 So welcome everyone for the God care board meeting. The first item on the agenda is the executive director's report, Susie Barrett. Thank you, Mr. Chair. I have two brief announcements. First, for next Wednesday's meeting, we will be hearing from the GMCB staff on non-standard qualified health plan design approval process and 2021 evaluation criteria. That's the only thing on our agenda at this point for next week. The February schedule for our meetings will be published by this Friday. And that's all I have to announce. Thank you, Susie. The next item are the minutes of Wednesday, January 15th. Is there an motion? So moved. Second. It's been moved and seconded to approve the minutes of Wednesday, January 15th. For about any additions, deletions, or corrections during discussion. Seeing none, all in favor signify by saying aye. Any opposed? Thank you. So with that, we'll welcome our friends from Diva down the front. Thank you for having us back again to walk through where we are with our consent policy. As several of the board members know, we were over at the legislature this morning and I believe you've got a copy of Dan Smith's letter to the House Health Care Committee. And I believe that we agree with Dan Smith's assertion that we've met all of the obligations in Act 53 and are prepared for the transition to the opt-out consent policy. So you've been working on this over the last few months to walk through the consent policies. Today, we're really gonna deliver an update on our implementation activities that occurred since November when we were here last. We're gonna illustrate how our efforts will continue to serve the purposes of educating Vermonters about their rights related to their sharing of their health information and records through the Vermont Health Information Exchange. And we're gonna provide you details on how we've updated the Health Information Exchange Plan in the context of the addition of an amendment, I'm sorry, an addendum to that plan for recommendations the last time we're here. Just to ground everyone in the work that we've been doing together, the legislature asked us to do these six sub-bullet points under Act 53. We've really over the last few months in this arena have talked about them in three specific work streams. One work stream has been focused on engaging Vermonters in helping to guide the outreach and education and we've really worked on stakeholder engagement with both advocacy organizations and Vermonters. The second has been that we will provide an update on the mechanisms that we've implemented. Many of which were in concept when we were here last time, but now are fully implemented in order to allow easier mechanisms for Vermons to opt out. And then the third work stream as a reminder is the evaluation work stream and there's been some activities there too. Related to that, since we've last met, we continue to do interviews and focus groups under the stakeholder engagement. We've developed communication tools and key messages based on the stakeholder input that we've received and we've engaged a small mammal who's a communications enterprise to help us develop materials that are accessible and follow what we've learned from our stakeholders. In addition to that, we've assessed the workflows that are needed and the policies and technology to manage the consent and vital, switching from opt in to opt out. We've developed training for the hotline at the vital and the office of the healthcare advocate and we've engaged providers in the changes to the policy. You will also hear that many of the opt out mechanisms that were intended to go into place so that we can be prepared or now in place including a hotline and a website which is different than it had been under the opt in policy. We've also established a stakeholder information, we've established an evaluation committee made up of stakeholders who are supporting the development of an evaluation plan and we've received over 11,000 responses to the in the statewide patient experience survey which included questions around consent policy change. So at this point I'd like to take an opportunity to have Maureen who has been updating you kind of on our stakeholder engagement process talk about the activities that they've unleashed in the network stream. I'm gonna just start with the overview with the work since November. So the public education campaign has launched. Many of you will have seen a front porch forum post that went out on Monday letting people know sort of the beginning of this story about what the health information exchange is. And we have a website that it's dragged into as well. I'll get a little bit more into the tactics in the next slide. Advocacy organizations and other partners have committed to participating in the getting the message out and some of them have already used their channels to post about the health information exchange. And we completed training with the staff of the office of the healthcare advocate so that when folks call that line with questions they are armed with answers and also know that vital is available as a backstop if those questions get really technical. But they've been great partners and have been really willing to help field those calls and answer those questions. I make one clarification point that came up this week. While the majority of our work to date has been framed around what we'll do before March 1st go live, that many of the educational materials and other things that you see that are built into this plan will continue past the March 1st deadline and we will continue efforts to inform Vermonters about the consent policy and the health information exchange and their rights therein. So what do we have up so far? We have a website that's live and we'd love for you to take a look at www.bthealthinfo.com. It's really basic, it's just a couple of pages. It's never gonna get complex or complicated that's not our goal for it but it will be built out with a couple of more resources including the frequently asked questions section and there will be a video that we'll be adding so we have that media in the mix. There's a communications toolkit that we are compiling. The first part of that is a social post that we've sent out to partners and that they've done to share as I mentioned a minute ago and the remainder of that toolkit will include more social posts, it will include posters, it will include a newsletter or a blog post, it will include a brochure, although most of the brochures will be distributed as printed copies by vital files handling all of that printing and sending it out to hundreds of organizations around the state. And so that's really just gonna be a place to centralize the resources so all of our partners have one place they can go and of course we're always available to answer questions and help strategize even to create custom executions. For instance, the Pride Center recently suggested to us and we had mentioned this last time because here I'm not sure that Facebook Live is a great way to get the message out, they get great traction with that and maybe we could do a Facebook Live video together. So we're also open as we develop this to doing custom work with any of the partners and advocates. The hotlines at Vital and the Office of the Healthcare Advocate are up and running and Andrea will talk a little bit about the outreach for the questions they're already getting, the incoming calls and like I said, we've got one front porch forum post out in the world and at