HIMSS Patient-Centered Payer Roundtable. December 20, 2012

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1 HIMSS Patient-Centered Payer Roundtable December 20, 2012

Agenda Welcome Call to Order and Roll Call (David Fitzgerald, Shelley Price) Topic discussion 2012 A Year in Review and Looking Ahead to 2013 (1) 2012: Overview of the Goals and Objectives of

Roundtable (Shelley Price) (3) Connectivity Channels in Communication What s Next for Payer Roundtable Communication in 2013 (Deanne Kasim) (4) An Entering of a New Era of Collaborative

2 Agenda Welcome Call to Order and Roll Call (David Fitzgerald, Shelley Price) Topic discussion 2012 A Year in Review and Looking Ahead to 2013 (1) 2012: Overview of the Goals and Objectives of the Payer Roundtable, 2013: Where Do We Go from Here (David Fitzgerald) (2) 2012: Retrospective of Strategic Goals and Objectives for HIMSS, 2013: New Alliance Opportunities for the Payer Roundtable (Shelley Price) (3) Connectivity Channels in Communication What s Next for Payer Roundtable Communication in 2013 (Deanne Kasim) (4) An Entering of a New Era of Collaborative Innovation What s Next for the Speaker s Team in 2013 (Kim Harding and Lance Stewart) (5) Election 2012 What It Means to the Payer and HIT community (Gary Austin) Housekeeping (Shelley Price) Adjournment 2

3 2012: Overview of the Goals and Objectives of the Payer Roundtable 2013: Where Do We Go from Here David Fitzgerald

4 PCPR Goal Objectives 2012 and Beyond What is a Roundtable? Roundtables are chartered by the Board of Directors. They exist to strengthen a HIMSS strategic initiative, and represent a specific core constituency within the Society s community. Vision: Improve patient care and quality outcomes in a cost-effective manner. Foster collaboration and trust between providers, payers and all health care constituents. Improve health care productivity and efficiencies by leveraging information technology. Mission: Provide a vehicle for payers, providers and other stakeholders to exchange ideas and dialogue on emerging health IT issues and opportunities. Advance the engagement and learning of payer stakeholders Impact public policy through the HIMSS Public Policy Committee Create a conduit for health IT and provider stakeholders to impact the payer community engagement and investment in improving of delivery of care. 4

5 PCPR Goal Objectives 2012 and Beyond Ask ourselves: How do we measure success? Is the roundtable representing the core constituency? Position the PCRT/HIMSS as an independent thought leader, payers have a voice in health care speak. Build out the payer footprint in health care - starting at HIMSS. Reach out into other HIMSS taskforces and gain partners Reach out to Providers form better relationships. Better collaboration between payers and providers to support improve care and outcomes. Need to better understand each group s priorities and goals and see where there area areas for discussion, collaboration. Holistic view of payer-provider IT solutions Health IT solutions are often siloed within both payer and provider organizations. The healthcare system is moving toward a more holistic view of patient care. The delivery system is becoming more integrated. Health IT professionals and systems need to also become more holistic in their viewpoints and integrated in function Vendors and Consultants are our friends they help dig ditches and work the details. Like many volunteer groups we have many followers, but few directly engaged. Find ways to engage everyone and welcome everyone. 5

6 2012: Retrospective of Strategic Goals and Objectives for HIMSS 2013: New Alliance Opportunities for the Payer Roundtable Shelley Price

7 Retrospective of Strategic Goals and Objectives for HIMSS Goal 1: HIMSS ensures all relevant stakeholders are engaged in the transformation of healthcare through IT and management systems. Goal 2: IT and related health policies of all stakeholder entities reflect transformational knowledge, experiences and best practices. Goal 3: Healthcare stakeholders have the knowledge, tools, experiences and best practices to make optimal decisions regarding the development, acquisition, deployment, use and value of IT and management systems.

