Finding Needles in a Haystack - Lonestar...
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www.pwc.com Finding Needles in a Haystack Advancing patient care, flow, and access by leveraging clinical data channels May 10, 2012
Transcript of Finding Needles in a Haystack - Lonestar...
www.pwc.com
Finding Needles in a Haystack Advancing patient care, flow, and access by leveraging clinical data channels
May 10, 2012
Agenda
Page
1 NSLIJ Health-E Customer Experience 1
2 Payers and Clinical Data 11
PwC
May 10, 2012
NSLIJ Health-E Customer Experience
1
Section 1
Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
PwC
May 10, 2012
What is the Health-E Customer Experience? “Health-E is a strategic vision that has evolved over the past several years based
on feedback from our customers that we need to improve our administrative processes…it’s about fundamentally changing the way our customers experience the healthcare system.‖
The vision describes:
• Establishing consistent and positive experience for customers wherever they go within the system
• Increasing the options by which customers contact and interact with the system
• Decreasing the redundancy and duplication in our processes from site to site
• Increasing the quality of our interactions and administrative outcomes for revenue cycle processes
• Building tools that support standard, informed, and real-time processes
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 1 – NSLIJ Health-E Customer Experience
PwC
May 10, 2012
The Health-E Customer Experience is driven by 3 primary objectives
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 1 – NSLIJ Health-E Customer Experience
PwC
May 10, 2012
Primary Objectives Defined: Enhance the Patient Experience
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 1 – NSLIJ Health-E Customer Experience
PwC
May 10, 2012
Primary Objectives Defined: Engage the Physician Community
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 1 – NSLIJ Health-E Customer Experience
PwC
May 10, 2012
Primary Objectives Defined: Facilitate Access and Movement Across Continuum of Services
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 1 – NSLIJ Health-E Customer Experience
PwC
May 10, 2012
How will this drive successful outcomes?
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 1 – NSLIJ Health-E Customer Experience
Integrated Enterprise Front-End
Key Vision Elements Tangible Outcomes
Self Service Capabilities via Physician and Patient Portal
Enterprise Contact Center
Check-in/Check-Out Redesign
• Enhanced and standardized enterprise patient access
• Enterprise scheduling tools and processes
• Availability of self-service functionality throughout the revenue cycle
• Rules-driven business processes
• Consolidated patient administrative systems Integrated Patient Statement
Leadership translated this vision into a tactical set of actions that the organization could execute to transform and standardize the business processes and technology supporting the patient administrative processes for the entire enterprise, including the hospitals and faculty practice plan
The vision will take many years to achieve, however, is in motion and a project team is actively implementing the integrated, enterprise front-end, and planning is underway for portal and contact center.
PwC
May 10, 2012
Enterprise Design Highlights
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 1 – NSLIJ Health-E Customer Experience
A group of people from throughout the NSLIJ health system and the representative system vendors met for several months to design the future state revenue cycle processes
• The design team collaboratively developed a future state operating model and nearly 80 future state process flows to facilitate implementation and execution
• Teams met over a three month period with a series of Integrated design sessions separated by more detailed subject matter specific working groups
Vision Intro and Design
Kick-Off
Weekly design workgroups
(2 days per week)
Synthesize and
confirm design
activity to date
Synthesize and
confirm design
activity to date
Collaborative implementation methodology workgroup
Patient Access 2
Charge Capture &
Coding
Receivable
Mgmt
Patient Access 1
Patient Access 2
Charge Capture
& Coding
Receivable
Mgmt
INTEGRATED DESIGN SESSION #1
INTEGRATED DESIGN SESSION #2
Weekly design workgroups
(2 days per week)
INTEGRATED DESIGN SESSION #3 Sprint 1 Sprint 2
Patient Access 1
PwC
May 10, 2012
Award winning methodology and service
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 1 – NSLIJ Health-E Customer Experience
The NSLIJ and PwC Team won the "Excellence in Management Consulting" award from the Association of Management Consulting Firms (AMCF). This award recognized the innovative customer experience initiative that will help better serve patients, as well as acknowledged how the project addressed cultural challenges while mobilizing a Project Management Office that quickly and effectively put vision into action.
