N-CHIP Business Plan Sustainment Plan to be the Leading North Country Health Care Technology Resource

Transcription

1 N-CHIP Business Plan Sustainment Plan to be the Leading North Country Health Care Technology Resource N-CHIP Team 6/21/2012

2 Contents Executive Summary... 2 Accomplishments... 2 Opportunity... 3 SWOT Analysis... 4 Sustainment Plan Assumptions... 4 N-CHIP Objectives... 5 N-CHIP Services... 5 Marketing Plan and Milestones... 6 Phase Phase Competition... 7 Financial Forecast... 9 Team... 9 Appendix 1: N-CHIP ROI Calculations This document lays out the strategic, financial and operational plan to sustain the North Country Health 1

3 Information Partnership as an entity to sustain and expand the North Country health care system. Executive Summary The mission of the North Country Health Information Partnership is to provide community-based services to healthcare professionals improving the quality and access to health care for North Country patients through leveraging health information technology. N-CHIP provides services to area healthcare providers in a cost effective model that strengthens the region s health care delivery system and ensures that participating providers meet HIT requirements established by regulating authorities. N-CHIP aims to achieve quality, access and economic benefits in the North Country envisioned in the Center for Medicaid and Medicare s (CMS) Triple Aim: improve the experience of care for patient; improve the health of the population; and reduce per capita costs of health care, while supporting sustainable medical practices. We bring local clinical leadership, nationally recognized technical expertise, and extensive regulatory and industry knowledge to the community. N-CHIP leverages its strong community presence and trust to provide individualized services and solutions to clients with an exceptional level of competence and integrity. Accomplishments N-CHIP, from its inception, has been a truly community-driven organization with local providers and administrators steering its mission, technical objectives and strategic decisions. This unique model has been highly successful in accomplishing health information technology developments in the region. EHR Adoption: N-CHIP has been directly involved in assisting 37 practices to fully adopt certified EHR technology, including 12 primary care practices, which represents 95% of the primary care practices in N-CHIP s service area. Patient-Centered Medical Home: N-CHIP worked with local providers to achieve PCMH Level 2 and 3 recognition from the National Committee for Quality Assurance. The 103 providers at 32 primary care practices make up 19% of PCMH Level 3 and 71% of Level 2 recognized providers that are certified nationally and located in a rural Health Provider Shortage Area. Each PCMH provider will receive $21.25* per Medicaid Visit for their recognition (*Level III). Meaningful Use: Two of the region s hospitals and 52 out of the 92 eligible providers have attested for meaningful use. HIE Integration: N-CHIP has worked with HealtheConnections, the hospitals and the providers in the region to successfully integrate those entities with the Health Information Exchange (HIE) and to utilize the Personal Health Record (PHR). All five hospitals are connected to the HIE and sharing lab results, radiology reports and images, transcribed reports and ADT information. In addition, 27 practices will be fully integrated with the HIE and the others will utilize the PHR. Clinical Measurement: N-CHIP is working to implement a Community Disease Registry in order to provide sustainable clinical quality reporting. The registry is expected to be in full use by the end of

4 Opportunity The health care system in the United States is rapidly changing and growing across the country. The driving forces behind health care reform are to reduce health care spending, increase health care access and capture the benefits of technology in health care delivery. Health information technology (HIT) is one of the fastest growing segments of the health care industry. There are many areas within the HIT sector such as EHR implementation, using EHRs to achieve more efficient workflows, meeting quality standards such as meaningful use and PCMH, and leveraging telehealth applications. N-CHIP understands that HIT plays a large role in health care as the government provides financial incentives to those who adopt technology effectively and penalize those who do not. The incentives or avoiding penalties are a strong motivating factor for providers; however, they are not obtained or avoided without costs. HIT is also a pivotal tool in gathering, analyzing and reporting clinical quality measures. These measures can provide valuable insight to a clinician in the care of individual patients as well as chronic disease management across their entire practice. As with the incentive/penalty programs, HIT-enabled quality analytics requires significant support to ensure it can be fully implemented without undue burden to practices. N-CHIP combines local clinical leadership, nationally recognized technical expertise, and extensive regulatory and industry knowledge to provide HIT services to clients to make the required changes achievable and cost-effective. At the center of N-CHIP s significant HIT accomplishments has been local clinical leadership and engagement. These factors are unique to N-CHIP, and have proved to be highly effective in creating interest, dedication and follow through for the project initiatives. The goal of N-CHIP sustainment is to maintain the work that has been done under HEAL 10 from EHR adoption, workflow redesign, quality recognitions, buy-in from providers, and qualification for incentives. It is necessary for N-CHIP to sustain itself past the HEAL-10 funding in order to sustain HIT developments in the region. N-CHIP can provide more intensive, higherquality services at a lower cost than can be provided by consultants traveling from outside the area. N-CHIP is committed to partnering with other organizations where it makes sense for the community. We believe at this point N-CHIP should be providing the majority of the services to this community. 3

