shared health confidential and proprietary. all rights reserved. this document contains confidential...
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of the Shared Health Incorporated.
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Shared Health Origins
Need for TennCare to lower cost and improve the quality of care in Tennessee
Visibility into patients record across providers was essential
Cost Savings identified in five areas
Tennessee Governor’s call for a solution January 2005
Shared Health Electronic Health Record that spans provider networks
Designed for multi payer / provider model
Facilitate the coordination of care among all stakeholders
1) Medication Management 4) Fraud and Abuse
2) Disease Management 5) Better Care & Oversight / Wellness
3) Clinical Waste
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Shared Health Today
Nearly 2 million patients (TN’s Medicaid Program, BCBST Employees, Nissan w/ Employees in MS, BCBST fully insured)
Data from 7 Managed Care Organizations
Links all Providers, Payers, and Consumers to same data set
Accessible by the Internet, NO NEED for special software, hardware or expensive implementation costs at the facility level
Clinical Outreach program supports provider adoption and utilization
On Site staff that work directly with provider community
No grant money supporting the effort
Improving quality and efficiency
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Clinical Health RecordTM (CHR)
Expands beyond the four walls of a traditional EMR assuring Providers comprehensive patient-centric data at the point of care which will prevent errors; improve quality and efficiency
Demographic Data – Across all providers and payers
Claims Encounter Data – Across all providers and payers Problems
Procedures
Diagnosis
Medication Histories – Regardless of location of fulfillment
ePrescribe solution – Applies across entire provider customer base
Laboratory Results – Across all providers
Immunizations – One central location for the state
EPSDT (Well-Child management templates) – One central location for the state
Allergies – Any authorized physician can review
Secure Messaging – Secure messaging between providers, consumers, and case managers
Shared Health Content Today
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Shared Health’s market role
Clin
ical
N
otes
Imag
ing
Dev
ice
Inte
grat
ion
Phy
sica
l A
sses
smen
t
Inpa
tien
t N
otes
Am
bula
tory
Lab
Provider Data Services
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Clin
ical
N
otes
Imag
ing
Dev
ise
Inte
grat
ion
Phy
sica
l A
sses
smen
t
Inpa
tien
t N
otes
Am
bula
tory
Lab
Multi-Provider Encounter Data
Benefits & Eligibility
Complete Meds
Reference Labs
Care coordination
Population BasedCDS
Pay
er D
ata
Ser
vice
s
It takes two data sets to achievePatient Centered
Electronic Health Record
Provider Data Set & Payer Data Set
Provider Data Services
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Patient Data HubWorking Together from a Common Foundation
State Data PBMs
User Provisioning & Access Mgt.
Terminology MediationIntegration Hub
Medicaid
“Provider” View
Payer’s
Consumer View
Lab Data
Shared Health Shared Health Payer Portal3rd Party EMR
Decision Support
Provider / Patient Data StoreHL7 v3 RIM
Person Identification / Record Locator Services
Shared Health
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
HIE Services provide EMPI, Access & Authentication, Demographics, Encounter Detail, Problems, Labs, Meds, eRx, Allergies, Immunizations, Well Child Screening, Secure Messaging, and P4P programs
Interoperability Strategy
Supportive of: Centralized Federated
Hybrid
HIE Services
RHIO Services
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Shared Services
Repository
Registries & Interoperability: Merging Data to Get the Whole Picture
Administrative Plus Data:-Patient Demographics-Claims data
-Diagnoses-Procedures-Admissions
-PBM (Pharmacy) Data-Lab Data (Limited)
Detailed Clinical Data:-All Lab-Detailed Exams
-History-Physical-Assessment and Plan
-All Orders-Images-In-Patient and Surgical Notes
Shared Services
Repository
Performance Measures
Transparency & P4P
Registries & Interop
-Key Outcomes: -Indicators -Results
-Key Process Events:-Disease States-Wellness Care
“Core” Clinical Data
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Shared Health: A Case Study
Shared Health’s HIT solutions are connecting clinicians with valuable patient information, quickly, accurately, and at the point of care
Scenario:
EMTs bring a 48 year old woman to the ER following a Motor Vehicle Accident
The patient is drifting in and out of consciousness and has multiple injuries including a compound fracture.
