harness your clinical and financial data with an enterprise health information exchange

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Harness Your Clinical and Financial Data with an

Enterprise Health Information Exchange

August 26, 2010

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Table of Contents

Consumerism in Healthcare

Physician Practice Alignment in Healthcare

Government, Payors, Analytics and Healthcare Reform

Enterprise Health Information Exchange Approach

Coordinated/Connected Care Examples

Questions

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About Perficient

Perficient is a leading information technology

consulting firm serving clients throughout North

America.

We help clients implement business-driven

technology solutions that integrate business

processes, improve worker productivity,

increase customer loyalty and create a more

agile enterprise to better respond to new

business opportunities.

Follow Perficient’s Healthcare IT team at:

Blogs.Perficient.com/Healthcare

Twitter.com/Perficient_HC

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Fast Facts

Founded in 1997 Public, NASDAQ: PRFT 16 locations throughout the U.S. & Canada:

– Chicago, Cincinnati, Cleveland, Columbus, Dallas, Denver, Detroit, Fairfax, Houston, Indianapolis, Minneapolis, New Orleans, Philadelphia, San Jose, St. Louis and Toronto

1,100+ employees Dedicated solution practices Served 400+ clients in past 12 months Alliance partnerships with major technology vendors Multiple vendor/industry technology and growth

awards

Key Differentiators:– Focused expertise, lower cost, faster time-to-value– IT Solutions with Business Focus– Mature, proven Project Methodology– Global Development Centers in China & Europe– Healthcare Thought Leadership

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Our Solutions

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QualityReporting

Provider Landscape….

Clinical ProcessesOrders, Medications, Results, Alerts

Scheduling, Pre-Reg

Billing, Collections,Denial Management

Charge CaptureEligibility and Medical Necessity

Checking

Point of Service Collections

Pay forPerformance

Reporting

RACAudits

Coding

Patient TransfersDischarge

RegistrationCheck In

EDI

StandardsICD 105010

PhysicianAlignmentConsumerism

ARRA

Decision Support

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Consumerism in Healthcare

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Healthcare Consumer Interesting Facts

Only 20% are content to let their doctor make the decision

93% of consumers are insecure about their ability to handle future health care costs

90% would willingly travel outside their community – including 39% to foreign countries - for comparable and less expensive treatment programs

Nearly half of Medicare enrollees are self-directed activists in their care, and many use websites for information about price and quality

78% want to customize their healthcare coverage and experience to include the features they value, with the cost changed accordingly

84% prefer generic drugs to name brands

34% would use a retail/walk-in clinic; 16% already have

Source: Deloitte LLP - United States

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Consumer Trends – Retail Clinics

Growth of Retail Clinics:– More than 1 in 3 consumers surveyed are receptive to the idea of using

retail clinics – 1 in 6 already have – Interest in retail clinics is especially high among Baby Boomers, with nearly

38% saying they would use a retail clinic

More than 800 clinics operate across the country at chain stores. With waiting times less than 30 minutes, most people go for convenience but this is also a more affordable option for the uninsured.– Convenient Care Association (CCA) is forecasting that retail clinic totals will

reach 5,000 by the end of the decade

Patient satisfaction is high for these centers:– 92% satisfaction with convenience– 89% satisfaction with quality of care


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Consumer Trends – On-Line Access

Source: Deloitte LLP - United StatesEconomist Magazine

Consumer Trends – On-Line Access

Source: Deloitte LLP - United StatesEconomist Magazine

Consumer Trends and Online Access

26%

33%

46%

60%

0% 20% 40% 60% 80% 100%

Consumers that would pay more for online access to medicalrecords and test results

Consumers that consult health related Web sites andpharmacists

Reported interest in keeping an online or software computerprogram personal health care record

Reported interest in online access to doctors, medicalrecords, test results and appointments

Online Access Generation Study: Gen X, Baby Boomers, and women are the most likely to use health-related sites

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Consumer Trends – Prevention & Wellness


Consumer Trends – Prevention & Wellness

Percentage of men and women that have opted for preventative health care

Men, 49.8%Women,

56.4%


Consumer Interest in Wellness Programs

26%

83%

65%

17%

0% 20% 40% 60% 80% 100%

Reported willing to pay extra for a wellnessprogram

Reported interest in participating in a wellnessprogram that would reduce premiums or lower

co-pays

Reported interest in participating in a wellnessprogram

Reported participating in a wellness program

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Preventative CarePersonalized Health Management

5%

53%

0% 20% 40% 60%

Reported they wouldpay extra for a

health/lifestyle coach

Reported interest inusing a health/lifestyle

coach

Consumers and Preventative Care

33%

50%

0% 20% 40% 60% 80% 100%

Reported takingpreventative measures to

lower the cost ofhealthcare

Reported takingpreventative measures to

reduce the need forhealth care

Preventative Care

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Consumer Trends -- Quality

Source: HealthView Plus 2006

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Physician Practice Alignment in Healthcare

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Physician Numbers

By 2025, the Association of American Medical Colleges projects a shortage of 124,000 physicians, 46,000 of them in primary care.

