Wednesday, November 10, 2010

#WHIT bright and early session on Accountability through Analytics

More from the last day of #WHIT...

A presentation by MDI and Analytics Partners on Accountability through Analytics

Lisa Davis, CEO of Analytics Partners and Cary Smith, VP of Business Architecture at MDI.

7:15 am -
8:10 am
BREAKFAST MARKET INSIGHT: Healthcare Reform: Leveraging Analytics to Optimize ACO Operations
Learn how data warehousing and analytics can help you address today’s most challenging healthcare reform initiatives.
  • Drive better outcomes through evidence-based guidelines and clinical performance measures
  • Use benchmarks to increase efficiency in contracting with health plans and providers
  • Monitor and manage adherence to regulatory guidelines
Lisa Davis
Chief Executive Officer and Founder
Analytics Partners 

 View Biography

Both companies are based in Jacksonville, FL.

MDI started developing networks and analytics for prisons. MDI offers a Software as a Service Analytics solution. They have an interesting claims analysis drill down based around a body map.

Cary Smith: 

Incentives emerging for Value-based decisions. Evidence-based medicine. NCQA put out draft standards that may influence ACO management.

Accountable Care Organizations will be judged based on their performance. 

A fascinating discussion ensued with the audience. A quick summary.... When patients have developed a condition measurements around the condition don't necessarily improve the outcome. The best option is to identify the condition and work out how to measure the pre-cursors to the condition and watch for it in order to take corrective action early. However, up to now the spending on lifestyle coaching has not paid off. I believe that the reason it has not paid off is that we have not worked out how to integrate the coaching in to the "Rhythm of life" of those individuals.

Is Medical Home a competitor to ACOs?

Companies appear to be ready to move forward with ACOs regardless of the outcome of the recent elections.

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#WHIT The final day of the conference and I am the only person here with an iPhone App that connects to my PHR

More from #WHIT....

8:10 am -
8:20 am
Co-Chairperson’s Welcome and Opening Remarks
Jennifer Covich Bordenick
Chief Executive Officer
eHealth Initiative 

 View Biography

I appear to be the only person in the audience with an iPhone App that has a link to my health record....

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Tuesday, November 09, 2010

#WHIT closing session from Day 2

More from WHIT:

Availity (who recently purchased RealMed) talking about connectivity between HealthPlan, Provider and Patient.

4:45 pm -
5:30 pm
CLOSING KEYNOTE PANEL DISCUSSION: Payer and Provider Collaboration – Pioneering Partnerships Advancing Cost Savings and Achieving Better Outcomes
  • Payment models to promote cost savings and better quality of care
  • Leveraging the power of providers and plans coming together to contain the rising cost of health care
  • Payer initiatives to incentivize improved quality and cost savings
  • Identifying and overcoming challenges
Catherine Peper, CISSP, CISM
Vice President of Health Information Technology
Blue Cross Blue Shield of Florida 

 View Biography

Joseph Taylor, CEBS, RHU, HIA
Vice President, Enterprise Business Process, Enterprise Health Care Management
Health Care Service Corporation 

 View Biography

Craig Schneider - Moderator

Catherine Peper taling about next generation of HIT systems 
- Industry Standards codes and formats
- PCMH and other emerging models

Competitors have to cooperate

Multi-Payer solutions are essential.

"Payers spend a lot to look different. Providers and integrators spend a lot to make payers look the same."

Availity & Humana drive market leading adoption:

Electronic Transactions:
97% E&B
90% Claims Submissions
72% claims status
70% E remittance Advice (big focus area)
36% EFT
25% Auth/Certs
26% e-RX
10% CareCalc
<1% ACP

Driving to 95% of all transactions being Electronic.

New in 2011:
- Enhanced Clinical Reviews
- Coordination of Benefits (e-COB)
- Care Opportunities / gaps in real time
- e-Campaign/contact management
- e-Appeals

Challenges:
ANSI 5010 - 1/1/2012
ICD-10  - 10/1/2013

Extreme Standardization coming immediately afterwards.

AHIP: ICD-10 will cost average Health Plan $12/Member

Alternative Care Delivery, Financing and Funding:

- Patient centered Medical Home
- e-visits / online  care / telemedicine
- Accountable Care Organizations
- Gain Sharing
- Bundled Payments
- Collaborative Care

We need to address standardization of clinical quality measures otherwise we will drown clinicians. 

Joe Taylor: VP and Enterprise Process Leader - CEBS

In clinical - If you build it they don't come. You have to integrate and meet the clinician where they want to be. 

We need a coordinated Partnership, Technology and Reimbursement Strategy

Practice Criteria and capabilities:
How ready is the practice? Access, EMR, NCQA criteria etc.
Shared Data on Gaps in Care via Clinical Connectivity - can you leverage MedDecision, Availity etc.
Use of High Value Efficient services - Specialist, Hospitalists, Ancillaries

Joe Taylor: Not sure how HIEs will work in practice. 

