A Strategy for Consumer

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A Strategy for Consumer Provider Engagement
Through e-Business InnovationAntonio Linares,
MDNorthern California HIMSS ChapterDecember
6th, 2007
Personal Health Records
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Agenda

• WellPoints 2010 Strategic Foundation and HIMSS
  Goals
  
• Opportunities to Improve Care and Transformation
• PHR is a Key Enabler to Leverage Information
• Interoperable Solutions, Collaboration and HL7
• e-Business Strategy and Consumer Focus in 360?
  Health
  

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WellPoint 2010 Strategic Foundation
Vision WellPoint will transform health care andb
ecome the most valued company in our industry
Transformation requires initiatives to address
health cares cost, quality, and safety
challenges.
Mission Improve the lives of the people we serve
and the health of our communities
Community orientation requires initiatives that
support patient care, regardless of payer
Differentiated Strategy Most trusted choice for c
onsumers and a
leader in affordable quality care
Differentiation requires unique initiatives that
allow for competitive gain
Health I.T. initiatives support improved patient
care for communities while offering competitive
differentiation for sponsoring plans
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HIMSS Strategic Direction

• Vision
• Advancing the best use of information and mgt
  systems for the betterment of health care.
  
• Mission
• To lead change in the healthcare information and
  management systems field through knowledge
  sharing, advocacy, collaboration, innovation, and
  community affiliations.
• Ambulatory Committee
• Working with leaders from large healthcare
  enterprises ambulatory clinics, medical
  practices, military health system, community
  health leaders plus consulting and vendor
  communities, the Ambulatory Information Systems
  Steering Committee expands HIMSS ability to
  increase the quality and cost-effectiveness of
  patient care by removing barriers to IT adoption,
  and increasing the use of EMR/EHRs and promoting
  business systems integration in the ambulatory
  setting.

Slide provided by Mary Griskewicz, M.S.,FHIMSS,
Senior Director, Ambulatory Information Systems
and Jill Redenius, Coordinator, Ambulatory
Information Systems, HIMSS
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Sustainable Opportunity to Improve Care
Theres a huge gap between the care doctors
provide and the care they ought to provide
- 40 of people with chronic disease dont
get recommended care - 50 of people dont
receive recommended preventive care
- 30 receive contraindicated acute care
- 20 receive contraindicated chronic
care - 500B/yr is spent on care that is
unnecessary We have an incredible armamentarium
of diagnostic and therapeutic interventions that
is expanding at a faster pace than ever before
The majority of Americans have lifestyles that
are unhealthy Increasing compliance with what we
already know to be the right thing to do is a far
bigger challenge today than figuring out what the
right thing to do is.
Earl Steinberg CEO Resolution Health Nationally
Known Health Services Researcher
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WellPoints Unique Information Opportunity

• Multiplicity of WellPoint brands and products
  result in a uniquely rich data environment that
  can be leveraged for health and business
  improvements.
• WellPoint is the leading health plan in the U.S.
  with approximately 34 million medical members.
  
• One in nine Americans receives coverage for their
  medical care through WellPoint's health plans.
  
• WellPoint is a Blue Cross or Blue Cross Blue
  Shield licensee in 14 states California,
  Colorado, Connecticut, Georgia, Indiana,
  Kentucky, Maine, Missouri, Nevada, New Hampshire,
  New York, Ohio, Virginia, and Wisconsin, as well
  as UniCare, our non-Blue health plan that
  operates nationwide.
• WellPoint offers a broad range of medical and
  specialty products including pharmacy, dental,
  life, disability, behavioral health, and workers
  comp.

