The Louisville Health Record Bank An opportunity to contain costs and improve care for everyone in t

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The Louisville Health Record Bank An
opportunity to contain costs and improve care for
everyone in the greater Louisville area
Developed by the Louisville Health Information
Exchange, Inc.

• DRAFT - October 4, 2006 - DRAFT

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Unsustainable National Cost Trends
In 2004 (the latest year data are available),
total national health expenditures rose 7.9
percent -- over three times the rate of inflation
(1). Total spending was 1.9 TRILLION in 2004, or
6,280 per person (1). Total health care spending
represented 16 percent of the gross domestic
product (GDP). U.S. health care spending is
expected to increase at similar levels for the
next decade reaching 4 TRILLION in 2015, or 20
percent of GDP (2). - National Coalition on
Healthcare Website October 1, 2006
A new survey of large employers finds businesses
and retirees experienced double-digit increase in
retiree health costs, with further increases
expected in 2005. - Findings from the
Kaiser/Hewitt 2004 Survey on Retiree Health
Benefits
Kentucky Medicaid Facing 675 Million Shortfall
in Fiscal Year 2006 Federal Actions Have Large
Impact on Budget   - Kentucky Cabinet for Health
and Family Services, June 20, 2005
UPS Inc. forecast a health care cost trend rate
of 8.5 percent for 2005 - Louisville Courier
Journal Sep 29, 2006
1,500 is added to the price of every single GM
vehicle simply to cover healthcare costs
GM CEO Richard Wagoner - Feb 2006
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Systemic Quality Problems
The United States has built an unrivaled
healthcare system that produces miracles. The
quality of our medical talent and innovation of
our scientific discovery are without equal. Yet,
our healthcare system continues to fail its
professionals and consumers. It is fraught with
and continues to propagate dangerous flaws.
Avoidable error runs rampant. Inappropriate
variance is commonplace. Waste is prevalent.
Delays are expected, even accepted. Purposeless
friction colors every facet of the care delivery
process. Notwithstanding the fact that U.S.
citizens spend more on healthcare than any other
nation, the United States ranks only 37th in
quality. No corporation would accept that quality
gap.
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A National Focus on Health IT

• Healthcare IT and Health Information Exchange
  (HIE) are focus areas for the Bush administration
  and Congress
• Key Themes
• Accelerate adoption
• Standards interoperability roadmap underway
• Need clarity on incentives, which should be
  driven locally
• National standards should be implemented and
  demonstrated regionally
• Private/public collaboration is requisite vs.
  federal subsidization
• Health Record Banking Act introduced to US
  Senate, by Senator Brownback (KS), June, 2006.

We started the process of encouraging
information technologyto spread throughout
healthcare, and set the goal that every
Americanought to have an electronic medical
record within 10 years. President George Bush,
Cleveland Clinic, January 27, 2005
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A Kentucky State Focus on Health IT

• Key Themes
• University of Louisville and University of
  Kentucky to work together to do research to drive
  development of e-health in Kentucky
• Supports local RHIOs (e.g Louisville, Cincinnati,
  etc.)
• Statewide payer-based health record initiative
  currently being considered.

Governor Ernie Fletcher and other officials at
the signing of SB2, authorizing the formation of
the Kentucky eHealth Network Weve only begun
to scratch the surface of the potential for
e-Health to transform health care in our state
and our country. Technology can make health care
safer, faster and more efficient. - Kentucky
Governor Ernie Fletcher August 22, 2005  
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Louisville as a Microcosm

• Healthcare Challenges in Louisville
• Rising type II diabetes incidence
• Rising untreated asthma incidence
• Rising un and under-insured populations
• emergency room over-utilization.

Louisville is, and has been for more than a
century, a microcosm of the nation. The food
industry, for example, uses Louisville as a
research test-community, because Louisvilles
demographics closely match the nation as a whole.
Healthcare is no different. Based on national
averages, Louisville will spend 7.9 billion on
healthcare in 2006, a figure anticipated to reach
11.1 billion by 2011. This trend is
unsustainable. The need to challenge our core
assumptions and historic approach is pressing.
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Louisville Health Information Exchange, Inc.

• History
• April, 2004 University of Louisville funded by
  state grant to research formation of health
  information exchanges in Louisville and Kentucky.
  
