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Funnels and Quilts · Indiana Health Information Exchange Funnels and Quilts J. Marc Overhage, MD, PhD, FACMI, FACP. Senior Scientist, Regenstrief Institute. Professor of Medicine,

Sep 26, 2020

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    Funnels and QuiltsJ. Marc Overhage, MD, PhD, FACMI, FACP

    Senior Scientist, Regenstrief InstituteProfessor of Medicine, Indiana University School of Medicine

    President and CEO, Indiana Health Information Exchange

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    ge Participants• “All” Indianapolis med/surg hospitals• Physician offices• Community health centers• Homeless care network• Public school clinics• County and state public health departments• National laboratories• Public schools• Pharmacies• PBMs

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    ge Data shared by all institutions• All ED and outpatient visits• All hospital discharges (dx, procedures)• All inpatient laboratory results• All outpatient laboratory results• Immunizations• All discharge summaries/admissions summaries• All operative notes• All radiology reports• All surgical pathology reports• Inpatient medications• Tumor registry data

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    ge Indianapolis MSA Data Landscape

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    70%

    80%

    90%

    100%

    Adjusted Patient Days Laboratory Results Medications Dispensed Physicain Practices Payors

    Other

    Indiana Oral & Maxillofacial Surgery Associates

    Central Indiana Cancer Centers

    Indiana Nephrology & Internal Medicine PC

    Otolaryngology Associates

    Indianapolis Neurosurgicla Grup

    Indiana Heart Physicians

    Midw est Eye Instiute

    Josephson-Wallack-Munshow er Neurotology PC

    Urology of IN

    Respiratory and Critical Care Consultants

    Northw est Radiology

    CorVasc

    Women's Health Partnership

    Orthopaedics Indianapolis

    Methodist Medical Group

    Northside Anesthesia

    Indiana Radiology partners

    American Health Netw ork

    Care Group LLC

    IUMG-PC

    IUMG-SC

    AHN

    Medicaid

    Prescription Solutions

    Anthem

    Medco Helath Solutions

    Express Scripts

    Caremark Rx

    Advantage

    M-Plan

    Humana

    Cigna

    United

    Wellpoint

    Medicaid

    Medicare

    Westview

    Riverview Hospital

    Madison Avenue

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    Data management

    Hospital

    Data repository

    Health Information Exchange

    Network applications

    Payers

    Labs

    tpatient RX

    Physician office

    Ambulatory centers Public health

    Data access and use

    Hospitals

    Physicians

    Labs

    Publichealth

    Payer

    • Results delivery• Secure document transfer• Shared EMR• Credentialing• Eligibility checking• Results delivery• Secure document transfer• Shared EMR• CPOE• Credentialing• Eligibility checking

    • Results delivery

    • Surveillance• Reportable conditions• Results delivery

    • Secure document transfer

    • De-identified, longitudinal clinical dataResearchers

    Payer

    Negotiated Access

    Data Reuse

    Ou

  • Level 1Level 2Level 3Level 4

    $(200)

    $(100)

    $0

    $100

    $200

    $300

    $400

    0 1 2 3 4 5 6 7 8 9 10

    Years

    in b

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    ge 10-Year Cumulative Value

  • Total value: $560M

    Provider

    Public Health

    Pharmacy Laboratory

    PayerOther Provider

    $138M

    $1M

    $14M

    $321M

    $86M

    N/A

    -$56M

    -$23M

    $696M

    $166M

    $281M

    $353M

    Radiology

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    ge Annual Savings Indianapolis MSA Level 4

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    Credentialing Eligibilitychecking

    Public health Results delivery Research Decisionsupport

    Disease mgmt

    Annualeconomicvalue ($M)

    •Patients•Physicians•Hospitals•Labs

    •Physicians•Hospitals

    •Patients•Physicians•Hospitals•Payors

    •Patients•Physicians•Hospitals•Payors•Employers

    •Patients•Physicians•Hospitals•Public health•Payors•Employers

    Beneficiaries1 •Patients•Hospitals•Labs•Public health

    •Patients•Researchers•Investigators•Pharma companies

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    ge Benefits Accrue to Stakeholders Across System

    (1) Includes quality of care/other non-economic beneficiaries as wellSource: BCG Analysis & Estimates

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    Increasingly structured clinical data

    Patient data

    Direct support of

    patient care

    Research

    Decision-supportDisease management & community health

    improvementPublic health lab reporting

    Public health surveillance

    Research

    Clinical trials screening & management

    Adminfunctions

    Credentialing

    Claims clearing

    Eligibility/referrals/pre-certification

    8

    9

    10

    Applications & tools

    2

    3

    4

    5

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    Results delivery1

    Major urban hospitals Non-hospital labs Pharmacies

    Physician offices Biological samples Payors

    Key question: How to orchestrate infrastructure build to target areas of highest value?

    Sequencing

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    ge Our Patchwork Quilt of Funding

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    J. Marc Overhage, MD, PhDIndiana Health Information Exchange, Inc.351 West 10th St., Suite 252 Indianapolis, IN 46202

    Voice: 317-278-7423Facsimile: (317) 278-4753 E-mail: marc.overhage@ihie.orgWeb address: www.ihie.org

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    Donald Duck

    Daffy Duck

    Pluto

    Sam Snidely

    Donald Duck

    Daffy Duck

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    Donald Duck

    Daffy Duck

    Pluto

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    Donald Duck

    Daffy Duck

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  • Public Health Emergency Surveillance

    System(PHESS)

    •56 Hospitals connected•> 4,000 ED visits per day

    Indiana StateDepartment of Health

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  • Clinical Data

    Sources

    Primary care physician

    Payors

    Clinical Data

    In office Tests

    Claims (no $)

    RulesEngine

    PatientLevelDetail

    DoctorLevel

    Summary

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    • Improve quality of care• Improve efficiency of care• Broad involvement

    – >90% primary care providers– ≈900,000 lives

    • Expanding to other markets– Lafayette– Bloomington– Ft. Wayne

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    Document title: Funnels and QuiltsParticipantsData shared by all institutionsSlide No. 4 (No title)Data Reuse10-Year Cumulative ValueAnnual Savings �Indianapolis MSA Level 4Benefits Accrue to Stakeholders Across SystemSequencingOur Patchwork Quilt of FundingSlide No. 11 (No title)Backup SlidesSlide No. 13 (No title)Slide No. 14 (No title)Slide No. 15 (No title)Slide No. 16 (No title)Slide No. 17 (No title)Slide No. 18 (No title)Slide No. 19 (No title)Slide No. 20 (No title)Slide No. 21 (No title)Clinical Quality Data ServicesClinical Quality Data Services (cont'd.)Slide No. 24 (No title)

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