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#WHIT iPhone and Smartphones used in HealthCare

More from WHIT:

4:00 pm -
4:45 pm
Integrating Mobile Devices to Improve Member Health and Wellness
Understand challenges involved in support of mobile devices from the myriad of new devices, disparate operating platforms and devices types and the overriding requirement to ensure privacy of information without squashing the “cool factor” for end users.
  • Capturing innovation, during ideation
  • Evaluation for adoption of emerging technologies
Aurel Kleinerman, MD, PhD
Chairman and CEO, Blue Iris Division
MITEM Corporation 

 View Biography

20% of physicians use Epocrates on iPhone = 175k physicians

Physicians and clinical workers ambulate.  They are mobile. 
Many Computers - No desk. 
Multi-tasking environment
Except when face-to-face with patients.

Physicians are information "Gluttons"
Medical references and Patient Data.

Healthcare delivery is a team effort. The Physician needs to be in touch.

The Appeal is a device that provides voice and data in one device.

All smartphones do this - But iPhone is doing it "right".

Large screen, lots of memory, push notification

Push Notifications are authenticated and encrypted. Works over cellular or WiFi.

iPad - Large screen and large battery - no need to recharge during the day unlike many laptops.

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#WHIT

#WHIT - 
11:15 am -
12:00 pm
The Role of Incentives in Driving Member Behavior – What Works and What Doesn’t
Although behavioral interventions have the potential to improve health, sustainable behavior change is difficult. Many people have difficulty changing health behaviors because it requires trade-offs between immediate consumption and delayed, often intangible, health benefits. Rewards and incentives can provide people with immediate and tangible feedback that helps make it easier for them to do in the sort-term what is in their long-term best interest (and the best interest of employers, insurers, and public policy - the quadruple bottom line).
  • Incorporating incentives platforms into your strategy
  • Explore how to measure results
  • Evaluate cost benefits
Les McPhearson
Director, Consumer Innovation
Humana, Inc. 

 View Biography

70-75% of cost in Healthcare is from preventable lifestyle driven issues.

ie. 15% of GDP  spending is preventable. $1.5T

"Every extra pound of belly fat is proof of the power of advertising"

Ken Thorpe, Emory University: Obesity related health care spending will quadruple to $344B in nine years

This is a business problem because businesses benefit from employees being healthy.
 Everyone else benefits from people being sick - Dee Eddington.

Focus on chronic conditions to bring down costs through disease management and clinical programs

Focus on 80% of low utilizers to KEEP costs down.

Wellness needs to be Proactive. Most are currently Reactive.
Incentives have a role to play. 

Engage people in their health, even when they aren't sick in ways that are fun and meaningful and reward participation and achievement.

Promote effective and on going relationships.

- Recognize needs
- Find passion points
- Build on existing relationships

Hyperbolic discounting. E.g. we discount value of exercise today for it's future intangible benefit.
don't see benefit = Don't Do.

Incentives make people do something they wouldn't have done.

- Initial sign-up 
- Participation
- Long term engagement

The incentive has to match the value of the benefit and effort to participate.

"Facilitate Health"   - Be supportive not prescriptive
Meet People where they are.

Make Fun things healthy.

Foster entanglement.... Make it coo, Fun and drive Excitement to maintain engagement
e.g. involve the family.

Incentives: Tangible and Intangible

It's not just gift cards. Intangibles are important such as Recognition, Virtual rewards, acceptance, group competition and Social Responsibility.

We are competing against Madison Avenue. 

Don't forget the financial and actuarial rigor.

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#whit Checking out Health Plan Innovation from Intermountain

More from WHIT: 

10:30 am -
11:15 am
Delivering an Integrated Patient Portal - An Intermountain Case Study
  • Defining a patient and member centric approach to developing functionality
  • Driving the organization towards integrated functionality across disparate business units and divisions, including hospitals, clinics and the health plan
  • Creating a system level governance model for decision making
Ryan Smith
Assistant Vice President, I.S. Operations and eBusiness
Intermountain Healthcare 

 View Biography

Looking at Patient Portal - 4 yr old design in transition.

Labs are most popular feature on the patient MyHealth site

PatientCam is an interesting initiative. 

Parents of children in the Newborn Intensive Care Unit. Introduced in 2009 at one site. Now expanding to other sites (they have 7 NICUs)

Parents can register and be able to log on to myHealth and be able to view (no audio) the crib that their baby is in.  30 minute segments of video are allowed. Nurses can override to take video offline.

This has reduced family stress when one or both parents can't be physically present at the NICU site. For example if the mother is being treated in another hospital or part of the hospital.

Family Tree - Family Health. Working with Microsoft HealthVault to capture family history information. 

InterMountain is largely a SharePoint Portal site with a FACETS back-end 
User Centric Design includes a Patient Advisory Council.

