Board Presentation

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NC HIE Board Meeting
Implementing Statewide HIE in
North Carolina
Date: April 21, 2011
Time: 1:00 pm – 3:30 pm
Conference Call ONLY
Dial in: 1-866-922-3257 Participant Code: 654 032 36#
Agenda
1:00 pm – 1:10 pm
Secretary Cansler
Welcome, Roll Call, Approval of Minutes from Feb. 17, 2011
Meeting
1:10pm – 1:15pm
Secretary Cansler &
Alan Hirsch
Welcome Jeff Miller, Incoming CEO
1:15 pm – 1:30 pm
Alan Hirsch
CEO Report
1:30 pm – 2:00 pm
Alan Hirsch, Fred
Goldwater &
Workgroup Chairs
Finance
– Upfront Funding
2:00 pm – 2:15 pm
Alan Hirsch & Poyner
Spruill
Review of changes to and approval of Bylaws
2:15pm – 2:30 pm
Alan Hirsch &
Workgroup Chairs
Progress and Next Steps for
– Governance
– Legal/Policy
2:30 pm – 3:00 pm
Fred Goldwater &
Workgroup Chairs
Clinical/Technical Operations
– Technical RFP Process
– Evaluation Committee
3:00 pm – 3:15 pm
Secretary Cansler
Open Public Comment & Closing Comments
2
CEO Report
3
CEO Report
•
•
•
•
Communications Firm
ONC Budget Approval
Operations Update
CCNC Medication Management Challenge Grant
Update
4
NC HIE Financing
5
Collaborative Infrastructure
Executive
Committee
NCHIE Board of Directors
NC HIE
Operations/
Staff
POLICY RECOMMENDATIONS
Governance
Work Group
Legal/Policy
Work Group
•Review bylaws
•Define the parameters
of Qualified
Organizations and
develop QO criteria
•Define oversight and
enforcement
mechanisms
• Proposed legislation
to facilitate opt-out
• Propose legislation
to harmonize state
medical record law
• Draft set of detailed
privacy & security
policies and
procedures
Tech/Clin Ops
Work Group
•Hire RFP consultant
•Define HIE RFP review
process
•Develop detailed
consensus
specifications
•Draft and issue RFP
Finance
Work Group
• Develop financing model
• Finalize initial payment
methodology/mechanics
• Develop sustainability plan
6
Finance: Timeline and Tasks
2011
Jan
Feb
Mar
Develop Financing
Model
Apr
May
Jun
Jul
Finalize initial payment
methodology / mechanics
Aug
Sep
Oct
Nov
Dec
Finalize participation agreements
and obtain funding commitments
• Refine approach
through Finance
Work Group
• Outreach to
stakeholders for
feedback and input
7
Financing Approach...Current Status
• In December 2010, NC HIE developed a four year (2011-2014) model that projected:
– Total administrative and operational costs for robust Statewide HIE... $24.4 million
– Total revenue from ONC Cooperative Agreement ............................... $11.9 million
– Anticipated shortfall .............................................................................. $12.5 million
• Key characteristics agreed upon to date:
– Participation in the statewide HIE is voluntary.
– Participants can pay through one of two mechanisms (“pay-as-you-go” or “pre-pay”).
– Goals of pre-payment option is to: (1) lock in multiyear commitments from a critical
mass of constituents; (2) reduce administrative burden; (3) ensure sufficient funding to
cover the anticipated shortfall ($12.5 million over four years).
– Pre-payment targets based on an agreed allocation per stakeholder category
• Hospitals (35%)
• Providers (10%)
• Commercial Health Plans (35%)
• Medicaid (20%)
8
Financing Approach...Proposed Mechanism for Prepayment
•
For pre-payers first installment (50% of total) due at time of initial closing ; remaining 50% at
“Go-live Date”
•
Pre-payments treated as accrued revenue and credits
– Pre-payment credit of 20% is equivalent to roughly 6% interest
Simplified Illustration of Prepayment Option
2011
2012
2013
2014
2015
Payment
$100,000
Credit
$20,000
Service Charge for Access Account Balance
to Statewide HIE Network at End of Year
-$120,000
$30,000
$90,000
$30,000
$60,000
$30,000
$30,000
$30,000
0
•
Regardless of status as either pre-pay or pay-as-you-go, there will be a common service charge
for all organizations of same classification (size, type)
•
Organizations pre-paying will have priority in implementation rollout
9
Financing Approach...Cost and Revenue Projections
•
NC HIE will seek prepayments to fund the anticipated four year funding gap.