Using the CHR, the ER physician has immediate access to a complete medical history and current medications.
She notices that her patient has been seen for Systemic Lupus and is on maintenance prednisone.
She avoids an intra-operative adrenal crisis by advising the surgeons that the patient requires cortisone during surgery.
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
EPSDT & Wellness Exams for Children
EPSDT ComponentsComprehensive Health (Physical and Mental) and Developmental
History
Comprehensive Unclothed Physical Exam
Vision Screening
Hearing Screening
Laboratory
Immunizations
Health Education/Anticipatory Guidance
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Utilizing Registries (EPSDT)
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Initial Assessment
Required Fields
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Feet InchesHeight: 6 2DATE: 1/13/07 3/26/07 4/30/07 6/1/07 9/10/07 12/8/07 GOAL TO CHECK ADDPulse 80 88 75 85 90 80 ADDSystolic 115 133 122 118 127 120Diastolic 86 80 78 73 84 75Resp 20 18 22 14 18 20 ADDWeight 155 165 170 178 170 ADDBMI 19.90 21.18 21.82 22.85 21.82 ADDHbA1C 7.00% 9.00% 7% ADDTot. Chol. 120 160 <145 ADDHDL-C 130 ADD
LDL-C ADD
ACT Score ADDADDADD
Microalbuminuria: Foot Exam: Dilated Retina Exam:
Date __/__/__ __/__/__ __/__/__
ADD
DIABETES EVALUATION
Claim received, but no resultCPT-II code in desired rangeCPT-II code in borderline rangeCPT-II code out of ideal range
UPDATE
Female HypertenAsthma COPDDiabetesMale
Microalbuminuria:Foot Exam: Dilated Retina Exam:
Date __/__/__ Date __/__/__ Date __/__/__
Claim received, but no result
CPT-II code in desired rangeCPT-II code in borderline rangeCPT-II code out of ideal range
Longitudinal Care Registries (mock-up screen)
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Feet InchesHeight: 6 2DATE: 1/13/07 3/26/07 4/30/07 6/1/07 9/10/07 12/8/07 GOAL TO CHECK ADDPulse 80 88 75 85 90 80 ADDSystolic 115 133 122 118 127 120Diastolic 86 80 78 73 84 75Resp 20 18 22 14 18 20 ADDWeight 155 165 170 178 170 ADDBMI 19.90 21.18 21.82 22.85 21.82 ADDHbA1C 7.00% 9.00% 7% ADDTot. Chol. 120 160 <145 ADDHDL-C 130 ADD
LDL-C ADD
ACT Score ADDADDADD
Microalbuminuria: Foot Exam: Dilated Retina Exam:
Date __/__/__ __/__/__ __/__/__
ADD
DIABETES EVALUATION
Claim received, but no resultCPT-II code in desired rangeCPT-II code in borderline rangeCPT-II code out of ideal range
UPDATE
Female HypertenAsthma COPDDiabetesMale
Microalbuminuria:Foot Exam: Dilated Retina Exam:
Date __/__/__ Date __/__/__ Date __/__/__
Claim received, but no result
CPT-II code in desired rangeCPT-II code in borderline rangeCPT-II code out of ideal range
B/P Trend
40
60
80
100
120
140
160
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Dec-07
Systolic
Diastolic
Longitudinal Care Registries: Track/Trend Outcomes (Graphing)
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Recent Analytic Highlights
Enrollees looked up in Shared Health:
Are “sicker”.
Have a lower admission rate.
Have higher generic use and better formulary compliance.
Enjoy higher wellness care rates for mammography screening, colon cancer
screening, post partum urine cultures and flu vaccination (50 – 64).
ER visits for Shared Health enrollees reflects Shared Health’s targeting Eds for adoption.
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Shared Health Demonstrating HIE Value Today
• Providers are using Shared Health to evaluate patients with high illness burden and complicated cases.
• Shared Health patients and purchasers reaping improvements when compared to controls:
Greater compliance with nationally recognized guidelines for wellness care.
Lower admission rates.
When admitted, lower length of stays.
Higher rates of generic and formulary compliant prescriptions.
