The Availity Health Information Network: Connecting for Health

1
The Availity Health Information Network
Connecting for Health

• NEFRHO Summit
• June 2, 2007

2
Market Drivers Shaping Change

• Compelling Event - HIPAA
• National Health Information Network (NHIN)
• RHIOs
• CDHP/High Out of Pocket Health Plans (HOOPs)
• Consumer choices
• Employer pressure
• Workplace clinics
• Payer pressure
• Potential Stark Law changes
• Retail store competition
• Vendor consolidation
• Funding EMRs and clinical automation

3
Application Convergence
4
The Collaborative Mission

• Facilitate secure information exchange between
  health care stakeholders, including payers,
  providers, ancillaries, etc. on a regional basis
• Provide real-time information needed to manage
  health care stakeholders business
• Reduce administrative complexity
• Reduce costs for all stakeholders
• Facilitate HIPAA and standards compliance
• Improve the patient experience
• Improve relationships between stakeholders
• Be viable

5
A Long Term Incremental Approach

• Requires planned migration
• Workflow changes
• Systems changes
• Commitment
• Money
• Time

4. Common Health Care Information Exchange
Platform
3. Real-Time Information Exchange
2. Internet
1. HIPAA
Leads to New High Value Applications -
Real-time claim adjudication - EHR/EMR
integration - E-Lab, E-Prescribing - FSA, HSA,
HRA, debit/credit card processing, automated fee
schedules and integrated settlement
6
Portal Product Principles

• Provider centric
• Strengthens value proposition between payers and
  providers
• Work collaboratively with payers, providers and
  vendors
• Self-service oriented
• Train, do not install
• Delegated administration and security
• Adoption first, then utilization
• Incremental, phased capability roll-out
• Support existing legacy vendors
• Open, standards based, available to all
  constituents

7
The Importance of RHIOs

• Health care is local
• Benefits are local
• Facilitates high level of trust
• Easier to align local incentives
• Local scope increases probability of success
• Specific local needs can be addressed
• Disaster preparedness and recovery
• Results in need for information to be shared
  across regions

• Infrastructure is there to support
• Medicare
• Medicaid
• Other federal and state agencies
• Supporting Organizations
• Payers
• Integrated Delivery Networks (IDNs)
• Academic medical centers
• State medical association
• State hospital association

8
RHIO Assumptions

• Constituents willing to collaborate on a common
  platform
• All driving towards a long term vision
• Platform is all constituent
• Smallest to largest
• Constituents willing to commit beyond start-up
  and early stumbles
• EMR, PBHR, EHR and PHRs cannot be in silos
• Long term goal in design but implement with a
  small wins mentality

9
Interoperability Issues

• Technical
• Architectural exchange decisions and data
  ownership
• Consolidated through to purely federated EHR
• Where are EHRs and who decides what is in an EHR?
• People and systems need secure controlled access
  to EHRs
• Centralized and distributed deployment possible
• Problem of language and vocabulary (different
  medical coding and terminology uses between
  Vendors and Providers)
• Social Political
• Concerns of health information being so available
• Confidentiality needs of patients
• Fear of doctors losing control over patient care
• Differing national and state legislation on
  privacy consent
• Clinician fear of more data entry cost of entry
  (time, )
• Cost and consequences of user training

10
Care Management Requires Data

• The following must be readily shared and
  accessible
• Comparative treatment cost outcomes
• Evidence based medicine
• Alerts
• Health risk assessments
• Wellness
• Population analysis
• Business rules transparency
• Family history
• Social history
• Treatment compliance
• Test results

11
Availity Care Profile Introduction

• Introduced in 2Q 2006 as the first multi-payer
  health record
• Compiled from last two years of health claims to
  enable cross-provider view of patient history
• Real-time access to patients prescriptions, lab
  events, radiology events, office visits,
  hospitalizations, immunizations, and
  diagnoses/procedures
• Other health plans invited to participate
• Security is ensured by offering access to
  authorized personnel only complete audit trails
  are available
• No new infrastructure is necessary leverages
  Availity Multi-Payer infrastructure, which is
  highly utilized by Florida hospitals and
  physician offices
• Easily integrated into clinical workflow print
  records or customize to adapt to physicians
  preferred view of patient history
• Uses Continuity of Care (CCR) industry standards
  to enable integration with Electronic Medical
  Record (EMR) and other legacy systems

12
The Availity Care Profile Interoperability

• The health care industry is pursuing solutions
  that facilitate the sharing and interoperability
  of health information
• Significant opportunity for collaboration among
  health care stakeholders to develop an effective
  health information system
• Government and commercial payers must participate
  to ensure long-term success

13
Availity Care Profile History

• More than 1,000 physicians from 400 sites and 15
  different specialties enrolled with the ACP
• More than 1,000,000 members available by June 1,
  2007
• High member acceptance
• Very positive feedback easy to use longitudinal
  record.
• Easily integrated into clinical workflow

14
Current Information Available

• The Availity Care Profile offers physicians and
  other health care providers additional
  clinically-relevant information to consider at
  the point of patient care.
• Enables real-time access to claim history from
  multiple health plans, including
• Diagnosis details and associated procedures
• Physician and hospital visits
• Prescriptions
• Laboratory andradiology events
• Immunizations