PwC
May 10, 2012
Primary Benefits
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 1 – NSLIJ Health-E Customer Experience
Customer Benefits
- Streamlined access to full continuum of care including centralized customer service center, enterprise scheduling at point of service
- Increased self service capabilities for functions such as online registration and bill pay
- Single registration process
Financial Benefits
- Increased point of service collections
- Reduced third party denials
- Minimize system leakage to non-health system providers
Process Benefits
-Completely redesigned business processes to support patient administration
- Enterprise standard processes to support one look and feel across system
- Increased efficiency and effectiveness of business process
Technical Benefits
- Consolidated and integrated patient administrative systems
- Standardized and accessible patient administrative data
- Reduced complexity of technical integration
- Increased agility due to streamlined systems
Expected
Strategic Benefits
PwC
May 10, 2012
Payers and Clinical Data Section 2
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
PwC
May 10, 2012
How will Payers use clinical data? Payers are moving beyond claims-based and administrative data, and seeking to acquire clinical data
The value of clinical data to a Payer:
• More comprehensive knowledge of patient/member clinical history
• More real-time access to clinical events
• Significant increase in capabilities to support predictive modeling
• Better awareness of treatment variability– quality, cost, and outcome
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 2 – Payers and Clinical Data
PwC
May 10, 2012
Payer Investments indicate direction Through their acquisitions, payers now own ―pipes‖ to many provider data sources, which will provide insight into monitoring patient outcomes
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 2 – Payers and Clinical Data
Aetna United Kaiser Permanente
Humana WellPoint
Current State / Key
Partnerships
• Partnered w/ NaviNet admin data exchange, claims history & Care Consideration alerts
• Purchased Medicity
• Purchased Axolotl and PICIS
• ―Virtual vertical‖ network w/o owning Providers
• Partnered w/Epic to create HealthConnect EMR
• Partnered w/ AthenaHealth for subsidized EHR
• Partnered w/ Availity: administrative data exchange
• IBM Watson
EMR Initiatives
• Pilot with Sharp using multiple EMRs
• Ingenix: CareTracker EMR w/ decision support
• Epic deployed enterprise wide - Largest EMR w/10M records online
• Athena Partnership pilots for subsidized EHR
• Acquiring clinical data to feed Watson and other initiatives
Clinical Information
and Exchange
• Medicity—Industry #1 vendor
• Axolotl —Industry #2 vendor : ―virtual health record‖ that accumulates many EMRs into one view
• EMR allows seamless information exchange
• Claims information exchange via Availity
• Developing LPR for exchange of key patient information with providers
Transforming Data into
Information
• ActiveHealth (partnered w/IBM for decision support)
• Ingenix assets • Internal resources with Convergent Medical Terminology product built
• Programs for providing clinical information and at-risk patient list to PCPs
Clinical Data Aggregation
• ActiveHealth • Ingenix assets • Internal programs • Internal programs • Internal programs with strategic solutions
PwC
May 10, 2012
How will Payers use clinical data? Payers are evolving into entities that have a much larger role in managing health
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 2 – Payers and Clinical Data
Member Transactions
Member Engagement
Chronic Care Focus
Continuum of Care Focus
Limited Technology
Leader in Technology
Provider Payer Provider Partner
From an Insurance
Company…
…to a Health Care Company
Payers will have insight into: • Outlier providers from a cost and quality
standpoint • Peer performance and outcome comparisons • Use of evidence-based practices by provider • Member/Patient treatment adherence • Much better understanding of care
coordination (or lack thereof) as patients move through a continuum of clinical settings
PwC
May 10, 2012
How will Payers use clinical data? A Case Study – WellPoint and IBM Watson
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 2 – Payers and Clinical Data
PwC
May 10, 2012
How will Payers use clinical data? A Case Study – WellPoint and IBM Watson
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 2 – Payers and Clinical Data
Health care is advancing rapidly. But so is the challenge for doctors to make the right decisions.