• Impressive efficiency improvements recognized Shared Health measures total cost for managing various episodes of care.
All costs - in-patient, out-patient, lab, imaging and pharmacy – are included for each type of episode and costs are benchmarked.
Clinicians using Shared Health in evaluating and treating patients show a marked efficiency improvement (lower costs) over controls.
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Shared Health
Anticipated Cost Savings Projection Model Details of Benefits
Fraud and Abuse
Medications Reduce adverse drug events(ADEs)
Increase formulary-driven savings
Promote problem-driven medication ordering
Reduce medication waste
Clinical Waste Reduce inpatient admissions due to
incomplete data in the E.D.
Reduce repeat outpatient visits due to incomplete patient data
Lower E.D. expenditures
Decrease diagnostic tests
Reduce defensive medicine
Better Care and Oversight Disease Management Resource
Increase patient safety
Preventative Care Increase participation rates for Well-Child
checks and Adult Immunizations
(Based on $170.00 PMPM in Year#1) Year 1 Year 2 Year 3
Projected Healthcare Spend $1.020 BN $1.170 BN $1.330 BN
Savings -to-Total Expense 0.7% 1.2% 1.6%
$0
$10,000,000
$20,000,000
$30,000,000
$
1 2 3
Year
Benefit Projections
Preventative Care
Fraud & Abuse
Clinical Waste
Better Care and Oversight
Medications
Total Benefit Savings Year 1 Year 2 Year 3Medications $1,908,669 $4,699,549 $7,986,910Better Care and Oversight $1,264,168 $4,383,047 $8,890,155Clinical Waste $1,374,937 $2,385,950 $4,124,995Fraud & Abuse $2,776,186 $3,494,223 $1,346,469Preventative Care $113,055 $171,111 $294,066
TOTAL $7,437,015 $15,133,881 $22,642,596
Example of 500,000 member population
Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Question # 1 – As a result of using the Shared Health Clinical Health Record, did you modify or eliminate a prescription?
Question # 1 Repsonses
3%
76%
21%
N/A
YES
NO
RESPONSE KEY:
Y - YESN - NON/A - Not Applicable
•After reviewing the Clinical Health Record, a provider in Knoxville refused to give another pain medication to a patient who had received four recent scheduled prescriptions within a two week period.
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Question # 2 – Did the Shared Health Clinical Health Record assist you with providing high quality, cost effective care?
•A provider in Knoxville, uses the system in conjunction with her EMR system. She inputs any missing information into her EMR until the two systems are integrated.
Question # 2 Repsonses
81%
19%
YES
NO
RESPONSE KEY:
Y - YESN - NON/A - Not Applicable
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Question # 3 – The information I retrieve from the Shared Health Clinical Health Record is useful and helps clinicians make more informed treatment decisions.
•One location stated that all of the providers look at the printed Clinical Health Record before making any medical decisions.
Question # 51
16%
26%
39%
432%
528%
69%
N/A0%
1 2 3 4 5 6 N/A
RESPONSE KEY:
1-Strongly Disagree2-Disagree3-Somewhat Disagree4-Somewhat Agree5-Agree6-Strongly Agree
Question # 3 Responses
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Question # 4 – Shared Health ePrescribe enhances efficiency during the medication prescribing process.
•A user from Gordonsville Clinic stated she was able to catch many drug seekers.
Question # 8
13% 2
15%
33%
418%
66%
N/A21%
534%
1 2 3 4 5 6 N/A
RESPONSE KEY:
1-Strongly Disagree2-Disagree3-Somewhat Disagree4-Somewhat Agree5-Agree6-Strongly Agree
Question # 4 Responses
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Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated. Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.
Health Information Technology and Its Role in Medicaid
HIT plays a critical role in Medicaid because… HIT allows continuity among consumers and clinicians
Continuity drives more informed decisions and better quality
Continuity enables better clinical decision support
HIT provides significant opportunities to achieve higher-quality healthcare, especially for chronically ill and high-utilizing populations
HIT facilitates real consumer empowerment and responsibility
Medicaid has the ability to lead reform across the nation because it has Critical Mass at both the state and national level
QUESTIONS ?