least three more are planned, probably more than that, at least three more were for March 1st but we've got more in the package that we'll be using. And then we are working on getting some earned media as part of this education campaign so news using the local papers that we know folks really do read and spend some time with. So we're planning on putting an article in as many local papers as possible and then working with the news media, the statewide news media to see if they're interested in getting this message out as well. So just a really quick preview here, really the best way to see this is to look at the website itself but this is what it might look like if you were looking at it on a desktop or laptop. It's absolutely mobile optimized. We know that the majority of folks who use it will be using it on their phones. And you can see that it's really a sort of friendly, almost casual approach to a complicated topic. And we've got good feedback so far from our partners about this approach and its effectiveness in communicating. And then this is our first social post. It says the Vermont Health Information Exchange lets doctors, nurses, hospitals and pharmacies securely read, share and add to your medical record across Vermont. It puts your providers on the same page. Learn more opt out at bthealthinfo.com. And that's sort of the style and tone that we're taking. But obviously focusing on different things in each execution. So security is more the topic in some executions. Your options are more the topic in other executions. So that's just a preview. Any questions about the campaign before we move on? Just a question on I guess, when did you go live with the number of hits you've had? Was that, are you projecting a certain amount? Sure, so the website went live last week the first time we really did any public messaging about it was at Front Porch Foreign Coast on Monday. We have analytics set up. I don't think any of us have actually opened that up and counted the hits yet, but we'll absolutely start doing that and we'll report back with the traction again. One of the things that folks often ask is why now? Why did we launch just before the date? And from all of the feedback we got, it was really important to folks that we made sure that the major push happens within the month and a half prior to the change in implementation of the consent policy so that there was a call to action at that point versus too early in the process where people may or may not understand that there was a need to act. So it was intentional. The one additional thing related to stakeholder engagement is we wanted the opportunity to ensure that one, at least one more time, and this will be ongoing as was pointed out this morning. Folks could ask or frequently ask questions about the consent policy and the consent strategy. So we will be holding a public hearing on February 4th from 1030 until noon in the Waterbury State Office complex as an additional opportunity. We're working more of these types of opportunities to be stepped over in the future. So vital as everyone is sharing is to really focus on the mechanisms to implement the new policy. And we really have been laser focused in the last six months on, primarily on offering easy ways for providers to opt out to reducing the burden on provider organizations. And really honestly focusing on the education because that has been historically a weaker area. Some of the educational resources that are available and we touched on some of these already, but the hotline is available and we are receiving calls and I'll provide more information about that in a few minutes. The Office of the Healthcare Advocate has numbered to call and they have been trained as Maureen mentioned and they were trained in December, I believe. We had a sample notice of privacy practices which is essentially a paragraph to share information about how patient's information is being transmitted. And organizations, we are encouraging them to put this in their disclosures. It's not mandatory, but we have had a number of organizations already doing that, so that's positive. Participating healthcare organizations will receive educational resources. They can also be a source of education and that will continue after March 1st. They will have provider patient brochures, they'll have opt out forms and those that will continue to collect consent choice will be prepared to do that after March 1st. And the, as I mentioned, the patient consent brochure will be available shortly and the bthealthinfo.com website is available right now. So the easy opt out options. Right now, as everyone is aware, the only way to opt out of the beehive in or out of the beehive is by visiting and participating healthcare organization in the current policy. In December, we, we at FINAL, trained our staff to be able to collect consent choice, but it would not be effective until March 1st. So we have received a number of those requests and we were able to do that, but participating healthcare organizations will continue, especially the electronic transmission of consent and continue after March 1st. We also have the hotline which is available and patients can opt out via the hotline after we verify identity and the online form we integrated into the bthealthinfo.com website. And that has been working well. After the front porch form post, we did receive a number of requests. We've also received a number of calls about questions related to what is this and do EMTs have access to this? Everything from there to I prefer to opt out. And so we have, again, a lot of requests and questions. There's also the ability to download and print the form. If that's the preference, people can come in to vital to email it to us or even fax it to us. So that takes care of the opening, expanding the opportunities for patients to opt out as far as reducing the burden on organizations that has also been a primary focus of ours. And we have been able to configure and audit essentially the ability for vital to support healthcare organizations in the consent collection process. So that's a huge step forward for us and we're really excited about it. The healthcare organizations have, we encourage them obviously to continue to collect consent, but they do have the ability to educate their patients about the behind and refer to vital for more information and for the healthcare advocates office. So another piece of this that's really exciting is that the stakeholders that have been engaged in this process have been fabulous and having more people aware of what this is, is it's very complex to understand by having more people engaged to support and help answer questions is super important. So we're happy with the outcome. Are there any questions? There's one. I can't remember, I think you might have told me this, told us this when you came last year, but how do you check identity over the outline and the phone? And that's a great question. So we have criteria that we've developed to have 95% confidence that someone is who they say they are. And there are elements such as name, date of birth, address, there are other criteria established and if they match on those, we feel comfortable that they are who they say they are. We lowered the threshold for people to opt out and primarily due to our great conversations we had with the healthcare advocates office and the ACLU to really determine that it is less dangerous for a person if they choose to opt out and impersonate somebody else than it is for