1. An Ingenix- Triad Consulting
proposal for
DOSSIA
and
the Lifelong Personal Health Record
July, 2007
Triad Consulting

2. Triad Healthcare Informatics
DOSSIA and Ingenix – Shared Objective
Finding a way to improve health care through a shared
vision:
 Define a unique set of roles
 One that delivers a set of solutions quickly, even if it
isn’t optimal, but one that can be improved with market
adoption
 Solution must include commitments by members to
benefit in the short term in return for meaningful
change driven by employers
 End state is one where employers advance the
improvement of health care in cost and quality

3. Triad Healthcare Informatics
Ingenix – Our Role
Ingenix Role
 Application Programming
Interface
 Control Application
 Agnostic Exchange
 Independent
 Drive Extract, Transform.
Load
 Provide Analytic Engines
 Offer Consumer Applications
 Offer Provider Applications
 Offer Employer Applications
Ingenix Benefit
 Short Term Client Services
 Long Term Improved Use of
Information not Just Data
 Improved Interoperability
 Public Domain
 Achieve Mission
 Market Competition
 Early Advantage

4. Triad Healthcare Informatics
Phased Approach
 Phase I – Pilot a solution that meets the needs of
Dossia members through existing vendor relationships
but is scalable to a broader population of employers
 Phase II – Scale the pilot solution to the Founding
members with all vendor’s data
 Phase III – Scale the solution to the broader market

5. Triad Healthcare Informatics
Employer Expectations for Consumer Health
 Flawless execution
– Employee satisfaction and appreciation of programs
– Strong account management and understanding of client concerns
 Minimal employer effort
 Minimal employee effort
 Seamless, effective partnership among vendors
 Data privacy controls
 Best-in-class tools for
– Accessing provider information,
– Assessing personal health information and charting progress
– Making provider and plan selections
– Claims adjudication and savings account administration
– Providing participants effective educational and decision-making
resources
– Delivering information in a format that is understandable given the
participants’ personal circumstances
– Providing comprehensive, timely information to providers concerning each
participant’s health needs, practice patterns and population trends

6. Triad Healthcare Informatics
Ingenix Vision
Providers of Data Sources
PBMs
Labs
Ingenix
Others
DOD AARP NMA
PHR
API
Application
Programming
Interface
Control
Application
Keys
Data Source
(virtual)
EBM, ETG, ERGs, PRGs, HCGs
Patient Providers
PHR
WebMD
Participating Employers
Participating Employers

7. Triad Healthcare Informatics
Participating Employers
Participating Employers
Shared Vision
Providers of Data Sources
PBMs
Labs
Ingenix
Others
DOD AARP NMA
PHR
API
Application
Programming
Interface
Control
Application
Keys
Dossia Data Source
(virtual)
EBM, ETG, ERGs, PRGs, HCGs
OMX OMX OMX
Patient Providers
PHR
WebMD
PHR
Impact
Consumer/Provider
Symmetry
Impact Pro
Ingenix Health
Manager
Symmetry
Impact Pro
Ingenix Health
Manager

8. Triad Healthcare Informatics
Starting with the End State
 Improving the speed and accuracy of health care data
aggregation
 Preserving privacy
 Create more meaningful information
 Market differentiation through use of data not
aggregation of data
 Employers driving the change

9. Triad Healthcare Informatics
Participating Employers
Participating Employers
Improving the System via OMX
Providers of Data Sources
PBMs
Labs
Ingenix
Others
DOD AARP NMA
PHR
API
Application
Programming
Interface
Control
Application
Keys
Dossia Data Source
(virtual)
EBM, ETG, ERGs, PRGs, HCGs
OMX OMX OMX
Patient Providers
PHR
WebMD
PHR
Impact
Consumer/Provider
Symmetry
Impact Pro
Ingenix Health
Manager
Symmetry
Impact Pro
Ingenix Health
Manager

10. Triad Healthcare Informatics
Technical Solution for Quicken Health

11. Triad Healthcare Informatics
The Opportunity
 Leverage the OMX Server Implementation for Dossia:
 Sends data on a subscription basis
 Secure and reliable
 Single point of integration at the health plan
 Web services architecture

12. Triad Healthcare Informatics
Applied to Dossia

13. Triad Healthcare Informatics
What is OMX?
 OMX = Open Medical eXchange
 Allows Health Plans to provide personal health data to
consumers in a secure and effective fashion
 Intermediary between Health Plan source systems/data
sources and the Quicken Health application.
 The OMX server is owned & maintained by the Health
Plan
 Key functions
 Manages user authentication using the Health Plan’s
rules
 Collects consumer data
 Provides data on demand – real time (first use) and
batch (subsequent use)

