HIMSS Patient-Centered Payer
Roundtable
September 20, 2012
Agenda
Welcome
Call to Order and Roll Call (David Fitzgerald, Shelley Price)
2-Minute Drills
IOM Report “Best Care at Lower Cost”
Topic discussion
The Power of a Virtualized Health Care Environment for Payers (Dr.
Andrew Watson, University of Pittsburgh Medical Center)
Housekeeping
(Shelley Price)
Adjournment
2
Agenda
Welcome
Call to Order and Roll Call (David Fitzgerald, Shelley Price)
2-Minute Drills
IOM Report “Best Care at Lower Cost”
Topic discussion
The Power of a Virtualized Health Care Environment for Payers (Dr.
Andrew Watson, University of Pittsburgh Medical Center)
Housekeeping
(Shelley Price)
Adjournment
3
2 Minute Drill: IOM Report
Best Care at Lower Cost: The Pathway to Continuously Learning Health Care in America
3 Imperatives for Achieving a Continuously Learning Health Care System:
(1) Manage rapidly increasing complexity
(2) Achieve greater value
(3) Capture opportunities from technology, industry, policy
4
2 Minute Drill: IOM Report
Best Care at Lower Cost: The Pathway to Continuously Learning Health Care in America
Characteristics of a
Continuously Learning
Health System
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2 Minute Drill: IOM Report
Best Care at Lower Cost: The Pathway to Continuously Learning Health Care in America
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Foundational Elements
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Care Improvement Targets
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Recommendation 1: The digital infrastructure. Improve the capacity to capture clinical, care delivery process, and financial
data for better care, system improvement, and the generation of new knowledge.
Recommendation 2: The data utility. Streamline and revise research regulations to improve care, promote the capture of
clinical data, and generate knowledge.
Recommendation 3: Clinical decision support. Accelerate integration of the best clinical knowledge into care decisions.
Recommendation 4: Patient-centered care. Involve patients and families in decisions regarding health and health care,
tailored to fit their preferences.
Recommendation 5: Community links. Promote community-clinical partnerships and services aimed at managing and
improving health at the community level.
Recommendation 6: Care continuity. Improve coordination and communication within and across organizations.
Recommendation 7: Optimized operations. Continuously improve health care operations to reduce waste, streamline care
delivery, and focus on activities that improve patient health.
Supportive Policy Environment
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Recommendation 8: Financial incentives. Structure payment to reward continuous learning and improvement in the provision
of best care at lower cost.
Recommendation 9: Performance transparency. Increase transparency on health care system performance.
Recommendation 10: Broad leadership. Expand commitment to the goals of a continuously learning health care system.
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2 Minute Drill: IOM Report
Best Care at Lower Cost: The Pathway to Continuously Learning Health Care in America
Strategies for Progress Toward Goal
Recommendation 1: The digital infrastructure.
•
Payers, health care delivery organizations, and medical product companies should contribute data
to research and analytic consortia to support expanded use of care data to generate new insights.
Recommendation 3: Clinical decision support.
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Public and private payers should promote the adoption of decision support tools, knowledge
management systems, and evidence-based clinical practice guidelines by structuring payment and
contracting policies to reward effective, evidence-based care that improves patient health.
Recommendation 4: Patient-centered care.
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The Agency for Healthcare Research and Quality, partnering with the Centers for Medicare &
Medicaid Services, other payers, and stakeholder organizations, should support the development
and testing of an accurate and reliable core set of measures of patient-centeredness for consistent
use across the health care system.
The Centers for Medicare & Medicaid Services and other public and private payers should promote
and measure patient-centered care through payment models, contracting policies, and public
reporting programs.
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2 Minute Drill: IOM Report
Best Care at Lower Cost: The Pathway to Continuously Learning Health Care in America
Strategies for Progress Toward Goal
Recommendation 5: Community links.
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Public and private payers should incorporate population health improvement into their health care
payment and contracting policies and accountability measures.
Recommendation 6: Care continuity.
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Public and private payers should promote effective care transitions that improve patient health
through their payment and contracting policies.
Recommendation 8: Financial incentives.
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Public and private payers should reward continuous learning and improvement through outcomeand value-oriented payment models, contracting policies, and benefit designs. Payment models
should adequately incentivize and support high-quality team-based care focused on the needs and
goals of patients and families.
Recommendation 9: Performance transparency.
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Public and private payers should promote transparency in quality, value, and outcomes to aid plan
members in their care decision making.
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2 Minute Drill: IOM Report
Best Care at Lower Cost: The Pathway to Continuously Learning Health Care in America
Next steps for payers
1. Seek to align incentives in support of high-quality, high-value, evidence-based care,
including alignment among multiple payers and across the care continuum.
2. Continually improve the value achieved by payment models, contracting policies,
and benefit design while minimizing administrative burdens and expanding
knowledge about the results of different payment and contracting models.
3. Support increased research in clinical effectiveness and cross-industry application
of the research results.