•
NC HIE has developed a “scenario calculator” to test different scenarios to illustrate
the interplay between prepayment and pay-as-you-go options and varying cost
considerations
•
The “scenario calculator” allows us to adjust three variables:
– Estimated administrative and technical costs for Statewide HIE over four years
– The number of entities that choose to Pre-pay
– The rate of participation for entities that choose Pay-As-They-Go
10
“Base” Scenario in Calculator...Base Assumptions in Three Variables
Cost
2011
2012
2013
2014
4 YR Total
Admin & Operations
$
1,800,000
$
1,800,000
$
1,800,000
$
1,800,000
$
Technology
$
7,259,500
$
4,851,170
$
3,558,573
$
1,580,407
$ 17,249,650
•Core Services (Hardware & software)
$
3,830,000
$
1,120,000
$
325,000
$
325,000
$ 5,600,000
•Value-Added Services (Phase 1 Services)
$
675,000
$
225,000
•Value-Added Services (Phase 2 Services)
$
250,000
$
1,250,000
$
1,400,000
$
47,196
$ 2,947,196
•Building and testing connectivity to QOs
$
1,802,500
$
1,287,500
$
772,500
$
51,500
$ 3,914,000
•Ongoing maintenance
$
702,000
$
968,670
$
1,061,073
$
1,156,711
$ 3,888,454
$
9,059,500
$
6,651,170
$
5,358,573
$
3,380,407
$ 24,449,650
2014
4 YR Total
Total Costs
Funding and Revenue
2011
$
-
2012
$
-
2013
$
7,200,000
900,000
Funding
$
7,963,044
$
2,005,656
$
1,774,567
$
235,000
$ 11,978,267
•ONC Funding
$
7,963,044
$
2,005,656
$
1,774,567
$
235,000
$ 11,978,267
Pre-Pay Revenue
$
12,471,383
$
-
$
-
$
-
$ 12,471,383
•Payers
$
4,364,984
$
-
$
-
$
-
$ 4,364,984
•Medicaid
$
2,494,277
$
-
$
-
$
-
$ 2,494,277
•Hospitals
$
4,364,984
$
-
$
-
$
-
$ 4,364,984
•Providers
$
1,247,138
$
-
$
-
$
-
$ 1,247,138
Pay-As-You-Go Revenue
$
-
$
336,727
$
740,800
$
1,225,688
•Hospitals
$
-
$
261,899
$
576,178
$
953,313
$ 1,791,389
•Providers
$
-
$
74,828
$
164,622
$
272,375
$
20,434,427
$
2,342,383
$
2,515,367
$
1,460,688
Total Funding and Revenue
$
Net Earning (+/-):
$ 11,374,927
$ (4,308,787)
$ (2,843,206)
$
(1,919,719)
Cumulative Earnings:
$ 11,374,927
$
$
$
2,303,215
Available for Reinvestment:
7,066,140
4,222,934
$
2,303,215
511,826
$ 26,752,865
$
2,303,215
Next Steps....
• The Finance Workgroup accepted a pre-pay approach that involves
a credit, commitment windows, common pricing to all stakeholders (of
the same class)
• Action items:
– Staff to build detailed legal document
– NC HIE, working with communications firm, will develop a strategy
to engage stakeholders and get feedback and refine accordingly,
and begin obtaining commitments based on any such refinement.
NC HIE Bylaws
13
Additional Workgroup Updates
14
Workgroup Snapshot
•Legal and Policy
– Opt Out Consent legislation introduced;
passed Senate, pending in House
– Currently refining privacy & security policies
– Next Meeting: April 25, 1:00-3:00 pm
• Governance
– Developing contract between Qualified
Organizations and NC HIE
– Defining the process for applying to be a
Qualified Organization
– Next Meeting: April 26, 1:00 – 3:00 pm
•Finance
– Building prepayment model and terms
– Next Meeting: May 26, 2:00-4:00 pm
•Clinical & Technical Operations
– Finalized RFP requirements
– RFP Evaluation Committee being formed
15
Governance
16
Statewide HIE Governance: Timeline and Tasks
2011
Feb
Mar
Apr
Develop Qualified
Organization Criteria
May
Jun
Jul
Aug
Sep
Define Oversight Roles and
Enforcement Mechanisms
Oct
Nov
Dec
Develop Participation
Agreements
• Define parameters of Qualified Organizations in the HIE
participation model
• Develop written criteria for Qualified Organization designation
• Develop recommendations related to QO application process.
