ConnectHealth Governance Meeting

7/18/2013Page 1 of 12

Healthcare – An Industry in Transition

• Dave Minch• President & COO, HealthShare Bay Area• Co-chair, California Association of HIEs

(CAHIE)

ConnectHealth Governance Meeting

7/18/2013Page 2 of 12

Healthcare – an Industry in Transition

• Healthcare corporations must look toward a future of less FFS and more capitation, shared risk, and competition:

What must your IT systems be capable of doing that they cannot do today?

What must your organization be capable of doing better than your competitors?

What will the industry look like 5 years from now, and how do I need to prepare for that vision today?

ConnectHealth Governance Meeting

7/18/2013Page 3 of 12

Payment Reforms Create Opportunities

• Capitation, Shared Risk, Incentive Payments; require:• Analytics based on threaded patients

(patients that have longitudinal records with all ambulatory and acute care encounters recorded and maintained)

• Ability to perform analysis based on patterns of care – grouping of patients by disease and disease stage

• Ability to look into geographic regions and perform population analysis and trending

ConnectHealth Governance Meeting

7/18/2013Page 4 of 12

More for Less – Working Smarter

• Capitation will limit funds and stimulate improved processes:• Individual PCP replaced by care team

which leverages lower-cost professionals• Increased reliance on EHRs and Registries

to track patients and determine required testing and interventions

• Increased use of care alerts and reminders to improve patient safety and decrease unnecessary testing and procedures

ConnectHealth Governance Meeting

7/18/2013Page 5 of 12

Survival Trumps Cooperation

• Healthcare corporations decide to develop & pay for their own captive HIOs:• They can determine exactly how their HIOs

are formed and maintained;• They can use the HIOs to bind their

providers;• They can leverage the HIOs to attract and

keep patients;• They can perform their own analytics;• They can maintain referral patterns within

their own ACOs.

ConnectHealth Governance Meeting

7/18/2013Page 6 of 12

and… What Does the Future Hold?

• What will the industry look like 5 years from now, and how do I need to prepare for that vision today?• Fewer, larger capitated healthcare

organizations competing for small and large groups of patients…

• How many “Kaisers” will it take to satisfy California’s needs?

• Use modern analytic techniques to allow potential addition of other data sources.

ConnectHealth Governance Meeting

7/18/2013Page 7 of 12

So… what is missing?

• Private HIOs can do a good job of analytics within their boundaries so long as they have data from all providers touching their patients.

• Public HIOs may or may not have adequate access to data for analytics and need to plan for patient consent.

ConnectHealth Governance Meeting

7/18/2013Page 8 of 12

Connector Strategy

• Access to patient encounters outside of the ACO walls.

• Notifications of encounters when patients are seen in other facilities within the connector territory.

• Distribution channel for information out to the secondary provider network.

• Onramp to the California Trust Network (CAHIE).

• Onramp for providers outside the private HIOs to interoperate.