Health Care Reform and Health IT:Making Health Care Value Real Payer Panel on Health I.T. Charles Kennedy, M.D. VP Health Information & Technology , WellPoint, Inc. H.I.T. Policy Committee Insurance Industry Representative
1. Medicare Chronic Care Pilot Running for over 2 years Incentives, chronic disease management strategies Many electronic records NO EVIDENCE OF INCREMENTAL VALUE 2. According to a study published in the Archives of Internal Medicine using 1.8 billion records with around 20% electronic, there was no difference between paper and electronic records on 14 of 17 axes, and splits on the other 3. 3. BCBS usage of heavily promoted PHRs is currently 0.2% 4. NRC/NAS 2009 study says current approaches will not meet objectives First Consulting Group (among others) completes white paper indicating net benefits of Health Information Technology worth $39 -$47 billion annually in care savings Center for Information Technology Leadership estimates deployment of ambulatory health record worth $44B in savings Office of the National Coordinator for Health Information Technology references studies which indicate savings from Health Information Technology deployment worth $78-$112 billion annually . Expectation Mismatch Challenge Real World Results Expectations
Health Careis about what happens to Individuals not Institutions
Primary care Home nursing Hospice Hospital unit Diagnostic unit Radio/chemotherapy center Surgical center Time Multidisciplinary team The Current Care Process – A Typical Cancer or Chronic Disease “Journey” Consultation & referral Follow-up Follow-up Symptomatic care Specialist palliative care Specialist consultation Follow-up Investigations Pre-operative treatment Second treatment … and self care? Surgery First case conference Second case conference
Speaker #1 • Health IT in a Tightly Integrated System • Andy Wiesenthal M.D. • Associate Executive Director • The Permanente Federation
Creating Patient Centric Solutions in Solo and Small Group Settings • Providers in PPO networks deliver care across institutions yet institutions arrange their I.T. systems with an inward focus. WellPoint’s Health IT solution must be able to integrate data from disparate databases to reflect how care is delivered across a variety of separate institutions. Systems Hospital I.S. MD 1 EMR Pharmacy MD 2 EMR Radiology Center Provider 1 Provider 2 Provider 3 Time Provider 4 Provider 5
Speaker #2-- Availity • Leveraging the Infrastructure that is Already Deployed in Physician Offices— • Julie Klapstein • CEO Availity
HIE Infrastructure Design Overview Where’s the Patient?
HIE Output: Unassembled Data HIEs attempt to create value by presenting more data to the treating physician at the point of care HIEs add value primarily when a physician who did not order the test needs to see the result and will take the time to look .
Care Setting 1 Care Setting 2 Information Systems Specific to Care Setting Care Setting 3 Care Setting 4 Care Setting 5 Time Aggregated Information Around the Individual Information and processes of most importance to Individual’s overall health and care Specific to Individual Binding The Individual’s Health History in Non Integrated Delivery Systems
Speaker #3: Ingenix • Turning Data into Information • Health Plan experiences with tools and technologies • Andy Slavett • CEO • Ingenix
Pay for Performance Program Components Several critical steps to executing a successful pay-for-performance program were identified. Programs reviewed are assessed against this value chain to determine areas of excellence. Program specific observations are then aggregated into a series of best practices along the value chain Critical Steps in Executing a Successful Pay for Performance Program Establish Performance Criteria Commit Funds Measure Performance (Quality) Recognize Quality Reward performance Support Improvements Awareness Process Outcomes Structure • Clinical • Technology • Patient satisfaction • Prevention • Disease management • Hospital safety • Applicability to different medical groups • Other • Incremental funds • Realigned funds • External funds • Data collection • Data analysis • Comparative internal profiling • Public profiling • Financial incentives: Flat fee per member • Financial incentives: Incremental revenue per unit or case • Recognition and awards • Contract negotiations and tiering strategies • Funding • Information sharing
Speaker #4-- WellPoint • Considerations in Metrics and Metric Development in Pay for Performance Programs— • Cathy MacLean MD • Vice President Clinical Quality Interventions
Speaker #5: WellMark • Programmatic Implications for Quality Incentive Programs • Rick Miller, D.O., is a medical director for Wellmark Blue Cross and Blue Shield. He is responsible for the Collaboration on QualitySM program, whose enrollment reached nearly 15,001 primary care clinicians this year.
WellPoint’s Real Time Clinical Integration Platform in Dayton Ohio This project integrates clinical and claim data creating a comprehensive, shared clinical and financial profile for patient, doctor, and health plan use A Personal Health Record (PHR) for the patient An electronic health record and ePrescribing A data exchange infrastructure allowing health coaches and physicians to use a common record A rules engine with evidence based medicine rules and benefit optimization rules In development: Health plan business rules that automate administrative functions
Physician View Health Summary
Dayton Results Summary Quality Results Financial Results 7.5% trend reduction IHR Utilization Stats • Employees: ------ 70% • Dependents: ------ 15% • Total*: ------------- 48% • 6 or more log ins---- 45% .60 higher risk score 20 10/23/2014 .