In some cases, midlevel providers, such as nurse practitioners and physician assistants, are helping to alleviate the burden on overworked primary care doctors.

The American Medical Association reports that the total number of physicians employed in community hospitals increased 24 percent between 2003 and 2007, while the number of physicians nationally increased only 8 percent.

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Physician Numbers (Cont.)

A recent survey by the Society for Healthcare Strategy and Market Development indicated that health care leaders across the nation believe the percentage of physicians on hospitals' active staffs who are employed will increase from 10 percent today to 25 percent by 2013.

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Physician Practice Challenges

50% of physician practices are small community based that have less than three physicians

Increased pressure around reimbursements

Increasing cost of running their practices

Increased regulatory rules and compliance requirements from CMS and the Payor organizations (i.e. P4P)

The recently based ARRA Stimulus Bill around adoption of EMRs and the associated behavioral changes

Challenges in creating the right incentive models

How do you Align and Connect to your Physician Practices?

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Physician Alignment Matters

The average annual revenue generated per medical Specialty:

• Orthopedic Surgery $3.0M

• Cardiology (noninvasive) $2.6M

• Cardiology (invasive) $2.5M

• General Surgery $2.4M

• Neurosurgery $2.4M

• Internal Medicine $2.1M

• Family Practice $2.0M

• Hematology/Oncology $1.8M

• Pulmonology $1.8M

• Gastroenterology $1.3MSource: Meritt, Hawkins & Assoc. and Healthcare Financial Mgt. Assoc.(HFMA)

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Physicians in Crisis

WHAT DOCTORS ARE SEEKING:

An American Hospital Assn. report found increased requests for jobs as well as money. During 2009, 56% of hospital CEOs said their facility got more physician requests for aid. Of those CEOs:

– 83% reported more physicians wanting increased pay for on-call or other services provided to the hospital.

– 69% reported more physicians seeking hospital employment.– 56% reported an overall increase in doctors asking for financial

aid.– 31% reported more doctors looking to sell their practices to

hospitals.– 23% reported more doctors seeking to partner on buying

equipment.

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Government, Payors, Analytics and

Healthcare Reform

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American Recovery and Reinvestment Act

Signed in February

Large component dedicated to Healthcare

Title XIII. Health Information Technology for Economic and Clinical Health Act -> HITECH Act

– Outlines roles, powers, etc– Updated security and privacy

provisions

Title IV. Medicare and Medicaid Health Information Technology

– Outlines incentives for Electronic Health Record adoption

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ARRA “Meaningful Use” EHR Criteria – Standard Reporting

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ARRA “Meaningful Use” EHR Criteria – Standard Reporting (Cont.)

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ARRA “Meaningful Use” Criteria -- Analytics

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2003

2006-07

2008

2009

2010

2011

10 Measures

21 Measures

27 Measures(10 Nurses)

30 Measures

72 Measures

127 Measures(43 Nurses)

This CANNOT be conquered one Core Measure or quality metric at a time.

An active vendor partnership is needed, with a solution that enables agility, adaptability, adoption and clinical excellence.

Unscalable personnel costs in suboptimal processes … … and lost pay for performance money …

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Quality Measures Reporting

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Pressure ulcers Surgical site infections Vascular catheter-associated infections Air emboli Blood incompatibility Catheter-associated urinary tract infections Hospital acquired injuries Preventable events – Object left during surgery

Once again,this CANNOT be conquered one Core Measure or quality metric at a time.

An active vendor partnership is needed, with a solution that enables

agility, adaptability, adoption and

clinical excellence.

8 Now, 21 by 2009

$36 B in Costs in 2008

National Private Payers

$70 B in Costs in 2009

WHY?

