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Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem Michigan Association of Health Plans Rick Murdock Executive Director Michigan.

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Presentation on theme: "Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem Michigan Association of Health Plans Rick Murdock Executive Director Michigan."— Presentation transcript:

1 Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem Michigan Association of Health Plans Rick Murdock Executive Director Michigan Association of Health Plans MICHIGAN ASSOCIATION OF HEALTH PLANS6/23/20101

2 Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem A Health Plan Perspective – Context For Health Plans Trends Obligations Expectations MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/20102

3 Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem Trends 1.Michigan Economy 2.Aging Population 3. “Retailing” of Health Care Purchasing Movement from Employers to Individuals 4.Increasing role of government 5.Value Based Purchasing and Delivery of Health Care in an Increasingly Diversified Market MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/20103

4 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 PLANS 6/23/20104

5 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 PLANS 6/23/20105

6 HospitalPrimary CareSpecialistHealth Plan Common Challenges in the Community State/Federal

7 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 PLANS 6/23/20107

8 Federal Reform: Health Plan IT Administrative Simplification 1.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 PLANS 6/23/20108

9 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 for all users – Self Service User Registration 6/23/2010 MICHIGAN ASSOCIATION OF HEALTH PLANS 9

10 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

11 Knowledge Management e-Prescribe PHR data access for physicians Secure /Fax Directed bulletins Secure File Exchange 24/7 Availability 3 rd Party SSO and Federation Disease Management Integration e-Prescribe Point of Service Evidence Based Guidelines Clinical Decision Support Immunization registry (Pending) Disease Management Lab and Rad results Performance Reporting Tools for Practice Development Legal Support for your practice Physician Education MSMS Physician Link My1HIE MyWorkspace General Fax Management Test Order Processing Online Universal referral form Credentialing Verification Services One-off claims entry FFS 1500 e-Claim submission Electronic Claims Attachments Eligibility Claim Status Medication History SSO to Participating Payer portals Distribution of Performance Reporting Claim Appeals Process MAHP Connect: Extending Services 6/23/2010 MICHIGAN ASSOCIATION OF HEALTH PLANS

12 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 PLANS 6/23/201012

13 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 PLANS 6/23/201013


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