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Key Enabler Timely Data Connected Physicians
Plan Med Mgmt
Physician-Patient Interaction
Current care management strategies influence
physician and member behavior AFTER a care
decision has been made resulting in abrasion,
admin costs, and sub optimal impacts to cost and
quality
U.M./C.M.
D.M.
PBM
RHI
WellPoints Health I.T. vision is to provide
needed, real time management information to embr
ace and re-enforce the physician-patient
relationship Key enabler of this strategy is
WellPoints integration of Personal Health Record
s (PHR) into the process of care
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Scalable and Interoperable Solutions
Exchange
Collaborate
Interact
Practice Mgmt Systems
Claims based PHR
CCR Support the Continuity of Care Record
Connected Health Record
CPOE E-Prescribing, Lab Order
Entry
WLP Program EDI Support
WLP Program WebMD PHR
WLP Program MedPlus, AllScripts
WLP Program Member Medical History System
WLP Program Kettering-CentrifyHealth
Office staff productivity Administrative Efficien
cy
Member Engagement Strategy Possible cost reductio
ns or quality gains
Plan Cost of Care savings Increased patient
safety, physician workflow improvements
Increased patient safety cost savings, Quality
gains
Optimal patient safety, costs and productivity
reduced cost of medical errors and liability




Scale Interoperable Solutions
Pilot Solutions for Interoperable Care
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Interoperable Systems Yields Interoperable Care
Each component of the Health Care delivery system
is already linked to an aggregating entity the
health plan A real world approach that leverage
s existing investments in I.T. and incrementally
builds on production infrastructure offers a much
higher likelihood of success Interoperable Heal
th Care supplants and enhances interoperable bill
ing and finances
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Information Management Framework Overview
Account Reporting
Health Management
Provider Metrics
Member Analytics

• Standards
• Processes
• Training
• Helpdesk
• Data Definitions
• Development Support
• Change Management
• Communications
• BI Competency Center

• Tools/Toolkit
• Governance
• Platform
• Architecture
• Strategy
• Operating Model
• Data Management
• Data Quality
• Environments

Enterprise IM Framework
Consolidated Data from All WellPoint Brands
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360Health Enterprise Clinical Data Mart
Administrative Data Claims, eligibility, demogr
aphics
Clinical Data lab, PHR, HRA, carved out services
PHYSICIAN COMPONENT
CONSUMER COMPONENT
Personal HealthRecords
Individualized Messages (MyHealth Advantage)
Integrated Care and Disease Management
E-HealthRecords
E-Prescribing
ClinicalResearch
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HL7 Overview of the PHR-S FM Standard

• By consensus agreement, a PHR system should
• Be consumer-oriented
• Provide a Longitudinal collection of personal
  health information
  
• List the functions that PHR systems shall,
  should, or may do
  
• Provide immediate electronic access to the
  consumer and to those authorized by the consumer
  
• Serve as an anchor point for system
  interoperability
  
• Provide a certification framework
• The resulting PHR-S FM standard is
• Consensus-based
• Internationally-oriented

Source John Ritter, Intel and HL7 EHR TC
co-chair PHR Work Group co-facilitator
Presentation at HIMSS PHR Roundtable 11-27-07
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HL7 Overview of the PHR-S FM Standard

• Five Chapters
• Overview
• Conformance Clause
• Personal Health
• Supportive
• Information Infrastructure

Source John Ritter, Intel and HL7 EHR TC
co-chair PHR Work Group co-facilitator
Presentation at HIMSS PHR Roundtable 11-27-07

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HL7 Categorization of the PHR-S FM Functions

• High-Level Functions
• Core Functions
• Health History Functions
• Other Relevant Information Functions
• Planning Functions
• System Functions
• Optional Services

Source John Ritter, Intel and HL7 EHR TC
co-chair PHR Work Group co-facilitator
Presentation at HIMSS PHR Roundtable 11-27-07

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WellPoint Personal Health Record (PHR)

• A repository of information that pre-populates
  data from multiple sources and organizes it in a
  consumer friendly manner
  
• Accessed via secure website
• Controlled by the individual, who decides what to
  include or not include in his/her PHR and how to
  use, enhance or share that information
  
• May be shared with the physicians office through
  a secure web portal or PIN
  
• Integrates data from WellPoints Health Risk
  Assessment, Medical claims, Rx, labs and worksite
  biometric screening results.

