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E-Health Networks The New Shape of Public Health NGA State Alliance for e-Health 2nd Annual State Learning Forum Stephen Goldsmith Daniel Paul Professor.

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Presentation on theme: "E-Health Networks The New Shape of Public Health NGA State Alliance for e-Health 2nd Annual State Learning Forum Stephen Goldsmith Daniel Paul Professor."— Presentation transcript:

1 E-Health Networks The New Shape of Public Health NGA State Alliance for e-Health 2nd Annual State Learning Forum Stephen Goldsmith Daniel Paul Professor of Government Director, Innovations in American Government Program Harvard University John F. Kennedy School of Government Developed in conjunction with Deloitte Center of Health Solutions and Deloitte Research

2 2 Governing by Network. Traditional Bureaucracy Is Inadequate Agency 1 Division Unit Agency 2 Division Unit Agency 3 Division Unit Department Bureau Citizen

3 3 Governing by Network. The New Shape of Government CCID Organizatio n Local Government Hospitals Federal Agency International NGOs NGOs State Government Health Provider

4 4 Governing by Network. Models of Government Hierarchical government Public-Private Partnerships Networked government Joined up government High Low HighLow Level of public/private collaboration Network mgt. Capabilities

5 5 Governing by Network. Types of Networks DEGREE OF GOVERNMENT INVOLVEMENT More Less Intergovernmental Supply chain Ad hoc Civic switchboard Information dissemination Service contract Channel partnership

6 6 Governing by Network. Networked Organization Models that HIT Can Learn From Anthrax Crisis Response SARS Hurricane Katrina Response

7 7 Governing by Network. Governing by Network has Many Advantages… Networked government benefits Improved Speed and flexibility Specialization Increased reachInnovation

8 8 Governing by Network. What a Health Network Might Look Like

9 9 Governing by Network. State HIE Network Model

10 10 Governing by Network. Health Information Exchanges Federal NHIN National Health Information Network State HIE RHIO Network Health Networks Network Health Networks The big picture of the health information network

11 11 Governing by Network. States must lead the change. …in collaboration with health consortiums, citizens, payers, providers, and others. States Can Play Many Roles in an HIE Network Convener Educator Administrator Policy Maker Initiator/ Catalyst Operator Coordinator The Many Roles of Government

12 12 Governing by Network. Obesity Mental Health Child Welfare Infant Mortality Information Sharing and Incentives Information Sharing Needs Schools Relation to Other Sectors Your Role Role of the Private Sector Managing the Network Issues and Delivery Networks = Sector 1 = Sector 2 Possible Organizations Public Hospital and Community Health Local Non Profits National Foundations State Health Policy and Finance

13 13 Governing by Network. 1.Define of Public Value Carefully Better Health, Not Better Transactions 2.Design Network CorrectlyUnderstand All Assets 3.Quality Decision Making 4.Congruence of Goals 5.Build Skills and Capacity 6.Network Leadership Key Principles to Create Networked Model

14 14 Governing by Network. After: DC Health Care Networks, From One to Many Before: DC General Hospital 1. New Role for Government: Focus on Public Value

15 15 Governing by Network. Public Value Definition The point of all activity is for each party to create value Government role: to transform existing social conditions in collectively desired directions Demonstrations of value creation lie in evidence showing changes in conditions Problem: Not everyone sees value in the same way

16 16 Governing by Network. Different Ideas of Value Satisfy patient demands Produce Better Health Reduce Costs Make a Profit Meet Social Needs Achieve a Just Society

17 17 Governing by Network. Four Programmatic Areas Behind The Curve to Reduce Cost and Improve Care Consumerism Coordination of Care Comparative Effectiveness/Evidence- based Medicine Healthcare Information Technology

18 18 Governing by Network. Examples of How Electronic Systems Drive Better Outcomes Care Management Improve care while managing costs, maximizing the health care investment. Care management, disease management, and utilization review. Electronic Health Records/Health Information Exchange Improve quality of care and enhance service to individuals. Patient Data Hub, allowing for the integration of disparate healthcare data sources and follow-on analysis to produce actionable information at the point of care. Emergency Department Diversion Prevent overcrowding, promote wellness, and make better use of scarce resources. Proactive medical management. Through data analysis of historical medical claims, access analysis, and education techniques. Lower ED usage. Long-Term Care / Renal Care Audits Detect and correct errors and prevent future overpayments. Make better use of data to improve care to individuals. Nursing Home Diversion Manage ongoing healthcare costs and provide care where its needed.

