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2/4/2010 1
HEALTH INFORMATION EXCHANGES – Building the National Super Highway
Sreedhar Potarazu MD MBAPresident and CEO
VitalSpring Technologies
Kevin Volpp MD PhDDirector, Center for Health Incentives,
Associate Professor, University of Pennsylvania School of Medicine and
the Wharton School
David Merritt Vice President and National Policy
Director at the Center for Health Transformation,
The Gingrich Group
Presentation to the National HIE Summit February 3rd 2010
2/4/2010 2
Agenda
HIE in ConceptHIE in PracticeHIE in Progress
A Choice of Architecture
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HIE Vision
A transparent and interoperable healthcare ecosystem where secure
and reliable health information exchange
transforms the delivery of care to an optimized level of efficiency and quality.
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10
20
30
40
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60
2004 2005 2006 2007 2008 2009
Operational HIEs
Current Progress of HIEs
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5
10
15
20
25
30
35
40
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7
HIE Development 2009
Recognition
Organization
Operation
Implementation
Planning
SustainmentExtension
57 Operational HIEs
36 HIE Implementations
52 Planned HIEs
Source: “Migrating Toward Meaningful Use: The State of Health Information Exchange,” eHealth Initiative, www.ehealthinitiative.org, August 2009.
The National HIE Super Highway
InfrastructureInternet, WANs
HIPAA Compliant Communication
Protocols
HIPAA Compliant Security/Privacy
Controls
HIPAA Transactions
HL7 Messaging
CCR/CCD Transactions
Data Mapping Utilities
Service LayersProvider-Provider
Provider-Payer
Consumer-Provider
Consumer-Payer
Provider-Laboratory
Provider-Pharmacy
Payer-Government
Provider-Gov’t
Application LayersClaims Processing
Results Reporting
Order Processing
Dx Imaging
E-Prescribing
Eligibility Verification
Fraud Detection
PHRs, EHRs
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 for
information) 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,
inefficient management of chronic disease, medication errors– Efforts to increase value from dollars expended rely heavily on
better communication between providers and improvements in provider efficiency and patient engagement
– Movement toward accountable health care organizations and bundled 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.
2/4/2010 8
HIE Conceptual Framework
The value of evolving an administrative exchange to a clinical exchange
• Analytics• Connectors
• Transactions• EDI
Healthcare Information Exchange
VitalSpringPlatform
Partner Platform+
1. An “invisible” information architecture that enables existing health care process and interactions, not create new ones
2. Supports eCare projects in their current and future states3. Enables transformation from a quality and clinical perspective, which then leads
to transformation from an operational and financial perspective4. Improves health care system wide
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A New Ballgame
Payment Reform
Accountable Providers
Population Health
Management
Healthy Patients
Appropriate Utilization
Increased Service Quality
2/4/2010 11
Insurance Stakeholders
• Medical, Rx, Dental, Vision claims data
• Disability, Workers Comp claims data
• Benchmarks
• Claims transactions portal
Insurance Carriers contribute:
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Insurance Stakeholders
• Analyze incidence rates by race, ethnicity, age groups and other factors
• Segment Diabetics by Risk and implement group-specific solutions
• Design health plan to cover diabetic supplies and preventive care
• Engage with plan members with timely information
Insurance Carriers benefit:
• Adequate network coverage
• Timely reminders and alerts based on claims data
• Comprehensive coverage of preventive care
2/4/2010 13
Hospital Stakeholders
• Electronic Medical Records (EMR)
Hospitals contribute:
2/4/2010 14
Hospital Stakeholders
• Analyze factors driving higher LOS and re-admissions
• Track recovery rates after hospitalizations
• Set incentives to reduce re-admissions
These capabilities will be critical as new provider payment mechanisms (bundled payments) are rolled out more widely
Hospitals benefit:
• Higher out-of-pocket for inpatient stays
• Access to low-cost physician services
• Clear communication and follow up on post-discharge care
2/4/2010 15
Physician Stakeholders
• Electronic Medical Records (EMR)
Physicians contribute:
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Physician Stakeholders
• Lookup comprehensive medical/Rx history prior to treatment
• Lookup drug-drug and drug-disease interactions before prescribing
• Offer new services to patients based on newly available data
Physicians benefit:
• Information on contraindications delivered in simple form
• Timely alerts and reminders from trusted source
• Convenient access to EMR
Improving Coordination of Care
Greater Rochester Health Information 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
Transforming Provider Behaviors
Independent Health (www.independenthealth.com)
• Using data to help physicians manage to clinical protocols
• 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
score for chronic care management– Improved HEDIS ranks from 25th percentile to
95th
– Incentives paid on performance and participation• Third Generation Reporting
– HIE will enable automatic performance scoring– MDs can access performance plans online– Payment will tie to performance
What about the consumer?
