The document discusses an integrated clinical engagement model used by payers to enhance quality of care through collaboration between payers, providers, and patients. A key component is a clinical data repository that integrates different types of patient data from various sources. This allows providers access to comprehensive patient information, payers to better manage costs and quality, and patients access to their own health information through personal health records. Challenges remain in fully implementing this model.

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

2. 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.

3. Integrated Clinical Engagement model

4. 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

5. 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

6. 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

7. PHR

8. PHR in an Integrated Clinical engagement model

9. Challenges

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