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Michigan Five-Year Health ITRoadmapCoordinating During Crisis:Information Technology Needs and Gaps for Emergency Services Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.October 21, 2020

Coordinating During CrisisRegionalStakeholderForum*CEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.

CedarBridge Group FacilitatorsTerry BequetteSenior ConsultantCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.Dawn BonderManaging Director3

Audio and Chat ControlsTo respond verbally, openthe Participants windowand click the Raise Handoption, and ourfacilitators will unmuteyou.Use the Chat toengage with allparticipantsCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.4

Connecting Your Phone LinePress #, Enter yourParticipant ID, Press #Example: #128581#CEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.5

Participating in the Virtual Forum If you would like to respond verbally to a question:o “Raise hand” in the participant box and facilitatorwill call on you;o State your name / organization, and beginspeaking; ORo Input your response in the chat To emphasize someone’s point, you may “stack” in thechat box (i.e. “ ” when you agree with what is beingsaid) Interactive polling will be used to collect and displayyour input in real-timeCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.6

Quick Poll Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.

A Message from the MDHHS DirectorROBERT GORDON, DIRECTORRobert Gordon serves as the director of the MichiganDepartment of Health and Human Services, where heoversees Medicaid programs, Children’s ProtectiveServices, food assistance, public health and manyother statewide health and human servicesprograms.CEDARBRIDGE GROUP Copyright 2019 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.8

Coordinating During Crisis:Health Information Technology for Emergency ServicesRecap &Insightsfrom onCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.SmallGroup“Breakout”SessionsReport OutandRoundtable9

Vision for a Five-Year Health IT RoadmapJim VanderMeyChief Innovation Officer, Open Systems TechnologyMichigan Health Information Technology CommissionCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.10

Vision for a Five-Year Health IT Roadmap: A Brief History20052006 Governor Jennifer Granholmannounces efforts to explore therole of IT in healthcaretransformation and improving careoutcomes 200 healthcare stakeholders areconvened The Michigan Department ofCommunity Health andDepartment of InformationTechnology are charged withconvening stakeholders to developa strategy The legislature establishes theHealth IT CommissionCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission. The “Conduit to Care” strategydocument is published Federal and state funding issecured to implement plans11

Vision for a Five-Year Health IT Roadmap:Strategic Planning During a Global Pandemic20192020 The Health IT Commission adoptsa resolution to update the“Conduit to Care” strategy The coronavirus pandemic causes engagement anddiscovery for the Statewide Roadmap to bereimagined for virtual spaces The Michigan Health EndowmentFund awards funding for thedevelopment of an updatedStatewide Health IT Roadmap 650 healthcare, social service, communitynonprofits, state and local agencies and consumerstakeholders are engaged.THANK YOU! Virtual forums, surveys, and interviews will informthe planning processCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.12

Principles for Updating the Statewide Health IT RoadmapAlignLeverage Existing Investments Business strategies Priorities Identify and add value to local efforts Maximize benefit from existing toolsShared Goals:Data Availability,Useability, InteroperabilityValidate InputInclusivity Share draft recommendations Solicit public comment Create spaces for broad feedback Conduct comprehensive environmental scanCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.13

Connecting Virtually to Develop a Five-Year Health IT RoadmapHealthcare StakeholdersVirtual Outreach andEngagementSocial Service StakeholdersVirtual ForumsElectronic SurveysGovernment AgenciesKey Informant InterviewsConsumers/AdvocatesCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.Partner Communications14

Roadmap Development ProcessLearning from the past: Principles in the Conduit to Care reportPrivacy and security are paramountData for clinical care processesRegional-level efforts are criticalCollaboration leads to achievableand measurable initiativesConsidering needs and gaps: What is working, what is missing?Information needs and gapsTechnology needs and gapsPolicy needs and gapsBusiness needs and gapsCollaborating on solutions: Roadmap developmentLeveraging existing investmentsIdentifying Information sources forcare/program/business needsIdentifying needed technologysystem functionalityIdentifying policies and programs todrive data availability and useabilityAddressing tomorrow’s challenges: Roadmap implementationAddress disparitiesPrioritizeInvestmentsFocus onQuadruple AimCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.Create valueMaximizepartnershipsEnsure stablefundingCreate governancemechanisms15

Strategic AlignmentLocal PlanningEffortsStakeholder Input CedarBridgeengagement Association outreachCEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission. Organizationalstrategies Altarum: BehavioralHealth and PHI tools andresearch MPHI: Health IT series Etc.5-YearHealth ITRoadmap16

Recap and Insights from theDiscovery Forum Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.

