hhie offices honolulu may 23, 2012 hawai’i health information exchange and booz allen hamilton...

HHIE OfficesHonolulu

May 23, 2012

Hawai’i Health Information Exchangeand Booz Allen Hamilton Business and Sustainability Planning EffortBoard Meeting Discussion

This document is confidential and is intended solely for the use and information of the client to whom it is addressed.

2Filename/RPS Number

Agenda

Item Time

Introductions and Program Overview 5 Minutes

Project Timeline and Deliverables 5 Minutes

Current State Analysis Interview Questions and Responses 5 Minutes

Current State Financial Analysis 10 Minutes

Analysis of Strengths, Weaknesses, Opportunities, and Threats 5 Minutes

Discussion 10 Minutes

Next Steps 5 Minutes

3

Agenda

Introductions and Program Overview

– Project Timeline and Deliverables

Current State Analysis Questions and Responses

Current State Financial Analysis

Analysis of Strengths, Weaknesses, Opportunities and Threats

Discussion and Next Steps


Booz Allen has assembled a cross-functional team to analyze sustainability alternatives and chart a path forward

Overview: HHIE must consider how it will ensure ongoing funding post-ONC, and which products and services it may offer to its clients. Booz Allen has developed a five stage plan to identify both costs and revenues based on current and future operations. Following the analysis, Hawai‘i HIE will be able to estimate its budget excess or gap and plan accordingly based on available funding resources.

Project Team:– Mark Johnson, Project Manager– Libby Sagara, Health IT SME– Timi Leslie, Vice President– Jeff Conway, Honolulu Office SME


The team will continue through the summer – beginning with the Current State Analysis – and following a four-step plan

Tasks and Deliverables DateTask 1 – Current State Analysis of Hawai’i HIE and REC business plan, including strengths and weaknesses. Analysis report of previous financial data; growth assumptions and governance data; strengths and weaknesses of the current business plan, governance and policies

May 23 BOD

Task 2 – HIE Environmental Scan of health information exchange activities among key stakeholders across the Hawai’i healthcare market. Environmental Scan report reflecting existing data, interviews with relevant key stakeholders to include payers, providers, labs, health information-related organizations and State leaders

June 13 EC/SC

Task 3 – Future Hawai’i HIE and REC Model and Offerings incorporating Hawai‘i HIE Board of Directors’ Meeting Facilitation input Potential Future Service Offerings reflecting feedback from Information Gathering Sessions with staff and Board

July 13 Annual BOD

Task 4 – Future State Business Model and Identified Keys for Success Test 3-5 potential operations structures and provide a specific recommendation on which is likely to lead to a financially sustainable entity, including future service offerings, revenues, costs, and cost structures resulting from expanded or reduced services, top sustainability options and key drivers for successful implementation over a 3-5 year time frame

August 15 BOD

August 31 Final Deliverable

6

Agenda








To best determine value, the team is interviewing a broad cross-section of Hawai’i health IT/HIE stakeholders

Interviews Scheduled Interviews Conducted Interviews Remaining

Beth Giesting, State, Healthcare Transformation Coord. Comm.

Christine Sakuda, HHIE Jeffrey Yu, Queens Medical Center

John McComas, AlohaCare Greg Suenaga, HHIE Janet Liang, President, Kaiser Permanente

Bruce Anderson/Alan Ito, HHSC Jeffrey Loo, HPREC Tom Tsang, State, Healthcare Transformation Coord. Comm.

Jennifer Diesman, HMSA Jorge Gutierrez, HHIE Todd Inafuku, Pharm D, CVS Caremark

Monique van der Aa, HPCA Money Atwal, Hilo Medical Center Hilton Raethel, SVP, HMSA

Nadine Owen, HHIE Gary Okamoto, Rehab Hospital of the Pacific

Josh Green, MD, Hawai’i State SenatorRyan Yamane, House of Representatives Health Chair

Ed Montell, HIBC Board Chair Skip Keane, Community Representative and laboratory SME

Barbara Stanton, AARP

David Saito, HIPA Steve Robertson, HPH Nadine Tenn-Salle, MD, Private Practice REC Member

Wesley Lo, Maui Memorial Medical Center

Peter Sybinsky, HHIC Kenny Fink, State, DHS, Med-Quest Administration

Raleigh Awaya, Clinical Laboratories Raymond Yeung, Diagnostic Laboratories George Greene, President, Healthcare Association of Hawai’i

*Additional updates to be made according to status on 5/23

Susan Hunt, Hawai’i Beacon Community *Additional interviews to be scheduled according to stakeholder availability

Emmanuel Kintu, Kalihi-Palama Health Center


As part of the Current State Analysis, we interviewed key stakeholders to better understand the value HHIE delivers

Which services do providers, payers and others request/demand from HHIE and HPREC?

– Access to patient information outside of (and in absence of) EHRs

– Direct Messaging among providers

– Direct Messaging between providers and labs

– EHR vendor selection

– EHR implementation support

– Central location for data for analytics and QI efforts

– Assistance with MU reporting (Stage 1, Stage 2?)