• January, 2006 LouHIE not-for-profit formed
  (501(c)4 community board
• March, 2006 all-community stakeholder board
  first meets.
• August, 2006 consensus vision/mission, business
  model and implementation plan.
• Vision/Mission
• To contain rising costs and improve quality of
  healthcare in the Louisville area by providing
  consumers and their providers anytime, anywhere
  access to complete healthcare information and
  decision-support.
• Goal
• A community-wide health record bank to facilitate
  electronic exchange of health information in the
  greater Louisville area
• Improve quality and cost of care through enhanced
  coordination
• Provide lightweight connectivity to area
  physicians free of charge
• Provide consumers access and control over their
  own health information.

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All-Community Input/Representation
University Health Care/ Passport

• Based on UofL complexity-science research on
  collaborative community networks.
• All stakeholders represented through board and
  committees
• Includes Purchasers, Payers, Providers and
  Practitioners
• Supports consensus decision-making process

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Cost/Quality Improvement Potential

• 480 million per year potential cost-containment
  identified for 1.1 Million population, e.g.
• 22 million hospitalizations (caused by adverse
  drug reactions).
• 50 million of unnecessary prescriptions.
• 44 million in duplicate tests/procedures.
• 50 cents per transaction on tens of millions of
  fax/paper/phone messages.
• Millions through incentivizing smarter consumer
  behaviors.

Each identified cost-saving category could also
improve care quality and outcomes.
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Examples
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Four Types Of Electronic Health Records

• Provider Electronic Health/Medical Record (EHR or
  EMR)
• Legal medical record owned and used by providers
  to manage their own patient population
• Used across multiple venues of care within an
  enterprise for multiple conditions
• Personal Health Record (PHR)
• Personally-managed health data
• Populated with data from HRBRs, EMRs PBHRs
• Wellness programs/condition mgmt.
• Payer Based Health Record (PBHR)
• Payer/insurer managed health data
• Populated through payment transactions
• Health Bank Record (HBR)
• Community owned record that serves a
  politically viable geography, region, or health
  system network
• Crosses traditional provider systems boundaries
• Derives summary information from multiple sources
• Ties into a national health infrastructure
• Enables biohealth, public health, outcomes
  management
• Supports pay-for-performance

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HBR Key Features / Benefits

• Provides a quick summary of key activity
  information
• Patient-centered record of aggregated health data
• Financial administrative
• Clinical
• Enables both aggregated and shared only views
  of the information
• Web-based, easy to deploy and easy to learn
• Contains extendable services, e.g. in-box, eRx,
  referral mgmt, etc.
• Interoperates with existing applications/services
• EMRs, PHRs
• Payer networks
• Consumer health savings account cards /
  membership cards
• Stepping-stone towards a full EMR
• Supports systems view of entire community
  healthcare system as basis for quality
  improvement measures (BPM etc.)

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Health Record Bank Information Exchange
Personal Health Record
Health Bank Record (HBR)
Electronic Medical Record
Payer Based Health Record
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Health Record Bank Processes v. 7-30-06
Consumer Benefits Discount on mthly benefits
contribution Rebates for healthy
behaviorsRebates for smart health shopping (e.g.
discounted MRIs) Use card to pay co-paysFree
personalized health reminders Discounts/coupons,
etc. (e.g. fitness club)
Healthcare Consumer
Benefits Sponsor (Employer, Insurer/ASO,
Medicaid, Medicare)
Data Withdrawals
Data Deposits
Svc. Fees Incentives
Incentives
Electronic Data Interface
Researchers Pharma, Public Health, Etc.
Consumer Permission
Electronic Drugs (PBMs) Lab Radiology Hosp Disch.
Summary Physician Visit Record eVisit Claims
LouHIE
Administrative TPAs, Processors, Employers
Health Record Bank
Providers Physicians Hospitals Clinical Pharmacie
s eVisit Disease Mgmt Web Portals

Provider Permission
Fax Data Interface
Fax/Scan Lab Radiology Physician Visit Record


Incentives
Operating Revenues
Bank Svc. Fees
Physician/Hosp. Benefits Better info at point
of care Better after-visit communications
incentives for using EMRs for care Reduced cost
of chart storageEMR volume pricing/incentives
Cost of Operations
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Sampling Of Shared Services

