh Health System• Department of Defense (DOD) • Department of Veterans Affairs • Dignity Health• Douglas County Individual Practice Association

(DCIPA)• Eastern Tennessee Health Information Network

(etHIN)• EHR Doctors • HealthBridge • HEALTHeLINK (Western New York)• Idaho Health Data Exchange• Inland Northwest Health Services (INHS)• Kaiser Permanente• Lancaster General Health

• Marshfield Clinic• Medical University of South Carolina (MUSC) • MedVirginia • MultiCare Health System• National Renal Administrators Association (NRAA)• New Mexico Health Information Collaborative

(NMHIC)• North Carolina Healthcare Information and

Communications Alliance, Inc. (NCHICA) • OCHIN • Quality Health Network• Regenstrief Institute • Social Security Administration (SSA)• South Carolina Health Information Exchange

(SCHIEx)• South East Michigan Health Information

Exchange (SEMHIE)• Strategic Health Intelligence • University of California, San Diego• Utah Health Information Network (UHIN)• Wright State University 7* 6 others in activation stage

State Engagement in eHealth Exchange

• Current status• 4 in production• 1 in activation• 2 engaging in pilot of new testing program• 11 others in the pipeline

• Approaches• Coordinated with state:

• States connect to eHealth Exchange as a participant (e.g. SC)• States refer regional HIEs to join eHealth Exchange (e.g. NY)

• Complimentary• Regional HIO joins Exchange since states focus on other types of exchange

modalities (TN)• Bridge

• Health System joins Exchange until state is in production (e.g. HI)• Independent

• Health systems or regional HIOs join Exchange independent of state effort

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Technology Solution Providers*• ApeniMED• Aurion • Axolotl • CareEvolution • CGI • Cogon • CONNECT • CSC • Epic • Harris• K Force• MEDecision• MedFX

• Medicity• Mirth • MobileMD• Northrop Grumman • OneHealthPort • Orion Health• SAIC • Talis• Thompson • Vangent • Wright State Research

Institute 9

* Plus other vendors engaged EHR HIE Interoperability Workgroup

National Return on Investment

• Efficiencies and cost savings realized to date through multi-party trust agreement, shared infrastructure and governance

• Significant potential savings by lessening the burden of testing prior to exchanging with a new partner

• Expands coverage throughout the US, reaching hundreds of hospitals, thousands of providers and millions of patients

• Incremental costs per participant decrease as participation grows, lowering the costs to HIE, while enabling HIE to scale nationwide

• Value to clinical decision making and cost savings increase exponentially with utilization

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eHealth Exchange Benefits

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Value Proposition

Implement once,

exchange with many

Recognition as part of trusted

community

Expanded connectivity

Cost effective and efficient

Enforced compliance

and accountability

Functional and scalable

shared services

TRANSITION STRATEGY 12

Transition Goals and Objectives

• Remain aligned with the national strategy

• Facilitate a smooth transition from ONC to a non-profit public-private endeavor, while assuring continued growth and continuity of eHealth Exchange operational support

• Double participation in the eHealth Exchange and increase utilization by 50%, with ability to support a full rollout in 2013

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Current – Future State

Current

• ONC NwHIN initiative - NwHIN Exchange

• Coordinating Committee*• DURSA*• Onboarding & testing

facilitated by ONC• Operations supported /

funded by ONC• Services provided to

participants for free

Future

• Public-private initiative - eHealth Exchange

• Coordinating Committee* • DURSA*• Testing facilitated by testing

body designated by CC• Operations supported/ funded

by Healtheway• Participants begin paying for

services in future14

* Unchanged

Exchange Trust Framework Unchanged

• DURSA remains in full force and effect• Coordinating Committee retains all authorities as specified in

the DURSA• Healtheway board does not have any oversight responsibilities

with respect to eHealth Exchange, but will operate under an agreement with the Coordinating Committee

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Exchange – Healtheway Interactions

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Exchange Coordinating Committee

Healtheway Community

Collaboration Program

May wish to join as members Industry

Eligible for CC Representation

Federal Participants

State Participants

Private Participants

eHealth Exchange

Healtheway Join

Select Healtheway to run Exchange / CC operations

Exchange / CC Operations

Support Program

Staff, legal support

CertificatesService

Registry Exchange Testing Body

SelectContract

eHealth Exchange Participation Fees

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Exchange CC – Healtheway Board Functions

Federal Participants

State Participants

Private Participants

eHealth ExchangeCoordinating Committee

Exec Director

Healtheway Board

3 CC Reps

Up to 9 Elected

Members

• Oversee eHealth Exchange participation

• Approve specs, test guides, policies• Enforce DURSA• Handle disputes / breaches• Approve changes to DURSA• Designate Healtheway to support

eHealth Exchange operations

• Assure corporation is effectively supporting and providing value to its customers (e.g. Exchange, etc.)