The answer: An analytical solution that can process massive amounts of data and provide reasoned responses to complex questions.
The question: What is IBM Watson?
Challenges Potential Opportunities
• Complex, costly medical conditions
• Huge, ever-growing body of knowledge
• Extensive patient health histories
• Complicated drug interactions
• Overlapping care coordination
• Quickly identify optimal treatment options
• Improved outcomes
PwC
May 10, 2012
How will Payers use clinical data? A Case Study – WellPoint and IBM Watson
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 2 – Payers and Clinical Data
WellPoint data
Extensive provider networks
Potential Knowledge Sources May Include:
• Latest medical research
• Complex treatment protocols
• Population health info
• Data analysis
• Patient medical history
• Lab results
Analyzes millions of
pages/second
Targeted treatment
options
IBM Watson technology to assist by analyzing data and providing
responses
PwC
May 10, 2012
How will Payers use clinical data A Case Study – WellPoint and IBM Watson
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 2 – Payers and Clinical Data
Health Care today Transformed with IBM Watson
• Varying treatment regimens • Evidence-based practices underutilized,
inconsistently applied • Limited patient access to information about
their condition and treatment path • Inconsistent care coordination • Low financial incentive for high-quality care • Multiple approvals for many services within
one treatment plan
• Fast access to a vast library of medical knowledge
• Effective, evidence-based treatment options • Shared decision-making between members
and providers • Automated authorization through course of
care management • More personalized care
PwC
May 10, 2012
Award winning Innovation
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Finding Needles in a Haystack • Advancing patient care, flow, and access by leveraging clinical data channels
Section 2 – Payers and Clinical Data
The WellPoint Watson team won the firm’s Pinnacle Award for Innovation – the highest award within WellPoint.
Pictured, Left to Right: Prakash Upadhyayula, Rickey Tang, Angela Braly, AJ Lang, Elizabeth Bigham, and Omar Latif
Closing messages and key takeaways
© 2012 PricewaterhouseCoopers LLP. All rights reserved. "PricewaterhouseCoopers" refers to PricewaterhouseCoopers LLP, a Delaware limited liability
partnership, or, as the context requires, the PricewaterhouseCoopers global network or other member firms of the network, each of which is a separate legal
entity. This document is for general information purposes only and should not be used as a substitute for consultation with professional advisors.
Health-E Insights: Impact of consumerization and physician alignment • Redesign of the patient flow process can increase alignment with physicians which can
increase admissions and simplify the physician administrative burden • Consistent consumer-facing processes and branding will reduce drift of patients to other
clinical providers • Managing transitions of care will enable better coordination on scheduling tests and
clinic visits, as well as better management of treatment adherence • Intensive and focused collaborative sessions will accelerate consensus with future-state
process design
Implications of Payers acquiring and aggregating clinical data: • Payers will have better knowledge of clinical care performance than most providers • Information derived from these programs will provide payers more opportunity to
intervene into the delivery of care • Partnering with payers for the sharing of data and the development of analytics will
allow both to be rewarded for high-quality, cost-efficient care
PwC would like to thank its clients NSLIJ and WellPoint for allowing us the opportunity to partner, as well as share this information today Go Rangers! Questions? Please contact: Paul Ceverha [email protected] 214-616-2432
© 2012 PricewaterhouseCoopers LLP. All rights reserved. "PricewaterhouseCoopers" refers to PricewaterhouseCoopers LLP, a Delaware limited liability
partnership, or, as the context requires, the PricewaterhouseCoopers global network or other member firms of the network, each of which is a separate legal
entity. This document is for general information purposes only and should not be used as a substitute for consultation with professional advisors.