17
Proposed Selection Criteria for Qualified Organizations (WORKING DRAFT FOR DISCUSSION ONLY)
1.
Organized as a non-profit or for-profit corporation whose articles of incorporation have
been filed with the North Carolina Department of the Secretary of State (or that has a
certificate of good standing if incorporated in a state other than North Carolina).
2.
Agree to comply with Statewide Policy Guidance (including technical specifications and
privacy and security requirements) and ensure QO participants comply with them.
3.
Agree to comply with “fair information” policy principles and require that QO participants
comply with them.
4.
Provide list of current NC HIE participants (as defined by the NC HIE Board), updated on a
regular basis in compliance with the process established by the NC HIE Board, and plan for
adding more participants.
5.
Annually submit a Program Plan that describes specific activities in which the QO will engage.
6.
Demonstrate financial viability as required by the NC HIE Board (currently under
discussion).
•
Includes demonstration of adequate and appropriate insurance coverage.
Important Topics to Consider in Selection of Criteria
 Extent to which criteria limit entities that could serve as QOs
 Establishing and maintaining overall system efficiency & integrity
 Understanding the administrative implications of compliance
Criteria are in draft form. Workgroup will submit a final formal recommendation to the board for consideration at future meeting.
Next Steps...
• April 26, 2011 Workgroup meeting: Finalize Qualified
Organization selection criteria recommendations for Board
• Future Workgroup meetings:
– Develop recommendations related to selection process. High level
overview of steps might include:
• NC HIE establishes application process for interested entities.
• NC HIE establishes application review process.
• NC HIE establishes process to notify applicant and the public that an organization has
been deemed as a QO.
• NC HIE establishes ongoing re-qualification process.
– Develop recommendations related to enforcement and oversight:
• Define Metrics
• Create evaluation process (ongoing compliance)
• Establish processes for
– Dispute resolution
– Organizations seeking to voluntarily rescind QO status
– Expulsion of non-compliant QOs
Legal and Policy
20
Legal & Policy: Timeline and Tasks
2011
Jan
Feb
Finalize Draft
Legislation
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Develop and Finalize Privacy and Security Policy and Procedures
• Opt Out Consent legislation has been passed by the Senate, pending
in House.
21
Legal & Policy: Development of Privacy & Security Policies
March Meeting:
• Definitions
• Eligible Participants
• Access to Protected Health Information for Treatment, Payment and
Health Care Operations
• Minimum Necessary Requirement
• Emergency Access
• Access Rights of the NC HIE Workforce
April 25 Meeting:
• Review Revisions to Above Sections
• Opt Out Consent Rights
• Restrictions on Access
• Accounting of Disclosures
• De-Identified Data
Additional Policies to Be Defined at Future
Meetings:
• Access to Data by Researchers
• Access to Data by Government Agencies
• Access by Patients
• Responding to Subpoenas and Discovery
Requests
• Security Policies (includes Breach)
• Sanctions
22
Clinical and Technical Operations
23
Clinical/Tech Operations: Timeline and Tasks
2011
Jan
Feb
Mar
Develop HIE RFP
Apr
May
Jun
Jul
Review Proposals,
Negotiate, Award Contract
for HIE Services
Aug
Sep
Oct
Nov
Dec
Develop, Deploy, Test, and Accept
HIE Services and
Connect to Qualified Organizations
• Secure RFP consultant
• Define HIE RFP review
process and recruit
evaluators
• Develop detailed
specifications
• Draft RFP
24
Massachusetts eHealth Collaborative NC HIE Team
•Micky Tripathi, Ph.D., MPP (Project Officer) - Mr. Tripathi is the president and CEO
of MAeHC and will lead the MAeHC team for the NC HIE project. Mr. Tripathi is a
nationally-recognized thought leader in the health information industry. His
leadership experience ranges from policy guidance at the Federal level, to
collaborative strategic planning at the State and community levels, to
implementation of health IT systems at the front line of healthcare delivery.