• Make financial decisions (e.g. annual budget, membership program, funding, etc.)

• Engage & oversee Executive Director / staff• Guide business strategy and oversee business

(e.g. programs, marketing, partnerships, etc.) • Set strategic direction

Appoint

• Any organization that wishes to be a part of Healtheway community collaboration (e.g. HIE, vendor, payer, non-profit, academic institution, etc.)

Governmental

Liaisons

HEALTHEWAY 18

Healtheway Mission

• To provide the infrastructure to support the safe and secure exchange of data which eHealth Exchange Participants use to further their respective missions to: • Improve clinical decision making and coordination, quality and

affordability of care; • Support meaningful use; • Enhance disease surveillance, support preparedness and routine

public health missions to improve public health; and• Realize efficiencies and expedite provision of funding and services

to individuals to support their care and well-being.• To provide services and programs to Healtheway Members to

advance implementation of HIE.19

eHealth Exchange Participation Fees & Deliverables• Annual Participation Fees: subscription fees that Participants,

as defined in the Data Use and Reciprocal Support Agreement (DURSA), pay an annual basis to: • Continue use of shared eHealth Exchange infrastructure – use of

digital certificate and service registry to discover exchange partners

• Reliance on shared testing process• The right to exchange with other Participants• Reliance on Coordinating Committee (CC) oversight mechanisms

established in the DURSA (e.g. breach notification, dispute resolution, etc.)

• Eligible for representation on the Coordinating Committee20

eHealth Exchange Anchor Participant Program• eHealth Exchange Participants who pay subscription fees for

the first two years (FY 2012 and FY 2013) will qualify for the program.

• eHealth Exchange will begin charging all Participants subscription fees, starting in FY 2014.

• Anchor program benefits• Significantly discounted fees • Recognition and added visibility and promotion• Priority for pilots• Featured in profiles, webinars, etc.

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Non-Federal Participant Tier 2012 2013 2014 2015 2016 2017 2018 2019 2020

Anchor Participant

< $1M $ 4,750 $ 4,750 $ 3,300 $ 3,300 $3,300 $3,300 $3,300 $ 3,300 $ 3,300

$1 - $10 M $ 9,950 $ 9,950 $ 7,000 $ 7,000 $7,000 $ 7,000 $7,000 $ 7,000 $ 7,000

More than $10 M $ 19,000 $ 19,000 $ 14,500 $14,500 $14,500 $14,500 $14,500 $14,500 $14,500

Other Participant

< $1M $ - $ 4,750 $ 4,750 $ 4,750 $4,750 $ 4,750 $4,750 $ 4,750 $4,750

$1 - $10 M $ - $ 9,950 $ 9,950 $ 9,950 $ 9,950 $ 9,950 $ 9,950 $ 9,950 $ 9,950

More than $10 M $ - $ 19,900 $ 19,900 $19,900 $19,900 $19,900 $19,900 $19,900 $ 19,900

Fiscal Year: May 1st of current year through April 30th of following year* Average annual savings to Anchor Participants, starting FY 2014 – 30%

Exchange: Anchor Participant Fee Schedule

Healtheway Member Benefits

• Eligible for voting seat on Healtheway board of directors, with ability to help shape the future of Healtheway and HIE implementation

• Right to select up to 9 members to serve on board• Voting rights at annual member meetings• Input on strategic direction• Input on strategy and joint work products with other initiatives

• Voice in cross-industry collaborative efforts, with unique opportunity to foster the future of the largest public and private exchange community of its kind in the US

• Promotion in member list, web site, communications and annual report

• Recognition of organizational commitment to cross-industry collaboration to unify industry

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Founding Members

• Members who join by December 31, 2012 and commit to two-years of membership

• Founding Member status, with a unique logo• Priority consideration for participating in Exchange pilots• Members who join by early September• Visible role in launch of Healtheway• Eligible for board representation at its formation (September

2012)

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Healtheway Membership Dues

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Annual Revenue* Annual Membership Fee

>$50 Million $50,000

$25-$50 Million $30,000

$10–$25 Million $18,000

$5–$10 Million $8,000

<$5 Million $5,000

* NOTES• Annual revenue shall be based upon annual healthcare revenue when organizations operate in different

industry sectors.• For governmental agencies, professional associations and academic institutions, the tiers are based upon annual

budget in lieu of annual revenue.

For more informationMariann YeagerInterim Executive DirectorO: 703-519-0012C: 703-623-1924myeager@healthewayinc.org www.healthewayinc.org

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