Health Care Reform and Health IT: Making Health Care Value Real

Health Care Reform and Health IT:Making Health Care Value Real

Charles Kennedy, M.D.

VP Health Information & Technology , WellPoint, Inc.

H.I.T. Policy Committee Insurance Industry Representative

Payer Panel on Health I.T.

Company Confidential | For Internal Use Only | Do Not Copy 2

Expectation Mismatch Challenge

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

Real World ResultsExpectations

.


Health Careis about what happens to

IndividualsIndividuals

not

Institutions


The Current Care Process – A Typical Cancer or Chronic Disease “Journey”

Hospital unit

Diagnostic unit

Multidisciplinary team

Radio/chemotherapy center

Surgical center

Home nursing

Hospice

Primary care

Symptomatic care

Follow-up

Follow-up

Second case conference

Follow-up

First case conference

Specialist consultation

Investigations

Consultation & referral

Time

Second treatment

Surgery

Specialist palliative care

Pre-operative treatment… … and and

self self carecare??


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.

Provider 1

Provider 2

Provider 3

Provider 4

Provider 5

Time

Hospital I.S.

MD 1 EMR

Pharmacy

MD 2 EMR

Radiology Center

Systems


Speaker #2-- Availity

Leveraging the Infrastructure that is Already Deployed in Physician Offices—

Julie Klapstein

CEO Availity


Where’s the Patient?

HIE Infrastructure Design Overview


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 .


Binding The Individual’s Health History in Non Integrated Delivery Systems

Time

Care Setting 4

Care Setting 1

Care Setting 2

Care Setting 3

Care Setting 5

Aggregated Information Around the IndividualInformation and processes of most importance to Individual’s overall health and care

Information S

ystems

Specific to C

are Setting

Specific to

Individual


Speaker #3: Ingenix

Turning Data into Information

Health Plan experiences with tools and technologies

Andy Slavett

CEO

Ingenix


Pay for Performance Program Components

Commit FundsEstablish Performance Criteria

Recognize QualityReward performance

Support Improvements

Measure Performance

(Quality)

Critical Steps in Executing a Successful Pay for Performance Program

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

• Clinical

• Technology

• Patient satisfaction

• Prevention

• Disease management

• Hospital safety

• Applicability to different medical groups

• Other

• Clinical

• Technology

• Patient satisfaction

• Prevention

• Disease management

• Hospital safety

• Applicability to different medical groups

• Other

• Incremental funds

• Realigned funds

• External funds

• Incremental funds

• Realigned funds

• External funds

• Data collection

• Data analysis

• Data collection

• Data analysis

• Comparative internal profiling

• Public profiling

• 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

• 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

• Funding

• Information sharing

Awareness Process Outcomes Structure


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.


Health IT Market Overview

Capabilities for health care value from Health I.T.

Capture data from source systems or

Interoperability

Understand the data in the context of the

patient’s clinical status

Apply evidence base and business

rules to data

Inform patient and doctor to take action

as care occurs

Claim Data • WLP MMHp • E-Prescribing--

AllScripts, MedPlus, Prematics…

• CalRHIO • Google Health

• RHI • ActiveHealth

• RHI• ActiveHealth• E-Prescribing

E-Prescribing

Clinical Data • CCHIT Certified EMRs

– E Clinical Works,

– United’s Care Tracker

– EPIC• Most RHIOs• Interface companies

• Orion

• Kaiser KP Connect with Dz Registry

• NY Health Information Exchange

Integrated clinical and claim data

• MS HealthVault• WellPoint’s IHR

WellPoint’s IHR WellPoint’s IHR WellPoint’s IHR

Resulting Record

Unassembled jig saw puzzle– narrow impacts to cost/quality

Assembled puzzle—cost and quality impacts likely

Actionable data to improve cost and quality

Transformed health care??


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 ViewHealth Summary




.

.60 higher

risk score

7.5% trend

reduction

Dayton Results Summary

20 04/20/23

Continuous Enrolled Study Cohort Health IT Non-Users

2007 2008 VarianceAllowed Cost 9,077,150$ 11,661,058$ 28.5%Mbrs 4126 4126 0.0%MM 37134 37134 0.0%Cost PMPM 244.44$ 314.03$ 28.5%Avg DXCG 2.13

Health I.T. Users2007 2008 Variance

Allowed Cost 1,839,258$ 2,226,974$ 21.1%Mbrs 666 666 0.0%MM 5994 5994 0.0%Cost per Pt 2,762$ 3,344$ 21.1%Cost PMPM 306.85$ 371.53$ 21.1%Avg DXCG 2.72

Measure IHR User IHR Non User DifferenceColonoscopy 41.50% 25.60% 15.90%Mammogram 10.50% -11.20% 21.70%Pap Smear 12.70% 0.80% 11.90%PSA 62.50% 24.40% 38.10%LdL Test 21.70% 1.10% 20.60%Hemoglobin A1C 13.90% 2.30% 11.60%

Measured in year over year change

Financial Results

IHR Utilization Stats

Quality Results

• Employees: ------ 70%

• Dependents: ------ 15%

• Total*: ------------- 48%

• 6 or more log ins---- 45%

Documents

Health Care Reform and Health IT: Making Health Care Value Real