•Mark Belanger, MBA (Project Director) – Mr. Belanger is the Director of Strategy at
MAeHC and will manage the NC HIE project. Mr. Belanger has expertise in
healthcare strategic planning and deep experience in the healthcare information
industry. Mr. Belanger currently manages the statewide HIE vendor procurement
project in the state of Missouri and the statewide HIE project for the state of New
Hampshire.
•
•Nael Hafez, MBA (Technology Director) – Mr. Hafez is MAeHC’s director of technical
services and will provide subject matter expertise to the NC HIE project. Mr. Hafez
has expertise in the full life-cycle of community-wide health information exchange,
from planning and design, to vendor selection, to deployment and ongoing
operations.
Jacqueline Baldaro, MHA (Project Manager) – Ms. Baldaro is a Project Manager at
MAeHC and will provide daily management of the project plan, project schedule,
communications, and reporting. Ms. Baldaro has expertise in healthcare strategic
planning, network development, business model design, enterprise design, and
operations management.
Overview of MAeHC Qualifications and Recent Experience
Highlights of MAeHC’s relevant experience and qualifications:
 State-level HIE technical services vendor procurement: MAeHC is currently completing the
technical services vendor selection process with the Missouri HIO
 State-level HIE strategic and operational planning: MAeHC led the statewide HIE strategic
and operational planning process for the State of New Hampshire. Throughout 2010, MAeHC
facilitated 6 multi-stakeholder workgroups, drafted the state’s strategic and operational
plans, and gained approval of the plans by ONC. MAeHC is now engaged to assist NH
stakeholders implement the plan.
 Regional Extension Center: MAeHC is operating the REC for the state of New Hampshire and
is providing REC services in Massachusetts, New York, and Rhode Island.
 Community-wide EHR, HIE, and Quality Data Center deployment: From 2004-2009 MAeHC
worked with 3 Massachusetts pilot communities to facilitate community-wide exchange of
health information and quality data.
 Beacon Community Technical Assistance: MAeHC was engaged by the ONC to provide
technical services to 3 Beacon communities regarding a unified approach to interfacing
between major HIE and EHR vendors.
 Federal Policy guidance: President and CEO of MAeHC, Micky Tripathi, is the Co-Chair of the
Health Exchange Working Group of the HIT Policy Committee and a member of the NHIN
Working Group, the Meaningful Use Working Group, the Certification/Adoption Working
Group, and the privacy & security tiger team.
26
Statewide HIE Technical Requirements
Clinical & Technical Operations Workgroup went through a prioritization process for
Operational Plan.
Across past four months, Workgroup has refined priorities and defined requirements
on a more granular level.
In addition, the NC HIE received comments from 24 additional NC stakeholders
through a public request for comment process.
NC HIE has inventoried and compiled more than 400 individual comments,
suggestions, and recommendations.
27
Timeline for Statewide HIE Services RFP
• Mar- Apr 24... Finalize requirements, develop evaluation procedures/team
• Apr 25............ Release RFP
• May 20........... Vendors responses due
• Jun 7.............. Best and Final Offers from vendors
• Jun 16............ Present final recommendations to NC HIE Board
• July 20........... Vendor contract finalized
28
Overview of Technology Services Vendor Selection Process
We are Here
Translate plan,
preferences, and
requirements –
release RFP
Conduct
reference
calls
Select and
prepare
evaluation
team
Conduct
BAFO
workshops
Review
written
responses
and down
select
Select
technology
partner
Conduct
finalist
product
demos
Contract
with
technology
partner
29
Evaluation Process for Statewide HIE Services RFP - DRAFT
6-8 Candidates will
emerge
RFP Responses
Expectation is that we will
receive around 20-30
responses
Review with CT
Operations
Workgroup
Rankings will be
reviewed with WG and
feedback will be
documented
Select
Vendor
Meet
Minimal
Req’ts
Staff will filter against a set
of minimum requirements
and completeness
Rank
Vendors
Vendors will be ranked in
two categories: functional
and business by
Evaluation Committee
Review with Executive
Committee/Board
Grade Candidates
Each member of Evaluation
Committee will grade
Candidates based on
established scorecard then
the Committee will
consolidate and normalize
the scorecard
Oral Presentations
Each finalists will do two
presentations: technical
and non-technical
Negotiate Contract
Review with CT
Operations
Workgroup
Review current candidate
scorecards with WG and
collect feedback
Select
Finalists
Based on scorecards and
CT WG feedback,
Evaluation Committee will
select 2-4 finalists
Board Approves Contract
Evaluation Committee will
select a recommended
vendor
30
Evaluation Committee - DRAFT
• Members of RFP Evaluation Committee
–
–
–
–
Three members of NC HIE Staff
Three members selected from a group nominated by CT Operations Workgroup
One representative from MAeHC
One or two experts drawn from the community to augment review team
• Requirements for Participation
–
–
–
–
–
Document all Conflicts of Interest
Sign Confidentiality Agreement
Sign Representation Agreement
Commit to full time participation during the Evaluation Week
Technical/Clinical/Business experience relevant to the creation of the HIE and
associated services
– Evaluation Committee participants will be asked to draw on their expertise and
perspective from across industries sectors with an eye toward supporting the
greater goal of a statewide resource for North Carolina rather than representing
their individual organizational priorities.