4. Make longitudinal data sets available for research and public health purposes.
5. Promote transparency to support care decisions and improvement efforts.
6. Ensure a balanced focus on all outcomes clinical, financial, service, and experience
and at multiple levels (individual, population).
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Agenda
Welcome
Call to Order and Roll Call (David Fitzgerald, Shelley Price)
2-Minute Drills
IOM Report “Best Care at Lower Cost”
Topic discussion
The Power of a Virtualized Health Care Environment for Payers (Dr.
Andrew Watson, University of Pittsburgh Medical Center)
Housekeeping
(Shelley Price)
Adjournment
10
The Power of a Virtualized Health
Care Environment for Payers
Andrew Watson, MD, MLitt, FACS
Department of Surgery, Division of Colorectal Surgery
Vice President, International and Commercial Services Division
Medical Director, Center for Connected Medicine
Executive Director, Telemedicine
University of Pittsburgh Medical Center
Running With Scissors
Virtual world of health care
Telemedicine is the main case study
Beyond telemedicine
A living laboratory – CCM / UPMC
Risks / milestones to the vision
Virtual World of Health care
Virtual World of Health Care
Consumer electronics market
Is this natural?
Today’s outcomes
What is the point of care?
Telemedicine
Telemedicine
Beyond Telemedicine
“Swim Lanes”
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Call center
SMS
Tablet
Visiting nurse (tablet)
Telemedicine clinic
Remote monitoring
Hospital in home
“New Models of Care”
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Continuum of care
Point of care
Employer on site
Remote monitoring
Transitional care
Chronic diseases
“At risk models”
Center for Connected Medicine
Founding Partners
Strategic Partners
Center for Connected Medicine
Risks / Milestones
Understanding connected medicine strategy
 Cultural Change
Benefit design / population health
Gain share (not reimbursement)
Understanding the risk bearing entities of
health care
Analytics
Conclusion
Virtual health care is a natural evolution
Triple aim is central
Payer led / new models of population health
Agenda
Welcome
Call to Order and Roll Call (David Fitzgerald, Shelley Price)
2-Minute Drills
IOM Report “Best Care at Lower Cost”
Topic discussion
The Power of a Virtualized Health Care Environment for Payers (Dr.
Andrew Watson, University of Pittsburgh Medical Center)
Housekeeping
(Shelley Price)
Adjournment
22
Housekeeping
• We want to hear from you!
• Roundtable member survey coming soon
• What do you see are Key Areas? Trends? Coming down
the pipeline?
• Ideas for speakers and topics
• 2-minute drills – want to present one?
• Get involved
• Join the Speakers Team. Join the Communications Team.
Write for the HIMSS Payer Insider.
• HIMSS.org 2.0
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Housekeeping
• IHE North American Connectathon
• Registration for the Connectathon is open through
Oct. 5, 2012
http://www.iheusa.org/connectathon-registration.aspx
• When:
• Where:
• What:
Jan. 28-Feb. 2, 2013
Chicago, IL
9 IHE domains will be offered for testing this year
The Consolidated CDA® standard will be tested to validate
CDA content with IHE integration profiles
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Housekeeping
• 2012 mHealth Summit -- Connecting the Mobile
Health Ecosystem
– When:
December 3-5, 2012
– Where:
Washington, DC.
– Focus: “The 2012 mHealth Summit will deliver new sponsors, partners and strategic
affiliates; expanded exhibit hall showcasing more than 400 exhibitors; new healthcare
delivery track; new global health track; mHIMSS Hospital Mobile Survey results; and keynotes
from industry luminaries. Overall, the 2012 mHealth Summit will offer attendees a
comprehensive representation of the mobile technologies in healthcare looking at
implementation and impact of its benefits and new opportunities. “
– Info at: http://www.mhealthsummit.org/
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Wrap-up
• Resources:
– HIMSS Calendar of Events:
– http://www.himss.org/ASP/confCalendarHome.asp
– Webinars and Audio Conferences
– http://www.himss.org/ASP/confCalendarHome.asp?cetid=200
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• Web page
Wrap-up
– Payer Topics and Tools page!
– http://www.himss.org/ASP/topics_payers_healthplans.asp
–.
– http://www.healthcarepayernews.com/himss-payer-insider
• Next meeting
– 3rd Thursday of the month from 4-5pm EST
• Thursday, October 18, 2012
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FY13 Leadership and Contact Information
Chairperson:
David Fitzgerald
Enterprise Systems Architect Manager
Aetna
FitzgeraldD2@Aetna.com
Vice Chairperson:
Gary Austin
Principal & Co-Founder,
TranzformHealth
GAustin@TranzformHealth.com
HIMSS Staff Liaison:
Shelley Price
Director, Payer and Life Sciences
HIMSS
sprice@himss.org
Nancy Devlin
Sr Assoc., Payer and Life Sciences
HIMSS
ndevlin@himss.org
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