triad ingenix dossia presentation

An Ingenix - Triad Consulting

proposal for

DOSSIA

andthe Lifelong Personal Health Record

July, 2007

Triad Consulting

Triad Healthcare Informatics

DOSSIA and Ingenix – Shared Objective

Finding a way to improve health care through a shared vision:

Define a unique set of roles One that delivers a set of solutions quickly, even if it

isn’t optimal, but one that can be improved with market adoption

Solution must include commitments by members to benefit in the short term in return for meaningful change driven by employers

End state is one where employers advance the improvement of health care in cost and quality


Ingenix – Our Role

Ingenix Role Application Programming

Interface Control Application Agnostic Exchange Independent Drive Extract, Transform.

Load Provide Analytic Engines Offer Consumer Applications Offer Provider Applications Offer Employer Applications

Ingenix Benefit Short Term Client Services Long Term Improved Use of

Information not Just Data Improved Interoperability Public Domain Achieve Mission Market Competition Early Advantage


Phased Approach

Phase I – Pilot a solution that meets the needs of Dossia members through existing vendor relationships but is scalable to a broader population of employers

Phase II – Scale the pilot solution to the Founding members with all vendor’s data

Phase III – Scale the solution to the broader market


Employer Expectations for Consumer Health

Flawless execution– Employee satisfaction and appreciation of programs– Strong account management and understanding of client concerns

Minimal employer effort Minimal employee effort Seamless, effective partnership among vendors Data privacy controls Best-in-class tools for

– Accessing provider information, – Assessing personal health information and charting progress– Making provider and plan selections– Claims adjudication and savings account administration – Providing participants effective educational and decision-making

resources– Delivering information in a format that is understandable given the

participants’ personal circumstances– Providing comprehensive, timely information to providers concerning each

participant’s health needs, practice patterns and population trends


Ingenix Vision

Providers of Data Sources PBMs Labs IngenixOthers

DOD AARP NMA

PHR

APIApplication Programming Interface

Control Application

Keys

Data Source(virtual)

EBM, ETG, ERGs, PRGs, HCGs

Patient Providers

PHR

WebMD

Participating Employers





Shared Vision


DOD AARP NMA

PHR


Control Application

Keys

Dossia Data Source(virtual)


OMX OMX OMX

Patient Providers

PHR

WebMD

PHR Impact

Consumer/Provider

SymmetryImpact Pro

Ingenix Health Manager

SymmetryImpact Pro



Starting with the End State

Improving the speed and accuracy of health care data aggregation

Preserving privacy Create more meaningful information Market differentiation through use of data not

aggregation of data Employers driving the change




Improving the System via OMX


DOD AARP NMA

PHR


Control Application

Keys



OMX OMX OMX

Patient Providers

PHR

WebMD

PHR Impact

Consumer/Provider

SymmetryImpact Pro


SymmetryImpact Pro



Technical Solution for Quicken Health

Internet

Intuit Hosted Services

Quicken HealthWeb – App Servers

Quicken HealthWeb App

Consumers

Content and OtherSupport Servers

Quicken HealthDataBase Servers

Health Plan

OMXServers

Health PlanInternal Systems

OMX DatabaseServer

Health Plan

OMXServers


OMX DatabaseServer

Health Plan

OMXServers


OMX DatabaseServer


The Opportunity

Leverage the OMX Server Implementation for Dossia: Sends data on a subscription basis Secure and reliable Single point of integration at the health plan Web services architecture


Applied to Dossia

Ingenix

Internet

Consumer Applications

Health Plan

OMXServers


OMX DatabaseServer

Health Plan

OMXServers


OMX DatabaseServer


Control Application

Keys


EBM, ETG, ERGs, PRGs, IHM

OMXServers

Analytic Processing

OMX DatabaseServer


What is OMX?

