hies and hixs: where the two shall meet
DESCRIPTION
As states and healthcare organizations begin to develop and implement health information exchanges (HIEs) and health insurance exchanges (HIXs) across the country, many have begun to wonder how these advanced technologies could interact to deliver better quality of care in the future. This is a critical moment for healthcare as it will set the stage for patient-centric models of care delivery.It is important that all key industry stakeholders begin the conversation, while these systems are in development, as to how patient and medical coverage data should converge. To help understand where these technologies are heading and how you can take advantage of the opportunities they present now, we invite you to join us for a complimentary, live webinar on Wednesday, March 30, from 1 p.m. to 2 p.m. CDT.TRANSCRIPT
HIEs and HIXs: Where the two shall meet
March 30, 2011
Download this presentation at www.slideshare.net/dellservices
Where are we now?
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Changing the healthcare information landscape
Drivers • ARRA/HITECH
• HC Reform/PPACA
• ICD-10/5010
• Quality Outcomes
• Consumerism
• Consolidation
Outcomes • Evidence Based
Medicine/DSS • Personalized
Medicine • Transparency/Cost • Improved Efficiency • Improved Quality • Public Health
Surveillance
4 Confidential
What are HIEs & HIXs and how do they fit into the changing landscape?
7/7/2011
Health Information Exchange (HIE): Facilitate the electronic flow of health data across the continuum of care to support processes that improve the quality and efficiency of care delivery and population health.
Health Insurance Exchange (HIX): Online marketplaces where customers can shop and purchase health insurance from payers that compete for new business.
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We are facing the greatest changes to healthcare in more than a generation – exchanges are at the heart.
New records in number of covered lives
Greater adoption of health information technology
New regulations regarding security
New market mechanism
Billions available in federal funding
New rules for managing members
New budget impact for states
Health Exchanges
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How do they work?
Income & Citizenship Validation
Plan Selection
Enrollment
Record Location
Record Exchange
Comprehensive Health Record
Health Insurance Exchange
Health Information
Exchange Identity
Management
7 Confidential
Where can they intersect initially?
7/7/2011
Income & Citizenship Validation
Plan Selection
Enrollment
Health Insurance Exchange
Having access to the individual’s complete electronic health record (EHR) will help decide the right plan for the individual.
Initially Individual uses EHR to decide
Over Time Tools help narrow down the choices
Complete Health Record
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Can’t we do more?
Income & Citizenship Validation
Plan Selection
Enrollment
Health Insurance Exchange
Once states have a handle on the health conditions affecting their population most, they can drive plan creation focused on that subset of the population.
Complete Health Record
Plan Creation
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Healthcare reform also called out ACO models. How do they fit into the mix?
Patients with chronic conditions (e.g. diabetes) often see multiple physicians
for their care.
Accountable Care Organizations (ACO) allow physicians, as a group, to treat the patient with the goal of improving quality while reducing cost.
Aligning incentives with optimization:
If the ACO meets quality standards and reduces costs, they receive 80% of the cost savings.
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Do ACOs change the process?
Income & Citizenship Validation
Plan Selection
Enrollment
Health Insurance Exchange
As ACOs evolve, the goal isn’t just picking the plan, the goal is selecting the ACO and plan combination that best fits the individual’s health.
Complete Health Record
ACO
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Sounds like a lot of moving parts. How do we put it all together?
Identity Management
Plan Selection Tools
Reporting & Analytics
Individual Stakeholders
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What are the challenges?
HIEs and HIXs are usually run through different state agencies.
It may be a while before some states have an HIE infrastructure in place covering all their citizens.
Many trying to “get something in place” to maximize funding.
Few states are have even begun to think how the two solutions will align.
Existing systems are built on old architectures and may not be flexible enough to properly handle future change.
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What To Expect Over The Next 6 Months
Continued uncertainty
Unpredictable implementation progress at federal and state level
State-specific agendas and hybrid solutions are emerging
Heightened levels of engagements and scrutiny
Helping small businesses and job growth
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What states and health organizations should be doing now
HIE HIX
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Points of interaction
Plan Selection Individuals use medical data to select best insurance plans
Enhance Products HIEs feed HIXs with population health data, which customize plans to meet specific health needs
Managed Care Guidance Selected plans guide patients towards medical management and care management programs
All Payer/All Claims Databases States track macro-level health of population
Payment Reform/ACO Access to data will drive changes in the way payment is received
How we can help
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Thank You Dave Marchand (972) 577-5595 [email protected]