someone who has already opted out to then opt back in. So for people to opt out, we feel very comfortable and confident in our ability to verify who they are and audit if we need to, our own information about the choice. And for those that want to opt back in, we do require a nonarized signature. Thank you. You're welcome. Jenny mentioned looking back at the evaluation, there's methodology listed in the latest reports. Mary Kate Molman is heading up an evaluation committee that means these stakeholders and they are giving all of their evaluation methods around these questions and sort of being simplified to say, did you receive the opt-out message and do you understand it? So as Jenny mentioned, we've fielded questions in the piece of experience survey about number of responses. That will be one method that we'll be using throughout the year but the evaluation committee will focus on a few more. And the results of that evaluation will be reported out in the next update, the health information exchange plan which is due to you all in November. So consent in the health information exchange plan. So when we present the health information exchange plan to you, as you all know, you asked for more information around the protocols for provider access as sort of our replacement to the 2014 policy that memorialized how we managed consent until today. So first I want to thank the staff that worked with us, Michael Barber and Ameren and Sarah Kinzler. There's always great partnership but they really helped us understand this request and hopefully come up with something that ensures that we aren't losing any of the topics covered in the 2014 policy and we are also fully reflecting current state and what Act 53 asked of us. So that was resubmitted to you guys a few days ago. And our intention is to continue to use the HIE plan as the basis for all high-level consent protocols and the management of consent or sort of operations as they were will live outside of the HIE plan. So strategy lives in the plan and operations lives in things like the D5 vital contract. Oh, I guess just as also as a reminder, when we did submit the health information exchange plan Caroline Stone from LIDL emailed over some additional documentation on connectivity criteria that's been included in the update of the health information exchange plan as well. Just going to go over the topics here. Maybe I'll just stop here and ask were there any questions on the submitted agenda or is it helpful if I go through the topics? There's no questions. Okay. So I will throw out the topics here for folks who are not on the board and didn't receive it. But again, it's an agenda to outline the protocols for provider access to information in the health information exchange. I think those were good. Yeah. Thanks for all of our topics for today. Any other questions from the board? Just one question on, you know, there was a variety of ways to opt out and what's the timing of that? I mean, how do you project how much backlog you might have, if there are forms? Sure. So I just want to clarify your question. Just asking if we have a backlog of information. Well, somebody calls in or they do an online form or they do something. I guess for somebody who is just going to the doctor and then realized, you know, they're now in this and they don't want to be in. How quickly are they out if they go to their doctor? Okay. Thank you. So our policy or our operating procedure is really two to three business days to make that request happen. Honestly, it'll happen before that. Typically, unless it happens to be a weekend, it may happen that Monday instead of the Saturday. But that is the turnaround time that we allow. We don't anticipate a backlog, to be honest. We are collecting choices right now. They won't be effective if they call us. They won't be effective until March 1st for the policy that's in place currently. But we can still collect their choice. Does that answer your question? Yes. Okay. It's just one follow up on the, you know, you've said sometimes if somebody wants to opt out, it won't go in until March 1st. But why not put it in now? I mean, they're not in now unless they opted in. So why wouldn't you put it in now? And so that's a great question. So right now, if that patient visits a participating healthcare organization, they can do that. If they're not, right now, they're actually defaulted out. So no one can ask this or chart anyway if they haven't been asked. So I think it was decided, I'm not exactly sure by whom, but that we should stay without an amendment to the current policy that we wanted to stay with the March 1st effectively. Okay. In any sense? Yeah, I believe the last time we were actually here, we had this discussion that the current consent policy that is in effect because the legislature put a date of March 1, that's when the opt out consent policy goes into place. But I want to assure you that it is effectively the same thing. If someone were to call today, they are currently opted out and they will continue to be opted out on March 1st. So regardless, effectively, it is the same thing as being opted out now. That's right. Yeah, that question keeps coming up. Technically and legally, it goes into place on March 1, but from a standpoint of a person, they are opted out now and they will be opted out in the future. And then we will assure the continuity of that regardless of whether they communicated that with their provider or they contacted the hotline. Okay, thanks. So I think it was you, Jenny, that said earlier in the presentation that the infrastructure that is put in place heading into March 1st will remain in place after March, well after March 1st. I'm just wondering if you have a sense of the timeline. At some point, this isn't going to be as hot a topic as it is right now. And just kind of an after-feed might happen in terms of the mechanisms that people use to continue to be informed or to opt in and opt out. And I'm just wondering how you see that unfolding, say, in the nine months or a year after March 1st. What would your infrastructure look like a year from then? Yeah, I will tell you that as part of this, I may come back to you in November and actually answer that question. We want to learn from the next month and a half of how effective the communication channels are that we're using now. The way that I've always led is to do incremental change in everything that we do. So, but that said, when we went out to purchase things like the front porch forum ads, we purchased more than we will actually deliver over the next month. And so we plan on continuing to deliver those post the implementation. They probably won't be as frequent. In fact, we have at least four that we were gonna do between February, between January 15th this week or the 20th and then March 1st. So almost one a week after that, we will probably space them out. But that's the type of media that I believe that we will continue to use if we find that it is effective over the next couple of months. Because we do believe strongly that while there is this change in the consent policy and it's on our minds, we wanna make sure that it stays on Vermonters minds. We looked into that when we first did it, and it was pretty high, but I can't remember off the top of my head. It's not the majority, but oh, I'm gonna get the numbers. Why don't we get back to you on that? I don't want to report to that until we get back. I'd just like to add that when we add out on Monday, on Tuesday, there were 