31
Open Public Comment and Closing Comments
32
ATTACHMENTS
Statewide HIE Components
Core HIE Services
– Foundational services hosted by NC HIE that facilitate
exchange health information across organizational
boundaries, such that multiple entities can:
• Identify and locate each other in a manner they
both trust;
• Reconcile the identity of the individual patient to
whom the information pertains;
• Exchange information in a secure manner
Security Services
Provider Directory
Message / Record
Routing / Return Receipt
Identity Management and
Authentication
Transaction Logging
Consent Management
Terminology Service
Transformation Service
Patient Matching / RLS
NHIN Gateway
Value-Added HIE Services
– Services that support the clinical priorities and use
cases to help providers, patients, and care givers
improve the safety, quality, and cost effectiveness
of heath care.
– Value-added services will be accessible via core
services
– Value-added Services can be offered at the state,
regional, or enterprise level.
– Value-Added services will be incrementally
deployed based on feasibility, cost, and magnitude
of benefits
CCD Exchange
Lab Results
Delivery
Lab
Normalization
Lab routing
for reporting
Quality
Reporting
Immuniz
Access
Rad Results
Delivery
Med Hx
Rad Image
Delivery
Procedure
Results
Delivery
Disease
Surveillance
CCD
Translation
Access to
Aggregated
Data
Clinical
Decision
Support
Phase 1 Value Added Services proposed in Operational Plan
Phase 2 Value-Added Services proposed in Operational Plan
Final decision regarding phased implementation will be informed
by forthcoming statewide HIE RFP
34
Technical Relationships: Core HIE Services, QOs, & QO Participants
Key Points:
* Core services provide a foundation for identifying QOs, ensuring security,
and providing a gateway to other QOs and additional HIE services
* QOs link to core services by conformance to interoperability specifications
* QOs provide a gateway to core services for their participants
NC HIE
Example
QOs...
Example QO
Participants...
Security Services
Provider Directory
Message / Record
Routing / Return Receipt
Identity Management and
Authentication
Transaction Logging
Consent Management
Terminology Service
Transformation Service
Patient Matching / RLS
NHIN Gateway
Large Hospital
System
Physician
Practice
Physician
Practice
Physicians (IPA,
PHO, PO)
Regional
Physician
Practice
HIO
Hospital
35
Technical Relationships: Value-added Services, QOs, & QO Participants
Key Points:
* Value-added Services are available to network participants and can be hosted by
different entities. For example:
1. NC HIE could host a CCD Exchange service
2. The Dept of Health could host an Immunization Access service
3. A QO could host a CCD Translation service
* Based on considerations of efficiency and practicality, the NC HIE Tech/Clinical Ops
Work Group continues to evaluate the ideal location for Value-added Services
Physician
Practice
Physician
Practice
Large Hospital
System
NC Immunization
Registry
3. CCD
Translation
2. Immuniz
Access
NC HIE
1. CCD
Exchange
Security Services
Provider Directory
Message / Record
Routing / Return Receipt
Identity Management and
Authentication
Transaction Logging
Consent Management
Terminology Service
Transformation Service
Patient Matching / RLS
NHIN Gateway
Large Hospital
System
Physician
Practice
Physician
Practice
Physicians
(IPA, PHO, PO)
Regional
Physician
Practice
HIO
Hospital
36
Mission Statement of the NC HIE
As included in its Operational Plan, the
mission of the NC HIE is:
• To provide a secure, sustainable
technology infrastructure to support
the real time exchange of health
information to improve medical
decision-making and the coordination
of care.