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WellPoint Personal Health Record in Operation

• Update Medical Histories via HRA
• Update Health Risks/Allergies

Request Hardcopy or access via PIN
PHR

• Lab Results
• Physician Visits
• Hospital Stays
• Diagnoses
• Prescriptions
• Clinical Alerts
• Interventions

Member
CLAIMS
Provider
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WellPoint e-Business Strategy Consumer Focus

• WellPoint will provide innovative online decision
  support tools and targeted information and
  messaging based on health events and online
  transaction capabilities connecting members,
  providers and care programs to improve healthcare
  decisions and outcomes!
• WellPoints eBusiness will become the health
  industry info-mediary and industry leader in
  driving adoption of personal health records
  through 360Health.
• WellPoints eBusiness will leverage new and
  emerging eBusiness technologies, including
  wireless and broadband, to provide greater
  convenience and real time information at point of
  care.

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eBusiness Our FOCUS

• Personalization Customization
• Engagement of the Consumer
• Usability
• Easy To Use Relevant Information
• Expansion/Integration of eHealth
• Transparency
• Consumerism
• Product Web Innovation
• Leveraging New Technologies
• Online Communities
• Blogs

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eBusiness Our Online Consumer Tools

• Member ePortal
• Innovative portal technology for high
  performance, usability and scalability
  
• Integrated online personal health record in
  partnership with WebMD
  
• Integrated online decision support tools in
  partnership with Subimo
  
• Strong online eRetail offering

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MyHealth Assessment
Identify Your Health Risks and how to lower them

Like many services on the site, the HRA is availa
ble in Spanish.
HRA data from the WebMD HRA feeds into the
MyHealth Record - personal health record (PHR)

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MyHealth Assessment - The NEW User Experience -
2007
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MyHealth Record - Personal Health Record

• The Personal Health Record is an easy to
• use tool that includes the medical
• information you provide in your Health
• Assessment and Health Trackers.
• You can even have your Anthem Blue
• Cross and Blue Shield claims automatically
• added.
• By adding a few more details like family
• history and over-the-counter medications,
• youll have an up-to-date personal and
• secure record, at your fingertips, anytime
• you need it.
• Member/Provider Connectivity allows your
• Provider to ADD notes within your personal
• health record (NY Pilot).
• In fact, you can print a neatly organized

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WellPoint - A Leader in Innovation and Strong
Web Foundation

• Industry Recognition
• eWeek Fast Track 500
• Distinguished Web Site - Healthcare Leadership
  Award for five consecutive years
  
• B to B NetMarketing 100
• Praise Worthy Web Site Consumer WebWatch
• Gold World Wide Web Health Awards
• WWW Webby Distinction for Medicare Part D
• Trust
• Consumer Web Watch Certification Consumers
  Union
  
• VIPPS Certification - Compliance with VIPPS
• HON accreditation - For aiming to improve the
  quality of medical and health information online
  
• URAC Certification For promoting quality and
  efficiency of health care delivery

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Innovations In Health Care

• Consumers want to take the web and their
  information with them wherever they go
  WellPoints innovative strategy delivers content
  and tools to todays wireless consumer devices
  through mobile MyHealth
• WellPoints innovative web based system for
  consumers allows them to download information,
  tools, health records, prescription data and cost
  information
• Portable personal health records allow access to
  claim, prescription and financial information
  across multiple technologies
  
• New online communities on specific disease
  conditions create new communication and
  information for members
  
• New message boards and online tutorials create an
  informed member
  

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Consumer-Centric Care Brings People Closer to
Their Medical Home and Care Givers
Timely High Quality Health Care
Trusted Online Health Tools
Seek Care
Seek Info

• Physicians
• Hospitals
• Pharmacy
• Lab/Ancillary

• Health Assessment Profile
• Health Library News
• Self Care Tools
• Physician/Hospital Profiles

Seek Help
Personal Empathetic Advisors
Claims, RX Hospital Review Data
Personal Health Record HRA Contributed Data
Proactive Risk Management Identification and Stra
tification