5 SWOT Analysis Strengths Weaknesses Internal Strong clinical leadership (PEC) Established 3-county medical collaborative relationships Learned best practices Built trust in the community Grant funds are unsustainable Limited local HIT workforce Opportunities Threats External Federal incentives for providers to capitalize on HIT Technology developments Telemedicine/ Telehealth Education/ workforce development Partnering with state-wide collaborative Outside consulting firms Wavering federal mandates Failure of HIE infrastructure Scope creep from grant-funded initiatives Sustainment Plan Assumptions The N-CHIP Sustainment Plan s primary goal is to sustain and extend the HIT developments in the region in order to improve the experience of care for the patient; improve the health of the population; and reduce per capita costs of health care, while supporting sustainable medical practices in the region. N-CHIP is uniquely positioned to accomplish these objectives. Several assumptions are made to formulate the Sustainment Proposal. Existing N-CHIP (HEAL-10) practices have expressed a willingness to pay for N-CHIP services going forward. We assume that the majority of these practices will subscribe for N-CHIP services. The practices in the region that are not a part of HEAL-10, the Gap practices, have also expressed interest in paying for or subscribing for N-CHIP services. The plan assumes that River Hospital s 7 hospital HEAL 21 application will be funded and will contract with N-CHIP for services. HRSA practices are expected to subscribe for N-CHIP services starting in fall of 2014 when the HRSA grant ends. N-CHIP can offer services to the practices at a lower cost and higher quality than others in the market. Practices, therefore, will prefer N-CHIP services over a competitor s service. The providers in N-CHIP s PEC will remain engaged in N-CHIP Sustainment after HEAL- 10 officially ends. 4

6 N-CHIP Objectives 1. Improve Experience of Care for Patient PCMH Survey Results % PC practices with PCMH % practices connected to HIE % of time hospital discharge data provided to PCMH PC provider % use of electronic referral process from PC to specialist % of specialist to send min data set electronically to PC within 5 days # patients accessing PHR 2. Improve the Health of the Population % reduction in potentially preventable admissions and readmissions % reduction in tests duplicated because results were not available Mortality and morbidity rates Length of patient stay Compliance 3. Reduce per capita costs of health care through supporting sustainment of medical practices % reduction in potentially preventable admissions and readmissions # incentive programs qualified for and accepted for $ per provider in incentive programs N-CHIP Services N-CHIP will offer both membership and hourly a la carte services for its clients. The membership fee structure for a small (1-2 provider) practice is $1,000 for a one year membership. A larger practice s membership (3+ providers) will cost $2,000. Providers include physicians, nurse practitioners and physician assistants. The N-CHIP membership will include the list of membership services below and discounted a la carte services ($100/hour). N-CHIP will evaluate a practice s needs before contract execution to give the practice an estimate of service costs. Non-members can receive N-CHIP services at a rate of $200/hour. Please see the list of included membership services and a la carte services below. Membership Services (Included in annual membership) Annual Practice/Clinic Assessment (High level analysis of practice needs & resources, up to 3 hours) Notifications and updates on deadlines, regulatory issues and key issues affecting practices and clinics (monthly newsletter and instant alerts) Access to N-CHIP consulting services at a reduced rate Annual In-Service for practice/clinic on HIT topic of choice (up to 2 hours) Assigned an N-CHIP Implementation Specialist as single point of contact (lead) for the practice 5

