DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Health Plan e-Collaboration: Convergence of Urgency

& Opportunity

Jeremy Nobel, MD, MPHNortheast Business Group on Health

Feb 23, 2012

Evolution of Technology

Evolution Payments

Evolution of Benefit

Designs

Health Plans: Are Extremely Well Positioned to Improve Health Care

IT-enabledCare

Support

Consumer-directed movementHSA/HDHPsEmployer-sponsored lifestyle reward programsIncentives for lower-cost alternatives

Moving from Pay for “Improved Process” to Pay for “Improved Outcomes”

CheaperFasterBetter

SmallerUbiquitousConnected

Real-time info and decision support for: providers, payers, patients, via web

Efficiency Engine

E-Collaboration: Now More Than Just a Power Point Slide

Care TeamCoordinated

Communications

Lab

Pharmacy

Self-Reported

Biometrics

Consumer-ControlledPermissions

IT-enabledCare

Support

IT-Driven Care-enables

“smart care” collaboration

for higher-touch, lower-

cost, care delivery

PCP

Specialist

Care Coach

IT-Driven Care enables timely HIE, avoids duplicate tests, eliminates medication conflicts

IT-Enabled Care Management CanDeliver the Value Purchasers Want

Reducing… resources required to achieve same or better outcome

– Elimination of duplicate diagnostic tests

– Streamlining of work-ups to exclude low-yield dx tests

– Avoiding provider visits simply to “check in” and collect data

Substituting… lower resource-intensive option in either prevention, diagnosis or treatment

– People (e.g. mid-level providers, pharmacists, health coaches, “efficient” provider networks)

– Place (e.g. shift to home or lower cost ambulatory setting)

– Product (e.g. shift to generic Rx)

Avoiding… complications, adverse reactions, or sub-therapeutic treatment improves both quality and efficiency

Initiation of most effective care pathways

Medical regimen adherence

Early detection or avoidance of ADE’s or side-effects

Reduction of ED and Hospital use

All While Allowing Patients to Feel Better “Noticed” and Cared For

How Can Plans Support Providers, Leading to “Value Based” Care?

Two Important Ways:

• Change the provider business relationship– Contract with providers to deliver “value based” care,

with reimbursement linked to “performance”– Medical Homes, ACOs, Episode Pricing, etc.

• Leverage Plan assets to partner with them– Offer Providers advanced analytics, on-line tools, and

shared care management services to improve care delivery effectiveness/efficiency

– Be an active info-mediary between members and providers, supporting collaborative and “value-based” care

OK, So What Happens Now? • I’d like to turn it over to our panel, the REAL experts, who will share their perspectives

• Then it will be YOUR turn