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An Ingenix - Triad Consulting
proposal for
DOSSIA
andthe Lifelong Personal Health Record
July, 2007
Triad Consulting
Triad Healthcare Informatics
DOSSIA and Ingenix – Shared Objective
Finding a way to improve health care through a shared vision:
Define a unique set of roles One that delivers a set of solutions quickly, even if it
isn’t optimal, but one that can be improved with market adoption
Solution must include commitments by members to benefit in the short term in return for meaningful change driven by employers
End state is one where employers advance the improvement of health care in cost and quality
Triad Healthcare Informatics
Ingenix – Our Role
Ingenix Role Application Programming
Interface Control Application Agnostic Exchange Independent Drive Extract, Transform.
Load Provide Analytic Engines Offer Consumer Applications Offer Provider Applications Offer Employer Applications
Ingenix Benefit Short Term Client Services Long Term Improved Use of
Information not Just Data Improved Interoperability Public Domain Achieve Mission Market Competition Early Advantage
Triad Healthcare Informatics
Phased Approach
Phase I – Pilot a solution that meets the needs of Dossia members through existing vendor relationships but is scalable to a broader population of employers
Phase II – Scale the pilot solution to the Founding members with all vendor’s data
Phase III – Scale the solution to the broader market
Triad Healthcare Informatics
Employer Expectations for Consumer Health
Flawless execution– Employee satisfaction and appreciation of programs– Strong account management and understanding of client concerns
Minimal employer effort Minimal employee effort Seamless, effective partnership among vendors Data privacy controls Best-in-class tools for
– Accessing provider information, – Assessing personal health information and charting progress– Making provider and plan selections– Claims adjudication and savings account administration – Providing participants effective educational and decision-making
resources– Delivering information in a format that is understandable given the
participants’ personal circumstances– Providing comprehensive, timely information to providers concerning each
participant’s health needs, practice patterns and population trends
Triad Healthcare Informatics
Ingenix Vision
Providers of Data Sources PBMs Labs IngenixOthers
DOD AARP NMA
PHR
APIApplication Programming Interface
Control Application
Keys
Data Source(virtual)
EBM, ETG, ERGs, PRGs, HCGs
Patient Providers
PHR
WebMD
Participating Employers
Participating Employers
Triad Healthcare Informatics
Participating Employers
Participating Employers
Shared Vision
Providers of Data Sources PBMs Labs IngenixOthers
DOD AARP NMA
PHR
APIApplication Programming Interface
Control Application
Keys
Dossia Data Source(virtual)
EBM, ETG, ERGs, PRGs, HCGs
OMX OMX OMX
Patient Providers
PHR
WebMD
PHR Impact
Consumer/Provider
SymmetryImpact Pro
Ingenix Health Manager
SymmetryImpact Pro
Ingenix Health Manager
Triad Healthcare Informatics
Starting with the End State
Improving the speed and accuracy of health care data aggregation
Preserving privacy Create more meaningful information Market differentiation through use of data not
aggregation of data Employers driving the change
Triad Healthcare Informatics
Participating Employers
Participating Employers
Improving the System via OMX
Providers of Data Sources PBMs Labs IngenixOthers
DOD AARP NMA
PHR
APIApplication Programming Interface
Control Application
Keys
Dossia Data Source(virtual)
EBM, ETG, ERGs, PRGs, HCGs
OMX OMX OMX
Patient Providers
PHR
WebMD
PHR Impact
Consumer/Provider
SymmetryImpact Pro
Ingenix Health Manager
SymmetryImpact Pro
Ingenix Health Manager
Triad Healthcare Informatics
Technical Solution for Quicken Health
Internet
Intuit Hosted Services
Quicken HealthWeb – App Servers
Quicken HealthWeb App
Consumers
Content and OtherSupport Servers
Quicken HealthDataBase Servers
Health Plan
OMXServers
Health PlanInternal Systems
OMX DatabaseServer
Health Plan
OMXServers
Health PlanInternal Systems
OMX DatabaseServer
Health Plan
OMXServers
Health PlanInternal Systems
OMX DatabaseServer
Triad Healthcare Informatics
The Opportunity
Leverage the OMX Server Implementation for Dossia: Sends data on a subscription basis Secure and reliable Single point of integration at the health plan Web services architecture
Triad Healthcare Informatics
Applied to Dossia
Ingenix
Internet
Consumer Applications
Health Plan
OMXServers
Health PlanInternal Systems
OMX DatabaseServer
Health Plan
OMXServers
Health PlanInternal Systems
OMX DatabaseServer
APIApplication Programming Interface
Control Application
Keys
Dossia Data Source(virtual)
EBM, ETG, ERGs, PRGs, IHM
OMXServers
Analytic Processing
OMX DatabaseServer
Triad Healthcare Informatics
What is OMX?