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Hospital
s
Primacy
Care MDs
Communi
ty Clini
cs
Specialt
y Care
MDs
Indepe
ndent L
aborato
ries
Outpatie
nt/Ambul
atory S
urgery
Centers
Pharmaci
es
Hebavio
ral Heal
th Prov
iders
Health P
lans
Local A
gencie
sRadi
ology PBM
Healthc
are IT
Vendors
State Agen
cies
Medicai
dCons
umers
Employer
s
Organizations Participating in HIE
Perhaps the most influential groups are the least represented
Source: “Migrating Toward Meaningful Use: The State of Health Information Exchange,” eHealth Initiative, www.ehealthinitiative.org, August 2009.
Current Status of Employee Engagement
Healthcare model is reactive • Members engaged after illness, resulting in higher costs for
members and employers Members have limited visibility into their personal data, • Difficult to understanding impact of utilization and health• Spend a disproportionate effort on the “administrative”
aspects of healthcareLittle capability for members to improve and proactively manage their health and wellness “Silos” and lack of awareness limit members’ ability to compare price, quality, and outcomes
Transforming Behaviors
Pactiv Corporation (www.pactiv.com)
• Help employees take control of their health and become better consumers
• Multi-employer “Health Hub” to promote information and tools for consumers
Paychex (www.paychex.com)
• Educate employees on the economics of health care
• Programmatic changes– Plan design changes – copay &
deductibles– Health questionnaire– Biometric screens– Smoking cessation
2/4/2010 22
Employer Stakeholders
• Medical, Rx claims data
• Health Risk Assessments
• Biometric data
• Eligibility & Demographic data
• Disability, Workers Comp data
• Employee engagement portal
Employers contribute:
2/4/2010 23
Employer Stakeholders
• Use Predictive Modeling to identify risk in advance
• Consider Value-based plan design
• Support disease management and wellness
• Implement on-site clinics, rewards programs
Employers benefit:
• Plan design supports preventive care
• Timely reminders for best-practice compliance
• Rewards program
2/4/2010 24
Consumer Stakeholders
• Personal Health Records (PHR)
• Health Risk Assessments (HRA)
• Biometrics
Consumers contribute:
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Consumer Stakeholders
• Easily maintain health records in a single place and share appropriately
• Engage in communications from various parts of the healthcare ecosystem now delivered in a streamlined manner
Consumers benefit:
• Easy access to PHR, EMR
• Streamlined, value-added communications from all components of the healthcare delivery system
• Plan design that complements healthcare needs
• Better access to care – Physician Network, Employer-sponsored programs, Clinics, etc.
Extending the RHIO
HospitalsLabsInsuranceDiagnostics
SYSTEMSSecurity Access
Consent LogMPI
MD RoutingApplication Services
RHIO SERVICES
SERVICE PROVIDERS
PHYSICIANS
HOSPITALS
INSURERS
EMPLOYERS
CONSUMERS
• Gateway to engage patients
• Protect/respect privacy
• Extend continuum of care esp for Medicaid and elderly
PHYSICIANS
HOSPITALS
INSURERS
HEALTH SERVICES
EMR/VHR
Engagement
• Complete clinical profiles
• Improved service• Increased quality• More effective care
programs
• Platform for eVisits, scheduling, Rx refill/renewal, personalized health messaging
A Parting Thought
What is “Meaningful Use?”
