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
Health IT Transformation(Insurance Exchange and Provider Perspective)
Curt Kwak
Chief Information Officer
August 19, 2014
• 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
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)
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
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
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
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
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
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
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
Conclusion
Coming together is a beginning
Staying together is progress
Working together is success
- Henry Ford
Questions?