OMX = Open Medical eXchange Allows Health Plans to provide personal health data to
consumers in a secure and effective fashion Intermediary between Health Plan source systems/data
sources and the Quicken Health application. The OMX server is owned & maintained by the Health
Plan Key functions
Manages user authentication using the Health Plan’s rules
Collects consumer data Provides data on demand – real time (first use) and
batch (subsequent use)
Triad Healthcare Informatics
OMX Specification
The OMX specification is simply a communication protocol that has been designed by the Quicken Health team (Intuit & Ingenix) to support the health data collection needs of consumers.
It is similar in use to OFX, yet modernized in design leveraging web services and xml topic structures. The API itself is fairly straightforward.
The Quicken Health Framework is expecting 3 basic things: The data provider will have a profile in a registry on an Intuit-hosted
server (stored in Nexareg, our metadata repository) The data provider will have the ability to respond to a defined set of
web service calls from the client in accordance with the specification – this includes appropriate user authentication and the ability to satisfy a request for data.
The data provider will have the ability to push appropriate notification information to an Intuit-hosted notification server
Triad Healthcare Informatics
Consumer Data is Protected
Data Resides on data provider systems, behind their firewalls UNTIL it is requested
OMX currently relies on health plan (or other data provider) ID/ password for authentication, leaving the data provider in control (HIPAA)
Communications between the OMX Server and requesting servers are secure and encrypted
Triad Healthcare Informatics
OMX Compatible with Existing Standards
OMX is based on HIPAA (X12 and NCPDP) Allow health plans to more easily map OMX requirements to
existing external interfaces 84% of OMX data elements (excluding payer branding
information) traced to standard transaction set Examples of data elements not referenced to standard
transaction set: data source system, custom information codes, begin and end dates for accumulators
Will continue to leverage the standards that exist HL7 lab result and other clinical data (CCD)
Working with standards and industry groups HITSP, CAQH, AHIP Working with consumer-oriented standards groups – AHIP,
Markle and others
Triad Healthcare Informatics
OMX Currently
Administrative and other payer data topics Claims/EOBs Member/ subscriber eligibility information Benefit plan information Provider information Payer web portal links
Ability to add additional topics easily
Triad Healthcare Informatics
Certification – Ensures Quality of OMX Providers
Data Quality, Integrity and Access Data is complete and conforms to OMX Specification Consistent with your portal Timely (no more than 24 hour lag) Historical data available (3 years recommended, 12 mo minimum)
Security and Authentication Acknowledge HIPAA obligations Provide authentication mechanism Available to termed members Sensitive data policies applied
Operations and Support Consumer support model is in place and all training complete System availability is managed and notification processes in place System response times are within range
Triad Healthcare Informatics
Current Solutions – Future Enhancements
Develop the end state infrastructure Needs to meet current employer and market needs Short term wins – part of move to end state Deliver more than what is available today With an eye towards the future Future is within reach with OMX
Triad Healthcare Informatics
State of Shared Health Care Information
Information flow is incomplete
Care Management
Providers Consumers
Care Management – health
information based on claims or
HRA’s
Providers – health information
based on services their practice
performed
Consumers – health
information based on what they
remember or understand
Triad Healthcare Informatics
Participating Employers
Participating Employers
Application of Impact Consumer/Provider
Providers of Data Sources PBMs Labs IngenixOthers
DOD AARP NMA
PHR
APIApplication Programming Interface
Control Application
Keys
Dossia Data Source(virtual)
EBM, ETG, ERGs, PRGs, HCGs
OMX OMX OMX
Patient Providers
PHR
WebMD
PHR Impact
Consumer/Provider
SymmetryImpact Pro
Ingenix Health Manager
SymmetryImpact Pro
Ingenix Health Manager
© Ingenix, Inc. 22
Sharing Care-Focused Information with all Constituents
Impact Pro Predictor
Impact Consumer Health
Impact Provider Patient Connection
Care-focused PHR
Impact Pro Predictor – enables
informed care managers to
coordinate care with consumers
and providers.
Impact Provider Patient Connection – enables prepared,
physician practice teams to deliver
better, proactive care.
Impact Consumer Health –
enables informed, activated
consumers to make better health
decisions.
