The document summarizes that health plans are well positioned to improve healthcare through technology and payment evolution. It discusses how IT-enabled care collaboration can deliver higher value for purchasers by reducing resources, substituting lower cost options, and avoiding complications. It suggests health plans can support providers and value-based care by changing reimbursement models and leveraging plan assets to partner with providers through tools, analytics and shared care management services.

1. Health Plan e-Collaboration:
Convergence of Urgency
& Opportunity
Jeremy Nobel, MD, MPH
Northeast Business Group on Health
Feb 23, 2012
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2. Health Plans: Are Extremely Well
Positioned to Improve Health Care
Evolution of Evolution
Technology Payments
Cheaper Moving from
Faster Pay for
Better “Improved
Smaller Process” to
Pay for
Ubiquitous
“Improved
Connected Outcomes”
IT-enabled
Care
Support
Consumer-directed
movement
Evolution HSA/HDHPs
of Benefit Employer-sponsored
Designs lifestyle reward programs
Incentives for lower-cost
alternatives

3. E-Collaboration: Now More Than
Just a Power Point Slide
Real-time info and decision support for:
providers, payers, patients, via web
Efficiency Engine
Lab
PC P
IT-Driven
IT-Driven Care-enables
Care IT-enabled “smart care”
enables Biometrics collaboration
timely HIE, Care
for higher-
avoids Support touch, lower-
duplicate C are C oach cost, care
tests, delivery
eliminates
medication
conflicts Pharmacy
Consumer-Controlled
Permissions Specialist
Care Team
Coordinated
Communications
Self-Reported

4. IT-Enabled Care Management Can
Deliver the Value Purchasers Want
Reducing… Substituting… Avoiding…
resources required to lower resource- complications,
achieve same or intensive option in adverse reactions, or
better outcome either prevention, sub-therapeutic
– Elimination of diagnosis or treatment treatment improves
duplicate diagnostic – People (e.g. mid- both quality and
tests level providers, efficiency
– Streamlining of pharmacists, health  Initiation of most
work-ups to exclude coaches, “efficient” effective care
low-yield dx tests provider networks) pathways
– Avoiding provider – Place (e.g. shift to  Medical regimen
visits simply to home or lower cost adherence
“check in” and ambulatory setting)
 Early detection or
collect data – Product (e.g. shift to avoidance of ADE’s
generic Rx) or side-effects
 Reduction of ED
and Hospital use
All While Allowing Patients to Feel Better “Noticed” and Cared For

5. How Can Plans Support Providers,
Leading to “Value Based” Care?
Two Important Ways:
• Change the provider business relationship
– Contract with providers to deliver “value based” care,
with reimbursement linked to “performance”
– Medical Homes, ACOs, Episode Pricing, etc.
• Leverage Plan assets to partner with them
– Offer Providers advanced analytics, on-line tools, and
shared care management services to improve care
delivery effectiveness/efficiency
– Be an active info-mediary between members and
providers, supporting collaborative and “value-based”
care

6. OK, So What Happens Now?
• I’d like to turn it over to our panel, the
REAL experts, who will share their
perspectives
• Then it will be YOUR turn