15
ACP Future Enhancements

• Invite participation by all stakeholders who
  support Continuity of Care Record (CCR)
  transactions and standards to create the full
  longitudinal, interoperable electronic health
  record
• Additional payers
• EMR (PMS, HIS) vendors
• PHR vendors
• RHIOs
• Other sources of information (lab orders, PBMs,
  etc)

MPI Master Patient/Person Index PMS Practice
Management System EMR Electronic Medical
Record HIS Health Information System
16
Architecturally Sound Solution

• Federated model does not require centralized
  databases
• Health information remains stored in the original
  system of record
• Allows a consolidated record to be compiled from
  all health plans who participate to create a
  longitudinal view of patients histories
• Other sources of data can be added (e.g., State
  of Floridas SHOTs immunization database)
• State-of-the-art disaster recovery
• Procedures and processes that allow access to
  patient information should the need arise
• Disaster recovery systems reside outside of
  Florida to guard against Florida-specific
  disasters

17
Payer Impact

• Payers must make claims information available to
  be supplied transactionally
• Payers must support the Continuity of Care (CCR)
  standard to enable Availity to request, receive,
  and display the information
• The more claims information payers make
  available, the better (payer differentiator)
• Enables providers to retrieve more information
  about their patients

18
Provider Benefits

• Provides a consolidated view of patients health
  care services across physicians and other
  providers, as well as participating health plans
• Provides background information about patients
  when little information is known or is
  unavailable
• First time patients
• Emergency visits
• Patients with increased health care needs (i.e.,
  chronic conditions, multiple diagnoses)
• Post hospital discharge
• Natural disasters
• Cultural and language barriers

19
General Benefits

• Helps improve patient safety, eliminate duplicate
  medical procedures, and aid in reducing
  unnecessary services and fraud
• Facilitates an improved sharing and
  interoperability of health information between
  clinicians and multiple payers
• Brings efficiencies and cost savings to the
  health care industry

Case Studies 1 day lower ALOS (Shared Health -
Tennessee)gt600 average savings of ED encounter
(Christiana Healthcare - Delaware)
20
General Benefits

• Fifty-one percent of American adults favor
  providers who use electronic medical records as
  compared to 17 percent who prefer providers who
  did not use electronic records.
• Sixty-eight percent of American adults favor
  insurance carriers who use electronic medical
  records as opposed to 16 percent who prefer
  carriers who do not.
• Over 50 percent of Americans surveyed would like
  to be able to check their claims and coverage or
  access personal records electronically.
• Nearly 75 percent of American adults believe the
  benefits of electronic medical records outweigh
  potential risks and 72 percent believe that an
  electronic record system is more efficient than a
  paper record system.
• Despite high interest, more than half of those
  surveyed 57 percent have not heard of, seen, or
  read about this type of technology prior to the
  survey.

Source Kaiser Permanente (by StrategyOne), May
2, 2007 1,000 American adults surveyed
21
Limitations

• Information is currently available up to the past
  24 months
• Services have been rendered, but the claim has
  not been filed
• The patient pays out-of-pocket and no claim is
  filed for the service
• Claims are paid by a payer who is not
  participating in the program
• The patient has restricted access to his/her
  claim information by opting out
• The patients employer group, or administrative
  services only (ASO) group, is not participating
  in sharing claims information
• Sensitive information is excluded per national
  and state regulations
• Psychiatric
• Substance abuse
• HIV/AIDS
• Sexually transmitted diseases
• Abortions

22
Availity Proven in the Florida Market

• Payer commitment stayed the course
• Payer deployment resource support
• Coordinated, joint deployment
• Product management approach
• Agreed to functionality
• Schedules maintained through value chain
• Payers and providers let Availity lead
  objective 3rd party with collective result as the
  goal

23
Technology Overview

• Standards-based technology components
• IP, HTTP/S, HTML, XML, ASTM CCR, HL7 CDA, et al
• Open connectivity specifications
• Industry strength security approach
• Delegated security model
• Highly available and scalable
• Consistent look and feel and simple B2B interface
• Single sign-on authentication and authorization

24
Benefits of the Availity Health Information
Network

• Centralized administration and increased security
• Improved revenue and cash flow
• Significant reduction in paper and paperwork
• Consistent look/feel across multiple
  payers/transactions
• Reduced number of errors
• Significant reduction in phone calls
• Consolidated support
• Improved office efficiency and time management
• Real-time information

25
Benefits of the Availity Health Information
Network

• More efficient provider workflow
• Can be integrated with legacy systems
• Self service functionality
• Simplified training
• Less downtime due to employee turnover
• Improved record-keeping and audit trail
• Platform for pragmatic migration to new formats,
  such as NPI, ICD10
• Improves quality of patient care and satisfaction

26
Summary

• Availitys key assets to be leveraged
• Proven architecture and scalability to support
  clinical transactions
• Proven multi-payer model
• Trusted advisor and leader on payer-provider
  collaboration
• Assured adoption and gradual improvement of
  standards
• Availity can build a delivery model and
  interconnectivity for RHIOs and beyond
• Availity has a viable and equitable financial
  model
• Win-win approach

27
Availity

• P.O. Box 550857
• Jacksonville, FL 32255-0857
• 904.470.4900
• 800.AVAILITY (282.4548)

P.O. Box 833905 Richardson, TX 75083-3905 877.EDIT
HIN (334.8446)
info_at_availity.com www.availity.com