40 interactions. So that gives you some sense that there's a fairly significant presence. People are looking at it. And I think the big front porch forum works is that the posts can be made on one day, but if there aren't enough posts in that community, it may be delayed a couple of days. So we'll continue to see more I think over the next week. So just as a measure. And the one thing as a reminder is that's only one of our tactics. We will also continue to work with our providers. And while we were not happy or satisfied with the outreach previously as being enough, our providers have already hit 47% of Vermonters in terms of asking them about consent. And they will continue to work on ensuring that individuals are informed. So we feel like the combination of several different things will hopefully get to Vermonters. At this point, we'll open it up to public comment. Again, very unusual. Thank you very much. Thank you. To this point, we want to invite the Bible team to come back and Beth, whenever you're ready, just take it away. I'm sorry for my not graceful entrance. I'm sorry. You're getting a lot of sympathy from me, I can tell you. I am sorry that means you had a similar incident, I imagine. Thank you for having us today. Just for those of you that I have not had the opportunity to meet with yet, I'm Matthew Anderson. I am the new CEO and president for vital. I've been on board. This is my eighth day. Are you still jumping? Are you three? Yes. And just the team is here today. I think you know for a few reasons. One is, as you heard from the team in November, we have an updated FY20 budget to present to you, which has changed since the budget you approved in the spring as a result of further negotiations and an expansion of the contract with DIVA, which reflects a new kind of focus and more efficient investment of the monies that they are putting into HAL IT. I think a great opportunity for us to partner and collaborate with some of the other stakeholders to move the work forward. So Bob, turn out who you know. We'll be presenting that for your hopeful approval. Following that, we will do our regular update, which will include an update by Christine Pershing on the collaborative services projects that we have underway with some good information about the first one, which has gone semi-live, and we've seen some positive results from. And then Caroline Stone will present our operational metrics. Great, thanks, Beth. Good afternoon. I'm Bob Trinneau, Vital's Chief Financial Officer. I'd like to thank the board for their time in reviewing Vital's updated budget this afternoon. I'd also like to thank Agatha Kessler and Sarah Kinsler for their help in getting us to this point. Next slide, please. Just to quickly review the path that has led us here, Vital's budget was approved in June with a condition that by the return in November to break the board on the outcome of Vital's negotiations with DIVA on the CY20 contract. The result of the negotiations with DIVA or the CY20 contract includes significant scope of work and represented increasing the capabilities of the VHI through the collaborative services projects. In addition, the most significant change to the work scope was the addition of a second phase to the collaborative services project. This new project is for the acquisition and implementation of a new data repository and the incorporation of Vital's homegrown health data management workouts and the Vermont clinical registry into this new data repository. We see this as a vote of confidence by the state following the hard work Vital has done over the past two years. After our November review, the Green Mountain Care Board has asked us to update our FY20 budget and that is why we're here and since November, there have been several significant events that we'd like to share with the Green Mountain Care Board. The first being that Vital's board has reviewed and approved this new updated FY20 budget and also that the CY20 contract has been executed in December between Vital and DIVA. Just for some clarification, Vital's FY20 budget period runs from July 2019 to June 2020 while the CY20 contract runs from January 2020 through December 2020. The CY20 contract affects our FY20 budget for that period of January through December of 2020, January through June of 2020. The additional works built in funding of the CY20 contract is the primary driver for the updated budget that you see before you. At the top line, we expect revenue to increase by $1.5 million. This is the result of new work from the new contract adding about $1.9 million of revenue and this is offset by $400,000 of reduction revenue that was originally forecast for cost sharing of the collaborative services projects. Further, we expect expenses to increase by $1.5 million to cover the cost of licenses, networking costs and to implement those technologies and for their ongoing maintenance. Overall, we expect to end the year with a deficit of $180,000, essentially the same as our original budget projection. We believe that we have sufficient cash reserves to handle the additional cost expenditures required by the new contract and expect to end the year with about $1.8 million of cash for 84 days. Next slide, please. There are three areas in which the new work scope has been added to the CY20 contract. There are projects that enhance the behind for things such as connectivity for EMS and emergency services, implementation effort for the new consent management policy, preparation and planning for additional data types and also the data governance implementation plan. The CY20 contract also contains funding for phase one of the collaborative services projects such as the Universal Master Patient Index, terminology services and the Rhapsody Infrastructure. The acquisition implementation of the new data platform is also included and this project will replace vital's existing health data management warehouse and consolidate the blueprint for health's clinical registry into a new data platform. This is a significant change as it has not only increased the scope of work or the CY20 contract but changed the assumption on how the projects would be initially funded. The initial funding, the original funding concept from the FY20 budget was for the phase one collaborative services projects to be cost sharing amongst the partners. With the consolidation of the VCR and the HDM, these relationships have changed somewhat as the funding to do the work has now flowed from Diva to Vital who will be the lead on implementing these collaborative services projects. We expect to do some cost sharing in the future but the timing will be later than what we originally thought and maybe with different partners as our capabilities become more known in the Vermont Health IT ecosystem. Next slide please. This chart details the new CY20 contract by Y9 for deliverable. That's the second column of numbers from the left. It compares to the predecessor, the CY19 contract, my items to show the differences in the new contract. While some items have remained more or less the same such as operations, data access, data quality and connectivity, the basic contract has increased by 400,000 from the new work in the consent management which is 175,000, 75,000 for preparation and planning for additional data types, 250,000 for connecting EMS and emergency services and 40,000 for the data governance implementation plans. In addition, the collaborative services projects had 1.7 million of funding to the CY20 