HHS Health Outcome Policy Priorities• Improve quality, safety, and reduce health disparities• Engage patients and families• Improve care coordination• Improve population and public health• Ensure adequate privacy and security protections for
personal health information
Source: HHS Meaningful Use Matrix, http://healthit.hhs.gov/portal/server.pt
Meaningful use should center on the patient experience, not on the provider infrastructure
What is “Meaningful Use?”
Engage patients and families• 2011 Objectives
o Provide patients with electronic copy of- or electronic access to- clinical information
o Provide access to patient-specific educational resources
o Provide clinical encounter summaries for patients
• 2015 Objectiveso Access for all patients to PHR populated in
real time with data from EHRo Patients have access to self-management
tools o Electronic reporting on experience of care
What should “Meaningful Use” mean?
Engage patients and families in a manner that promotes their own specific and personalized experience of their own health care in order to assist them in making decisions based on thorough evaluation of their best possible options
• New 2011 Objectiveso Provide coordinated information to patients from all of their health service providerso Provide access to patient-specific educational resources o Provide clinical encounter summaries for patients
• New 2015 Objectiveso Access for all patients to personalized portals populated in real time with data from all
health care service providers from which they have received serviceo Patients have access to self-management tools o Electronic reporting on experience of careo Electronic report on quality of care and provider ratings
Health Reform
What has happened?• Parsing of Senate and House Bills• Insurance exchanges• Medicaid expansions• Medicare cuts• “Cadillac plan” tax• Prevention and wellness credits• Employer enrollment and cost coverage mandates• HSA and Flex Spend caps
What’s Next?
Behavioral Economics of Healthcare
Engaging the Consumer
Thank you for your time
Contributors
35
Behavioral Economics and Healthy Behaviors
The Need for Health Information ExchangesFebruary 4, 2010
Department of Health Care ManagementCenter for Health
Incentives, Leonard Davis Institute of Health Economics
CHERP, Philadelphia VA Medical Center
University of Pennsylvania School of Medicine
Kevin Volpp, MD, PhD
Kevin Volpp, MD, PhD – not for reproduction without permission 1
Individual behavior is key to the health of the US population
• 71% of US population overweight or obese
• Smoking the leading cause of preventable mortality – 438,000 deaths per year
• 50% of patients put on statin post-AMI stop taking within 1-2 years Schroeder SA. N Engl J Med 2007;357:1221-1228
Source: Schroeder SA. N Engl J Med 2007; 357:1221-1228
40
Inadequatehealthcare10
Environmentalcauses5
Social circumstances
15Genetic predisposition
30
Behavioral patters
Kevin Volpp, MD, PhD – not for reproduction without permission 2
22,000
14,000
4,000500
8,569
4250
5,000
10,000
15,000
20,000
25,000
2,498
1990 20001995 2005
55
Nationwide growth of payday lenders vs. Starbucks coffee shop locations, 1990-2005
Payday lendersStarbucks
Problems are not restricted to health…
Kevin Volpp, MD, PhD – not for reproduction without permission 3
Information does not always solve the problem
Kevin Volpp, MD, PhD – not for reproduction without permission 4
Using decision errors that ordinarily hurt people to help them
People make decisions in ways that are often far from optimal
• Overweighting of the present
• Insensitivity to probabilities
• Framing
• Loss aversion
• Status quo / default bias
Source: Loewenstein, Brennan, and Volpp, JAMA, 2007
In designing interventions, we
can use these biases to make
interventions more effective
Kevin Volpp, MD, PhD – not for reproduction without permission
How, when, how often we present information is key to changing behavior• Information needs to be:
• visual and readily comprehensible to consumers• available at the time people are interested in finding it• customized to each individual consumer
• Frequent feedback is essential, given the many other stimuli people are bombarded with
• Technology provides a platform that enable interactions that can drive higher rates of consumer engagement• Change defaults • Information framing• Bidirectional feedback for incentive programs
Source: Volpp, Pauly, Loewenstein et al., Health Affairs 2009; Blumenthal K and Volpp KG, JAMA 2010
