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HEALTH INFORMATION EXCHANGES Building the National Super Highwa

Sreedhar Potarazu MD MBAPresident and CEO

Sreedhar Potarazu MD MBAPresident and CEO

5/16/2010 1

Presentation to the FIU HIT Initiative April 28,2010

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Agenda

HIE in Concept

HIE in Progress

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A Choice of Architecture

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HIE Vision

A transparent and

ecosystem where secureand reliable health

n ormat on exc angetransforms the delivery of

of efficiency and quality.

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The National HIE Super Highway

Infrastructure Service Layers Application Layers

Internet, WANs

HIPAA CompliantCommunication

Protocols

Provider-Provider

Provider-Payer

Claims Processing

Results Reporting

Order Processing

HIPAA CompliantSecurity/Privacy

Controls

onsumer- rov er

Consumer-Payer

Provider-Laborator

Dx Imaging

E-Prescribing

Eligibility Verificationransac ons

HL7 Messaging

CCR/CCDTransactions

Provider-Pharmacy

Payer-Government

Fraud Detection

PHRs, EHRs

Data Mapping Utilities Provider-Govt

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Where the focus is today

What is the value of health information exchanges?

For Providers

Improved access to test results and care received

Improved quality of practice life (i.e., less hassles looking forinformation) and reduced search costs

Reduced staff time handling test results and clerical tasks

For Payers and Employers

Reduced costs from provider staff time, redundant tests,ne c ent management o c ron c sease, me cat on errors

Efforts to increase value from dollars expended rely heavily onbetter communication between providers and improvements in

Movement toward accountable health care organizations andbundled payments will make alignment between improved

quality and efficiency from HIE more salient to providers

Source: Migrating Toward Meaningful Use: The State of Health Information Exchange, eHealth Initiative, www.ehealthinitiative.org, August 2009.

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HIE Conceptual Framework

The value of evolving an administrative exchange to a clinicalexchange

1. An invisible information architecture that enables existing health care process

and interactions, not create new ones2. Supports eCare projects in their current and future states

3. Enables transformation from a ualit and clinical ers ective, which then leads

Healthcare Information Exchan e

to transformation from an operational and financial perspective

4. Improves health care system wide

VitalSpringPlatform

Partner Platform+

Analytics Connectors

Transactions EDI

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5/16/2010 8

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A New Ballgame

Payment Reform

Appropriate

Utilization

Accountable Healthy

Providers

ncrease

Service Quality

Health

Management

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Insurance Stakeholders

Insurance Carriers contribute:

Medical, Rx, Dental, Visionclaims data

Disability, Workers Compc a ms a a

Benchmarks

Claims transactions portal

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Insurance Stakeholders

Insurance Carriers benefit:

Analyze incidence rates byrace, ethnicity, age groupsand other factors

egmen a e cs y sand implement group-specificsolutions

Design health plan to cover

Adequate network coverage

Timely reminders and alerts based onclaims data

diabetic supplies andpreventive care

Engage with plan members

Comprehensive coverage of preventivecare

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Hospital Stakeholders

Hospitals contribute:

Electronic Medical Records(EMR)

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Hospital Stakeholders

Hospitals benefit:

Analyze factors driving higherLOS and re-admissions

Track recovery rates afterosp a za ons

Set incentives to reduce re-admissions

Higher out-of-pocket for inpatient stays

Access to low-cost physician services

These capabilities will becritical as new providerpayment mechanisms

Clear communication and follow up onpost-discharge care

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out more widely

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Physician Stakeholders

Physicians contribute:

Electronic Medical Records(EMR)

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Physician Stakeholders

Physicians benefit:

Lookup comprehensivemedical/Rx history prior totreatment

oo up rug- rug an rug-disease interactions beforeprescribing

Information on contraindicationsdelivered in simple form

Timely alerts and reminders from trustedsource

based on newly available data Convenient access to EMR

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Improving Coordination of Care

Greater Rochester HealthInformation Organization (www.grrhio.org)

Improve availability of lab results,digital images, medications, history &physicals, discharge summaries,transcriptions

Create a framework of clinical quality

improvement

HITEC consortium evaluating e-prescribing and MD behaviors

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Transforming Provider Behaviors

Independent Health (www.independenthealth.com)

Using data to help physicians manage to

First Generation Reporting Identify participation rates for high risk members

Rates doubled within two years

Physicians get bonuses for achieving targets

Second Generation Reporting

MDs report on 10 measures to create composite

Improved HEDIS ranks from 25th percentile to95th

Incentives paid on performance and participation

HIE will enable automatic performance scoring

MDs can access performance plans online

Payment will tie to performance

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What about the consumer?