contract. The phase two project, the future data platform adds 2 million to the CY20 contract. To reject revenue for the updated budget, we time-phased each of the deliverables in the new contract for the two fiscal years that are affected, FY20 and FY21. And this is shown in the two right hand columns. So the total for revenue projected for the FY20 contract is 4.1 while the FY21 contract is 4.7 million. In this chart, we're presenting the final auditing revenue numbers for FY19 along with the original FY20 budget which was approved by the Green Mountain Care work in June along with the update for the budget for FY20 to highlight the new workscope differences due to the CY20 contract. It should be noted that our original FY20 budget assumed that the CY20 budget for that contract would be less than what it had been in CY19. Further, that the collaborative services partners would pick out the implementation costs of the projects that they were leading. This contract construct has changed since our review in May. The original budget included 400,000 of revenue associated with cost sharing amongst the participants. The assumptions for the FY20 updated budget show that we are projecting 4.1 million in revenue for CY20 and this is 1.9 million over the original FY20 budget. It includes phase one and phase two. Phase two for us though represents more of an unknown at this time as we are in the midst of a vendor selection process as we speak. We expect by the end of the first quarter to have those numbers firmed up and be well on our way towards contracting with the final vendor. The key, one key departure from the assumptions for the original budget is the degree and timing of the cost sharing amongst the collaborative services partners. While this reduces the budget by 400,000 in revenue it is more than offset by the increased state contract funding of 1.5 million, which the total of these two result in an increase to our FY20 budget for revenue of 1.5 million. Expenses are projected in the FY20 update to be 1.5 million greater than our original FY20 budget. I will discuss this in greater detail on the next chart. Finally, the change in net assets or otherwise known as net income for the FY20 updated budget is projected to be essentially unchanged from the original budget which the Green Mountain Care Board approved. Next slide please. Expenses for the FY20 budget are projected, as I mentioned, to increase by 1.5 million and this is comprised of an additional 800,000 for consultants to augment vital staff in the performance of the additional work required by the FY20 contract. Because of the short accelerated timeframe of these projects, vital felt that it was important to only bring on staff to address the maintenance of this new functionality and to have consultants do the shorter term implementation tasks. We are adding two positions to our staff, a technical support person and a programmer analyst. In addition, there's 154,000 of additional legal support for contracting support in the acquisition of the future data platform along with supporting and guiding us through the consent management implementation and other projects where legal guidance is needed. There's a $157,000 increase to network costs primarily due to implementation of the Zora and which is a cloud technology and also increased costs to our MPI vendor. We have included an increase in education and research and that is related to implementing the consent management and there is an increase to help catalysts which is our V-Hi hosting software for the connection to the EMS and emergency services project. And finally, we've added a $150,000 contingency which accounts for about 2% of total expenses to account for the uncertainty and costs in the areas such as the future data platform. Changes to Vitals balance sheet are that we expect cash to be about 190,000 lower than originally estimated due to the increase in expenditures for these new projects. Our cash on hand was originally assumed in our FY20 budget to be about 117 days. The new updated budget assumes 84. Again, this is driven by the increased expenditures from the new work scope that we've taken on in the FY20 contract. Our WIP, our work in process has increased by 800,000 and this work flex costs associated with the future data platform which have been incurred but have not been recognized as we have not completed the implementation tasks of the future data platform until after the end of the fiscal year. There is also a minor change to net property and equipment to reflect the acquisition of new computer hardware and Vitals accounts payable is about 400,000 more. Again, reflecting the increased expenditures from the collaborative services projects. In short, Vitals balance sheet is still strong. Our current cash position is 2.7 billion and we expect our cash flow will be sufficient to cover the new work scope even though we estimate that our liabilities will increase in this period. This concludes my remarks on the FY20 updated budget. What brought the insurance costs down by close to 19,000? By 19, we went out with an RFP this summer and we solicited local firms and we actually switched brokers and we're able to lower our E&O insurance policy premium by about $20,000. Good, questions from the board? I took two. On the 400,000 cost sharing that's no longer in there, is that just a timing and how many people were you looking at sharing costs for this collaborative services? Okay, the original construct was to share amongst three participants, Vital, Capital Health Associates and OneCare. That has since changed. I think it's more of a timing issue. We, I guess we're a little bit more aggressive on when we believe that we could seek cautionary revenue. I foresee that it's gonna be something that we are going to include in our FY21 budget, but given how much work we have on the table, it more than through the state contract, it more than covers our exposure to the loss of that revenue. And then the 150,000 contingency, that hasn't been something that I don't think you've had in the budget before. I know you put it in when you made this change and you presented that to us a couple of months ago, but any update on if you think you're gonna need that or? I don't have an update. In fact, we plan on getting the RFPs in Friday. So it's just a timing and I wish I could have more information about where we'll be in terms of the vendor costs for the future data platforms. Okay, and if you don't need it, you're just gonna drop it to the bottom line. Yeah, that's correct. So I'm looking, I think it's a slide six in your 1.501 million in expense increases. And I'm just, I'm looking at the language that says addition of 802,000 for consultants to augment by the staff. And I'm just wondering if you can have that. There's a lot of moving parts here between fiscal years and calendar years. And I'm just wondering if you can give some overview as to what my suit-based builders here in vital's budget and what are essentially 25 expenditures over the 2020-21 period. Could I just clarify, you're asking whether there are recurring charges in that number or recurring in one time? Well, it's, you know, the language just says the addition of 820,000 for consultants to augment by the staff. And that implies to me that consultants are not permanent. They're consultants and you're not bringing them on board. And just of that 1.5 million dollars, I'm just trying to say, what should we expect should be in your base going forward out of 2020 