7 N-CHIP A La Carte Services (Charged per hour) Implementation and Optimization: Reference Documentation Assistance (cheat sheets, manuals, etc.) System Upgrade (i.e. Version 6.7 to 6.8) Customization of PMS/EMR systems Technical Assistance outside of vendor contract Workflow Redesign: Assess, Recommend and Implement Individualized Training for clinicians and staff Information Assurance: HIT Compliance, Risk Analysis, HIPAA data security, Policies & Procedures, Documentation Assistance Testing: That forms work properly and workflow redesign is compatible with EMR; beta is linking to reporting Direct and Indirect Vendor Support: User Groups HIE Liaison EMR Vendor Management: Selection, Contract Negotiation & Review, Advocacy, Customer Support Liaisons Integration (HIE, medical device, PHR, mobile) Financial and Clinical Quality Improvement: Incentive Programs: Identify, Implement and Obtain (Meaningful Use, PQRS, NCQA, etc.) Revenue Optimization (system-wide) Financing Assistance (TBD) Build and Support Assistance for Quality Program(s) in Practice Regulatory Advisories (i.e. changes to e-prescribing) Liaison with State and Federal regulatory agencies Business/Clinical Intelligence: Input, Validate and Reporting Large Projects ICD-10 Transition System Upgrade Purchases (i.e. Version 6.7 to 7.0) Turn-key System Installation Marketing Plan and Milestones N-CHIP s technical capability and expertise has become well known to physicians participating in the HEAL-10-funded project. Those providers are very aware of what we do and will provide endorsements and demand for N-CHIP services. In our first three years, N-CHIP has achieved significant results that translate into millions of dollars for the local community. Regional, state and national recognition of our results and the endorsement of local, community providers position N-CHIP well to expand its marketing to the larger community. The N-CHIP Marketing Plan will allow the organization to look ahead to the next five years and build on its initial success as a NYS HEAL-10 grantee in order to transform itself into a sustainable organization with earned revenue providing a significant part of its budget along with community funding. 6

8 Phase 1 N-CHIP Outreach: Phase 1 of our marketing plan will be focused on leveraging our local provider endorsements and national recognitions to gain new clients. Over the past six months, we have fielded several requests for additional support for existing clients and new support from other providers in the community. This is evidence that we will continue to gain clientele through word of mouth endorsements of existing clients and stakeholders. Direct Marketing: In the first phase we intend to become more active in marketing our services directly to area medical practices through presentations at hospital medical staff meetings and hospital senior management, direct mail brochures, and medical office rounding. By reaching more and more potential clients, N-CHIP will keep its services in demand. The cost of Phase 1 activities is minimal, and will therefore boost the financial picture of N-CHIP early on. The cost of acquisition of additional service or new clients will be less than the revenue we expect to bring in from those services and/or clients. Refer to the pro forma on page 9. Phase 2 Infrastructure and support: In phase 2, we will continue to expand on subscribed practices as well as engage subscribed and non-subscribed practices in larger support engagements (consulting) for initiatives such as Meaningful Use Phase 2, ICD-10, PQRS and other project type efforts. In addition, we plan on extending support to other parts of St. Lawrence County to incorporate the new FDRHPO member hospitals (Claxton-Hepburn and Clifton-Fine) and their associated clinics. Clinical Quality Measures: In phase 2, we plan on further developing the disease registry to assist members in gathering, assessing and reporting clinical measures to gain insight, prioritize resources, improve care, and qualify for quality-based incentive programs. Competition There are several entities in the market that are able to provide similar services to N-CHIP. N- CHIP is committed to partnering with outside agencies, such as PCDC and HealtheConnections, when the partnership is beneficial to the community. The table below summarizes the other entities in the market, areas of competition and areas of collaboration. 7

9 IPRO PCDC Entity Name HealtheConnections Independent, Local IT Resources Westelcom Description/Core Functions Clinical data reporting; Statewide learning and action networks; Quality Assurance and Performance Improvement Capital Investment; PCMH consulting services; Policy & Advocacy Connection to HIE/EHR Adoption Software/Hardware/Net work Support Software/Hardware/Net work Support Collaborative Potential For existing IPRO clients, such as the Children s Clinic, we can be the feet on the ground to take advantage of IPRO s expertise, but reduce costs by allocating the tasks to the most appropriate resource. For existing PCDC clients, such as the REC practices, we can be the feet on the ground to take advantage of PCDC s expertise, but reduce costs by allocating the tasks to the most appropriate resource. Assist in HIE workflow optimization and on-site support to augment HeC s offerings Assist with clinical workflow optimization and EHR adoption to augment his back-end IT expertise. Assist with clinical workflow optimization and EHR adoption to augment his back-end IT expertise. Competitive Potential For existing/new customers of IPRO, we have the potential to provide the same or higher levels of expertise, more inperson support and all at a lower cost. For existing/new customers of PCDC, we have the potential to provide the same or higher levels of expertise, more inperson support and all at a lower cost. No competitive issues with the HIE. With EHR adoption, our expertise with ecw, Vitera, Medent, MicroMD and CareTracker as well as our local presence gives us a key competitive advantage. Some competitive overlap in hardware/software and network support, however that area is not our target service offering and are only providing these services in the absence of existing support. Some competitive overlap in hardware/software and network support, however that area is not our target service offering and are only providing these services in the absence of existing support. 8

