HIMSS - Real Payer and Provider Collaborations - Final
Signaler
Daniel AbdulSuivre
17 Jun 2016•0 j'aime•187 vues
HIMSS - Real Payer and Provider Collaborations - Final
17 Jun 2016•0 j'aime•187 vues
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Signaler
Daniel AbdulSuivre
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HIMSS - Real Payer and Provider Collaborations - Final
- 1. HIMSS MN Presents: Role of Provider and Payers in Improving Health Outcomes Thursday, February 26, 2015 Welcome!
- 2. Thank you to all our Annual Sponsors!
- 6. Please keep an eye on HIMSS MN Communications for further information HIMSS MN 2014-2015 Event Calendar Date Format March 12th Networking Event April 13th HIMSS National Chapter Reception (Hard Rock Chicago) May 21st 14th Annual Spring Conference (Send in abstracts!) June 25th 3rd Annual Charity Golf Tournament June TBD Twin Cities Summer Social July TBD SE Minnesota Summer Social August 5th Webinar: Patient Portal
- 7. The role of Providers and Payers in improving health outcomes through interoperability Dan Abdul, VP/CIO UCare Daniel Abdul © 2012 Real Provider and Payer Collaboration
- 8. 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 4 3 2 Current State1
- 9. 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?
- 10. Who is the patient MRN: 000123456789
- 11. 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.
- 12. Healthcare – It’s about the patient “Why are you here today and can you tell me your symptoms over the last three months?”
- 13. “The state of health care information.”
- 14. 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
- 15. 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
- 16. 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.”
- 17. Security is not an Excuse
- 18. 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
- 19. 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 where Avoid information gaps between providers Reduce the exit cost to the patient Stop asking questions you know I can’t answer Interoperability enabling a learning health system Patients 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.)
- 20. 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
- 21. A View at the Future Daniel Abdul © 2012 Information if transferable in near real-time based on the patients desires Personal Health Record Payer Aggregated Health Information Regional Health Information Registry Healthcare Provider Patient
- 22. Think Innovative
- 23. Please keep an eye on HIMSS MN Communications for further information HIMSS MN 2014-2015 Event Calendar Date Format March 12th Networking Event April 13th HIMSS National Chapter Reception (Hard Rock Chicago) May 21st 14th Annual Spring Conference (Send in abstracts!) June 25th 3rd Annual Charity Golf Tournament June TBD Twin Cities Summer Social July TBD SE Minnesota Summer Social August 5th Webinar: Patient Portal
Notes de l'éditeur
- UCare is an independent, nonprofit health plan Was created in 1984 , with almost 500,000 members in Minnesota and western Wisconsin. UCare serves more people from diverse cultures and more people with disabilities than any other health plan in Minnesota. Just over $4 billion in revenue and just shy of 1000 employees So how do we get to true collaboration in HealthCare and not just build interoperable systems. And why is this even important?
- We need to remove the EMR and Claims systems from being the center of our universe and put the patient there. Interoperability mandate is one of the tools that can unify our view of the patient but compliance alone will not necessarily drive the outcomes we need. So how do we think differently about this. Several success stories I read about are tied to vendor proprietary technology which in my opinion has it’s limits. I like my vendor partners and we need them.
- What does this have to do with interoperability and collaboration? A physician can only see what’s in the EMR. A lot of us don’t see physicians in only one health system. A lot of history and information correlation is lost when this happens.
- This leads to a health care information map that looks something like this. And by the way, some of those pipes are blocked.
- EHR system across providers (Currently the main focus). How about including payer data which would really support ACO and other similar relationships. This could also drive population health. Payer get the information of the doctor vist when you patient was out of town. And for those of use that are embracing PHR solutions or even just wearables that keep our vitals, sleep and exercise history.
- The value of knowledge diminishes over time knowledge has little power if no one shares it Knowledge has almost no power if not leverage to address a need. Knowledge is very inter-related; i.e. one part adds value to another part and when combined, knowledge has much more power in contrast to restricting knowledge to certain select areas. Knowledge in itself gives you no strategic advantage unless acted upon.
- Tell that to Anthem. Security is a big obstacle. This is a key element the opposition to interoperability use in their argument. But lets first align expectations with reality. Physical security example. Cyber security in reaching a tiping point similar the crime wave in 1933 to 1934 which led to the formation of the FBI. This is clear a national security issue, which CIOs alone can’t fix. We should not let anyone think we can. However, what if we create models that allow interoperability but let the patient decide how much risk, vs, value they want.
- How useful will phones be, if I could only call people in my city or who use the same phone company. Anything short of open standards, has a limit. The video conferencing market is a good example of the vendors eventually realizing the importance of interoperability and forming the Unified Communications Interoperability Forum Alliance.