Emergency Medical Card allows a CCD export so members can take information from medical records with them.

New design:

More color.
Loses Left side navigation and move to Horizontal Tab metaphor.

Building a browser-based App for mobile. Basic functions. e.g. Request a Prescription Refill.

Governance: eBusiness Chairs Committee and involves senior executives from all groups.

"When you look at information from Patient/Consumer Perspective you have a compelling argument for creating an integrated patient view of all services you provide."

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@Whit Day 2 kicks off with an interoperability discussion

More from #WHIT World Health Care Innovation and Technology Congress 6.0

8:15 am -
8:30 am
Co-Chairperson’s Welcome and Opening Remarks
Jennifer Covich Bordenick
Chief Executive Officer
eHealth Initiative 

 View Biography

We have come a long way. 
10-15 years ago very little support for EHRs. Consumers not interested. 

How many kids coming out of med school in the next few years will put up with an EHR that doesn't come up on their iPhone/iPad?

The Opening Panel will discuss interoperability

8:30 am -
10:00 am
KEYNOTE PANEL DISCUSSION: Interoperability – Establishing an Infrastructure to Support a Connected Health Environment
  • Key components to creating a truly interoperable health care system
  • The role of regulatory and certification bodies
  • Evaluate standards and adoption
  • Identify new approaches to integration
  • Evaluate the cost of interoperability
  • The future of interoperability: The relationship between PHRs and the consumer movement with RHIOs, HIEs, and NHIN – how will they all coexist?
Moderator:
Aaron Seib
Chief Executive Officer
National eHealth Collaborative 

 View Biography

Panelists:
Bill Beighe
Chief Information Officer
Physician Medical Group of Santa Cruz and Santa Cruz Health Information Exchange 

 View Biography

Tom Burns
Executive Vice President
Alcatel-Lucent;
President
Enterprise and Strategic Industries organization 

 View Biography

Gwendolyn Lohse
Deputy Director and Managing Director, Committee on Operating Rules for Information Exchange (CORE)
CAQH 

 View Biography

Charles (Chuck) Parker
Executive Director
Continua Health Alliance 

 View Biography

Bill Spooner
Senior Vice President and Chief Information Officer
Sharp HealthCare 

 View Biography

Aaron Seib is moderating the panel.

Bill B: Real adoption of EHRs is low. The apps are not very good and they are not interoperable. Clinical and Billing are typically separate.

Santa Cruz HIE has 95% inclusion of 270,000 county population in the Master Patient Index. This has been built since 1996. 100k documents exchanged each month. 400+ MDs and 700+ Users.

The average practice size in Santa Cruz is 3 Physicians.

Gwen L: CAQH Non profit alliance of Health Plans and trade associations. CORE Committe on Operating Rules for Information Exchange (CORE)
UPD: Universal Provider Datasource. A database of providers. 870,000 unique providers. 600 participating plan, hospitals and others use UPD. 12 States and DC have adopted the CAQH Standard Provider application.

CORE rules have a connectivity requirements. Aligned with MHIP.

IBM analysis - CORE Phase 1 could yield $3B of savings over 3 years across the industry

Chuck P: Continua - pushing market in one direction for devices. Develop industry standards. Creating an ecosystem of interoperable Health Devices.

Certification program for interoperability of devices and the collective power of the organizations to encourage market standardization.

Tom B: Alcatel - Improve people's lives by helping them communicate. 

HealthCare - investing in Telemedicine, remote care. Most investment in healthcare has been about admin and moving paper. Not in advancing the care of patients.

Bill S: Sharp HealthCare of San Diego. Interoperability has focused internally on patients in the network.  Sharp's approach is to connect everyone in network in to their IT Network and provide the link to the San Diego HIE and on to the National HIN

Low adoption of EHR in small practices. 

Everyone needs a Patient Consent Framework.

By 2020 Patients will EXPECT alerts, to use their phone to access information.

Bill B: Providers want to share information. so much benefit comes from sharing. But there needs to be confidentiality. 

Bill S: the emergence of the PHR means the patient owns their data.

Gwen L: How do we start building trust in to the system. Transparency and Trust are two critical building blocks. 

Tom B: You have to work across the silos to convince people of the benefits of sharing.

Bill B: we need to build a medical grade network. One that can reach out to insecure endpoints.

Bill S: Devices are ahead of the business models. 

Question from the Audience: What is happening to move forward the issue of Unique Patient Identifier

My thoughts: Why is this an issue? Is there a Universal ID for the Internet - No - Yet things work. We are seeing Facebook, Google, OpenID and others that provide the ability for an INDIVIDUAL to connect multiple personae together. 

Tom B: Consent will become less of an issue with Gen Y. They are sharing on their wall anyway.

"it's the network"  (stoopid!)

Chuck P: Connectivity creates value. Microsoft anf Google need apps and devices that give life and meaning to the PHR.

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