Again, unscalable personnel costs in suboptimal processes … … and lost reimbursement …

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Non-reimbursement for Preventable Conditions: The “Never Events”

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Healthcare Reform

Health Systems need to be focused on reimbursement mitigation strategies

The advent of Accountable Care Organizations (ACOs) should to be evaluated and considered by many healthcare organizations

We appear to be moving towards a capitation reimbursement model for care delivery

Health Systems that are able to harness and partner with all the disparate care delivery entities are going to be able to drive a sustainable business model

CMS and Health Insurance Payors are driving reimbursement models that put Health Systems at risk for the cost of the continued delivery of care that is not coordinated or aligned

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Enterprise Health Information Exchange Approach

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Healthcare Organizations are Experiencing the Most Challenging Environment in Decades…

Manage regulatory changes and maintain compliance

Improve citizen care without increasing costs

Prevent internal & external security breaches

Manage data growth – analytics, clinical information

Facilitate availability & reliability of services

Support move to personalized healthcare

Drive engaged physician and patient relationships

Improve clinician satisfaction

Create TRUE clinical and financial data transparency

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Solution On-Ramps Drive Progressive TransformationDelivering ROI and Increasing Reuse With Each Project

Time

Fle

xib

ilit

y

Start with disparate systems with complex integration

Achieve a simplified SOA-enabled infrastructure

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Pick an on-ramp project and start rationalizing

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Build on the value of previous projects and reuse assets

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Applications have to be “ripped and replaced”

Integration is done with “hardwiring”

Wit

ho

ut

SO

A

New services can be built flexibly by reusing assets

Integration is done “loosely” with modular “services”

Why a Framework for healthcare?

• Roadmap and reference architectures based on best practices

• Incremental development

• Easier integration with disparate applications

• Share critical clinical and operational information

• Service reuse across the organization

• Reduced maintenance and operational risk

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ESB for Healthcare

Healthcare Integration and Interoperability

Solution• High performance integration and exchange of

clinical, business, and administrative information across the healthcare organization.

• Compliant with HL7 V2, V3 Clinical Document Architecture, Continuity of Care Record.

• Routing and transformation services.

Governance

Health Integration Framework

Business Partners

Healthcare Provider Solutions

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Health Analytics

Enterprise Health Analytics

Solution

• Enterprise data warehouse, tools and capabilities to aggregate and analyze data across the healthcare organization to improve clinical and business outcomes and results.

• Reporting and Dashboards for Meaningful Use, patient safety, quality, research and business operations.

Governance


Business Partners


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Portals

Provider and Citizen Portals

Solution• Single secure web portal for Providers or

citizens, providing access to clinical, financial and administrative information from disparate legacy applications.

• Real-time integration using SOA:• Multi-vendor• Multi-system

• Unified communications for physicians, staff and patients.

Governance


Business Partners


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Health Information Exchange

Health Information Exchange

Solution• Secure exchange of healthcare information across local, regional, state-

wide and/or national healthcare communities.• Based on Integrating the Healthcare Enterprise (IHE) profiles• Document registry and repository services• Record locator services• Fine grained access and consent management• Collaborative messaging services• Real-time monitoring and feed of topical information for bio-surveillance

or public health

Governance


Business Partners


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An Enterprise HIE Reference Architecture

EpicEpic CernerCernerLawsonLawson

SiemensSiemens AgfaAgfa EclipsysEclipsys

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Coordinated/Connected Care Examples

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Performance Excellence

Healthcare System

BusinessRules

ClinicalBest Practices

KeyPerformance

Indicators

Chief Medical Officer

Chief Nursing Officer

Department Directors

Nurse Unit/Shift Managers

Attending Physicians

Alerts Risk Assessments

Daily Dashboards Weekly/Monthly Reports

Patients

Health StatusPost Discharge

MonitoringTherapy Adherence

Alerts/Reminders

CertificationAccreditation

RegulatoryCompliance

Outcomes-based Reimbursement

Quality/SafetyProcess

Improvement

Quality Reporting KPI Monitoring Process Monitoring

Enterprise Applications, Electronic Health Record,Revenue Cycle Solutions, Diagnostic, Testing


Meaningful Use

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Coordinated Care Platform Increased use of information technology to capture clinical data, and more importantly, connect the participants

in the care process, creates significant opportunities for organizations to materially improve Health outcomes



Patients/Consumers Healthcare

Systems

Physicians, Clinicians, Medical Homes

Building on Foundational HIT

systems and infrastructure

Create a data-driven, intelligent,

collaboration Platform

Connect Health Systems with their

Consumers and Physicians to

achieve outcomes

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Care Coordination Platform ExampleRetail PharmaciesPBMs

Medical HomePCPs

Care Management Team

Patients/Consumers

Prescription PickupsRx Refills

Record Medication Usage

Home Device Integration

Alerts/eReminders/Calls

Update CareTracker

Health InformationExchange

Clinical ProtocolsClinical

Best PracticesEHR

Maintain Chronic Disease Patient Registry

Assign/Create Clinical Protocol for Chronic Patients

Monitor Patient StatusMedication Adherence

Protocol Adherence

Manage Events(Rx, Appts, Alerts,Secure Messaging)

Health Care System

Personal Health Records

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Questions?

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