health it summit in seattle 2014 - case study "health it transformation: insurance exchange and...
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Health IT Summit in Seattle 2014 - Case Study "Health IT Transformation: Insurance Exchange and Provider Perspective" with Curt Kwak, Chief Information Officer, Proliance SurgeonsTRANSCRIPT
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Health IT Transformation(Insurance Exchange and Provider Perspective)
Curt Kwak
Chief Information Officer
August 19, 2014
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• Agenda:
• Orientation of Washington Health Benefit Exchangeo Journey
o Organization Successes & Challenges
o IT Organization Successes, Challenges
o IT transformation
• Transition back to the Provider World (Proliance Surgeons)o Impact from ACA
o General observations
o IT Challenges & Opportunities
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Washington Health Benefit Exchange
o A new marketplace for each state
o Health benefits for individuals, families & small business
o Option to develop a state based or be part of the Federal Exchange
o Washington state’s strategy:
• Public/private partnership
• Provide a shopping experience/anonymous browsing
• Aggregate billing services
• Tax credits & financial help through the exchange
• Washington dedicated customer support
• Tight collaboration with:
o Washington State agencies (HCA, DSHS, OIC & Governor’s Office)
o Federal Government (CMS & CCIIO), as well as Federal government
agencies – IRS, INS, SSA, Medicare, etc.
• Single, committed System Integrator – Deloitte LLC
• Maintained a solid lock on the deliverables for the first open enrollment
(10/1/2013)
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Organization Successes
o Achieved the 10/1/2013 go-live commitment (with bumps & bruises)
o Enrolled our very first applicant at 4:05AM on 10/1/2013
o WA Health Plan Finder delivered on time and on budget
o Application performance issues were expected and stability was established
by 3rd day
o By end of the first open enrollment…
• Over 1.2 million Washingtonians enrolled through the WAHPF
• Over 150,000 Washingtonians enrolled in qualified health plans
• Exceeded Medicaid enrollment projections by over 2 fold
• Averaged 4k to 5k calls/day at CC
• Transaction of millions of Premium dollars
• Solid marketing & communication plans
• Millions of hits on WA HPF
• National attention & compliments
• Made the top 3 State based exchange list
• 90+ % application throughput
• 95% EDI/Invoice accuracy
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Organization Challenges
o Application instability at the time of go-live w/plenty of media
attention
o Staffing challenges
o Usability challenges
o We didn’t know what we didn’t know!
o 5% of applications not getting through
o 5% of EDI/invoice errors
o Political environment
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IT Successes & Challenges
o Demand on IT
o Excellent partnership with the System Integrator, even during the toughest of
times
o Team cohesion & solidarity
o Team transparency
o A culture of trust & collaboration
o Developed & maintained IT goals & objectives
o IT Governance (CIO workgroup)
o Noted the struggles outside of Washington for perspective
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What’s next?
o Back in the Provider world with Proliance Surgeons
• One of the largest surgical practices in the country
• 200 physicians specializing in Orthopedics, Ear, Nose & Throat, with
reconstructive & general surgery
• Over 60 locations through out the Puget Sound region & out to Tri-Cities
• Over 1,600 employees
• Team physicians for the Seattle Mariners, Seattle Seahawks and the
Seattle Storm, as well as dozens of collegiate and recreational leagues
throughout the greater Seattle area.
Dr. Khalfayan, Seattle OPA
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IT Objectives at Proliance Surgeons
Challenges:
o Relatively young group of IT professionals
o Enterprise IT concept is growing within Proliance
o How we are looking to chart the next steps?
o Establish a Comprehensive inventory:
• Skillset, capacity, knowledge
• Central & distributed system inventory, including:
o Software, hardware & licensing
o Risk mitigation:
• Compliance risks
• Data security
• Data management, including backups
o Cultural focus & shift:
• Culture of Customer Services
• Culture of Accountability
• Embracing servant leadership
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Care Center Focus
• 60 Care Centers throughout the region
• Asking for :o Stability of the clinical systems
o Improve Network access
o Help Desk efficiency & knowledge
o Responsiveness from the helpdesk
o Lack of follow through on issues
• Have noted:o Communication has improved – on outages
o Seeing improved follow through on care center projects
o Stay focused and keep the stakeholders in the loop
o IT Governance/Committee
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In general
o No direct impact from ACA noted
o Diligently preparing for ICD-10 and Meaningful use stage 2 establishment
o Impact to primary care is noted, but not as significant as they thought
o (about 10% increase overall)
o Input from the ER’s we associate with are also consistent
o Referrals not impacted
o Payers side, however, remains to be seen (reimbursements, accuracy,
impact from carrier participation with the Exchange, etc.)
• IT Focuso Many of the best practices from the Exchange has carried over
o Employee focus & culture shift
o Servant leadership
o Embracing the mission & becoming individual leaders
o The word accountability has meaning on day to day operations
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Conclusion
Coming together is a beginning
Staying together is progress
Working together is success
- Henry Ford
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Questions?