8 Payers and Health Plans Provide tools and resources Publish a briefing series on healthcare reform and health insurance exchanges, highlighting payer adoption and use of HIT. Engage payers in healthcare transformations Grow the Payer Roundtable as a vehicle to exchange learning, build the knowledgebase, cultivate thought-leadership Support HIMSS13 expanded offerings to the payer industry by growing the HIMSS13 sponsored networking lunch Support HIMSS G7 event that connects banking, payer and mobile communities

9 New Alliance Opportunities for the Payer Roundtable AHIP Building a partnership Others? education resource development & support, event sponsorship

10 Other Growth Opportunities TOP IT ISSUES: *The ability to aggregate total cost of chronic condition so as to bundle payments and share savings with all stake holders Survey to get your feedback and direction Emerging topics Annual Conference: HIMSS14 and Beyond TOP IT ISSUES: * Chronic Population Management TOP IT ISSUES: *Facilitating a true partnership between all stake holders using automation as the tool TOP IT ISSUES: * Clinical data aggregation and sharing between all stake holders

11 Connectivity Channels in Communication What s Next for Payer Roundtable Communication in 2013 Deanne Kasim

12 Focus of the Communications Team Communicating latest health IT news in the payer community. Helping to foster Payer-Provider collaboration, knowledge generation, solution sharing. Communicating discussions, ideas from the (PCPR) monthly meetings and annual conference sessions. Growing participation in the group through sharing of news, ideas and generating publicity.

13 Call for Volunteers! Be a HIMSS Payer guest blogger! (Share ideas, knowledge get your name out there!) Write brief ( words) news stories, thought pieces, and Roundtable recaps for the HIMSS Payer Insider (bi-monthly in the Healthcare Payer News). Coordinate group comments on draft regs, HIMSS policy statements and get the payer perspective heard.

14 Get Involved and Be Heard! Contact Shelley Price, HIMSS / sprice@himss.org / Nancy Devlin, HIMSS / ndevlin@himss.org / Deanne Kasim, PCPR Communications Team Chair / dkasim@santesys.net /

15 An Entering of a New Era of Collaborative Innovation What s Next for the Speaker s Team in 2013 Kim Harding & Lance Stewart

16 Role of Payers and Interoperability Initiatives and standards definition - IHE Profiles and HL-7 Spotlights on federal and private sector innovators and NextGen thought leaders for HIT Joint AHIP and HIMSS Payer Innovation Summit Open for other suggestions

17 Call to Join the PCPR Speakers Team Join the Roundtable s Speakers Team and further knowledge sharing and partnership building! The Speakers Team is responsible for topics and content for roundtable. It identifies and invites speakers, with input from leadership team, and maintains the high level of quality of content. What do we want you to do? Use your ear to the ground to identify and pull in emerging trends, new ideas, key issues, critical content areas, and high quality speakers. Generate ideas and potential speakers for upcoming HIMSS events and webinars as needed, HIMSS13 payer events like the networking luncheon. Build a successful, engaging, and beneficial roundtable! Contact Shelley Price, HIMSS / sprice@himss.org Nancy Devlin, HIMSS / ndevlin@himss.org Kim Harding, PCPR Speakers Team Co-Chair / Kimberly.Harding@floridablue.com / Lance Stewart PCPR Speakers Team Co-Chair / Lance.Stewart@emids.com /

18 Election 2012 What It Means to the Payer and HIT Community Gary Lumpy Austin

Impact of Election 2012 ObamaCare Impact HIX (Health Exchanges) MU (Meaningful Use) Medicaid Expansion ACO Transformation CMS enters the 21 st century

19 Impact of Election 2012 ObamaCare Impact HIX (Health Exchanges) MU (Meaningful Use) Medicaid Expansion ACO Transformation CMS enters the 21 st century Fiscal Cliff Leaves its Mark Medicare Eligibility Physician Payments Gary M. Lumpy Austin President TranzformHealth

20 ObamaCare Lives Blue View Red View Gary M. Lumpy Austin, President

HIX: Health Insurance Exchanges The Facts 2013: Put up or Shut up 10 Rely on Feds 18 States to own 22 No decision to date Gary M. Lumpy Austin, President Gaustin@TranzformHealth.com 585.967.

