1. One Union Station Providence, RI 02903 (401) 274-4564 www.riqi.org

2. 2 The RI Quality Institute A collaboration among hospitals, health care providers, insurers, business, academe and government for the purpose of improving health care quality, safety and efficiency.

3. 3 Our Mission To improve the quality, safety and efficiency of health care in Rhode Island and serve as a learning laboratory for the nation.

4. 4 Guiding Principles Collaboration—first and foremost Collaboration—first and foremost Real improvement is required Real improvement is required Win-win for all participants Win-win for all participants Focus on system improvements that none of us can achieve alone Focus on system improvements that none of us can achieve alone Senior Leaders required Senior Leaders required

5. 5 Electronic Prescribing with SureScripts as the First Initiative True electronic prescribing offers a strong value proposition for all involved True electronic prescribing offers a strong value proposition for all involved We knew we could build on the IT infrastructure and the experience gained We knew we could build on the IT infrastructure and the experience gained Built physician confidence in our organization and our motives Built physician confidence in our organization and our motives Beta testing began in June, 2003 and by the end of 2004, if all goes as planned, we will have 75% of RI pharmacies connected and more than 45% of active RI prescribers Beta testing began in June, 2003 and by the end of 2004, if all goes as planned, we will have 75% of RI pharmacies connected and more than 45% of active RI prescribers

6. 6 The Cost and Quality Opportunity Unnecessary Cost Practice Variation Fisher, Wennberg, et al, Annals of Internal Medicine, 2003 “…30% of direct health care outlays are the result of poor-quality care…” MBGH, Juran, etal 2002 “…20 to 30 percent of the acute and chronic care that is provided today is not clinically necessary.” Becher, Chassin 2001 “…cost of poor quality was … nearly 30% of the expense base…The biggest opportunities were in the core medical processes that comprise the majority of what we do.” Mayo Clinic “Costs associated with poor health care account for 30% of the premiums people pay.” David Lawrence, MD “The cost of poor quality in health care is as much as 60% of costs” Brent James, MD, IHC

7. 7 Projected U.S. Health Expenditures and Waste Source: U.S. Department of Health and Human Services, Gordian Project analysis $3.3 T $1.7 T Unnecessary Cost $515 B $990 B Aggregate Waste $7.4 Trillion

8. 8 Misaligned Incentives Drives Lack of Capital PhysiciansOthers Source: Center for Information Technology Leadership, 2003 Ambulatory Computer-based Physician Order Entry

9. 9 The “Others” (89%) Source: Health, United States, 2002 Medicaid Medicare Households Employers State/Local OtherFederal Purchasers of Health Care

10. 10 The Rhode Island Health Improvement Initiative (RIHII)  Give physicians the tools they need  Information technology  Connectivity to the entire community  Best Practices (Evidence-Based Medicine, Chronic Care Model, Person-Centered Care, etc.)  Heavy implementation/process redesign support  Reward physicians’ use of best practices  Fund it through a stakeholder coalition  Share the gains with physicians  Provide community governance

11. 11 RIHII Overview What to do? What to do? Where to start? Where to start? Cost? Cost? Benefit? Benefit? ROI? ROI? Who to finance it? Who to finance it? Why to finance it? Why to finance it? Comprehensive approach Manageable place—100K people $9 M per year > $100 M per year 77% (10 year compound annual return) Public/Private Partnership Safer, higher quality care at a lower cost (1) per 100k people 1 1

12. 12 Projected Community Health Expenditures per 100,000 People Source: U.S. Department of Health and Human Services, Gordian Project analysis $1.1 B $615 M Unnecessary Cost $185 M $320 M Aggregate Waste $2.5 Billion

13. 13 Meanwhile… Statewide connectivity/Master Patient Index development Statewide connectivity/Master Patient Index development Effort to promote state-wide adoption of Electronic Health Records (EHRs) Effort to promote state-wide adoption of Electronic Health Records (EHRs) Further expansion of e-prescribing Further expansion of e-prescribing

14. 14 The Role RIQI is Considering for the Future: Market Institution (as described in the Thompson/Brailer 10-year plan) – Regional Health Information Organization (RHIO) Market Institution (as described in the Thompson/Brailer 10-year plan) – Regional Health Information Organization (RHIO) – Center for regional collaboration – Certifying organization – Connection center – Keeper of the Master Patient Index – Provider of access/authentication/security – Provider of data/document storage