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Michigan Association of Health Plans. Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem. Rick Murdock Executive Director Michigan Association of Health Plans. Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem. A Health Plan Perspective - PowerPoint PPT Presentation
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Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem
Michigan Association of Health Plans
Rick MurdockExecutive DirectorMichigan Association of Health Plans
MICHIGAN ASSOCIATION OF HEALTH PLANS6/23/2010 1
Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem
A Health Plan Perspective
–Context For Health Plans• Trends• Obligations• Expectations
MICHIGAN ASSOCIATION OF HEALTH PLANS6/23/2010 2
Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem
Trends1. Michigan Economy2. Aging Population3. “Retailing” of Health Care Purchasing• Movement from Employers to Individuals
4. Increasing role of government5. Value Based Purchasing and Delivery of Health
Care in an Increasingly Diversified Market
MICHIGAN ASSOCIATION OF HEALTH PLANS6/23/2010 3
Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem
Trends (continued)
6. Consolidation of State and National Health Plan Markets
7.Increasing Reliance on Technology to Transact Business and Deliver Health Care
MICHIGAN ASSOCIATION OF HEALTH PLANS6/23/2010 4
Issues in Healthcare• Quality• Lack of information at the point
of care• Clinical Decision Support• Patient Centered Medical
Home
Efficiency• Paper based processes• Segmented data sources• Lack of integration
Process• Information needs• Inefficiency in the office• Administrative simplification
Security• Providing Secure access to
information where it is needed• Storing data centrally vs. accessing
data where it resides• Reduce unsecured printed
information
MICHIGAN ASSOCIATION OF HEALTH PLANS6/23/2010 5
HospitalPrimary Care Specialist Health Plan
Common Challenges in the Community
State/Federal
Information Technology: Obligation for Health Plan Participation
• “Meaningful Use” Incentives for Providers
• Medicaid IT Strategy (Medicaid Health Plans Role)
• State Information Technology Plan (MiHIN)
MICHIGAN ASSOCIATION OF HEALTH PLANS6/23/2010 7
Federal Reform: Health Plan IT
Administrative Simplification1.Existing Requirements to be implemented:– HIPAA (5010 Transaction Codes)– ICD-10
2.Standard Operating Rules– Eligibility Verification/Claims Status– Health Claims– Standard for EFT, Claims Remittance
MICHIGAN ASSOCIATION OF HEALTH PLANS6/23/2010 8
Leveraging a Single Platform
The MAHP Vision(MAHP) is partnering with members and Covisint to simplify collaboration through a centralized web
solution, called “MAHP Connect.” This solution enables the sharing of information from MAHP and MAHP members to their respective communities.
• Base Solution Offering:– Centralized MAHP Portal with Security and Messaging– 24/7 Support and Help Desk– On-boarding Support for new members– Multi-Payer and Medicaid Eligibility Validation– Multi-Payer Claim Status Check– Federated SSO from MAHP Portal to participating Members Portals– Secure File Exchange Services– Directed Bulletin Services– Secure E-Mail for all users– Self Service User Registration
6/23/2010 MICHIGAN ASSOCIATION OF HEALTH PLANS 9
Leveraging a Single Platform• The MAHP Vision (continued)
• MAHP Connect Target Services – Targeted Services:
• Medicaid COB 1500 Solution• Referrals and Authorizations• One-off Claims Entry• Electronic Claims Attachments• Expose virtually any 3rd party application• Admission Notifications• Appeals Processing• Documentation Requests/Response• Consent Forms Processing
• Integration to emerging Health Information Exchanges in Michigan• Tools for delivery of MAHP Member specific information and services
6/23/2010 MICHIGAN ASSOCIATION OF HEALTH PLANS 10
Knowledge Managemente-Prescribe
PHR data access for physiciansSecure Email/FaxDirected bulletins
Secure File Exchange24/7 Availability
3rd Party SSO and Federation
Disease Management Integratione-Prescribe
Point of Service Evidence Based GuidelinesClinical Decision Support
Immunization registry (Pending)Disease Management
Lab and Rad resultsPerformance Reporting
Tools for Practice DevelopmentLegal Support for your practice
Physician EducationMSMS Physician Link
My1HIE MyWorkspaceGeneral Fax Management
Test Order Processing
Online Universal referral formCredentialing Verification ServicesOne-off claims entryFFS 1500 e-Claim submissionElectronic Claims AttachmentsEligibilityClaim StatusMedication HistorySSO to Participating Payer portalsDistribution of Performance ReportingClaim Appeals Process
MAHP Connect: Extending Services
6/23/2010 MICHIGAN ASSOCIATION OF HEALTH PLANS
MAHP Connect: Laying the Foundations
• Simplify and unify administration Easily remember One ID & password Easily learn one simple Interface Minimum hardware/software requirements Supercharge the Fax machine – connect it to the network Securely communicate with in-network portal users Connect existing PMS & EMR to Covisint then share data with any AppCloud application
• Improve security and access to sensitive data No need to share IDs Delegate access to applications (sidecars, etc.)
• Immediate time savings translate into real $$$
Providers• Simplify and unify administration
Reduce costly helpdesk calls Gain Control over paper processing with Bar coded Fax management & workflow Securely communicate in-network portal users
• Improve security, audit & tracking Reduce ID & password sharing Leverage delegated access to applications
Leverage economies of scale Shared security Shared infrastructure and services Leverage Covisint’s messaging hub
Payers
MICHIGAN ASSOCIATION OF HEALTH PLANS6/23/2010 12
Successful Health Plans will need to…• Offer exceptional value in the marketplace to purchasers.
– Employers– Government– Individuals
• Meet the value expectations of many different purchasers with diverse needs.– Quality (including Patient Safety)– Cost Effectiveness – Access and Flexibility (product design, information systems, etc.)– Health and Productivity Management– Is health care an expense or investment?
• Shift the focus from treating illness to include maintaining wellness. – Move individuals to taking personal accountability for maintaining health
• Recognize the value of relationships.
• Maximize the value of technology.
MICHIGAN ASSOCIATION OF HEALTH PLANS6/23/2010 13