1. Business Models for Health Information Technology: Towards a Conference White Paper James G. Anderson, Ph.D. Purdue University

2. Quality Problems Underuse of Effective Health Services  50% preventive care  30% acute care  40% chronic care Schuster et al., 1998

3. Quality Problems Overuse of Health Services  30% acute conditions  20%chronic conditions Schuster et al., 1998

4. Quality Problems Misuse of Health Services  Harvard medical Practice Study estimated 1% of hospitalized patients sustained injuries from negligence  In Colorado, 0.8% of hospitalized patients suffered injuries  In Utah, 0.95% of hospitalized patients suffered injuries Brennan et al., 1991; Thomas et al., 2000

5. “Crossing the Quality Chasm” Changes in U.S. Health Care  Level A: Experience of patients  Level B: Functioning of small units of care delivery  Level C: Functioning of Organizations that support small units  Level D: Environment of policy, payment, regulation, accreditation and litigation

6. Report Conclusions  “In its current form, habits and environment, American health care is incapable of providing the public with the quality health care it expects and deserves”

7. Changes in the Experience of Patients  Improved access to information  E-mail communication with their health care provider  Greater participation in decision making and management of their care

8. Changes in the Small Units of Health Care CurrentNew Care primarily based on visits Care based on continuous relationship Professional autonomy resulting in variability Care customized according to patients’ needs Professionals control care Patients control care Medical information contained in the record Information is shared freely with the patient Decision making based on experience Decision making based on evidence

9. Changes in the Small Units of Health Care CurrentNew Individual responsibility for safety System responsible for safety SecrecyTransparency Reaction to needs Anticipation of needs Cost reduction Waste decreased Emphasis on individual professionals/institutions Cooperation among professionals/institutions

10. Changes in Health Care Organizations  Implementation of best practices standards  Use of IT to support clinical decision making  Investment in workforce knowledge/skills  Development of effective teams/teamwork  Coordination of care among services/settings  Improved measurement of performance and outcomes

11. Changes in the Health Care Environment  Financing  Regulation  Accreditation  Litigation  Professional education

12. Obstacles  Measurement/reporting of quality of care  Low investment in systems redesign  Underdeveloped IT infrastructure  Financing structure: Lack of ROI  Litigation threats  Over regulation  Current professional education

13. The Future: Business Models for Quality  Whose business are we talking about?  What do we mean by rewards? For whom?  Who is going to pay to improve quality under the current financing systems?

14. Business Models Empire Blue Cross Proposal:  Authorize higher DRG payments for hospitals that agree to meet Leapfrog Group recommendations.  A portion of the estimated savings from reduced errors would be refunded to the hospital.

15. Business Models Temple University Health System:  Temple physicians used an e-prescribing application from Allscripts Healthcare Solutions as a tool to boost formulary compliance as part of a comprehensive risk- reduction plan.  The 80-member practice has seen an increase in prescribing of preferred generics and negotiated a 10% reduction in its annual malpractice premium.