to 21 and 22? Of that 800,000, the majority of that is, almost entirely is for implementation tasks. I think that we haven't really developed a sense for what we'll need in terms of ongoing support from consultants, but we have brought on two additional staff people, one of which was specifically for maintenance of the new functionality. So in that sense, we were trying to use the consultants to handle the short-term work and bring on a staff position to handle maintaining the new functionality. Does that capture? What it does, I'm just, kind of it does. Obviously, it's a more detailed picture than that question, but I just know that as the vital budget was developed in I think 2017 and 2018, it was done so with anticipation of building cash for carry forward to sustain the budget going forward. And so I'm just in my mind trying to understand the balance here between the fact that it was a carry forward concept and here we might be investing in some ongoing investments that will be the way of that faster absent that additional revenue growth. I think that once we get the vendor selection completed, we'll have a better idea of that because each of those offerings will have a different footprint in terms of what will be required to maintain them. It may be in some alternatives, it may be minimal and it may be that the vendor actually is taking on that role and in other offerings, it may be the reverse. So until we take the numbers from the vendors and can put them into a total cost of ownership, we don't really have a sense for what it will look like in 21 yet, but we will be bringing that to the board in our next budget review, which will be coming up I believe in May. So we'll have better information at that point because it will be through the vendor selection and we'll have contracted with that vendor. So we'll have an idea of what it will take. And given Mike Smith's departure and his assumption of the sector human services with corrections and issues that Bravo retreat, I'm wondering if he's called and asked if he can come back. You know, we all miss Mike, he was quite a character and we are enjoying getting to know Beth and I'm sure that we could have some make work for Mike if you were to come back and you could find something. But yeah, I think if you asked everybody, he did make a big mark on the organization and we wouldn't be where we are today without his leadership. And we're all here and we support Beth because as our new CEO, she's gonna take us to the next level and we're really excited about that. Any other questions from the board? Collaborative services. Thank you Bob. By the way, Mike is known to drop in. As you know, I've been involved in the collaborative services project for some time now and I'm pleased to share our progress in both phase one and phase two with you today. The three components of the first phase of the collaborative services project are a universal master patient index, terminology services and enhanced interfacing capability. As the lead for the UMPI portion, Vital has been hard at work implementing the Virato solution. Testing began in November and last month we completed testing and moved on to a production smoke test. Both terminology services and interfacing are being provided by Curates Innovations, a subsidiary of Health InfoNet, MAIMS HIE. The collective environments for Term Atlas and Rhapsody were provided to us at the end of last month and implementation work is currently underway. As an extra update to the universal MPI project, we are excited to share our preliminary match rates increased over 25% in early January. We will continue sharing our progress as this new capability matures. And as you've heard a few times now, even today, the second phase of the collaborative services project is called the Future Data Platform. As we share in November, Vital is working with participants from eight healthcare organizations across the state to select a shared healthcare data platform. This platform will replace the VHI Health Data Management repository, support blueprint clinical data analytics and be available for additional data types in the future. Since our last update, the team has narrowed down to three vendors. Those three vendors gave extensive onsite presentations last month and we begin performing due diligence. We are currently completing the due diligence and as Bob mentioned, the RFP responses are due at the end of this week. Once results are evaluated, the group from these eight participants will be recommending a vendor to vital leadership as well as diva leadership next month. And once that is complete, contracting and implementation can begin. Are there any questions about the collaborative services projects? Thank you for the update. Can you give us a sense of timing in terms of the implementation of the terminology services and the interesting in phase one? So you mentioned that where you are now, but when would you expect to be fully up and running? We are working towards implementing that this month and next month. There's active work going on right now. Caroline's team and my team are working closely together to roll that out. I would say the tentative go live right now when we've been talking about how things go, we just got the environments and how testing goes, but the tentative go live right now would probably be the end of April. Thank you. And there might be ways we can phase in in some cases earlier than others. So that's all being worked out for the teams right now. Great. And you never know what comes up in testing and you don't want to rush it. Exactly. We want this to be right. And we have an existing system that's working right now. So we're working on making it a clean transition and even if it takes a little bit longer. Yeah, great. Do you have any questions on cooperative services? Sure. All right. And as we've provided before, we wanted to give you an update on our quarterly metrics. So this is the end of our calendar year reporting and you can see we've provided over 900 hours in 2019 to any organization that requested help with meaningful use or security risk assessments. We were able to handle anyone who requested that help. So that's been a great accomplishment this year. In a chart that's very familiar to you all, our consent rate did go up a little bit this month. It had been trending level, but it went up a slight bit in December and that would be due to the fact that when Porter Medical Center and Central Vermont Medical Center switched to Epic, they are now collecting electronic consent as well. So it's a slight update, but we're looking forward to the day when on March 1st when this flips and we have a lot more people in. This 47% is still not the best number for our providers that we're looking to access data on their patients. One of our major goals is getting more data and that includes both new and replacement interfaces. At the end of the year, we had a target of 85 new and replacement interfaces. We completed 121 in 2019. We've also been working on work plans with our clients trying to, the work plans layout, what is needed to get them to tier two or eventually to tier three. We completed 120 of those, which exceeded our target on that as well. And we did get 28 locations meeting tier two commentary criteria this year, which is fabulous. And we're looking forward to continuing that work. There are many organizations right now that are working on their work plans to get to tier two in 2020. For plan of care utilization, we've seen