Interoperability and the Journey to Value-based Reimbursement

Transcription

1 Interoperability and the Journey to Value-based Reimbursement Jonathan M. Niloff, M.D., MBA Chief Medical Officer Connected Care & Analytics McKesson Technology Solutions

2 Any descriptions of future functionality reflect current product direction, are for informational purposes only and do not constitute a commitment to provide specific functionality. Timing and availability remain at McKesson s discretion and are subject to change and applicable regulatory approvals. 2

3 Value-based reimbursement (VBR) is the Future How can I reduce the total cost of care? How can I improve quality? How can I succeed in VBR? 3

4 VBR does not live in a vacuum How can I reduce the total cost of care? How can I improve quality? How can I succeed in VBR? How can I improve the patient experience? Where can I reduce expense without compromising quality? 4

5 Interoperability is an imperative The ability of a system to exchange electronic health information and use electronic health information from other systems without special effort on the part of the user. - HHS Definition 5

6 Progression of Interoperability in the Financial Market 1967-Crawl 1980-Stand 1990-Stretch Branch-specific ATM 2000-Jog Networked ATMs 2015-Run Int l Independent ATMs Online Banking Mobile Apps for Financial Health 6

7 Interoperability is a journey that takes time Outcome Analytics Environment Crawl Stand Walk File exchanges, read/write files from databases Mostly batch Niche Efficiencies Publish Point to point interfaces within a single organization Basic intraorganizational exchange Organizational Efficiencies Standardized interfaces Transactional interoperability Basic Reporting Descriptive Analytics Interface engines Emerging standard data sets Document based exchange Diagnostic Analytics Cross-organizational Efficiencies Stretch Plug-n-play interfaces Web and mobile services with read/write access Maturing standard data sets Advanced security framework Prescriptive Analytics Value-based Health Engage Jog Machine to machine exchange Discrete data integration Exposed business functions Integrated data across settings and systems Predictive Analytics Precision Medicine Run Synchronize Integrated information and processes Individualized workflow and UX Real-time Orchestration Today: making the shift toward person-centered interoperability and a learning health system Learning Health System 7

8 McKesson on the Move: Leveraging Our Extensive Footprint 3.3 Billion financial transactions representing $1.8 Trillion processed annually by RelayHealth Financial 4.6+ Million CDAs sent electronically from McKesson EMRs in Billion pharmacy transactions processed annually 2.8 Billion RelayHealth clinical transactions 150 Million C-CDAs annually RelayHealth: national services provider 72% & 34% of Acute-Care EHR Market of Ambulatory Care EHR Market 78 Million imaging studies managed each year 8

9 Steps on the journey to maturity

10 Optimizing Interoperability for Better Population Health 10

11 Optimizing Interoperability for Better Population Health 11

12 CommonWell Health Alliance enables data access through person-centric network CommonWell Services Clinic PCP Community Hospital Person Enrollment Record Location Patient Identification & Linking Data Query & Retrieval Lab IDN Post-Acute Pharmacy Specialist 12

13 Built into the provider workflow Specialist OB-GYN Primary Care MATCH Hospital (Surgery) MATCH Lab MATCH Physical Therapy NO MATCH 13

14 Optimizing Interoperability for Better Population Health 14

15 Optimizing Interoperability for Better Population Health Deliver prioritized insights and needed actions in the workflow of the most appropriate person based on real-time analytics on streaming data informed by Big Data and machine learning predictive analytics 15

16 Innovating on a network >17 Billion Pharmacy transactions processed annually Payers/PBMs Eligibility messaging Claims pricing and validation 50,000 Pharmacies Claims adjudication Workflow Intervention efficiency Patient MessagingRx adherence Safety & compliance Pharmacy Solutions % System Uptime Physicians eprescribing Prior authorizations Rx benefit inquiry Government CMS transaction facilitator REMS Pharma Manufacturers Patient adherence Safety & compliance 16

17 Driving medication adherence and efficiency The Old Way EMR Electronic Rx Pharmacy Benefit Request Pharmacy Solutions Patient picks-up Rx Learns about co-pay or need for prior authorization. Wasted time on callbacks, explanations Pharmacy Benefits Manager 17

18 Driving medication adherence and efficiency The New Way Benefit Request EMR Benefit Request Pharmacy Solutions Benefit Response Pharmacy Benefits Manager RxBenefit Clarity Prior Auth Required R x Patient/Physician conversation Patient picks-up Rx 18

19 Use Case: Interoperability in Cancer Discovery HIMSS Interoperability Showcase Modality Worklist Request/retrieval DBT Images DBT Gantry Radiology Report McKesson Radiology Workstation Oncologist Information System Primary Care Physician EMR Radiology Report Health Information Exchange Radiology Report Hospital Screening Program State Cancer Registry 19

20 Shared Vision for Better Health Business Care Connectivity 20

21 Key Takeaways VBR will change the dynamic of healthcare interoperability and intelligent use of data are essential enablers For VBR success, we must make the shift toward person-centered interoperability and a learning health system Interoperability is more than just moving data around Interoperability is a journey, with most of the industry at the walk stage McKesson is leveraging its systems and networks to solve challenges such as: Data aggregation for decision-making Care coordination across settings, systems and geographies Administrative simplification Patient and family engagement 21