© Ingenix, Inc. 23
Impact Consumer/Impact Provider Currently
• Demographics• Encounters• Medications• Providers• Self-reported
© Ingenix, Inc. 24
Impact Consumer Implementation at DOSSIA
• Demographics• Encounters• Medications• Providers• Self-reported
Data from employers supplied to DOSSIA
DOSSIA administers (typically) monthly processing. Could be a BPO process
provided by Ingenix, or run by DOSSIA.
Internet access to the datamart. Hosted by DOSSIA or Ingenix.
Consumer access is through the Impact Consumer web site, or through a
DOSSIA-supplied portal accessing Impact Consumer information
Back office access to the datamart also available
© Ingenix, Inc. 25
Protected Health Information
• Demographics• Encounters• Medications• Providers• Self-reported
We assume DOSSIA is HIPAA compliant. Alternatively can employ
Ingenix’s HIPAA compliant BPO.
Consumers must grant access to their information to physicians BA’s in place with network
physicians?
© Ingenix, Inc. 26
Participating Employers
Participating Employers
Consumer Behavior Change with Non-Traditional Data
Providers of Data Sources PBMs Labs IngenixOthers
DOD AARP NMA
PHR
APIApplication Programming Interface
Control Application
Keys
Dossia Data Source(virtual)
EBM, ETG, ERGs, PRGs, HCGs
OMX OMX OMX
Patient Providers
PHR
WebMD
PHR Impact
Consumer/Provider
SymmetryImpact Pro
Ingenix Health Manager
SymmetryImpact Pro
Ingenix Health Manager
© Ingenix, Inc. 27
Ingenix Health Manager
Reporting
• Activity report• Outcomes report• Efficacy report
Continuous improvement thru “organic” learning system
Create 360° Health Profiles(Includes individual health and lifestyle information)
Prioritize Individuals for Intervention(Based on 360° Health Profiles)
Create Target Groups(Matched to available interventions)
Segment Population(Creates segments by unique characteristics)
Data Management, Segmentation & Targeting
Tailored Messaging & Activation
Create Engagement Profiles (Includes 360° Health Profiles and Activation Plan)
© Ingenix, Inc. 28
Health and Consumer Information to Change Behavior
Data Management, Segmentation and Targeting• Get a deeper understanding of consumers with 360-degrees of data
Integrate health and consumer information from multiple data sources Match data at the individual level Apply methodologies to address potential data gaps
• Understand the unique needs of populations to provide customized health solutions Identify unique health needs and characteristics of populations across the health continuum Reveal gaps in intervention program needs and delivery mechanisms
• Identify target groups for health intervention, integrating health outreach Match individuals to available interventions based on health needs and preferences Prioritize individuals for intervention based on readiness to change and likelihood of engagement Uncover previously unidentified consumers for intervention – before they get sick
Tailored messaging & activation• Engage consumers in health intervention for better health outcomes• Create tailored messaging, using direct marketing and behavioral science techniques,
to activate consumers• Deliver information needed to tailor interventions at the target group or individual level
Reporting• Measure and deliver better health and financial outcomes• Continuously refine and improve intervention program effectiveness
© Ingenix, Inc. 29
Ingenix Health Manager End-to-End Solution
Data Management, Segmentation & Targeting
Tailored Messaging & Activation
Delivery Reporting
Report TypesData Standardization and Matching
Data Analytics Outreach Enrichment
Data MatchingIndividualProvider
Multi-payerMulti-source
Scoring/RatingCost
QualityVolumeSeverity
ETL Process
Population Segmentation
Application of Business
Rules
Stratification of Members
•Medical Care Cost & Utilization•Pharmacy Cost & Utilization•Lab Values•Socio-economic•Demographic•Health Risks/Status•Life Stage Clusters•Consumer Preference•Productivity & Absence•Physician & Hospital Quality•Provider Directory•Program Inventory•Benefit Parameters (e.g., costs, fee schedules, detail)•Plan Parameters•Intervention Activity •Intervention Results
Consumer Intelligence Warehouse Grouper
Technology
Predictive Model
Health Messaging Campaigns
Health Interventions
Heath Portal
24-Hour Health Line
Heath Risk Assessment
Lifestyle Behavior Health
Coaching
Disease Management
Case Management
End-of-Life Management
Connecting Physicians &
Patients
Individual Activation
Plans
Intervention Enrollment Messaging
Cost and Quality
Messaging
Provider Messaging
IHM Data Mart
Indi
vidua
l Dat
a So
urce
s
12
Identification of Target
Groups
• Intervention Activity
• Intervention Outcomes
• Return on Investment
• Intervention Efficacy
• Activation Response
• Special Studies
© Ingenix, Inc. 30
Benefits
Employer Benefits Continued decision support Improved decision support
Market Benefits Independent exchange Applying current market
standards
Recommended