an increase of over 4,000 chart accesses over last year. So we had 41,000 chart accesses this year. We're hoping for more after the consent change in March because when they go to look, they will find more people that have been sent in. For plan of care utilization, provider results delivery, this is one of those key services that we offer that is kind of invisible to most people. We deliver electronic results for laboratory radiology transcriptions right into people's EHRs. So when the doctor orders a lab test, it shows up in the EHR for their patient. And we have 469 providers that use this service and we delivered over 1.4 million results this year. That's an increase, we had 1.3 million last year. So that is the last of our updates. Any questions on the quarterly metrics? Any questions in the board? Jess? My first question is the consultations around meaningful use and security risks. I'm just curious, what is the exact date of this roughly and thoroughly? I'm guessing main goal of use is coming down, I mean security risk is coming up in terms of the breakdown of what we're really consulting on. Or is it really happening now? I think it depends on the organization. We do do a lot of security risk assessments. I think that people like that as a service. I think that we, the plan as we do know that meaningful use is starting to taper off. So we're using the time allocated there to do the security risk assessments and also to help the organizations with some data quality work as we work towards, you know, meaningful use goals, dovetail very nicely with a lot of the payment form programs and measures that they're trying to work on. So we're trying to make sure that we can look at the organization holistically when we go in and work on all of that at the same time. But yeah, we are reducing the number of hours that we will, that are more contracted for with Diva in this area next year. We went from 80 hours a month to like 50 hours a month. That's consulting time. And the next question was just around the providers that are receiving the results from the labs. Do you have goals in mind, particularly after that comes in around the ideal number you would have for how many providers will eventually be using? So it was of course 69, I just was wondering what is your achievable number of providers that you could eventually access? I think, you know, this is a service that they have to request. So some, and it also depends on some of the laboratories to participate. So how do we get built up? Yeah, the results delivery, I think, we'll just continue to do those as requested. We definitely have a backlog of those. So what we have to prioritize, what we can and can do, they require testing when they're first set up with the hospitals, the hospital labs. So that can sometimes present scheduling challenges. So is the backlog that providers want for those results? But you haven't been able to do the testing. Okay, so there is demand out there. Yeah, yeah, there is. And, you know, the other challenges were only contracted for so many a year. So we've been working with the state to prioritize that. One of the priorities that we're talking about this year and hasn't been affirmed up, but it is the designated agencies as they're all switching EMRs. And we're trying to make sure that we align with what the state is doing with that process. So I can't say a target. There are some vendors and some labs that have gone made direct point-to-point connections and don't come through our system. I would say I would like to be able to service anyone who wants it. They can also, some providers get their lab results through Vital Access because that's easier for them than setting up any HR connection which can cost money from their vendor even if we can do the local trade. So there's a number of factors that go into it. So I can't really put a target and say I want to get to this number, but I can say I want to be able to service all the demand that's out there. And if I had my way and we had ultimate funding, we would do all of them. The magic one. Yes. Thank you. Yeah. Other questions from the floor? Now we'll open up to the public for comments. Here we are. My name is Eric Schulte, I just want to ask you can you talk about the match rate for UMTI going up 25% and I'm just curious what the magnitude increase there is as in like what 25% of what, like what do we start with? So those, that number is based off of some defined beneficiary files that we receive and we were, you know, we were targeting for the organizations that send us beneficiary files, we were able to take those up over, you know, we were in the sixteenth somewhere and we were able to take them up over 90%. So that's the only way we can effectively measure match rates when we have a defined population. If someone can define the population of Vermonters I'd be having to tell you what we're matching on but that's kind of an unknown for us and you know, we're just starting to explore all the capabilities of the new tool now that it is in production. Thank you. Other comments or questions from the floor? Well, thank you very much. Beth, you're showing a great leadership skill because you delegated so much today. We're glad that you survived your first meeting at the Green Mountain Care Board and really excited for your opportunities as Bob said to take the organization to the next level. So, thank you. Thank you very much. Thank you. At this point, we want to invite Sarah and the other team to come down. So for the record, this is Sarah because she's our chance to be a member of strategy and operations. At least I know who I am today. That's awesome. And I was the cast of our health policy director from the board. So thank you. We thought we would just do preliminary staff recommendations and a review of our analysis together for both presentations rather than in between. So I will quickly run for the proposed changes to the 2019 to 2020 HIE plan having to do with consent. As a reminder, we have three major oversight responsibilities related to HIE, HIT and Vigil. The first is to review the state HIE plan down on this HIE plan. We reviewed and approved the 2019-2020 plan in November on the condition that deeper return of the new year would have an update plan to reflect the new off-down-consent model being implemented on March 1st when they have done that today. In addition, we're charged with reviewing the connectivity criteria for providers connecting to the VHIE. The proposed amended HIE plan also includes additional documentation on those 2020 connectivity criteria which the board had seen in November but wasn't included in that version of the plan. And then lastly, the board is tasked with reviewing the vital budget and we'll talk a little bit more about that in a few minutes. So as a reminder, we used four principles to assess the HIE plan back in November. The starred principles here on the slide are the ones that are most relevant to our conversation today about HIE consent. So first, I think this is the key today is aligned in the statutory requirements. Title 18 states that the HIE plan shall include standards and protocols designed to promote education, patient privacy, physician breast practices, electronic connectivity to healthcare data and overall more efficient and less costly means of delivering quality healthcare remote. And effective March 1st that it shall provide for each patient's electronic health information that is contained in the Vermont Health Information Exchange