14. Triad Healthcare Informatics
OMX Specification
 The OMX specification is simply a communication protocol that
has been designed by the Quicken Health team (Intuit & Ingenix)
to support the health data collection needs of consumers.
 It is similar in use to OFX, yet modernized in design leveraging
web services and xml topic structures. The API itself is fairly
straightforward.
 The Quicken Health Framework is expecting 3 basic things:
 The data provider will have a profile in a registry on an Intuit-hosted
server (stored in Nexareg, our metadata repository)
 The data provider will have the ability to respond to a defined set of
web service calls from the client in accordance with the specification –
this includes appropriate user authentication and the ability to satisfy a
request for data.
 The data provider will have the ability to push appropriate notification
information to an Intuit-hosted notification server

15. Triad Healthcare Informatics
Consumer Data is Protected
 Data Resides on data provider systems, behind their
firewalls UNTIL it is requested
 OMX currently relies on health plan (or other data provider)
ID/ password for authentication, leaving the data provider in
control (HIPAA)
 Communications between the OMX Server and requesting
servers are secure and encrypted

16. Triad Healthcare Informatics
OMX Compatible with Existing Standards
 OMX is based on HIPAA (X12 and NCPDP)
 Allow health plans to more easily map OMX requirements to
existing external interfaces
 84% of OMX data elements (excluding payer branding
information) traced to standard transaction set
 Examples of data elements not referenced to standard
transaction set: data source system, custom information codes,
begin and end dates for accumulators
 Will continue to leverage the standards that exist
 HL7 lab result and other clinical data (CCD)
 Working with standards and industry groups
 HITSP, CAQH, AHIP
 Working with consumer-oriented standards groups – AHIP,
Markle and others

17. Triad Healthcare Informatics
OMX Currently
 Administrative and other payer data topics
 Claims/EOBs
 Member/ subscriber eligibility information
 Benefit plan information
 Provider information
 Payer web portal links
 Ability to add additional topics easily

18. Triad Healthcare Informatics
Certification – Ensures Quality of OMX
Providers
 Data Quality, Integrity and Access
 Data is complete and conforms to OMX Specification
 Consistent with your portal
 Timely (no more than 24 hour lag)
 Historical data available (3 years recommended, 12 mo minimum)
 Security and Authentication
 Acknowledge HIPAA obligations
 Provide authentication mechanism
 Available to termed members
 Sensitive data policies applied
 Operations and Support
 Consumer support model is in place and all training complete
 System availability is managed and notification processes in place
 System response times are within range

19. Triad Healthcare Informatics
Current Solutions – Future Enhancements
 Develop the end state infrastructure
 Needs to meet current employer and market needs
 Short term wins – part of move to end state
 Deliver more than what is available today
 With an eye towards the future
 Future is within reach with OMX

20. Triad Healthcare Informatics
State of Shared Health Care Information
Information flow is incomplete
Care
Management
Providers Consumers
 Care Management – health
information based on claims or
HRA’s
 Providers – health information
based on services their practice
performed
 Consumers – health
information based on what they
remember or understand

21. Triad Healthcare Informatics
Participating Employers
Participating Employers
Application of Impact Consumer/Provider
Providers of Data Sources
PBMs
Labs
Ingenix
Others
DOD AARP NMA
PHR
API
Application
Programming
Interface
Control
Application
Keys
Dossia Data Source
(virtual)
EBM, ETG, ERGs, PRGs, HCGs
OMX OMX OMX
Patient Providers
PHR
WebMD
PHR
Impact
Consumer/Provider
Symmetry
Impact Pro
Ingenix Health
Manager
Symmetry
Impact Pro
Ingenix Health
Manager

22. © Ingenix, Inc. 22
Sharing Care-Focused Information with all
Constituents
Impact Pro
Predictor
Impact Consumer
Health
Impact Provider
Patient Connection
Care-focused
PHR
 Impact Pro Predictor – enables
informed care managers to
coordinate care with consumers
and providers.
 Impact Provider Patient
Connection – enables prepared,
physician practice teams to deliver
better, proactive care.
 Impact Consumer Health –
enables informed, activated
consumers to make better health
decisions.

