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1 Executive Roadmap: Examining the Impact of Healthcare Reform, Stimulus Funding and HIT Regulations Miriam Paramore, SVP Clinical and Government Services.

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Presentation on theme: "1 Executive Roadmap: Examining the Impact of Healthcare Reform, Stimulus Funding and HIT Regulations Miriam Paramore, SVP Clinical and Government Services."— Presentation transcript:

1 1 Executive Roadmap: Examining the Impact of Healthcare Reform, Stimulus Funding and HIT Regulations Miriam Paramore, SVP Clinical and Government Services AAHAM Conference, Laughlin, NV April 15, 2010

2 Stakes Are Very High Medicare Trust Fund Reserves to be exhausted by 2017 (2009 Annual Report, Social Security and Medicare Board of Trustees) 41 states face budget shortfalls adding up to $35 Billion (Kaiser Commission on Medicaid and the Uninsured, February 2010)

3 March 21, 2010 YEA 219 NAY 212

4 House Passes Healthcare Reform in Historic Sunday Night Vote H.R. 3590, Patient Protection and Affordable Health Care Act (previously passed by Senate) + H.R. 4872, Health Care & Education Affordability Reconciliation Act of 2010 Fiscal Impact Costs $938 billion over a decade Cuts the deficit by $143 billion in the first ten years ( ) Cuts the deficit by $1.2 trillion in the second ten years Expands health insurance coverage to 32 million Americans (or 94%)

5 Basic Provisions H.R H.R. 4872: Insurance Reforms Prohibits insurance companies from denying coverage to individuals with preexisting conditions (effective immediately for children and applies to all individuals beginning in 2014) Closes the doughnut hole gap in Medicare prescription drug coverage Prohibits insurance companies from placing lifetime caps on coverage Requires health plans to allow young adults up to age 26 to remain on their parents insurance policy Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program

6 Individual health insurance mandate for most US residents; penalties for individuals who do not obtain insurance Penalties for employers that do not offer health insurance Expands Medicaid to cover individuals with income less than 133 percent of the federal poverty level Increases funding for Community Health Centers Establishes 50 health insurance exchanges, administered by states, through which small businesses and individuals can buy coverage Subsidies for premiums and cost sharing through the new insurance exchanges Tax credits to small businesses to make employee coverage more affordable Basic Provisions H.R H.R. 4872: Access to Coverage

7 Beyond the Headlines: Administrative Simplification Provisions Accelerates HHS adoption of uniform standards and operating rules for electronic transactions governed under the Health Insurance Portability and Accountability Act (HIPAA) Expands HIPAA transactions and requires uniform standards and operating rules for the following: Eligibility verification Claims status Claims remittance Claims attachments Referral certification and authorization Electronic funds transfer (EFT) payments Requires health plans to certify compliance or face financial penalties

8 85% 15% Cost of Care = $2 T Admin Costs = $360 B Total U.S. Healthcare Spend = $2.4 Trillion 4% on Prevention Where does the money go?

9 9 Practical Savings Today: Measuring Progress Through the US Healthcare Efficiency Index ushealthcareindex.com

10 Independent Advisory Council 10

11 Index Development and Implementation Phase 1: Industry data 5 basic transactions Phase 2: Primary data collection National Progress Report on Healthcare Efficiency (April 2010) Phase 3: Expansion: Pharmacy Adherence and Safety Index With Vanderbilt Center for Better Health Phase 4: Expansion: Dental Index

12 National Progress Report on Healthcare Efficiency: 2010 Key Learnings 1.Transparency on costs is vital to the nations economy; healthcare is murky at best 2.Lines are blurring between manual and electronic processing 3.Costs must be removed at the system level to avoid perpetual cost shifts 4.Efficiency is a journey, not a destination: continue to drive transaction value ushealthcareindex.com

13 Dont Throw it Away! Stopping paper checks in healthcare would save $11 billion a year

14 To Get There, Start From Where You Are Print and Mail Electronic Patient Statements Electronic Lockbox Electronic Funds Transfer A B

15 what would u do w/ $30 B? ushealthcareindex.com

16 But Its Not Just About Healthcare Reform… 16 HITECH: February 17, 2009

17 ARRA and HITECH ACT: Unprecedented Investment in Health IT American Recovery and Reinvestment Act (ARRA) enacted in February 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, subsection of ARRA, expands states role in HIE and adoption of EHRs Meaningful Use Interim Final Rules: 1. Medicare and Medicaid EHR Incentive Programs 2. Standards, Implementation Specifications, and Certification Criteria Eligible providers or hospitals must meet these 3 requirements: 1. Use certified EHR in a meaningful manner (ex. E-Prescribing) – specific checklist and thresholds 2. Utilize certified EHR technology to conduct electronic exchange of health information to improve the quality (such as promoting care coordination) 3. Submit information on clinical quality and other measures in a manner specified by the Secretary $22 billion in spending on HIT Public comment period for Interim Final Rules ended March 15

18 18

19 HIPAA Simplified: Practical Tools 19 Simplified Gap AnalysisFull Gap Analysis One-Stop Shop

20 Seventy-one percent of U.S. health care executives surveyed said that electronic health record systems are likely to get attention and budget approval in their hospitals in 2010, according to a recent StatCom survey.StatCom survey Meanwhile, 53% of U.S. health care executives surveyed said that computerized physician order entry systems are likely to receive attention and budget approval in their hospitals in 2010, the survey found. Thirty-one percent of survey respondents predicted that patient flow and logistics technology would receive attention and hospital budget approval in Results are based on a November 2009 survey of 440 U.S. health care executives. What Technologies Are Likely To Get Attention /Budget Approval in 2010?

21 Meaningful Use: RCM + EMR + HIE = MU Product Development MU upgrade by Oct. 1 CCHIT modular certification Operations HR Plan IT/Ops Alignment Customer Service Plan – dedicated lab team Marketing Easy and Lite Money-back Guarantee Multi-Lab Connectivity (Lab Hub) Direct and Channel Promotions Sales Cross-selling with Payer, Provider, Pharmacy and Government sales teams New pricing models to remove barriers Strategy 1. MU Portal 2. National eLab Hub 3. eLab Hub Pilot on NHIN 4. Strategic Partnership

22 Meaningful Use is Easy! *Certification in process pending the final rules from the federal government 1.Eligible healthcare providers want to meet Meaningful Use requirements in order to qualify for stimulus funds 2.To do so, they need to be able to connect payers and to other providers for exchange of administrative, financial, and clinical data 3.Emdeons Meaningful Use Portal integrates Emdeon Office and Emdeon Clinician EMR Lite* to deliver one solution to EPs

23 Navigating HIT Over the Next 5 Years: 5010/ICD-10 + HITECH/Meaningful Use 23 + Healthcare Reform

24 Questions? Miriam Paramore SVP Clinical and Government Services


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