to be accessible to healthcare facilities, healthcare professionals and public and private payers to the extent committed under federal law unless the patient has affirmatively elected not to have the patients all electronic health information shared in that manner. So that's not full but the HIE consent addendum to the HIE plan establishes those standards and protocols necessary to protect patient privacy while complying with statutory requirements specifically within the opt-out model. So staff look at that, isn't that? And then for the third and fourth criteria, I focused my review on the stakeholder and consumer engagement since that was a major focus of Act 53 and also was the fourth criteria or part of the fourth criteria on review. So Act 53 as you have described lays out specific requirements for stakeholder engagement and implementing the opt-out consent model. And Diva and his partners really can work closely with the HIE steering committee with advocates with representatives of special populations and with members of the general public during implementation to explore messaging and address concerns that might be out there. These efforts have been described by Diva in their Act 53 implementation reports which were submitted to the legislature and to the board on August 1st, November 1st and January 15th. And the board has also heard public comment in the past few meetings when we've heard these reports from advocates and others about that stakeholder engagement. So given this, the staff, the Goal and Hire staff recommendation is to approve the revised 2019 to 2020 HIE plan to act upon first sunsetting of previous consent policy from 2014 on February 29th. So this can then receive a public comment and we'll be accepting public comment on this obviously indefinitely but for the purposes of this vote through Sunday, February 2nd. Any questions on the HIE consent piece or HIE plan? Questions from the board? We'll open it up to 12 of them. Any other questions? We'll move on to the vital budget adjustment. So as previously mentioned, the board is also tasked with reviewing and improving the vital budget. That came to the board in 2015 and was first to exercise with them in 2016. This year we received vital budget and you feel like we've heard it in May with the comment in early June. Okay, so the next two slides sort of summarize the FY20 impact of the updated calendar year 20 contract that Vital just presented. So we pulled out the pieces that were effective in the FY20 budget and what you'll be voting on in terms of amended budget order. So first to remind you that this request for an amended budget order reflects the expanded scope of work that Vital is taking on. It's primarily coming from their collaborative services project, consent management, and the EMS emergency services. And those numbers up there, the FY20 impact of those projects. The revenue increase, as you just heard from Vital, is $1.5 million over what has already been improved by the remount care board. This is coming from state funding, $1.8 million in increased state funding with the offset of that $400,000, a reduction of $400,000 in that collaborative services, the cost sharing. So the overall impact is the $1.5 million in revenue. On the expense side, there's basically exactly the same increasing expenses, $1.5 million, this is coming from, and this is directly related to that same expanded scope of work. It's coming from consultant and legal expenses, network services, additional staffing costs, and then that $150 in contingency for the unknowns associated with the collaborative services project. So the bottom line is that it has basically no effect on their operating loss. They were expecting to lose a little and cover that with their days cash on hand. You just heard that their days cash on hand position was being diminished, going from what you originally approved, 117 days cash on hand to I believe it's 84 days cash on hand. They expect to recover that in their next budget cycle and the reason it's diminishing so much is because of the timing of the phase two of collaborative services. So again, that number is expected to come back up on the next budget cycle. So any questions? So as a reminder, the board has in the past used four criteria to assess vital spectrum requests and we will quickly look through each of those with respect to the budget adjustment. So in terms of transparency, better than five with the initial FY 2020 budget guidance and has kept us informed about the possibility of needing a budget adjustment. You know, when I present to the board in both August and November, in addition we'll have a public comment period open through Saturday the second once again. In terms of aligning with HIE plan goals, the adjusted budget will advance the HIE plan goals by supporting projects like the HIE presented implementation and the collaborative services project. In addition, there will be process and timeline we're developing a partnership with Eva and Vital and we're adjusted to accommodate their contracting timeline. And lastly, the board will of course continue to ensure that the decisions are sufficiently clear. So based on this assessment, the preliminary staff recommendation would be to approve the adjusted vital budget as presented with the condition that, maintaining the condition that we have the original budget order that Vital continue to commit and present quarterly which they have done, even when it's not required. And again, this will be kept in public comment received through February 2nd. You were scheduled to vote that first week of February? Yeah, of course scheduled to vote on February 5th. Any questions from the board, Robin? I have one question. So I would assume that governments and operations would also include updates on the consent implementation. So I don't think it necessarily needs a change to your recommendation, but I just wanted to voice that assumption. Absolutely, and that's something that we could definitely ask the board. This is, this condition has been in place for the second budget cycle now and really is intended to express that. We've requested that Vital provide us with the same kind of operational metrics ongoing so that the board can have a consistent set of metrics to compare over time, but we can certainly add updates on consent implementation and other key projects. So will that include the de-identified data statement? I don't understand your question. So I thought there was going to be a recommendation as part of the implementation from Diva for the change that clarified protection of everyone's data? Absolutely, so in the proposed amendment to the HIE plan, there is, in that consent addendum, there is a line specifying for providing sale of de-identified data in the VTI. So that's contained in the HIE plan amendment. Okay, I'll take a look at that language, but I hope it's more than just sale. I hate to see something being given away with the grade. I believe it's commercially used. Okay. But we can double-check on that and it will confer with Diva team to better understand. Any other questions from the board? Seeing none, we need a couple of comments. Thank you very much. Thank you. Is there any role business to come before the board? Seeing none, is there any new business to come before the board? Seeing none, is there a motion to adjourn? Second. It's been moved and seconded to adjourn. All those in favor, 25% aye. Aye. Any opposed? Thank you, everybody. Have a great rest of the day.