Keynote Presentation: Connecting the Dots

Presenter: Aneesh Chopra, President, CareJourney

Understanding where technology and data are headed has never been
more important for success, and itʼs even more true during the transformation
of healthcare. Health plans need a strong game plan to thrive in a value-based
care environment.

Transcript

1. Aneesh Chopra @aneeshchopra Connecting Dots: How Open Data, Open APIs and Payment Reform will Fuel Care Delivery Reform
2. American Competitiveness @ Stake The Goal: Constraining HC inflation to GDP + 0% unlocks $1T+ in value by 2025, enabling investments to maintain competitiveness 1 2 3 The Context: A growing coalition of public and private stakeholders believe that better care will cost less The Call to Action: By opening up data and adjusting payment models, we can tap into the expertise of the American people to surface, then scale, what works
3. Open Government Data as Infrastructure Source: https://graphics.wsj.com/medicare-billing/; CareJourney
4. The (Personalized) Health Internet Era
5. Earning Consumer Trust to Access Data
6. Source: https://support.apple.com/en-us/HT208647 ONC Consumer Aggregation Across Networks Clinically-integrated networks operating on multiple EHRs can aggregate FHIR resource servers for a single API feed for consumer designated apps
7. Progress @ the Pace of Standards Source: http://argonautwiki.hl7.org/index.php?title=Main_Page After dramatic reduction in aircraft manufacturing following WWI, then-Secretary Hoover encourages industry collaboration on engine, wing standards, commercialized on popular DC-3, Boeing 247
8. Health Plans Standardizing Access for 2020 Source: CARIN Alliance
9. Health Systems Intermountain Healthcare Jefferson Health Marshfield Clinic Health System Medical University of South Carolina & Health Sciences SC Mount Sinai Health System (NY) MultiCare Health System and Physicians of SW Washington OCHIN OrthoVirginia Rush University System of Health Trinity Health U.S. Department of Veterans Affairs Health Plans and others Anthem BlueCross BlueShield of North Carolina BlueCross BlueShield of South Carolina BlueCross BlueShield of Tennessee Cambia Health Solutions Florida Blue Humana Manifest MedEx Medigold Oscar Health SMART Property of CareJourney Confidential and Proprietary HL7/ONC Launch “Bulk” FHIR Testing Source: https://blog.hl7.org/leading-healthcare-stakeholders-commit-to-real-world-testing-of-hl7- fhir-bulk-data-implementation-guide
10. Source: dpc.cms.gov CMS Extends “Data @ Point of Care” in Bulk
11. NIH Publishes “FHIR-Survey Monkey” Tool Reference: Weeks, W. B., Cao, S. Y., Lester, C. M., Weinstein, J. N., & Morden, N. E. (2019). Association Between Community Economic Distress and Receipt of Recommended Services Among Medicare Fee-for-Service Enrollees. Journal of General Internal Medicine. doi:10.1007/s11606-019-05076-6; City of Chicago Relationship Between Distressed Community Index Score Quintile, 2017 FFS Medicarel Enrollees' Mean Demographics, Rush Market Counties Least Most 1 2 3 4 5 Number of ZIP Codes 101 66 45 35 35 Mean Distressed Community Index score 10.3 29.2 48.3 69.7 92.0 Zip Code-level demographics Mean number of FFS Medicare enrollees 2185 1672 2035 1299 2128 Mean HCC risk score 0.86 0.91 0.96 1.00 1.13 Mean per-capita Medicare Part A & B expenditures $10,558.97 $11,200.37 $12,153.76 $12,675.63 $15,841.69 Zip Code-level mean proportion of eligible enrollees receiving recommended care Flu shots (%) 54.9% 49.6% 43.1% 37.7% 27.9% Annual wellness visits (%) 35.0% 28.9% 23.7% 23.5% 18.5% Transitional care management (%) 11.8% 11.7% 9.2% 9.3% 6.6% Advanced care planning visits (%) 3.2% 3.5% 3.2% 2.8% 2.0% Distressed Community Index score quintile
12. Democratizing Payment Model Design Source: White House Office of the CTO “The evaluation…indicate that beneficiaries…have achieved success with losing weight and reducing the incidence of diabetes.” - CMS Actuary
13. A Leadership Moment: 5 Emerging Enablers Consumer Data Access via Trusted Apps – FHIR Data Query IG 1 2 Apps for Provider Directories (No ‘Surprise Billing’) – FHIR Validated Health Directory IG 3 Open Standards for Patient Assessments (“My Goals, My Situation”) – FHIR Questionnaire IG 4 Open Standards for Physician Scheduling – FHIR Scheduling Resource 5 Open Data for Performance Transparency - TBD Source: https://www.theatlantic.com/technology/archive/2015/07/the-secret-startup-saved-healthcare-gov-the-worst-website-in-america/397784/ “The old login system cost $250M to build…$70M annually to stay online. The new system cost about $4M to build, and…less than $1M to maintain.”
14. “Under Construction:” Transparency Total Patient Costs Time Opportunity to refer to high- value specialists Single Encounter Timely delivery of a Transitional Care Visit or MTM service Potential Readmission Traditional Provider Evaluation Ideal ”Longitudinal” Patient Journey Evaluation Provider #1 Provider #2
15. Apps for Health Information Fiduciaries Link: ADT Feed + Scheduling Source:eMedicare; CareJourney Episode Detail Cost Outcome Volume (relative to benchmark) CC - Hypertension 209 CC - Hyperlipidemia 127 CC - Ischemic Heart Disease 124 Total 658 Dr. John Doe Cardiologist New York, NY
16. Thank You