– Others?


Stakeholder interview responses help us better understand the value they see from current HHIE services…

What advantages do providers, payers, labs, pharmacies currently gain from participating in HHIE and HPREC?

– Potential access to clinical information from other providers

– Potential access to patient data in absence of an EHR

– A trusted, secure source of patient information

– Access to referrals/specialty care messaging

– Increased efficiency and continuity of care

– Federally guided set of standards

– Access to data for quality reporting

– Collaboration between labs

– Free technical assistance with EHR implementation

– Assistance with achievement of Stage 1 MU goals


…as well as which services and value they would like HHIE to deliver

What are key stakeholders investing in HHIE, and what do they expect to gain from this investment?

– Time, energy and thought leadership to achieve improved health information exchange

– Payer financial investment to improve quality of care, patient safety and costs

– Provider financial investment to increase efficiency and improve access to information

– Lab support and financial investment (coding standardization, interfaces) to create efficiencies

– State, DOH investment in immunization registries

– HHIC efforts to include additional data (labs, standalones)

11

Sustainability Committee members considered what scenarios have been tried, succeeded or failed…

Federal funding

Non-profit/foundation funding

State or Medicaid funding

Membership fees

Transaction fees

Subsidies

Others?

12

Agenda








Forecast revenue exceeds expenses through FY 2013 with cash reserves sufficient for funding through FY 2014

2010 2011 2012 2013 2014$ M

$1 M

$2 M

$3 M

$4 M

$5 M

Grant In-Kind Other Spending

Cash Reserve Remaining at End of YearFY 2010 FY 2011 FY 2012 FY 2013 FY 2014

$71380.40 $352,020.25 $866,777.43 $1,060,178.05 $272,860.71


Receipt of federal grants follows the federal fiscal year and is contingent on locating over $1.2M in matching funds

FY 2010 FY 2011 FY 2012 FY 2013 FY 2014

Match Requirement 10% 10% 14% 33% 33%

Total $40,013 $60,597 $282,917 $686,117 $185,815

FY 2010 FY 2011 FY 2012 FY 2013 FY 2014

Match Requirement 11% 11% 11% 11% 11%

Total $14,743 $73,409 $181,411 $220,472 $26,111

HIE Matching Requirements

REC Matching Requirements

Current non-federal revenues come solely from partner donations and total $610,000. Without additional revenue, federal funds will be reduced in an amount equal to the

shortfall.


Several critical assumptions must hold true in order to maintain the validity of the forecast

An additional $900k in non-federal revenues will be secured through the end of FY 2014

HHIE will be successful in obtaining a waiver to complete work by 2014, extending the federally preferred accelerated 2013 schedule

If any of these assumptions are false, HHIE could face a liquidity crisis forcing programmatic cuts as early as this fiscal year


With only current revenue, HHIE and HREC will become cash flow negative in FY 13 and insolvent within FY14

2010 2011 2012 2013 2014$ M

$1 M

$2 M

$3 M

$4 M

$5 M

Grant In-Kind Other Spending

Cash Reserve Remaining at End of YearFY 2010 FY 2011 FY 2012 FY 2013 FY 2014

$71,380.40 $352,020.25 $859,731.26 $630,038.88 ($740,324.46)

17

Agenda








To address its future needs, HHIE will need to leverage its strengths to seize opportunities and overcome challenges

Strengths– Collaboration among health IT stakeholders– Support of State health care leadership– Agreement on program mission of health information

exchange– Shared ownership of improved population across Hawai’i– Launch of Direct Messaging– Achievement of REC EHR implementation goals– Trusted forum to discuss HIE scenarios

Weaknesses– High operations costs to generate a limited set of provider-

facing services– Dependence on federal and grant funding for operations – Board, key stakeholders may not realize immediate, direct

impact from HHIE services– Large number of independent practices may receive mixed

messages (EHR vs Direct)– Services have required significant staffing to achieve

success to-date

Opportunities– Increased safety, efficiency, access to patient data – Coordination of existing HIE programs and efforts– Building from increase in statewide EHR implementation– Standardization of coding, messaging– Centralized data source of data for QI and analysis– Continued increase in EHR use and MU achievement– Pilot success stories to share that improve chances of

achieving future grant funding (State, Federal, foundation)

Threats– Inability to demonstrate value of Direct Messaging to

providers with EHRs– Inability to secure matching funds to meet 2013 budget

goals and/or to secure funding post ONC grant period– Board and key stakeholders have competing priorities from

their primary organizations (technology projects and funding obligations)

– Competing health information exchanges/organizations– Increase in market share of leading EHRs

HHIE SWOT Analysis

19

Agenda








Next steps include incorporating Board and stakeholder feedback into a State and National HIE Environmental Scan

Incorporate Board feedback into Current State Analysis

Continue internal and key stakeholder interviews to incorporate into HIE Environmental Scan

Hold weekly meetings with HHIE project team and monthly meetings with Executive Committee

Prepare for key dates: – June 13 Executive Committee Meeting– July 13 Board Meeting– August 15 Board Meeting

Others?

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