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How patient summary standards can improve risk assessment for health insurance?

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How patient summary standards can improve risk assessment for health insurance?

  1. 1. Reinforcing the Bridges and Scaling up EU/US Cooperation on Patient Summary Trillium IIThis project has been cofunded by the European Union’s Horizon 2020 research & innovation programme under grant agreement No 727745 Catherine Chronaki Trillium-II Scientific Coordinator Secretary General HL7 International Foundation Brussels How patient summary standards can improve risk assessment for health insurance?
  2. 2. Outline • Digitization of medicine: implications for eHealth and telemedicine standards • Changing landscape of health insurance • Patient summaries as entry point to health information of a person or a community • Evaluate the benefits accrued with use of patient summaries in changing the narrative of health insurance to support value-based care. How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  3. 3. www.estandards-project.eu eStandards – eHealth Standards and Profiles in Action for Europe and Beyond Vision of the global eHealth ecosystem  people have navigation tools for safe and informed health care  interoperability assets fuel creativity, entrepreneurship, and innovation eStandards will:  nurture digital health innovation  strengthen Europe’s voice & impact  enable co-creation and trusted provider-user relationships Base Standards Use Case based Standards Sets Assurance and Testing Live Deployment Feedback and Maintenance Tooling and Education Forums and Monitoring eStandards How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017 4
  4. 4. www.estandards-project.eu Innovation is where standards are most needed: to unlock data for trust & flow Today: • Massive health data accumulated in silo EHR systems serving documentation purposes. We need to move from passive documentation to active use of information and knowledge creation: activation! • Patient summaries defined at the macro level: cross-border exchange for emergency or unplanned care at a national level. Need to address communities and individuals! • Standards and profiles address a predefined exchange of information. Need flexible use of available content and structure, recognizing national, regional or local jurisdictions trust & flow! Shaping the future: Focus on the top level: systems of innovation! 5 Systems of record – documentation systems -EHRs Systems of differentiation – profile based data exchange Systems of innovation – unlock data and user experience + + - - C h a n g e G o v e r n a n c e How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?" June 1, 2017
  5. 5. www.estandards-project.eu Making Digital Work for health with Trust and Flow • Co-create – to make it real using standards • Governance – to make it scale for large-scale deployment • Alignment – to make it flourish in a sustainable way 6 How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?" June 1, 2017
  6. 6. Patient summary standards Think Patient summary as vaccinations medications encounters Identification allergies Implantable devices Health team Security preferences Security preferences problems How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  7. 7. NHS-Digital Summary Care Record • The SCR is an electronic record of important patient information • Access to SCR information means that • At a minimum, the SCR holds important information about • The patient can also choose to include additional information in the SCR How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  8. 8. ObjectivesTrillium Bridge II (2017-2019) • Engage and educate stakeholders on the social value of patient summary standards • Establish a Global Community of Practice for Digital Health Innovation How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  9. 9. Context, role and adoption of the international patient summary in the global ecosystem • Establish the case of the patient summary as a citizen’s right and enabler, and validate its global role in different contexts • Consult with key stakeholder groups to identify needs, use cases, and promote patient summary standards • Assess key enablers and success factors for adoption of the international patient summary for benefit realization • Collect and Revise educational and training material of relevance to the international patient summary • Lead the way towards productive and safe use of health data How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  10. 10. Health Insurance in the United States • Explosion of data and technology offer opportunities for risk assessment • Shift to provider risk-bearing models e.g. 30 day readmission • Heightened value of direct relationships with providers • Greater transparency through readily available information on pricing, networks, costs, and quality. • Increasing regulatory uncertainty with health exchanges • Health management organizations • Accountable care organizations How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  11. 11. Health insurance in Europe • Bismarck and "Social Health Insurance" (1883) right of labor • Beveridge: the National Health Service (1948) right of residency • Universal Health coverage • Most countries in Europe use a mix How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  12. 12. Health Insurance in the United States on the News 2011-2013 • “The end of Health insurance companies” (NewYorkTimes) • “The end of private health insurance in America” (Forbes) • “Is this the end of health insurers?” (Washington Post) • “Insurance companies as we know them are about to die” (New Republic) • “Why health insurance companies are doomed” (Fortune) How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  13. 13. 2015: Private health insurance: growing global market of 1 trillion€ • Private health insurance [124bn€ in 2015, from 0.01% to 6.1%] • Health insurance Industry transformation • Aging population living with disease • Increased healthcare consumption • Rising global disease burden in chronic / non-communicable diseases • Healthcare systems in trouble unable to match supply and demand • An opportunity for private insurance to invest! How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  14. 14. 15
  15. 15. Forces shaping health systems: Risk • Shift of risk and medical expenses • Misalignment between categories of risk • Need for a new focused management model • Need for closer partnership of providers and private payers How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  16. 16. Forces facing health systems: technology • Rapid progress in analytics and digitization • Innovation in medicine How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  17. 17. Forces facing health systems: regulation • Health insurance regulation • Incentives for private payers • Possibility to reach low-income segment How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  18. 18. Forces facing health systems: consumers • Consumers become more health aware • Insurance companies need to be able to engage directly with consumers • Support the patient’s health journey: How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  19. 19. New business models for health insurance • New Roles: • New Business models: • Engage the health consumer: How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  20. 20. • Insurers introduce products that use fitness data for pricing • Aspire to be orchestrators of the healthcare ecosystem on behalf of consumers deriving insights through advanced analytics and connectivity Trust and Transparency
  21. 21. Can patient summaries help build trust to sustain partnership with insurers? Scale-up use of patient summaries • Listening to the patient and the family • Quality assurance • Health goals • Early warnings • Transitions of Care: Smooth discharge, transitions, and hand-offs • Emergency or Urgent episodes: Safe care • Risk Assessment How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  22. 22. How can patient summary standards help insurance with risk assessment? Raising the bar for Patient Summaries • Understood • Easy • Desirable • Rewarding • A Habit Is that enough for the era of health? Patient summaries can be the key to unlocking health information • Know consumers and what drives their behaviors • Guide consumers toward the information they need to make better decisions • Engage consumers to help prepare them for and enable behavior change • Inspire consumers to build loyalty How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  23. 23. Embracing the digital: Prescribing mobile health apps • Could patient summaries offer a minimum data set that all health apps could readily and with minimum cost comply to? • Would that also benefit health insurance companies? Establish basic level of interoperability globally with the International patient summary collaboration of CEN/HL7 How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017
  24. 24. Global Community of Practice for Digital Health Innovation Let’s join forces to make digital health happen.. Apply to become an Ambassador! Please Contact us: mhm@medcom.dk euoffice@HL7.org www.trilliumbridge.eu @trillium_II EvaluateBridge HarmonizeGuide