Organizations Participating in HIE

40

45

50

Perhaps the most influential

20

25

30

35 groups are the least represente

5

10

15

Hospitals

Prim

acyCareMDs

Comm

unity

Clinics

Specialty

CareMDs

IndependentLabo

ratories

Ambulat

orySurge

ryCe

nters

Pharm

acies

Heba

vioral

HealthP

roviders

HealthP

lans

LocalA

gencies

Radiology PBM

Health

careITVe

ndors

State

Agencies

Medicaid

Consu

mers

Emplo

yers

Outpa

tien

Source: Migrating Toward Meaningful Use: The State of Health Information Exchange, eHealth Initiative, www.ehealthinitiative.org, August 2009.

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Current Status of Employee Engagement

Healthcare model is reactive

Members engaged after illness, resulting in higher costs formem ers an emp oyers

Members have limited visibility into their personal data, Difficult to understanding impact of utilization and health

Spend a disproportionate effort on the administrativeaspects of healthcare

manage their health and wellness

Silos and lack of awareness limit members ability to

, ,

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Transforming Behaviors

Pactiv Corporation (www.pactiv.com)

Help employees take control of theirhealth and become better consumers

Multi-employer Health Hub to promoteinformation and tools for consumers

Paychex (www.paychex.com)

Educate employees on the economics of

Programmatic changes

Plan design changes copay &

Health questionnaire

Biometric screens

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Employer Stakeholders

Employers contribute:

Medical, Rx claims data

Health Risk Assessments

Biometric data

Eligibility & Demographic data

Disability, Workers Comp data

Employee engagement portal

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Employer Stakeholders

Employers benefit:

Use Predictive Modeling toidentify risk in advance

Consider Value-based planes gn

Support disease managementand wellness

Plan design supports preventive care

Timely reminders for best-practicecompliance

Implement on-site clinics,rewards programs

Rewards program

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Consumer Stakeholders

Consumers contribute:

Personal Health Records(PHR)

Health Risk Assessments

Biometrics

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Consumer Stakeholders

Consumers benefit:

Easily maintain health recordsin a single place and shareappropriately

Eas access to PHR EMR ngage n commun ca ons

from various parts of thehealthcare ecosystem nowdelivered in a streamlinedmanner

Streamlined, value-added communicationsfrom all components of the healthcaredelivery system

Plan design that complements healthcareneeds

Better access to care Physician Network,

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Employer-sponsored programs, Clinics, etc.

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Extending the RHIO

SERVICEPROVIDERS

EMR/VHR

SYSTEMS RHIO SERVICES

PHYSICIANS

HOSPITALS

PHYSICIANS

Complete clinicalprofiles

Improved service

Increased quality

Hospitals

Labs

Insurance

Security Access

Consent Log

MPI

MD RoutingApplication Services INSURERS

HOSPITALS

programs

EMPLOYERS

Gateway to engagepatients

Protect/respectprivacy

INSURERS

CONSUMERS

Extend continuum ofcare esp forMedicaid andelderly

HEALTHSERVICES

Platform for eVisits, scheduling, Rxrefill/renewal, personalized healthmessaging

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A Parting Thought

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What is Meaningful Use?

HHS Health Outcome Policy Priorities

Im rove ualit safet and reduce health dis arities

Engage patients and families Improve care coordination

Improve population and public health

Ensure adequate privacy and security protections for

ersonal health information

Meaningful use should center on the patient experience, not on

the rovider infrastructure

Source: HHS Meaningful Use Matrix, http://healthit.hhs.gov/portal/server.pt

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What is Meaningful Use?

Engage patients and families

2011 Objectives

o Provide patients with electronic copy of- orelectronic access to- clinical information

-

resources

o Provide clinical encounter summaries for

patients ec ves

o Access for all patients to PHR populated in

real time with data from EHR

o Patients have access to self-mana ement

toolso Electronic reporting on experience of care

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What should Meaningful Use mean?

Engage patients and families in a manner that promotes their own specific and

decisions based on thorough evaluation of their best possible options New 2011 Objectives

o Provide access to patient-specific educational resources

o Provide clinical encounter summaries for patients

New 2015 Objectives

o Access for all patients to personalized portals populated in real time with data from all

health care service providers from which they have received service

o Patients have access to self-management tools

o ec ronc repor ng on experence o care

o Electronic report on quality of care and provider ratings

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The Health Law

What has happened?

Parsing of Senate and House Bills

Insurance exchanges

Medicaid expansions

Cadillac plan tax

Prevention and wellness credits Employer enrollment and cost coverage mandates

HSA and Flex Spend caps