Recap of Discovery Forum:Coordinating During CrisisSeptember 16th, 202027 attendees fromEMS, health IT,hospitals, andother sectorsIdentified keyissues andopportunitiesrelated to EMS andhealth ITFacilitated dialoguewith interactivepolls on EMS tools,investments, andaccess toinformationCoordinating During Crisis: EMS Considerations Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.

Theme #1 – Top Priority: Better Coordination Between Emergency MedicalServices, Hospitals, and Emergency Departments Need for accurate and timely access to medicalinformation at the time of an emergency Need for better coordination with mental health andsubstance use disorder providers“I dream that some day in the future, hospital outcomes will beprovided electronically to EMS agencies via linked IT systems thatcommunicate based on patient identifiers.there are significanthurdles regarding sharing confidential information.”Comment from participant in prior forumCEDARBRIDGE GROUP Copyright 2019 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.19

Theme #2 – A Digital Divide is Impacting Rural EMS ProvidersCEDARBRIDGE GROUP Copyright 2019 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission. Connectivity to external information sources duringemergency response is a significant issue in rural areasdue to the lack of reliable internet connectivity andcellular service Access to patient information is an issue acrossMichigan, but more pronounced in rural areas Many urban EMS responders are dispatched byhospitals with access to the hospital EHR Some regional EMS provider systems retain patientinformation to be available on a subsequentresponse20

Theme #3 – Prioritize Connectivity to Leverage Existing InvestmentsMost rural-based respondents expressed afrustration with not being able to connect totheir technical solutionso Investments are needed to expandbroadband and cellular network serviceso Need to connect/report to MI EmergencyMedical Services Information System (MiEMSIS) Under-utilization of the Hospital Hubsystem?CEDARBRIDGE GROUP Copyright 2019 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.21

Coordinating During Crisis:Emergency ServicesRegionalConsiderationsand Opportunities*CEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.

Connectivity is CrucialLack of connectivity impacts Response – where to go; ETA; vitalinformation Access to patient information Care coordinationLack of connectivity hinders additionalinvestments and the ability to realize thefull benefits of current investmentsLack of connectivity contributes todisparities in health care outcomesCEDARBRIDGE GROUP Copyright 2019 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.23

Testing New ModelsCenters for Medicare and Medicaid ServicesEmergency Triage, Treat, and Transport (ET3) ModelPromising Interventions Are on the 3Current StateMedicare currently pays for emergency ground ambulance services only when beneficiaries aretransported to a limited number of covered destinations, even when a lower-acuity, lower-cost settingmay more appropriately meet an individual's needs.Re-Aligning Incentives for Future StateET3 Model interventions will allow beneficiaries to get the care they need and enable ambulancesto work more efficiently

What is ET3?Emergency Triage, Treat, and Transport (ET3) is a voluntary, five-year payment model that willprovide greater flexibility to ambulance care teams to address emergency health care needs ofMedicare Fee-for-Service (FFS) beneficiaries following a 911 call. CMS will continue to pay to transport a Medicare FFS beneficiary to a hospital emergencydepartment or other covered destination. In addition, under the model, CMS will pay participants to1) transport to an alternative destination partner, such as a primary care office, urgent careclinic, or a community mental health center (CMHC), or2) initiate and facilitate treatment in place with a qualified health care partner, either at thescene of the 911 emergency response or via telehealth.CEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.

How Might ET3 Model Improve EMS Services inMichigan? The ET3 model will allow Medicare beneficiaries to access the most appropriate emergencyservices at the right time and place. The model will also encourage local governments, their designees, or other entities that operateor have authority over one or more 911 dispatches to promote successful model implementationby establishing a medical triage line for low-acuity 911 calls. As a result, the ET3 model aims to improve quality and lower costs by reducing avoidabletransports to the ED and unnecessary hospitalizations following those transports. As part of a multi-payer alignment strategy, CMMI will encourage ET3 model participants topartner with additional payers, including state Medicaid agencies, to provide similarinterventions to all people in their geographic areas.CEDARBRIDGE GROUP Copyright 2020 CedarBridge Group, LLC. All Rights Reserved. Do not reproduce without permission.