E-Health Networks The New Shape of Public Health NGA State Alliance for e-Health 2nd Annual State Learning Forum Stephen Goldsmith Daniel Paul Professor.

E-Health Networks The New Shape of Public Health

NGA State Alliance for e-Health2nd Annual State Learning Forum

Stephen GoldsmithDaniel Paul Professor of GovernmentDirector, Innovations in American Government ProgramHarvard University John F. Kennedy School of Government

Developed in conjunction with Deloitte Center of Health Solutions and Deloitte Research

2 Governing by Network .

Traditional Bureaucracy Is Inadequate

Agency 1

Division Division

Unit Unit

Agency 2

Division Division

Unit Unit

Agency 3

Division Division

Unit Unit

Department Department Department Department Department Department

Bureau Bureau Bureau Bureau Bureau Bureau

Citizen


The New Shape of Government

CCID Organizatio

n

Local Government

HospitalsFederal Agency

International NGOs

NGOsState

Government

Health Provider


Models of Government

Hierarchicalgovernment

Public-Private Partnerships

Networkedgovernment

Joined upgovernment

High

Low

HighLow

Level of public/private collaboration

Network mgt. Capabilities


Types of Networks

DEGREE OF GOVERNMENT INVOLVEMENTMore Less

IntergovernmentalSupply chain Ad hoc

Civic switchboard

Information dissemination

Service contract

Channel partnership


Networked Organization Models that HIT Can Learn From

Anthrax Crisis Response

SARS Hurricane Katrina

Response


Governing by Network has Many Advantages…

Networked government

benefits

Improved Speed and

flexibilitySpecialization

Increased reach Innovation


What a Health Network Might Look Like


State HIE Network Model


Health Information Exchanges

FederalNHIN

National Health Information

Network

State HIE

RHIO RHIO

NetworkHealth Networks

NetworkHealth Networks

The “big picture” of the health information network


States must lead the change.

…in collaboration with health consortiums, citizens,

payers, providers, and others.

States Can Play Many Roles in an

HIE NetworkConvenerEducator

AdministratorPolicy Maker

Initiator/ CatalystOperator

Coordinator

The Many Roles of Government


ObesityMental

Health

Child Welfare

Infant Mortality

Information Sharing and Incentives

Information Sharing Needs

Schools

Relation to Other Sectors

Your Role

Role of the

Private Sector

Managing the

Network

Issues and Delivery Networks

= Sector 1= Sector 2

Possible Organizations

Public Hospital andCommunity

Health

Local Non Profits

National Foundations

State Health Policy and Finance


1. Define of Public Value Carefully Better Health, Not Better Transactions

2. Design Network Correctly—Understand All Assets

3. Quality Decision Making

4. Congruence of Goals

5. Build Skills and Capacity

6. Network Leadership

Key Principles to Create Networked Model


After:DC Health Care Networks, From One to Many

Before:DC General Hospital

1. New Role for Government: Focus on Public Value


Public Value Definition

• The point of all activity is for each party to create value

Government role: to transform existing social conditions in collectively desired directions

•Demonstrations of value creation lie in evidence showing changes in conditions

• Problem: Not everyone sees value in the same way


Different Ideas of Value

•Satisfy patient demands

•Produce Better Health

•Reduce Costs

•Make a Profit

•Meet Social Needs

•Achieve a Just Society


Four Programmatic Areas Behind The Curve to Reduce Cost and Improve Care


Examples of How Electronic Systems Drive Better Outcomes

Care ManagementImprove care while managing costs, maximizing the health care investment. Care management, disease management, and utilization review. Electronic Health Records/Health Information ExchangeImprove quality of care and enhance service to individuals. Patient Data Hub, allowing for the integration of disparate healthcare data sources and follow-on analysis to produce actionable information at the point of care.

Emergency Department Diversion Prevent overcrowding, promote wellness, and make better use of scarce resources. Proactive medical management.

Through data analysis of historical medical claims, access analysis, and education techniques.Lower ED usage.

Long-Term Care / Renal Care AuditsDetect and correct errors and prevent future overpayments. Make better use of data to improve care to individuals.

Nursing Home DiversionManage ongoing healthcare costs and provide care where it’s needed.


Pennsylvania NEDSS system The development of PA-NEDSS has allowed the Pennsylvania

Department of Health to cut the reporting cycle patient cases from3 weeks to fewer than 24 hours.

2. Design Network: Map Parties, Understand Tools

2. Design Network: Map Parties, Understand Tools


PA-NEDSS – An HIE Making a Difference

Investigators

Laboratories CDC

Local & StateHealth

Departments

DOH Central Office

Physicians

Hospitals

EDR App

Integrated Data

Collection, Management

, Analysis, Transmissio

n, and Disseminatio

n

Epi-X

Rapid reporting and discussion of

health events, 24/7

access to key officials and

expert assistance

Health Alert

Network

Health Information Technology

More Timely

Intervention

MoreComplete

Patient View

Privacy Centric & Secure

Bio-terrorism RapidDetection Rapid

Response Enabler

Point ofCare Data

Entry

Real-timeData

Collection

400+

700+

170+

20

Master Patient Index

Patient Search & Match

De-duplication

Linked Disease Reports

HL7 based HIE

Patient Centric System

Working Example : Extending Existing Public Health Systems to Serve as HIE channels; All Actors Work Toward Same Goal