10 Financial Forecast N-CHIP Sustainment Pro-Forma Projection Jul-Dec Grant Revenue HEAL-10 $ 166,500 HRSA Grant $ 220,000 $ 300,000 NYS Health Foundation Grant $ 48,000 Total Grant Revenue $ 434,500 $ 300,000 Contractual Revenue $ 136,300 $ 333,500 Membership Revenue $ 6,400 $ 51,000 Membership Service Revenue $ - $ 50,000 Consulting Fee Revenue $ - $ 150,000 Total Revenue $ 577,200 $ 884,500 Operating Expense $ 456,200 $ 878,697 Operating Income, (loss) $ 121,000 $ 5,803 Hospital Funding $ - $ - Net Income, (Loss) $ 121,000 $ 5,803 Team Corey M. Zeigler HIT Program Manager Dr. Steven Lyndaker Medical Director John Wheeler HIT Financial Analyst Charles McArthur Quality Analyst Serena Maupin HIT Implementation Specialist David Jones HIT Implementation Assistant Chris Grieco HIT Implementation Assistant Pat Fontana HIT Implementation Assistant Liza Winters Lead Nurse Informaticist Ingrid Exford Administrative Assistant 9

11 Return on Investment for Private Practices Appendix 1: N-CHIP ROI Calculations N-CHIP has designed a model to calculate the potential return on investment (ROI) for clients utilizing subscription and hourly services. The model includes several assumptions which address the variability across our current and future client practices. Included here are two scenarios to illustrate the spectrum of ROI for small to medium size practices in the North Country. The calculations also show the advantage to using N-CHIP services versus using an outside consultant who would travel to the practice 3 times per year. Small Private Practice Assumptions: 1 eligible Medicare Provider 0 eligible Medicaid Providers Achieved PCMH Level III prior to 2012 Attested for Meaningful Use Stage 1 in Medicaid Visits N-CHIP Return on Investment for Private Practice Year 1 (2012) Year 2 (2013) Year 3 (2014) Year 4 (2015) Costs N-CHIP Membership $ 1, $ 1, $ 1, $ 1, N-CHIP Hourly Services N-CHIP Hourly Consulting Cost ($100/hr) $ 11, $ 5, $ 18, $ 5, Outside Consultant Hours (85% of N-CHIP time) Outside Consultant Hourly Services ($200/hr) $ 19, $ 9, $ 31, $ 9, Outside Consultant Travel Costs $ 2, $ 2, $ 2, $ 2, Income MU Medicaid Income $ - $ - $ - $ - MU Medicare Income $ 18, $ 12, $ 8, $ 4, PCMH Income $ 4, $ 4, $ 4, $ 4, N-CHIP ROI (N-CHIP costs less Income) $ 9, $ 9, $ (7,350.00) $ 1, N-CHIP ROI Over 4 Years $ 14, Outside consultant ROI $ 5, $ 9, $ (17,195.00) $ 1, Outside Consultant ROI Over 4 Years $ (1,660.00) 10

12 Large Private Practice Assumptions: 4 eligible Medicare Provider 0 eligible Medicaid Providers Achieved PCMH Level III prior to 2012 Attested for Meaningful Use Stage 1 in Medicaid Visits N-CHIP Return on Investment for Private Practice Year 1 (2012) Year 2 (2013) Year 3 (2014) Year 4 (2015) Costs N-CHIP Membership $ 2, $ 2, $ 2, $ 2, N-CHIP Hourly Services N-CHIP Hourly Consulting Cost ($100/hr) $ 11, $ 5, $ 18, $ 5, Outside Consultant Hours (85% of N-CHIP time) Outside Consultant Hourly Services ($200/hr) $ 19, $ 9, $ 31, $ 9, Outside Consultant Travel Costs $ 2, $ 2, $ 2, $ 2, Income MU Medicaid Income $ - $ - $ - $ - MU Medicare Income $ 72, $ 48, $ 32, $ 16, PCMH Income $ 15, $ 15, $ 15, $ 15, N-CHIP ROI (N-CHIP costs less Income) $ 74, $ 56, $ 27, $ 24, N-CHIP ROI Over 4 Years $ 181, Outside consultant ROI $ 70, $ 56, $ 18, $ 24, Outside Consultant ROI Over 4 Years $ 170,