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

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How can the patient summary improve risk assessment for insurers? In "Digital health and insurance: a perfect partnership?“ June 1, 2017

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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
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  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

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