Editor's Notes

  • Good morning ladies and gentlemen.
    We have a problem with health data. My premise is that patient summaries can serve as the entry point to health information.
    The health information of an individual or a community.
    My talk today will be on Trillium II – an initiative that aims to create a community of innovation for the practice of digital health starting from the notion of patient summaries.

    And my premise here for you to think about is that patient summaries can serve as the entry point to navigate through a person’s health data offering essential data and links to find additional information.



  • Systems of record – SQL / CDA/CCD /
    Systems of differentiation – IHE Profiles / PCHA/Continua Profiles
    Systems of innovation – FHIR / OpenEHR Archetypes
  • To develop, deliver, test and deploy standards sets which are properly adapted to a dynamic healthcare system, we need a constant flow of interaction between three types of activities:

    Co-creation between all relevant stakeholders
    to make it real using standards

    A supportive and appropriate governance system
    to make it scale toward large-scale deployment

    The flexibility to adapt and align as needs and requirements change
    to make it stay in a sustainable way
  • From 3% Europe, 14%, North America (15bn/12bn), 0.1% Africa (10bn/12.5bn), 5% Asia Pacific (15bn/10bn), 5% LatAm (30bn/25bn).
  • Explosion of data and technology have implications for risk
    Shift to provider risk-bearing models e.g. 30 day readmission
    Heightened value consciousness among both consumers and employers, which often leads to more direct relationships with providers
    Greater transparency through readily available information on pricing, networks, costs, and quality.
    Increasing regulatory uncertainty
    Health management organizations
    Accountable care organizations
  • Aging population 65+ 3.1% per year according to World population prospects, UN
    In the US one third of healthcare expenditures are related to chronic disease 19 to 23% according to McKinsey
    OECD 2000-2012
    communicable diseases 31/23/12/5 low-lower middle- upper middle – high income
    Non-communicable diseases 65-71-81-87
    Injuries 4-5-7-8

    Growing market with excellent prospects in eastern Europe
    Romania (p27%), Turkey (p3%), Ukraine 16%
    US (p13%) 6%, Germany (p11%), Switzerland, Netherlands 2%, Italy (p4%) 1%, Czech Republic (p25%), Slovakia (p17%)


  • The portion of healthcare spending devoted to classic insurable medical risk is decreasing (28%)
    Governments might impose regulations that eliminate core aspects of the insurance market e.g. flexibility in underwriting and pricing or replance insurance with public programs so that private insurance offers only supplementary products
    Need for new business models:
    e.g. risk impaired annuity from chronic disease
    Risk category, Consumer discretion, Consumer ability to absorb risk/expense, Potential financial approach, Potential reimbursement
    Routine, H, H, Saving, credit/prepaid cards, fee for services
    Preventive, H, H, Free, Fee for services
    Chronic Care, H, M (Catastrophic H, L) Insurance with incentives for proper management and risk impaired annuity, nested episodes with population health models
    Discretionary, H, M, Savings and credit cards, Episodes
    Purely elective, H, M, Savings and credit cards, Episodes
    Catastrophic non chronic, L, L, Insurance, Episodes
    End of Life, L, M, Savings, viatical, reverse mortage, Episodes




  • The transparency into care dlivery performance makes possible very different payment and risk intermediation models: expansion of episode and bundled payment modesl, incentives baded on population health, complete capitated risk, transfer levels of financial risk to providers.
    Potential for transparency in the care delivery performance can test bundled payment modes, incentives based on population health, eliminate 30 day -readmission costs

    Wearable trackers quantify personal activity generating valuable data for private payors: measures collected, fully automated visualization and longitudinal evaluation, comparison with family, friends, and the online community.

    AXA partner with Samsung to provide discounts for healthy behavior
    John Hancock uses fitbit for life insurance offering 15% discound
    Generali uses discovery health, and offers vouchers and gifts for activity and prevention exams



  • In case of Emergency, the patient summary is there in our mobile phone and can be understood anywhere in the world
    Emergency response teams can use the patient summaries to capture accurately the aggregate and individual needs of a community hampered by disaster.
  • Insurance companies have a lot of data
    Reciprocity: Trust and sharing can walk hand in Hand
    insurers could populate some Patient Summary data elements
    since they pay for most medical care regardless of who provides it, they know about meds and problems at a minimum)
    Sometimes, create complete Patient Summaries to improve the care of their insured patients during transitions of care. (US)

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