• Health Bank Record (HBR)
• EMPI
• Lightweight documentation
• Secure messaging and in-box
• Electronic prescribing
• Front office management
• Benefit eligibility and claims management
• Referral management
• Scheduling
• Consumer connectivity
• Personal health record
• Chronic condition management
• Analytics and outcomes (data warehouse)
• Public health
• Bio-surveillance
• Disaster preparedness

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Timeline (starts Oct. 2006)
Mth 1-6
Mt 7-12
Mth 13-24
Mth 25
Organize
Get subscription Commitments Install
Infrastructure
Drugs, Labs Radiology
Consumer Services

• Raise 375,000
• Organize team
• Physician eHR Program
• Develop business plan and tech specs
• Community Input

• Raise 425,000
• Get 150,000 PMPM Commitments
• Choose vendor(s) negotiate vendor investment
• Launch HRB service(s)

• Implement drugs, labs, radiology services
• Pre-populate consumer records
• Basic services free to consumers, hospitals,
  physicians

• Bundle services payment into benefits plan
• Distribute HRB linked cards (optional)
• Start rebates/ incentives
• Start consumer messaging

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Investment

• Start-up Funding 375K mths 1-6 425K mths
  7-12.
• Self-insured employers (top 30), Insurers,
  Medicaid, Medicare and Not-for-Profits asked to
  contribute
• Founding Sponsors pay 2-10 per covered life (one
  time) and get discount on future PMPM
  subscription fees.
• Additional contributions welcome
• Covered lives used for pricing due to correlation
  with expected benefit
• Greater Louisville MSA based covered lives should
  be included.

• Monthly subscription fees per member per month
  (PMPM) once system launched
• Discounts for volume

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Projected Purchaser Benefit

• Over six years, purchasers (individuals,
  employers, payers, Medicaid and Medicare and
  safetynet funders) representing 500,000 covered
  lives in Louisville have potential to achieve
  benefits of up to 655,000,000.

• Better care and oversight
• Chronic condition management
• Waste
• Reduced inpatient admissions
• Reduced repeat outpatient visits
• Lower ED expenditures
• Decrease in diagnostic procedures
• Medications and e-Prescribing
• ADE savings
• Formulary-driven savings
• Problem driven medication ordering
• Reduction in medication waste
• Fraud and abuse
• Drug abuse and diversion

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Preliminary Costs and Revenues
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HRB an Emerging Approach

• Health Record Banking Act June 2006, introduced
  to US Senate by Senator Brownback (KS).
• Dr. William Yasnoff, former HHS official and
  consultant to LouHIE, now leading formation of
  Health Record Bank Association in Washington DC.
• Other communities exploring similar approach.
• Kansas City (Healthe MidAAmerica) has launched
  health record bank system with 80,000 paying
  members at present (www.healthemidamerica.com)
• Tennessee looking at similar model
• Rhode-Island has authorized a statewide health
  record system.

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Technology is Available

• Several vendors have made feasible proposals to
  LouHIE
• Viable open-source technology anticipated in
  2007.
• Screen shots of one sample technology follow.
  (courtesy Healthe Mid-America)

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Source Third Party Administrator (TPA)

• Benefits
• Coordination among care providers
• Assurance of patients identity
• Eliminates redundant paperwork for consumers

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• Benefits
• Proxy for problem list gives context to
  physicians
• Avoid inappropriate admissions due to lack of
  information
• Decreased diagnostic procedures

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Source Pharmacy Benefit Manager (PBM)

• Benefits
• Monitor compliance with medication regimens
• Reduce adverse drug interactions
• Eliminate duplicate prescriptions, improves
  safety, reduce abuse
• Provides context around medications to clinicians

Sources TPA State Registries

• Benefits
• Identifies need for vaccinations or other health
  maintenance
• Augments state registries

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Sources Reference Labs Provider Organizations

• Benefits
• Reduce inappropriate and redundant lab testing
• Enables drug/lab interaction checking
• Provides context around labs to clinicians
• Supports disease management

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Additional Functionality

• Electronic Prescribing (eRx)

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Thanks to Healthe MidAmerica

• For sharing their successes and materials.
• (Some slides in this presentation developed by
  HealtheMidAmerica).

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Thank You

• In the area of benefits cost-containment, we are
  out of silver bullets. All we have left is
  silver bee bees. Investment in e-health
  infrastructure is the next logical step for
  containing rising costs.
• - Julien Carter, former HR Director, University
  of Louisville