#1|------- VITL FY24 Budget Presentation and Quarterly Report to the Green Mountain Care Board May 17, 2023 VITL#2Contents Introduction • FY23 Activities & Year End Forecast •FY24 Budget Request • Program Highlights • Quarterly Metrics Abbreviations List VITL 2#3Our work is guided by the State's HIE Strategic Plan and VITL's Strategic Framework Vermont HIE Strategic Plan Goals VITL Strategic Directions 1. Create One Health Record for Every Person 1. Focus on our Customers 2. Tell Our Story 2. Better Health Outcomes 3. Be the Go-To Partner for 3. Improve Health Care Operations 4. Use Data to Enable Investment and Policy Decisions VITL 4. Exchanging Vermont's Health Information Build a Learning Organization 5. Ensure Sustainability 3#4VITL FY23 Accomplishments & Forecast Year End Performance 4#5FY23 Activities 120 new interfaces over 18-month contract * Query connection to the Immunization Registry, participation in ASTHO learning community with VDH * Security Program alignment to NIST 800-53 with security controls validated under a System Security Planning (SSP) process Upgrade to FHIR R4 * API Planning - implementation in FY24 * Social Determinants of Health Planning - implementation in FY24 * Connections to designated agencies for substance use disorder (Part 2) data * Reporting platform live- tuning continues * Hub connection to eHealth Exchange (UVMHN, VA, DOD) Medicaid Interoperability (on hold) * New public education campaign delivered * Organizational realignment VITL LO 5#6. FY23 Year End Forecast Performance is forecast to be above budget at ~$560k • Largely due to timing in projects - reprioritization and shift in timelines to FY24 ● Revenues ~$1.6m below budget • $1.4m deferred to FY24 Expenses ~$2m below budget Software, licensing, and outside support $1.2m below budget Staffing $300k below due to vacancies (active hiring in spring) VITL 6#7VITL Fiscal Year 2024 Proposed Budget • Contract Proposed Budget Message Archive Investment 7#8. FY24 Contract • ● • Abbreviated contracting & budgeting schedule Contract with AHS 4/26 for CMS submission - 60 day review Reminder: Contract is now on a fiscal year basis, not a calendar year basis, so the proposed budget is based on one contract Maximum FY24 Contract (draft) Revenue in FY24 budget Maintenance and Operations • DDI budgeted Potential additional projects $11,296,612 $ 9,360,675 $6,155,875 $3,204,800 $ 1,935,936 (not budgeted) VITL 8#9FY24 DDI Projects Budgeted Project FY24 Contract Budgeted Revenue $500,000 VITL FHIR APIS Interfaces Medicaid /AHS Support Immunization Registry Integration Lab Reporting for VDH Other VDH MDAAP Support New Data Types and Security Portal Medication Functionality Total VITL Revenue Bi-State (pass through) Total FY24 Contract Budgeted Revenue $1,125,000 $130,800 $189,000 $280,000 $47,000 $190,000 $285,000 $100,000 $2,846,800 $358,000 $3,204,800 9#10FY24 DDI Potential Projects, Not Budgeted The FY24 contract includes the potential for AHS to request additional projects of VITL: Up to 125 additional interfaces for MDAAP VITL . Support Medicaid Reporting & Analytics. • Task Order for new needs $1.1m $578k $100k 10#11VITL Revenue State Contracts CY20 FY24 Statement of Activities Total Contracts FY23 FY23 Variance Item FY22 Audited Financials Original Approved Budget Jan. 2023 Amended FY23 Year End Forecast FY24 Proposed Budget Budget FY24 Proposed Budget & FY23 YE Forecast 588,345 CY21 M&O CY21 DDI 1,473,889 3,695,250 1,443,338 1,439,054 CY22/23 M&O 3,023,188 CY22/23 DDI 605,269 Public Health Grant Revenue 6,564,294 1,897,799 262,500 6,246,376 2,987,030 658,701 6,228,776 2,139,316 730,107 698,000 71,406 (6,228,776) (1,441,316) SFY24 M&O 6,155,875 6,155,875 SFY24 DDI 3,204,800 Total State Contracts OCV Contract 9,385,941 639,998 10,025,939 10,167,931 430,000 10,597,931 10,672,460 394,167 11,066,627 9,026,793 429,998 9,456,791 Patient Ping Fees 73,756 VITL Direct Fees 121,200 72,000 45,000 67,776 72,737 10,788,782 429,996 11,218,778 72,000 3,204,800 1,761,989 (2) 1,761,986 (737) 48,210 48,209 41,819 (6,391) Collective Medical 1,375 2,500 2,500 1,375 1,375 Route Notification Fees 54,064 26,693 53,386 26,693 