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The Availity Health Information Network: Connecting for Health

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Funding EMRs and clinical automation. CONFIDENTIAL Availity, L.L.C.. Application Convergence ... Provide real-time information needed to manage health care ... – PowerPoint PPT presentation

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Title: 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
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