OMX = Open Medical eXchange Allows Health Plans to provide personal health data to

consumers in a secure and effective fashion Intermediary between Health Plan source systems/data

sources and the Quicken Health application. The OMX server is owned & maintained by the Health

Plan Key functions

Manages user authentication using the Health Plan’s rules

Collects consumer data Provides data on demand – real time (first use) and

batch (subsequent use)


OMX Specification

The OMX specification is simply a communication protocol that has been designed by the Quicken Health team (Intuit & Ingenix) to support the health data collection needs of consumers.

It is similar in use to OFX, yet modernized in design leveraging web services and xml topic structures. The API itself is fairly straightforward.

The Quicken Health Framework is expecting 3 basic things: The data provider will have a profile in a registry on an Intuit-hosted

server (stored in Nexareg, our metadata repository) The data provider will have the ability to respond to a defined set of

web service calls from the client in accordance with the specification – this includes appropriate user authentication and the ability to satisfy a request for data.

The data provider will have the ability to push appropriate notification information to an Intuit-hosted notification server


Consumer Data is Protected

Data Resides on data provider systems, behind their firewalls UNTIL it is requested

OMX currently relies on health plan (or other data provider) ID/ password for authentication, leaving the data provider in control (HIPAA)

Communications between the OMX Server and requesting servers are secure and encrypted


OMX Compatible with Existing Standards

OMX is based on HIPAA (X12 and NCPDP) Allow health plans to more easily map OMX requirements to

existing external interfaces 84% of OMX data elements (excluding payer branding

information) traced to standard transaction set Examples of data elements not referenced to standard

transaction set: data source system, custom information codes, begin and end dates for accumulators

Will continue to leverage the standards that exist HL7 lab result and other clinical data (CCD)

Working with standards and industry groups HITSP, CAQH, AHIP Working with consumer-oriented standards groups – AHIP,

Markle and others


OMX Currently

Administrative and other payer data topics Claims/EOBs Member/ subscriber eligibility information Benefit plan information Provider information Payer web portal links

Ability to add additional topics easily


Certification – Ensures Quality of OMX Providers

Data Quality, Integrity and Access Data is complete and conforms to OMX Specification Consistent with your portal Timely (no more than 24 hour lag) Historical data available (3 years recommended, 12 mo minimum)

Security and Authentication Acknowledge HIPAA obligations Provide authentication mechanism Available to termed members Sensitive data policies applied

Operations and Support Consumer support model is in place and all training complete System availability is managed and notification processes in place System response times are within range


Current Solutions – Future Enhancements

Develop the end state infrastructure Needs to meet current employer and market needs Short term wins – part of move to end state Deliver more than what is available today With an eye towards the future Future is within reach with OMX


State of Shared Health Care Information

Information flow is incomplete

Care Management

Providers Consumers

Care Management – health

information based on claims or

HRA’s

Providers – health information

based on services their practice

performed

Consumers – health

information based on what they

remember or understand




Application of Impact Consumer/Provider


DOD AARP NMA

PHR


Control Application

Keys



OMX OMX OMX

Patient Providers

PHR

WebMD

PHR Impact

Consumer/Provider

SymmetryImpact Pro


SymmetryImpact Pro


© Ingenix, Inc. 22

Sharing Care-Focused Information with all Constituents

Impact Pro Predictor

Impact Consumer Health

Impact Provider Patient Connection

Care-focused PHR

Impact Pro Predictor – enables

informed care managers to

coordinate care with consumers

and providers.

Impact Provider Patient Connection – enables prepared,

physician practice teams to deliver

better, proactive care.

Impact Consumer Health –

enables informed, activated

consumers to make better health

decisions.

© Ingenix, Inc. 23

Impact Consumer/Impact Provider Currently

• Demographics• Encounters• Medications• Providers• Self-reported

© Ingenix, Inc. 24

Impact Consumer Implementation at DOSSIA


Data from employers supplied to DOSSIA

DOSSIA administers (typically) monthly processing. Could be a BPO process

provided by Ingenix, or run by DOSSIA.

Internet access to the datamart. Hosted by DOSSIA or Ingenix.