26,693 (0) Total Program Fees 250,396 Misc. Revenue 6,592 146,193 9,000 171,873 147,639 141,887 (5,753) 57,680 78,866 60,000 (18,866) Potential impacts to revenue (150,000) (150,000) Total Revenue $ 10,282,927 $ 10,753,124 $ 11,296,180 $ 9,683,297 $ 11,270,664 $ 1,587,367 VITL Expenses Labor Related Expenses Labor Cost Fringe Total Labor Related Expenses Material/Services 2,377,919 954,180 3,332,099 2,649,637 1,098,875 3,748,512 2,534,958 983,517 3,518,475 1,243,402 2,305,938 905,770 3,211,708 (1,243,402) 3,053,287 1,290,160 4,343,447 747,349 384,390 1,131,739 Network Expenses Software Outside Support Education & Outreach Travel Supplies Occupancy 419,552 3,106,334 678,797 3,308,537 2,060,377 2,107,200 682,802 3,252,114 2,706,470 533,239 2,345,151 580,723 2,596,203 47,484 251,052 2,370,031 2,758,533 388,502 45,488 157,076 150,576 131,609 189,900 58,291 2,965 30,000 30,000 16,274 72,100 55,826 9,136 10,850 10,590 10,687 25,950 15,263 116,318 63,120 63,120 30,124 26,752 (3,372) Telecom 49,576 44,699 44,699 26,116 27,041 925 Insurance 94,875 163,190 163,190 112,634 145,690 33,056 Other 95,819 50,000 50,000 71,416 70,000 (1,416) Training/Prof. Develop. 77,804 177,438 345,738 265,153 236,588 (28,565) UFF Contract Costs 97,878 93,385 Loss Provision Contingency Total Material/Services Total All Expenses 108,919 100,000 70,000 6,285,041 6,890,906 7,662,684 5,912,435 100,000 6,829,480 100,000 917,045 $ 9,617,140 $ Change in Net Assets $ 665,787 $ 10,639,418 $ 113,706 $ 11,181,159 $ 115,020 $ 9,124,143 $ 559,154 $ 11,172,927 $ 97,737 $ 2,048,784 (461,416) Carry Forward Project Investment Investment: Rhapsody Redesign $ 175,000 $ (175,000) 175,000 (175,000) $ Creation of HDM Rebuild Reserve (650,000) Add back CAPEX Adjusted Net Assets $ 665,787 $ (40,000) 73,706 $ (40,000) (35,632) (20,000) 75,020 $ (126,478) $ 77,737 $ 15,632 204,215#12Budgeted Revenue Sources Category Maintenance & Operations (M&O) Amount $6,155,875 • Description Contract amount down slightly from current contract, working to accommodate Design, $3,204,800 • Collecting data, new data types Development & • Enabling FHIR-based data interoperability Implementation • Public Health (DDI) • Bi-State pass-through Deferred Revenue $1,428,107 . One Care VT $429,996 Other $201,887 Potential Impacts ($150,000) • VITL • Revenue collected but not recognized for projects still underway: reporting, APIs, Part 2 Anticipates renewal Patient Ping, VITL Direct, Interest, Misc Allowance for contracts under negotiation 12#13Budgeted Expenses: Staffing VITL Staff Expenses Gross Salaries 80% Payroll Taxes 7% Health/Life/Dental 10% Retirement Contributions 2% Administrative Costs 1% • Creates one new position in Technology • • Includes enterprise architect, a budgeted position, which was in Outside Support in FY23 One existing position remains in Outside Support - contracted from Maine HIE Includes COLA and anticipated benefits cost increases 13#14Budgeted Expenses: Software & Outside Support Software Expenses Outside Support • . • VITL VHIE SaaS & Licensing, $1,947,352 Business Software, $108,850 Enhancements, $540,000 Project, $2,036,537.50 Operational, $721,995.60 Similar breakdown to FY23 Enhancements are DDI cost estimates VHIE costs include licensing of MedicaSoft NXT, Integration Engine, Master Patient Index, Terminology Services, Results Delivery, HISP . Similar breakdown to FY23 Project costs are DDI cost estimates, includes Bi State/ VRHA Operational costs include legal, accounting, database support, communications, and consulting/contractors 14#15VITL Expenses ($000s) Indirect Rate 25.9% 27.4% 12,000 27.4% 24.8 10,000 8,000 6,000 5,883 5,404 5,076 5,905 3,048 • VITL works to keep indirect costs in check • Due to budget scale, small changes in costs impact the rate 4,000 2,468 2,073 2,086 2,000 1,008 924 674 837 1,259 FY22 Audited 1,280 1,125 1,296 FY23 Budgeted FY23 Projected FY24 Proposed Indirect Labor Costs Indirect Materials & Services Direct Labor Direct Materials & Services 15#16Balance Sheet Assets VITL $10,000,000 $9,000,000 $8,000,000 $7,000,000 $6,000,000 $5,000,000 $4,000,000 $3,000,000 $2,000,000 $1,000,000 $0 FY22 Audited FY23 