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HealthBridge is one of the nations largest and most successful health information exchange organizations. From Interaction to Integration to Transformation:

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Presentation on theme: "HealthBridge is one of the nations largest and most successful health information exchange organizations. From Interaction to Integration to Transformation:"— Presentation transcript:

1 HealthBridge is one of the nations largest and most successful health information exchange organizations. From Interaction to Integration to Transformation: Healthcares Journey & Informations Role Mike Mote Vice President Product & Service Strategy 1

2 2 HealthBridge Background

3 3 HealthBridge One of the nations oldest, largest, most advanced and successful health information exchanges In operation since 1997 501c3 Not for Profit One of only a handful of HIE/RHIOs nationwide with a sustainable business model (Pre ARRA) 97% of revenue from fees; <3% grants 5-12% annual return for last eight years

4 4 HealthBridge Delivers more than 3.5 million clinical messages PER MONTH; more than 35 million messages for 2010 Total of 50+ hospitals, 7500 physicians Connectivity with 40+ HIS/LIS; 27 different ambulatory vendors, 60+ versions Provide technology infrastructure for four other HIEs – Dayton HIN, CCHIE, HealthLINC, NEKY RHIO Cincinnati Network 26 local hospitals in Kentucky, Ohio and Indiana 5500+ physicians 17 local health departments Large commercial, hospital, & physician office labs Diagnostic centers

5 5 HealthBridge

6 6 HealthBridge HIE Value Progression Meaningful Use, Medical Home and Payment Reform Basic HIE Stage 1 MU EHR Adoption (REC Services) Basic Electronic Messaging (NHIN DIRECT) Community Portal Web-Based Results Delivery Value: Dramatic reduction in redundant paper, phone contacts; Greater efficiency Intermediate HIE Stage 2&3 MU Structured Data Delivery to EHRs Results Delivery (Lab, Rad, ADT, etc.) ED, Admission, & Discharge Alerts & Notices Summary Record Exchange (CCD) Value: Necessary to achieve truly electronic workflows; Dramatic increase in efficiency Advanced HIE PCMH, ACO & Payment Reform Readiness Data Warehouse & Analytics Disease Registry Quality Reporting Support Full Integration Services & Bidirectional Exchange Value: Dramatic improvements in quality and performance

7 7 HealthBridge – HIE Services EHR Integration/Interfaces Electronic Results Delivery – Labs, Radiology, ADT, etc. Electronic Order Entry E-Prescribing HIE Portal & User Management HIE Technology Support – Master Patient Index, Provider Directory and Record Locator Service Summary Record Exchange Nationwide Health Information Network Direct and CONNECT Gateway & Connectivity Public Health Reporting & Syndromic Surveillance Billing and Eligibility Verification HIE Consulting, Outsourced Technology & Implementation

8 8 HealthBridge – Future Plans REC - Expanded Meaningful Use Assistance for Stages 2-3 Beacon - Enhanced Suite of Quality Improvement, Care Transformation and Accountable Care Services and Tools (Data Warehouse, Data Analytics, Summary Patient Records, etc.) Patient Engagement - Connectivity to Personal Health Records, Mobile Technologies and Consumer Technologies (Beacon, IN Challenge Grant) HIE Expansion – Connect to new providers and stakeholders for improving continuity of care (home health, long-term care, payers, etc.) Connect with State HIEs and Provider Networks (IN, KY, OH) Use Nationwide Health Information Network (NwHIN) Direct and CONNECT platforms Spread of Advanced Technologies to Other Communities Community Credentialing

9 9 From Interaction to Integration to Transformation: Healthcares Journey & Informations Role Creating a Community Data Repository

10 10 Healthcares Journey Whether or not you believe that REFORM is coming here are some thoughts to ponder: The US healthcare system is broke; the current rate of growth can not be sustained; 1/6 th of the US economy is based upon healthcare New York Times article claims By 2020 the American health insurance industry will be extinct. Accountable care is coming; Value based payments are coming; Volume based payments will continue to decline Missing data today results in missed opportunities to: Prevent complications Ensure better outcomes Reduce unnecessary costs Reduce patients safety risks Improve transitions in care

11 11 Incentives Penalties Business Realities The Journey

12 12 Care Transactions Individual Provider Care Plans with some coordination via referrals Care Integration Coordinated Care Plans & Early stage PCMH Care Transformation Single Care Plan & Advanced stage PCMH; the Medical Community Care Deliverys Journey

13 13 Care Transactions Patient Outcomes Measures Care Integration Population based metrics & health status measurements Care Transformation Demonstrable Improvement in Population Health with ongoing refinement of the metrics Quality Metrics Journey

14 14 Care Transactions Fee for Service Care Integration Pay for Performance & Shared Savings Care Transformation Providers at Partial to Full Risk Payment Reforms Journey

15 15 Care Transactions Provider-centric reporting based upon productivity & patient care protocols Care Integration Population based quality & performance analysis, health status analysis, & risk analysis Care Transformation Predictive modeling & performance forecasting, outcomes analysis, & incentive modeling Data Analytics Journey

16 16 Care Transactions Individual EHR or paper medical records; individual vendor or provider application of standards & codes Care Integration Clinical information sharing with standards based interoperability moving to data integration with semantic normalization Care Transformation Community based clinical & claims data repository with community data and coding standards Informations Journey

17 Informations Role 17 Care Transactions Support Provider delivered care; support patient level quality reporting Care Integration Longitudinal patient record, ED & Public Health alerts; Point-of- care decision support, PHR, & remote patient monitoring Care Transformation Enable predictive modeling, risk adjusted analytics, accountable care business & operational modeling

18 Informations Role – Domain Requirements 18 People & Organizations Lab Orders & Results Medications & Prescription Information Patient Provider Payer Staff Facility Immunizations Radiology & Transcribed Reports Referrals & Authorizations Medical Conditions (Allergies, Family- social-medical history) Encounters Appointments Master Data (ICD, CPT, DRG, HCPCS, CCS, CRG …), Geography Revenues (Charges, Grants..) Products Member Enrollment Medical & Rx Claims Revenue, Billing, & Payment Data Utilization Provider Payer Legend: Clinical Observations & Vital Signs Expenses (Payroll, Supplies, Infrastructure, …)

19 19 Creating a Community Data Repository & Establishing a Community Data Trustee

20 20 HealthBridges Data Infrastructure New Suite of Health Care Innovation & Quality Improvement Tools and Services funded through Beacon Program: Disease Registry Clinical & Claims Data Warehouse Data Analytics and Business Intelligence Alerts & Notifications Transitions in Care Assistance Quality Reporting Support Process Improvement and Workflow Redesign Support

21 21 HealthBridges Solution Components Enterprise Master Patient Index (eMPI) IBMs Initiate Clinical & Claims Data Repository & Clinical Analytics PluralSofts CareQuotient Semantic Data Normalization Clinical Architectures Symedical Claims Data Grouping Engines OPTUMInsights Symmetry Patient Registry WellCentives Registry

22 22 Why? Today this enables Identification of gaps in care Point-of-Care Decision Support Patient engagement Longitudinal Patient Record ED, Admission, & Discharge Alerts & Notices Information exchange at the point of Transitions in Care Intra-practice comparative performance analytics Interoperability between organizations (Rosetta Stone)

23 23 Why? Tomorrow this will enable: Population-based performance measurement Risk adjusted comparative performance analytics Risk adjusted comparative cost analytics Predictive modeling & performance forecasting Service demand forecasting Payment incentive modeling Revenue versus cost modeling ACO business and operational modeling Best practice identification & modeling

24 24

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