23. © Ingenix, Inc. 23
Impact Consumer/Impact Provider Currently
• Demographics
• Encounters
• Medications
• Providers
• Self-reported

24. © Ingenix, Inc. 24
Impact Consumer Implementation at DOSSIA
• Demographics
• Encounters
• Medications
• Providers
• Self-reported
Data from employers
supplied to DOSSIA
DOSSIA administers (typically) monthly
processing. Could be a BPO process
provided by Ingenix, or run by DOSSIA.
Internet access to the
datamart. Hosted by
DOSSIA or Ingenix.
Consumer access is through the Impact
Consumer web site, or through a
DOSSIA-supplied portal accessing
Impact Consumer information
Back office access to the
datamart also available

25. © Ingenix, Inc. 25
Protected Health Information
• Demographics
• Encounters
• Medications
• Providers
• Self-reported
We assume DOSSIA is HIPAA
compliant. Alternatively can employ
Ingenix’s HIPAA compliant BPO.
Consumers must grant access to
their information to physicians BA’s in place with network
physicians?

26. © Ingenix, Inc. 26
Participating Employers
Participating Employers
Consumer Behavior Change with Non-Traditional
Data
Providers of Data Sources
PBMs
Labs
Ingenix
Others
DOD AARP NMA
PHR
API
Application
Programming
Interface
Control
Application
Keys
Dossia Data Source
(virtual)
EBM, ETG, ERGs, PRGs, HCGs
OMX OMX OMX
Patient Providers
PHR
WebMD
PHR
Impact
Consumer/Provider
Symmetry
Impact Pro
Ingenix Health
Manager
Symmetry
Impact Pro
Ingenix Health
Manager

27. © Ingenix, Inc. 27
Ingenix Health Manager
Reporting
• Activity report
• Outcomes report
• Efficacy report
Continuous improvement thru
“organic” learning system
Create 360° Health Profiles
(Includes individual health and lifestyle information)
Prioritize Individuals for Intervention
(Based on 360° Health Profiles)
Create Target Groups
(Matched to available interventions)
Segment Population
(Creates segments by unique characteristics)
Data Management,
Segmentation & Targeting
Tailored Messaging
& Activation
Create Engagement Profiles
(Includes 360° Health Profiles and Activation Plan)

28. © Ingenix, Inc. 28
Health and Consumer Information to Change Behavior
Data Management, Segmentation and Targeting
• Get a deeper understanding of consumers with 360-degrees of data
 Integrate health and consumer information from multiple data sources
 Match data at the individual level
 Apply methodologies to address potential data gaps
• Understand the unique needs of populations to provide customized health solutions
 Identify unique health needs and characteristics of populations across the health continuum
 Reveal gaps in intervention program needs and delivery mechanisms
• Identify target groups for health intervention, integrating health outreach
 Match individuals to available interventions based on health needs and preferences
 Prioritize individuals for intervention based on readiness to change and likelihood of engagement
 Uncover previously unidentified consumers for intervention – before they get sick
Tailored messaging & activation
• Engage consumers in health intervention for better health outcomes
• Create tailored messaging, using direct marketing and behavioral science techniques,
to activate consumers
• Deliver information needed to tailor interventions at the target group or individual level
Reporting
• Measure and deliver better health and financial outcomes
• Continuously refine and improve intervention program effectiveness

29. © Ingenix, Inc. 29
Ingenix Health Manager End-to-End Solution
Data Management,
Segmentation & Targeting
Tailored Messaging
& Activation
Delivery Reporting
Report TypesData
Standardization
and Matching
Data Analytics Outreach
Enrichment
Data Matching
Individual
Provider
Multi-payer
Multi-source
Scoring/Rating
Cost
Quality
Volume
Severity
ETL
Process
Population
Segmentation
Application
of Business
Rules
Stratification
of Members
•Medical Care Cost &
Utilization
•Pharmacy Cost &
Utilization
•Lab Values
•Socio-economic
•Demographic
•Health Risks/Status
•Life Stage Clusters
•Consumer
Preference
•Productivity &
Absence
•Physician & Hospital
Quality
•Provider Directory
•Program Inventory
•Benefit Parameters
(e.g., costs, fee
schedules, detail)
•Plan Parameters
•Intervention Activity
•Intervention Results
Consumer
Intelligence
Warehouse Grouper
Technology
Predictive
Model
Health
Messaging
Campaigns
Health
Interventions
Heath Portal
24-Hour
Health Line
Heath Risk
Assessment
Lifestyle
Behavior
Health
Coaching
Disease
Management
Case
Management
End-of-Life
Management
Connecting
Physicians &
Patients
Individual
Activation
Plans
Intervention
Enrollment
Messaging
Cost and
Quality
Messaging
Provider
Messaging
IHM Data
Mart
IndividualDataSources
12
Identificatio
n of Target
Groups
• Intervention Activity
• Intervention Outcomes
• Return on Investment
• Intervention Efficacy
• Activation Response
• Special Studies

30. © Ingenix, Inc. 30
Benefits
Employer Benefits
 Continued decision support
 Improved decision support
Market Benefits
 Independent exchange
 Applying current market
standards