HIMSS MN Presents:

Role of Provider and Payers in Improving Health Outcomes

Thursday, February 26, 2015

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HIMSS MN 2014-2015 Event Calendar

Date FormatMarch 12th Networking EventApril 13th HIMSS National Chapter Reception (Hard Rock Chicago)May 21st 14th Annual Spring Conference (Send in abstracts!)June 25th 3rd Annual Charity Golf TournamentJune TBD Twin Cities Summer SocialJuly TBD SE Minnesota Summer SocialAugust 5th Webinar: Patient Portal

Daniel Abdul © 2012

The role of Providers and Payers in improving health outcomes through interoperability

Dan Abdul, VP/CIO UCare

Real Provider and Payer Collaboration

Agenda

Competition Can’t Stand in the Way of Results

Sharing Data is Not Enough

Innovators Will Still the Day

Security is Not an Excuse

The New Collaboration Paradigm6

5

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Current State1

Healthcare – It’s about the patient

Have you ever been to a clinic, or heard a patient’s story, where it seems the entire process is about meeting standards, regulations and contract language?

Who is the patient

MRN: 000123456789

Healthcare – It’s about the patient

At the core of improving healthcare is a unified view of the patient and their goals by all the patient’s providers and payers.

Federal and State laws have been passed to drive toward this, but true interoperability continues to elude us. While progress has been made in smaller groups, large-scale interoperability will take a radically different way of thinking.

Healthcare – It’s about the patient

“Why are you here today and can you tell me your symptoms over the last three months?”

“The state of health care information.”

Current Obstacles We can address foundational, structural and

semantic levels of interoperability, but what about the missing data? EHR vs. PHR vs. Payer data We overlook the value of narrative clinical notes

Different organizations view interoperability strictly through the lens of the data they need

Address smaller providers - home-grown and legacy applications

Traps of proprietary technology and standards

Sharing Data is not Enough

Data is not information Most organizations are not fully leveraging the

data they have to create actionable information We need to share the goals of the patient and the

next best action The patient needs to be in the drivers seat

Healthcare – It’s about the patient

If you are unfortunate to see a specialist in another network, you get “fill out these ten medical history forms so we can get information that is already in your records. Oh and by they way start from birth.”

Security is not an Excuse

Healthcare can’t be a zero-sum game Healthcare is extremely complex, and is built upon

a long history of siloed efforts All else being equal, a firm does what is in their

best interest – the joint provider and payer interest needs to be the patient’s interest

Lower exit cost for patients, “a true marketplace” Registries are desired, but let’s look at patient-

physician driven sharing methods. i.e. Blue button Reduces the feeling of a loss of control by the patient Reduces the concern of being on “the grid”

Competition Can’t Stand in the Way of Results

Don’t make cost saving the driver of interoperability. What can’t we do today that we would be able to do?

Provide better care for chronic disease any whereAvoid information gaps between providersReduce the exit cost to the patient Stop asking questions you know I can’t answer Interoperability enabling a learning health systemPatients will learn from the outcomes that have been

achieved for specific treatments and be able to make informed decisions based on that understanding

Innovators Will Steal the Day (cont’d.)

The technology needs to work across borders The software is a tool, the information is the

product Duplicating and overlapping standards, from

vendors and standards development organizations (DSO), slow us down

Vendors currently are not incentivized to achieve what is best for the patient

The New Collaboration Paradigm

Daniel Abdul © 2012

A View at the Future

Information if transferable in near

real-time based on the patients desires

Personal Health Record

Payer Aggregated Health Information

Regional Health Information Registry

Healthcare ProviderPatient

Think Innovative

Please keep an eye on HIMSS MN Communications for further information

HIMSS MN 2014-2015 Event Calendar

Date FormatMarch 12th Networking EventApril 13th HIMSS National Chapter Reception (Hard Rock Chicago)May 21st 14th Annual Spring Conference (Send in abstracts!)June 25th 3rd Annual Charity Golf TournamentJune TBD Twin Cities Summer SocialJuly TBD SE Minnesota Summer SocialAugust 5th Webinar: Patient Portal