Copyright © 2005 Deloitte Development LLC. All rights reserved. 21

Decide Who Should Do the Integrating

Government1

Prime Contractor2

Third Party 3

Government

Contractor

Subcontractor

Subcontractor

Subcontractor Subcontractor

Subcontractor

Subcontractor

Subcontractor

Contractor

Contractor

Contractor

Third PartyPrivate

Provider

Contractor

Subcontractor

Contractor Contractor

Contractor

SubcontractorSubcontractor

Subcontractor

Subcontractor

SubcontractorSubcontractorSubcontractor

Subcontractor

Government GovernmentGovernment Government Government

Subcontractor

Subcontractor

Subcontractor Subcontractor

Subcontractor

Subcontractor

GovernmentGovernmentGovernmentGovernmentGovernment

PrimeContractor


Education and

RhetoricMoney

RegulationsCapacity to

Convene

Information Sharing and Incentives

Information Sharing Needs

Role of Other

Government Agencies

Relation to Other Sectors

Your Role

Role of the

Private Sector

Managing the

Network

DoUse multiple levers to build and activate networks

= Sector 1= Sector 2

Don’t Manage each network the same way

Sector Scale


• Driving network governance vision down the organization

• Training and recruiting for the new skill sets (and cultural change) needed

• Treating partners as real partners

• Developing and enforcing shared outcome goals

• Horizontal management in a vertical government

• Government as 800 pound gorilla

3. Quality Decision Making: Numerous Challenges


4. Aligning Values and IncentivesCongruence of Goals: Develop the Network Design

• What

– Goal of network?

• How

– Levers used to initiate and sustain network?

– Type of network?

– Identify each parties goals

• Who

– Partners in the network?

– Who integrates network?

4. Aligned Values and IncentivesCongruence of Goals: Develop the Network Design


Share - Don’t offload risk

Guidelines for Sharing Risk

• Which network partners are best at managing which risks?

• Who is bringing the bulk of innovation to the table?

• How much control does the public sector have over the network and/or over the particular risk involved?

• Are the contract costs of the risk shifting worth it?

• Are the risks actually regulatory in nature?


Assuring the Performance of Networked Arrangements

Public Health “Networks”

Which have Worked?

What Could Work Better?

Future “Networks”

Define Best Practices

Monitor Performance

Chara

cteri

stic

s of

“Netw

ork

s”


A Life Cycle Approach to Performance

Achieving results

from networks

Structure Incentives/Share Risk

Measure Network Performance

Set Goals/Align

Values

ManageChange


Federal and State agencies working together can:

• Provide backbone services for other participants to build their networks

• Provide process, monetary, policy, interoperable standards, and other support for these participants to get on the network

• Extend existing health and human services networks and infrastructure

• Coordinate across networks and improve data sharing and decrease redundancies

5. Build Capacity: New Networks and Extend Existing Ones

HIE networks that will enable a unique unprecedented combination of public (federal and state), non-profit, commercial, and citizen networks to come

together and get connected as part of one large integrated network to provide quality outcome based healthcare transformation

5. Build Capacity:New Networks and Extend Existing Ones


Open Source Innovation: Tapping into the “Wisdom of the Crowds”

• A large group of people is better at solving complex problems than an expert, no matter how brilliant

• What are the implications for government?


Keys to Unlock the Kingdom

Unlocking information unleashes the power of networks to fulfill public services and discharge government duties. Governments can use IT tools to facilitate this result in five ways:

• Coordinating activities

• Synchronizing responses

• Enabling a single client view

• Sharing knowledge

• Measure performance


Do Invest resources to ensure cultural alignment is achieved within your organization.

Don’t Expect changes to happen overnight.

6. Networked Leadership:Encourage Behaviors that Promote the Networked Approach

©2005 Deloitte. All rights reserved

10 Apr 2023

Attributes of Highly Effective Network/Relationship Managers

AttributesAttributes

Successful network managers have the ability to:

Work across sector boundaries

Work across sector boundaries

Identify the Network ParticipantsBest Placed to Meet Goals

Identify the Network ParticipantsBest Placed to Meet Goals

Recruit managers who can excel in this new environment

Recruit managers who can excel in this new environment

Thrive in Highly Fluid Environment with High levels of Discretion

Thrive in Highly Fluid Environment with High levels of Discretion

Develop and Manage Relationships & Strategy

Develop and Manage Relationships & Strategy

Understand What Each Partner/ Stakeholder Needs in order to

Perform Role in Network

Understand What Each Partner/ Stakeholder Needs in order to

Perform Role in Network

Embrace mission change from doer to enabler, from rowing to steering

Embrace mission change from doer to enabler, from rowing to steering

©2005 Deloitte. All rights reserved

10 Apr 2023

1. Define of Public Value Carefully Better Health, Not Better Transactions

2. Design Network Correctly—Understand All Assets

3. Quality Decision Making

4. Congruence of Goals

5. Build Skills and Capacity

6. Network Leadership

Key Principles to Create Networked Model


A Change of Thinking Needed…

“People are very open minded about new things. As long as they are exactly like the old ones.”

- Charles Kettering

E-Health Networks The New Shape of Public Health NGA State Alliance for e-Health 2nd Annual State Learning Forum Stephen Goldsmith Daniel Paul Professor.

Documents

network issues

better health

state hie network model

roles of government

health care investment

health consortiums

public value slide

dc health care networks