Consumer access is through the Impact Consumer web site, or through a

DOSSIA-supplied portal accessing Impact Consumer information

Back office access to the datamart also available

© Ingenix, Inc. 25

Protected Health Information


We assume DOSSIA is HIPAA compliant. Alternatively can employ

Ingenix’s HIPAA compliant BPO.

Consumers must grant access to their information to physicians BA’s in place with network

physicians?

© Ingenix, Inc. 26



Consumer Behavior Change with Non-Traditional Data


DOD AARP NMA

PHR


Control Application

Keys



OMX OMX OMX

Patient Providers

PHR

WebMD

PHR Impact

Consumer/Provider

SymmetryImpact Pro


SymmetryImpact Pro


© Ingenix, Inc. 27


Reporting

• Activity report• Outcomes report• Efficacy report

Continuous improvement thru “organic” learning system

Create 360° Health Profiles(Includes individual health and lifestyle information)

Prioritize Individuals for Intervention(Based on 360° Health Profiles)

Create Target Groups(Matched to available interventions)

Segment Population(Creates segments by unique characteristics)

Data Management, Segmentation & Targeting

Tailored Messaging & Activation

Create Engagement Profiles (Includes 360° Health Profiles and Activation Plan)

© Ingenix, Inc. 28

Health and Consumer Information to Change Behavior

Data Management, Segmentation and Targeting• Get a deeper understanding of consumers with 360-degrees of data

Integrate health and consumer information from multiple data sources Match data at the individual level Apply methodologies to address potential data gaps

• Understand the unique needs of populations to provide customized health solutions Identify unique health needs and characteristics of populations across the health continuum Reveal gaps in intervention program needs and delivery mechanisms

• Identify target groups for health intervention, integrating health outreach Match individuals to available interventions based on health needs and preferences Prioritize individuals for intervention based on readiness to change and likelihood of engagement Uncover previously unidentified consumers for intervention – before they get sick

Tailored messaging & activation• Engage consumers in health intervention for better health outcomes• Create tailored messaging, using direct marketing and behavioral science techniques,

to activate consumers• Deliver information needed to tailor interventions at the target group or individual level

Reporting• Measure and deliver better health and financial outcomes• Continuously refine and improve intervention program effectiveness

© Ingenix, Inc. 29

Ingenix Health Manager End-to-End Solution

Data Management, Segmentation & Targeting

Tailored Messaging & Activation

Delivery Reporting

Report TypesData Standardization and Matching

Data Analytics Outreach Enrichment

Data MatchingIndividualProvider

Multi-payerMulti-source

Scoring/RatingCost

QualityVolumeSeverity

ETL Process

Population Segmentation

Application of Business

Rules

Stratification of Members

•Medical Care Cost & Utilization•Pharmacy Cost & Utilization•Lab Values•Socio-economic•Demographic•Health Risks/Status•Life Stage Clusters•Consumer Preference•Productivity & Absence•Physician & Hospital Quality•Provider Directory•Program Inventory•Benefit Parameters (e.g., costs, fee schedules, detail)•Plan Parameters•Intervention Activity •Intervention Results

Consumer Intelligence Warehouse Grouper

Technology

Predictive Model

Health Messaging Campaigns

Health Interventions

Heath Portal

24-Hour Health Line

Heath Risk Assessment

Lifestyle Behavior Health

Coaching

Disease Management

Case Management

End-of-Life Management

Connecting Physicians &

Patients

Individual Activation

Plans

Intervention Enrollment Messaging

Cost and Quality

Messaging

Provider Messaging

IHM Data Mart

Indi

vidua

l Dat

a So

urce

s

12

Identification of Target

Groups

• Intervention Activity

• Intervention Outcomes

• Return on Investment

• Intervention Efficacy

• Activation Response

• Special Studies

© Ingenix, Inc. 30

Benefits

Employer Benefits Continued decision support Improved decision support

Market Benefits Independent exchange Applying current market

standards

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