More from #WHIT (here is the Agenda). No for the first panel session:
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Dr. Winkenwerder: Change appears to be driven by Federal Government rather than the industry.
Is the Affordable Care Act creating a more affordable health care system?
Lonny R: Extending care to 30M uninsured is a great step forward. We need incentives and health plan designs to increase affordability.
Craig S: Health Insurance Exchanges could drive competition in some markets
Cost of care is lower in Madison, WI than in Milwaukee by 30%.
Is this an indication that integrated systems have an advantage in cost of care delivery.
Todd R: MA experience - Accountable Care Organization model is a challenge. Product changes are needed and increased transparency back to the consumer.
James W: Big difference between lowering unit cost to individual and lowering costs overall. Geisinger reduced costs by focusing on case management for specific diseases. They also provided a free case manager to each clinic (in or out of network). All has helped reduce cost for managing diabetes and reduced in-patient stays.
Redesign processes from end to end and then run processes efficiently.
Theresa C: Opportunities for cost savings: Indian Health Service embraced IT 25 years ago. IHS spends over $1B with private insurers. IHS has embraced the concept of Primary Care Medical Home. IHS focus on small rapid cycle innovation projects. Cycle rapidly and then spread what works.
HITECH Act:
Craig S: in 2010 have used technology to keep medical cost trend at 2% against national average of 10%. Pharmacy is running at a negative cost trend. Data collection has enabled them to mine for opportunities to improve.
Investing in HIE to gain access to out of network information - test results and treatments etc.
Lonny R: Aetna offering Personal Health Record for members. Working with IBM to share this information via a HIE.
James W: If you can't deliver quality care at a lower affordable cost you will be out of business in 5 years. How do you decrease cost? The Flu shot example. don't push the flu shot question to the doctor and clinician. Instead reach out to consumer directly via their preferred channel (PHR, email, US Mail). Call a custom hotline to setup appointment. If no action in 2 weeks, queue in Call Center. This approach has reduced Doctor workload. Reduced cost and increased uptake to well above national levels.
Theresa C: IT Developers - keep your eye on the larger objective. Don't just code the current specific requirements. Keep the large system architecture in mind.
"We need to get beyond the visit"
Craig S: Lean process improvement identified that providing information to patient at end of the visit needs to be 100% and not just aim to achieve the Meaningful use level of 50%.
Question from Audience: IDEO and others say "Design around the Extreme" - how does that apply to Indian Health Service. IHS go to Providers for input. Engaging front line providers get's them good results. Agile Rapid Process Development. 2 week process.
IHS publishes Design and Process Requirements Specifications. These are available to the public on the web. You don't need to reinvent the wheel.
Question from the Audience: How do we deal with HIPAA and privacy.
Craig S: Dean uses Epic and shares information in the area with other groups via CareEverywhere. It requires Patient approval to share.
Question from Audience: How do you account for data quality issues that emerge from Insurance Fraud?
Todd R: Challenge is to find the outliers in the data. Better real time data will help to solve this challenge.
Lonny R: Will ICD-10 help by improving granularity of data? This is an open question.
Question from Audience: Anyone working on Standards for Electronic records for privacy and security.
Dr. William W: Yes - the government committees working on meaningful use are addressing this.
James W: Standards will be some of the most important things to emerge from HITECH and Affordable Care activity.
