Finding Needles in a Haystack Advancing patient care, flow, and access by leveraging clinical data channels

Transcription

1 Finding Needles in a Haystack Advancing patient care, flow, and access by leveraging clinical data channels

2 Agenda Page 1 NSLIJ Health-E Customer Experience 1 2 Payers and Clinical Data 11

3 Section 1 NSLIJ Health-E Customer Experience 1

4 Section 1 NSLIJ Health-E Customer Experience 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 2

5 Section 1 NSLIJ Health-E Customer Experience The Health-E Customer Experience is driven by 3 primary objectives 3

6 Section 1 NSLIJ Health-E Customer Experience Primary Objectives Defined: Enhance the Patient Experience 4

7 Section 1 NSLIJ Health-E Customer Experience Primary Objectives Defined: Engage the Physician Community 5

8 Section 1 NSLIJ Health-E Customer Experience Primary Objectives Defined: Facilitate Access and Movement Across Continuum of Services 6

9 Section 1 NSLIJ Health-E Customer Experience How will this drive successful outcomes? 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. Key Vision Elements Integrated Enterprise Front- End Self Service Capabilities via Physician and Patient Portal Enterprise Contact Center Check-in/Check-Out Redesign Integrated Patient Statement Tangible Outcomes 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 7

10 Section 1 NSLIJ Health-E Customer Experience Enterprise Design Highlights 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 INTEGRATED DESIGN SESSION #1 INTEGRATED Sprint 1 DESIGN SESSION #2 Sprint 2 INTEGRATED DESIGN SESSION #3 Patient Access 1 Patient Access 1 Vision Intro and Design Kick-Off Patient Access 2 Charge Capture & Coding Synthesize and confirm design activity to date Patient Access 2 Charge Capture & Coding Synthesize and confirm design activity to date Receivable Mgmt Receivable Mgmt Weekly design workgroups (2 days per week) Weekly design workgroups (2 days per week) Collaborative implementation methodology workgroup 8

11 Section 1 NSLIJ Health-E Customer Experience Award winning methodology and service The NSLIJ and 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. 9

12 Section 1 NSLIJ Health-E Customer Experience Primary Benefits 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 Process Benefits Expected Strategic Benefits Financial Benefits - Increased point of service collections - Reduced third party denials - Minimize system leakage to nonhealth system providers Technical 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 - Consolidated and integrated patient administrative systems - Standardized and accessible patient administrative data - Reduced complexity of technical integration - Increased agility due to streamlined systems 10

13 Section 2 Payers and Clinical Data 11

14 Section 2 Payers and Clinical Data 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 12

15 Section 2 Payers and Clinical Data Payer Investments indicate direction Through their acquisitions, payers now own pipes to many provider data sources, which will provide insight into monitoring patient outcomes Aetna United Kaiser Permanente Humana WellPoint Current State / Key Partnerships EMR Initiatives Clinical Information and Exchange Transforming Data into Information Clinical Data Aggregation Partnered w/ NaviNet admin data exchange, claims history & Care Consideration alerts Purchased Medicity Pilot with Sharp using multiple EMRs Medicity Industry #1 vendor ActiveHealth (partnered w/ibm for decision support) Purchased Axolotl and PICIS Virtual vertical network w/o owning Providers Ingenix: CareTracker EMR w/ decision support Axolotl Industry #2 vendor : virtual health record that accumulates many EMRs into one view Ingenix assets Partnered w/epic to create HealthConnect EMR Epic deployed enterprise wide - Largest EMR w/10m records online EMR allows seamless information exchange Internal resources with Convergent Medical Terminology product built Partnered w/ AthenaHealth for subsidized EHR Partnered w/ Availity: administrative data exchange Athena Partnership pilots for subsidized EHR Claims information exchange via Availity IBM Watson Acquiring clinical data to feed Watson and other initiatives Developing LPR for exchange of key patient information with providers Programs for providing clinical information and atrisk patient list to PCPs ActiveHealth Ingenix assets Internal programs Internal programs Internal programs with strategic solutions 13

16 Section 2 Payers and Clinical Data How will Payers use clinical data? Payers are evolving into entities that have a much larger role in managing health From an Insurance Company Member Transactions Chronic Care Focus Limited Technology Provider Payer to a Health Care Company Member Engagement Continuum of Care Focus Leader in Technology Provider Partner 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 14

17 Section 2 Payers and Clinical Data How will Payers use clinical data? A Case Study WellPoint and IBM Watson 15

18 Section 2 Payers and Clinical Data How will Payers use clinical data? A Case Study WellPoint and IBM Watson Health care is advancing rapidly. But so is the challenge for doctors to make the right decisions. Challenges Complex, costly medical conditions Huge, ever-growing body of knowledge Extensive patient health histories Complicated drug interactions Overlapping care coordination Potential Opportunities Quickly identify optimal treatment options Improved outcomes 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? 16

19 Section 2 Payers and Clinical Data How will Payers use clinical data? A Case Study WellPoint and IBM Watson Potential Knowledge Sources May Include: Latest medical research Complex treatment protocols Population health info Data analysis Patient medical history Lab results WellPoint data Extensive provider networks Analyzes millions of pages/second Targeted treatment options IBM Watson technology to assist by analyzing data and providing responses 17

20 Section 2 Payers and Clinical Data How will Payers use clinical data A Case Study WellPoint and IBM Watson Health Care today 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 Transformed with IBM Watson 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 18

21 Section 2 Payers and Clinical Data Award winning Innovation 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 19

22 Closing messages and key takeaways 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 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.

23 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 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.