Budget FY23 Forecast FY24 Proposed Other Assets Accounts Receivable Prepaid Expenses Property & Equipment, net Cash 16#17Reinvestment: Create a Reserve For Message Archive Rebuild . ● Would like to set aside $650k of FY23 and prior year surplus to implement a new message archive & complete the transition from legacy infrastructure A Message Archive contains the complete, original records we receive from heath care organizations - not de-duped, translated, curated, tuned • • • · Critical for operational and data quality support Tracks message history Allows us to replay messages if something goes wrong. Serves as a data backup Could support future functionality enhancements Integration Engine HCOs Message Archive (complete record of original messages) verato Metadata (for operational support and data quality) VITL Medicasoft 17#18Why this is important • . • Existing infrastructure (HDM) was internally-built and used for: ● - Client reporting (e.g., Blueprint, OCV) – moving to MedicaSoft • Message archiving The infrastructure is end of life and will soon be unsupported. • Original plan was for 'lift and shift' of non client reporting capabilities to cloud, however further research identified risks and need for different approach Building on modern cloud technology could improve operations, and unlock potential for future analytic capabilities VITL 18#19VITL Program Highlights 19#20VHIE as Health Data Utility • Emerging model for shared health data infrastructure Statewide entities that combine, enhance, and exchange electronic health data across care and services settings for treatment, care coordination, quality improvement, and public and community health purposes • HDUS emphasize multistakeholder organizational and use case-specific data governance with an emphasis on public health VITL 20#21· • FY23 Program Highlight: Launch of Bidirectional Immunization Data Sharing In April VITL launched the first bi-directional immunization data sharing connection, between the Vermont Department of Health and a health care provider - Northeastern Vermont Regional Hospital (NVRH) Clinicians and staff at NVRH can query for patients' comprehensive immunization records from inside the NVRH EHR • The result is more complete patient health records and a more efficient workflow • With VDH, invited to participate in the Association of State and Tribal Health Organizations (ASTHO) Immunization Data Exchange, Advancement and Sharing Learning Community VITL 21#22Next Steps: Bidirectional Immunization Data Sharing • • VITL is working with additional hospitals, Federally Qualified Health Centers, and independent practices to build more bi-directional immunization data sharing connections Forecasting data will also be made available Work will continue in FY24 VITL 22#23The What and Why's of APIs What? • • . Code that enables interoperability - defined as "the ability of two or more systems to exchange health information and use the information once it is received." (ONC) Based on established standards - HTTP/S, REST, JSON, XML and FHIR A move away from building large monolithic systems towards smaller microservices Reusable functionality can support multiple different applications VITL Web app in Browser Why? . • Request Internet API Response Web Server Database CMS Interoperability and Patient Access Final Rule • "to achieve appropriate and necessary access to complete health records for patients, health care providers, and payers" and "reduce overall payer, health care provider, and patient burden through the proposed improvements to prior authorization practices" CMS Interoperability and Prior Authorization Processes Proposed Rule "improve health information exchange to achieve appropriate and necessary access to complete health records for patients, health care providers, and payers." 