1. Health Information Technology
Health Plan Role and Perspective
Charles Kennedy M.D.
V.P. Health Information Technology
Notes:
This template should be used by:
Technology & Operations
Human Resources
Ethics, Compliance & Internal Audit
Health Solutions
Legal & Public Affairs
Actuarial, Integration & Information Management
Finance

2. WellPoint’s 2010 Aspiration
WellPoint is recognized for ensuring that customers receive high quality, effective care at a lower cost than competitors in the same geography. This cost advantage is built on innovative initiatives in care management, health improvement, health care quality and safety, and network management resulting in single digit trend, better outcomes and improved member health.
NOTES:
Please provide a brief but comprehensive summary of your 3-Year Strategic Plan.
“We aspire to transform health care and become the most valued company in our industry. In our view, ensuring our members have access to proven, quality care is the most important value driver we can offer”.
Larry Glascock

3. WellPoint Imperatives
WellPoint’s 2010 Aspirations have been translated into key
imperatives which include Information and Provider Partnerships
2010 Aspiration
Differentiating Strategies
Key Imperatives
Consumer Focused
Consumer Culture
Most Trusted
Choice
Choice Based
Public Perception
Public Health Oriented
Consumer Experience
Affordable
Quality Care
Accessible & Affordable
360 Health
Highest Quality
Information
Provider Friendly
Provider Partnerships

4. Information: Comprehensive Patient View
Many data sources need to be connected to form a complete patient view including clinical data sources, personal data sources (WebMD) and payer based data (PBHR) via the EDL framework

5. Comprehensive Electronic Health Record
Patient Data Sources
Comprehensive Electronic Health Record
“EHR”
By weaving these primary sources of patient data together, a health plan can transform itself from a payer to an Infomediary.
EHR = PBHR + EMR + PHR

6. Disease and Integrated Care Management
Infrastructure Development: Data Warehouse
Clinical data sources:
Such as lab, radiology, PHR, HRA,
carved out services
WLP health plans data (enterprise data warehouse)
Physician Component
Member Component
Personal
Health
Records
(WebMD)
Disease and Integrated Care Management
(HMC)
E-Health
Records
(Mr ED)
Clinical
Research
(HealthCore)
Individualized
Messages
(RHI)
E-Prescribing
(RXHub)
WellPoint (the infomediary) creates value through applications which access existing
data warehouses. These applications present information which influence practice
patterns and member behavior enabling optimal use of the health care system.

7. Health I.T. Application Development
WellPoint is piloting key health I.T. programs, surfacing and resolving challenges. Key challenges include data timeliness, quality and granularity. Systems leverage this data for unique, differentiated value
EHR Decision Support E-Prescribing, Imaging and Laboratory Procedures
Payer Sentinel Systems Physician, Patient Messaging
through phone/letters
ResolutionHealth—System deployed, Study completed to prove value of service, larger roll out ongoing
EHR Information
(Electronic presentation of
Diagnosis Drugs, Imaging, Lab… data)
WellPoint MR. ED: Pilot deployed, analytic review of effectiveness launched, expansion of pilot underway due to early positive feedback.
WellPoint E-Rx programs: Review of initial program underway, corrective action completed
Easy Ease of Implementation Hard
Value
High
Low

8. Clinical Messaging Development
Providers
Enrollment
Benefits
Med Claims
Rx Claims
Lab Results
Data Standardization and Integration
Clinical Literature
review of evidence
New knowledge via
Rules Engine
Identify Actionable Targets
Targeted Interventions
Health Plans and
Care Managers
Providers
Members

9. E-Prescribing Example
Before E-Rx
Information changes decisions after the fact, resulting in re-work, dis- satisfaction, sub- optimal results
PBM
Internet Friends DTC Samples Pharma detailing
After E-Rx, PBM derived information (plus other data sources over time) enables best decisions AT THE POINT OF CARE IN THE POINT OF TIME they are made
PBM
PBM (plus other data over time)

10. Anticipated Drivers of Benefit
Practice pattern variation increases costs and results in sub optimal quality. Clinical data linked to clinical decision support reduces variation and increases adherence to evidence based medicine
Benefit Drivers
Providers
Cost
Practice Pattern Variation
Benefit Accrual
Practice Pattern Variation
Diagnostic Studies
Redundancy of Tests
Error Reduction
Overall Savings
EMR
Health Information Exchange
Clinical Decision Support

11. Other Key Plan Activities
Although data activities are important, other more traditional health plan functions will be required to drive health I.T..
WellPoint Opportunities
Program Example
Development of payment methodologies which reward the use of Health I.T. and clinical objective achievement
Re-imbursement methodologies that enable gain sharing of efficiencies generated by health I.T. tools
Development of new innovations that leverage clinical infrastructure
WellPoint Foundation opportunities to help defray infrastructure cost challenges
P4P programs with components dedicated to Health I.T. use
Prospective payment methodologies which enable win-win results
Phase 4 drug safety studies
Center for Health Economics and Technology