19 19 Governing by Network. Pennsylvania NEDSS system The development of PA-NEDSS has allowed the Pennsylvania Department of Health to cut the reporting cycle patient cases from 3 weeks to fewer than 24 hours. 2. Design Network: Map Parties, Understand Tools

20 20 Governing by Network. PA-NEDSS – An HIE Making a Difference Investigators Laboratories CDC Local & State Health Departments DOH Central Office Physicians Hospitals EDR App Integrated Data Collection, Management, Analysis, Transmissio n, and Disseminatio n Epi-X Rapid reporting and discussion of health events, 24/7 access to key officials and expert assistance Health Alert Network Health Information Technology More Timely Intervention More Complete Patient View Privacy Centric & Secure Bio-terrorism Rapid Detection Rapid Response Enabler Point of Care Data Entry Real-time Data Collection Master Patient Index Patient Search & Match De-duplication Linked Disease Reports HL7 based HIE Patient Centric System Working Example : Extending Existing Public Health Systems to Serve as HIE channels; All Actors Work Toward Same Goal

21 Copyright © 2005 Deloitte Development LLC. All rights reserved. 21 Decide Who Should Do the Integrating Government 1 Prime Contractor 2 Third Party 3 Government Contractor Subcontractor Contractor Third Party Private Provider Contractor Subcontractor Contractor Subcontractor Government Subcontractor Government Prime Contractor

22 22 Governing by Network. Education and Rhetoric Money Regulations Capacity to Convene Information Sharing and Incentives Information Sharing Needs Role of Other Government Agencies Relation to Other Sectors Your Role Role of the Private Sector Managing the Network Do Use multiple levers to build and activate networks = Sector 1 = Sector 2 Dont Manage each network the same way Sector Scale

23 23 Governing by Network. Driving network governance vision down the organization Training and recruiting for the new skill sets (and cultural change) needed Treating partners as real partners Developing and enforcing shared outcome goals Horizontal management in a vertical government Government as 800 pound gorilla 3. Quality Decision Making: Numerous Challenges

24 24 Governing by Network. 4. Aligning Values and Incentives Congruence of Goals: Develop the Network Design What –Goal of network? How –Levers used to initiate and sustain network? –Type of network? –Identify each parties goals Who –Partners in the network? –Who integrates network? 4. Aligned Values and Incentives Congruence of Goals: Develop the Network Design

25 Copyright © 2005 Deloitte Development LLC. All rights reserved. 25 Share - Dont offload risk Guidelines for Sharing Risk Which network partners are best at managing which risks? Who is bringing the bulk of innovation to the table? How much control does the public sector have over the network and/or over the particular risk involved? Are the contract costs of the risk shifting worth it? Are the risks actually regulatory in nature?

26 Copyright © 2005 Deloitte Development LLC. All rights reserved. 26 Assuring the Performance of Networked Arrangements Public Health Networks Which have Worked? What Could Work Better? Future Networks Define Best Practices Monitor Performance Characteristics of Networks

27 Copyright © 2005 Deloitte Development LLC. All rights reserved. 27 A Life Cycle Approach to Performance Achieving results from networks Structure Incentives/ Share Risk Measure Network Performance Set Goals/Align Values Manage Change

28 28 Governing by Network. Federal and State agencies working together can: Provide backbone services for other participants to build their networks Provide process, monetary, policy, interoperable standards, and other support for these participants to get on the network Extend existing health and human services networks and infrastructure Coordinate across networks and improve data sharing and decrease redundancies 5. Build Capacity: New Networks and Extend Existing Ones HIE networks that will enable a unique unprecedented combination of public (federal and state), non-profit, commercial, and citizen networks to come together and get connected as part of one large integrated network to provide quality outcome based healthcare transformation 5. Build Capacity: New Networks and Extend Existing Ones

29 29 Governing by Network. Open Source Innovation: Tapping into the Wisdom of the Crowds A large group of people is better at solving complex problems than an expert, no matter how brilliant What are the implications for government?

30 30 Governing by Network. Keys to Unlock the Kingdom Unlocking information unleashes the power of networks to fulfill public services and discharge government duties. Governments can use IT tools to facilitate this result in five ways: Coordinating activities Synchronizing responses Enabling a single client view Sharing knowledge Measure performance

31 31 Governing by Network. Do Invest resources to ensure cultural alignment is achieved within your organization. Dont Expect changes to happen overnight. 6. Networked Leadership: Encourage Behaviors that Promote the Networked Approach

32 ©2005 Deloitte. All rights reserved 8-Jan-14 Attributes of Highly Effective Network/Relationship Managers Attributes Successful network managers have the ability to: Work across sector boundaries Work across sector boundaries Identify the Network Participants Best Placed to Meet Goals Identify the Network Participants Best Placed to Meet Goals Recruit managers who can excel in this new environment Recruit managers who can excel in this new environment Thrive in Highly Fluid Environment with High levels of Discretion Thrive in Highly Fluid Environment with High levels of Discretion Develop and Manage Relationships & Strategy Develop and Manage Relationships & Strategy Understand What Each Partner/ Stakeholder Needs in order to Perform Role in Network Understand What Each Partner/ Stakeholder Needs in order to Perform Role in Network Embrace mission change from doer to enabler, from rowing to steering Embrace mission change from doer to enabler, from rowing to steering

33 ©2005 Deloitte. All rights reserved 8-Jan-14 1.Define of Public Value Carefully Better Health, Not Better Transactions 2.Design Network CorrectlyUnderstand All Assets 3.Quality Decision Making 4.Congruence of Goals 5.Build Skills and Capacity 6.Network Leadership Key Principles to Create Networked Model

34 Copyright © 2005 Deloitte Development LLC. All rights reserved. 34 A Change of Thinking Needed… People are very open minded about new things. As long as they are exactly like the old ones. - Charles Kettering


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