23#24Health Care API Technical Standards • · ● • - FHIR (Fast Healthcare Interoperability Resources) – a standard that defines how healthcare information can be exchanged between different computer systems SMART on FHIR & OAuth 2.0 - defines the mechanisms applications use to get appropriate authorization to FHIR resources OpenID Connect - the identity layer above OAuth 2.0 protocol used to verify the end-user's identity - United States Core Data for Interoperability (USCDI) – the standardized set of health data elements which enable nationwide, interoperable health information exchange VITL 24#25. Public Education VITL VITL continues its public education work in partnership with participating organizations. . • VITL offers a toolkit of education resources to support patient education by participating organizations Participants are encouraged to partner in patient education beginning at onboarding, during check-ins, and via an email campaign VITL will continue its direct outreach to Vermonters in recurring education campaigns. VITL is planning the next education campaign, to begin in summer 2023. 25#26VITL Quarterly Metrics 26#27VITL Percent of Vermont Patients Opted Out of the Vermont Health Information Exchange 1.25% 1.25% 1.24% 1.24% 1.24% 1.24% April-22 May-22 June-22 July-22 August-22 September-22 October-22 1.15% 1.15% 1.15% 1.09% 1.09% 1.09% November-22 December-22 January-23 February-23 March-23 27#28VITL 625 VITLAccess Queries by Organization Type 105 12 572 20,895 15,648 April 2022 - March 2023 536 6,541 5,139 11 7,682 22,858 21,157 ■Community Health Center: 536 ■Designated Agency: 5,139 Emergency Services: 22,858 ■Federal/State Agency: 21,157 ■Federally Qualified Health Center: 7,682 ■Home Health Agency: 11 ■Hospital: 15,648 ■Hospital Owned Practice: 625 ■Independent Practice: 20,895 ■Long-Term Care: 572 ■Retail Pharmacy: 12 ■Specialized Services Agency: 105 Payer: 6,541 28#29VITL Pilot of the new VITLAccess began in February, rollout began April 19th, rollout completed in June. April-22 6,003 2,634 1,511 VITLAccess Queries by Month 12,669 11,061 10,007 10,545 9,596 9,834 9,184 8,986 9,100 9,130 9,652 7,475 May-22 June-22 July-22 August-22 September-22 0 0 0 0 0 0 0 0 0 →Legacy Portal October-22 November-22 December-22 ―New Portal January-23 February-23 March-23 29#30VITL April-22 May-22 45,978 45,072 June-22 39,940 Queries of the Vermont Health Information Exchange via eHealth Exchange (University of Vermont Medical Center, Veterans Affairs, Department of Defense) eHealth Exchange point-to-point connections were decommissioned during the VITL platform transition. eHealth Exchange policy requires any new connections be through the Hub model. VITL is implementing capabilities for data sharing via the eHealth Exchange Hub. July-22 August-22 September-22 October-22 November-22 December-22 January-23 February-23 March-23 30#31VITL April-22 May-22 Results Delivery by Result Type 105,937 101,811 96,155 99,025 98,540 98,788 100,595 96,166 94,749 94,242 91,659 88,502 June-22 July-22 August-22 September-22 October-22 November-22 ■Laboratory Results ■Radiology Reports Transcribed Reports Number of providers receiving results = 586 December-22 January-23 February-23 March-23 31#32VITL Results Delivery by Receiving Organization Type April 2022 - March 2023 3,530 10,698 553 686 392,876 21,819 12,739 723,268 ■Designated Agency: 3,530 ■Federal/State Agency: 686 ■Federally Qualified Health Center: 723,268 ■■Hospital: 12,739 ■Hospital Owned Practice: 21,819 ■Independent Practice: 392,876 ■Long-Term Care: 553 Rural Health Center: 10,698 32#33VITL Glossary 33#34Abbreviations Frequently Used VITL and Our Work HIE: Health Information Exchange HDU: Health Data Utility VHIE: Vermont Health Information Exchange VITL: Vermont Information Technology Leaders Inc. Financial Terms CY: Calendar Year DDI: Design, Development, and Implementation FY: Fiscal Year M&O: Maintenance and Operations Partners and Programs AHS: Vermont Agency of Human Services CMS: Centers for Medicare and Medicaid Services DVHA: Department of Vermont Health Access MDAAP: Vermont's Medicaid Data Access & Aggregation Program OCV: OneCare Vermont SOV: State of Vermont VDH: Vermont Department of Health Technology and Standards API: Application programming interface - a connection. between computers or between computer programs FHIR: HL7's Fast Healthcare Interoperability Resources data standard IMR: Vermont Department of Health's Immunization Registry VITL 34