Expectations of the NC HIE Work Groups
•
Participants have been nominated and invited to participate by the NC HIE governing board cochaired by Secretary Lanier Cansler and Mr. Charlie Sanders for your expertise in your field and
your commitment to improving health care quality, access, and affordability for all North
Carolinians.
•
Workgroup members are asked to draw on their expertise and perspective from across
industries sectors with an eye toward supporting the greater goal of a statewide resource for
North Carolina.
•
Workgroups are expected to be multi-stakeholder, nonpartisan and all discussions, meetings
and decision-making processes to be fully transparent.
•
Workgroups are asked to consider multiple stakeholder group perspectives when working
toward solutions.
•
Workgroups will be asked to make consensus-based recommendations to the NC HIE governing
board. In cases where consensus is not reached, the workgroup is expected to put forth a
balanced, fair consideration of the pros and cons of an issue.
•
Workgroup members are expected to respect the opinions and input of others and to engage in
fair meeting conduct to work toward consensus recommendations.
•
Workgroup members are strongly encouraged to attend meetings in person whenever possible.
•
Public stakeholder input is encouraged.
Governance Work Group
Co-Chairs
• Ben Money, NC Community Health Association
• Tom Bacon, UNC School of Medicine, AHEC
Members*
• Connie Bishop, MSN RN, NC Nurses
Association
• Jacquelyn Boyden, Boyden Healthcare
Consulting
• Janis Curtis, Duke Health System
• Craigan Gray, DHHS DMA
• Mark Gregory, Kerr Drugs
• Don Horton, LabCorp
•
•
•
•
•
•
Steve Keene, NC Medical Society
Harry Reynolds, IBM
Craig Richardville, Carolinas Healthcare System
Pam Silberman, NC Institute of Medicine
Craig Souza, NC Healthcare Facilities Association
Sam Spicer, New Hanover Regional Medical
Center
* NC HIE is currently evaluating the potential inclusion of a representative
from a local HIE due to the departure of representative from WNC DataLink,
Clinical/Technical Operations Work Group
Co-Chairs
• Allen Dobson, CCNC
• J.P. Kichak, UNC Hospital
Members
• Ben Alexander, WakeMed
• Cynthia Cox, Raleigh Medical Group
• Sam Cykert, AHEC, Moses Cone
• Michael Fenton, NC CIO Office
• John Graham, UNC Institute for Public Health
• Susan Helm-Murtagh, BCBSNC
• Arlo Jennings, Mission Hospitals
• Yan Wang Kolbas, NC Nurses Association
•
•
•
•
•
•
•
Bill Leister, LabCorp
Keith McNeice, Carolinas Healthcare
System
John A. (Sandy) McNeill, NC Health Care
Facilities Association
Don Spencer, UNC Health Care
Angela Taylor, NC DHHS
James Tcheng, Duke University
John Torontow, Piedmont Health
Finance Work Group
Co-Chairs
• Maureen O’Connor, BCBSNC
• Dr. Dave Tayloe, Goldsboro Pediatrics
Members
• Mark Bell, NC Hospital Association
• Brian Harris, Rural Health Group, Inc.
• Yvonne Hughes, Coastal Connect HIE
• Mark Miller, Novant Health
• John Minnich, CSC
•
•
•
Steve Owen, NC Medicaid
Phred Pilkington, Cabarrus County
Health Dept.
Devdutta Sangvai, MD, Duke University
Medical Center
Legal/Policy Work Group – Legislation and Implementation Subcommittee
Co-Chairs
• Senator Josh Stein
• Representative Jeff Barnhart
Members
• Linda Attarian, NC DHHS (Vice-Chair)
• Judith Beach, Quintiles
• Mark Botts, UNC School of Government
• Chris Collins, NC Office of Rural Health and
Community Care
• Brian Forrest, Access Healthcare
• Chris Hoke, NC Department of Health &
Human Services
• Linwood Jones, North Carolina Hospital
Association
•
•
•
•
•
•
Trish Markus, Smith Moore Leatherwood
Barbara Morales-Burke, Blue Cross Blue
Shield of North Carolina
Melanie Phelps, North Carolina Medical
Society
Troy Trygstad, Community Care of North
Carolina
Robin Wright, NCHICA Consumer
Advisory Council
Bill Wilson, AARP
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