21 HIX: Health Insurance Exchanges The Facts 2013: Put up or Shut up 10 Rely on Feds 18 States to own 22 No decision to date Gary M. Lumpy Austin, President Lumpy Color Commentary For the most part, Blues going State HIX, Reds going Fed HIX Red bet is that Feds will never get it right Generational opportunity for nationals to acquire members Blues at great risk Self-branded ACOs are the wildcard 21

22 MU: Meaningful Use MU for 2011 MU1 ers Core & menu criteria MU for 2011 MU ers Higher MU2 thresholds HIE still not reality Infinity and Beyond MU4: HIEs? Gary M. Lumpy Austin, President Lumpy Color Commentary Reds are going to put heavy pressure on CMS to accelerate metrics, and therefore on vendors to remain compliant. This will cause a big meltdown in EMR vendors Care management and analytics vendors will M&A at a premium 22

23 Medicaid Expansion The last big Blue-Red fight within ObamaCare We ll underwrite for 3 years, then son, you re on your own What will the eligibility threshold be (138%)? Play along, or we pull all Federal funding Gary M. Lumpy Austin, President Gaustin@TranzformHealth.com

24 ACO Transformation Intra/Inter market delivery consolidation TX: Baylor-Scott & White MI: Henry Ford-Beaumont TN-MA/CT: Vanguard and Tufts and Waterbury Hosp Payer-Delivery tension increases Highmark-UPMC, West Allegheny, Jihads declared Gary M. Lumpy Austin, President

25 ACOs Forming Self-Branded Payers CA: Sutter ATL: Piedmont-WellStar NYC: NorthShore-LIJ DC: MedStar Health DTW: Henry Ford Health System VA: Sentara Health & Inova Health Gary M. Lumpy Austin, President

26 Fraud CMS Enters the 21 st Century 2009: $2B 2011: $4.1B 2012: $5B to date Estimates as much as 10% payments are fraudulent Crimes > $500k else not usually prosecuted Data Release ~ 1/3 of US, could approach ½ within 5 years Consumer engagement via Blue Button Much stronger HIPAA enforcement BCBSTN $1.5m, PHX-Cardio $100k (5 docs), Cignet $4.3m Gary M. Lumpy Austin, President Gaustin@TranzformHealth.com

27 The Fiscal Cliff Only politically viable way to control Medicare is upping age eligibility, tagging expenditures to Life expectancy (eligibility) and COLA (spend) or some similar generally accepted metrics Means testing, other penalize the rich plays won t get you there financially Gary M. Lumpy Austin, President Gaustin@TranzformHealth.com

28 Open Discussion 28

29 Housekeeping MU3 RFC: HIMSS Draft Response Comments due to Shelley or Nancy January 2 HIMSS Public Policy Principles available The Board of Directors approved the Public Policy Principles in December: Save the Date: HIMSS Annual Call for Committee Volunteers Opens Jan. 2 Closes March 1, 2013:

30 Resources: Wrap-up HIMSS Calendar of Events: Webinars and Audio Conferences 30

31 Web page Wrap-up Payer Topics and Tools page!. Next meeting 3 rd Thursday of the month from 4-5pm EST Thursday, January 17,

32 FY13 Leadership and Contact Information Chairperson: David Fitzgerald Enterprise Systems Architect Manager Aetna Vice Chairperson: Gary Austin Principal & Co-Founder, TranzformHealth HIMSS Staff Liaison: Shelley Price Director, Payer and Life Sciences HIMSS Nancy Devlin Sr Assoc., Payer and Life Sciences HIMSS 32

HIMSS Patient-Centered Payer Roundtable. November 15, 2012

HIMSS Patient-Centered Payer Roundtable November 15, 2012 Agenda Welcome 2-Minute Drills Topic discussion Housekeeping Call to Order and Roll Call (David Fitzgerald, Shelley Price) Join the Roundtable