Integrated Clinical Engagement Model to enhance quality of care Saji Salam MD,MBA Cognizant Business Consulting Healthcare Practice Harvard Quality Colloquium, Aug 19 2008

Abstract Consumerism, a renewed focus on wellness, debates on cost and quality of care and the election year politicking are some of the market forces that are pushing the key stakeholders in healthcare, i.e payer, provider and patient to collaborate towards providing a seamless healthcare experience for the patient. Payer organizations are rolling out Integrated Clinical Engagement models is response to the trend. A Clinical Data Repository is a key component in this initiative. This presentation examines the clinical data infrastructure models required, and the challenges involved in using an integrated clinical engagement model to enhance quality of care.

Consumerism, a renewed focus on wellness, debates on cost and quality of care and the election year politicking are some of the market forces that are pushing the key stakeholders in healthcare, i.e payer, provider and patient to collaborate towards providing a seamless healthcare experience for the patient.

Payer organizations are rolling out Integrated Clinical Engagement models is response to the trend. A Clinical Data Repository is a key component in this initiative.

This presentation examines the clinical data infrastructure models required, and the challenges involved in using an integrated clinical engagement model to enhance quality of care.

Integrated Clinical Engagement model

Key Drivers Integrated Clinical Engagement Model Employers Health Plans Providers Members Industry - Creating efficiencies in health benefits vendor management by limiting choice to a few plans - Focus on medical management capabilities of plans - Wellness focus as a way to reduce costs - Competition is using Integrated Healthcare Management as differentiator - Customers buying into the same P4P driving increased cooperation from providers - Forrester (and other analysts) - Leading Health Plans -Vendors such as Microsoft, Google,Quicken Demand for better “consumer experience” CDH pushing for more responsibility for healthcare to members

- Creating efficiencies in health benefits vendor management by limiting choice to a few plans

- Focus on medical management capabilities of plans

- Wellness focus as a way to reduce costs

- Competition is using Integrated Healthcare Management as differentiator

- Customers buying into the same

P4P driving increased cooperation from providers

- Forrester (and other analysts)

- Leading Health Plans

-Vendors such as Microsoft, Google,Quicken

Key Stakeholder benefits Provider Access to an integrated view of patient’s clinical information at point of care Patient/Member Access to personal health information Portability (?) Payer Ability to manage costs and quality Address medical management functions Outcome: Better Quality of care

Provider

Access to an integrated view of patient’s clinical information at point of care

Patient/Member

Access to personal health information

Portability (?)

Payer

Ability to manage costs and quality

Address medical management functions

Outcome: Better Quality of care

Integrated Clinical Engagement-Data model Clinical Data Repository Payer / Purchaser Info Pharmacy Data Encounter/Clinical Data including co morbidities Labs / Imaging Data Family/Social History/ Demographic data Provider quality/cost data Medical Management Info (HRA, DM, CM etc) Claims Data

PHR

PHR in an Integrated Clinical engagement model

Challenges

Q & A Contact:saji.salam@cognizant.com