About the Webinar http://www.modernhealthcare.com/article/20140804/SPONSORED/308049925/ For payers and providers, manual workflow processes around transitions of care are often time intensive, costly and leave gaps in care. The key to improving care coordination efforts for defined high-risk populations is developing an interoperability strategy that addresses key business drivers and workflow challenges around people and processes that impact transitions of care. Then, determining the right technologies to connect care teams with the right information at the right time that can improve the way healthcare is delivered. By attending this webinar, you will learn: How strategic interoperability capabilities can solve key workflow challenges; How rules-based alerting supports population management; and How defining optimal transitions of care can reduce costs.

1. “Our collective ability to provide the right data, to the right people at the right
time along the complete care continuum has no longer become a nice to have –
it is an imperative. “
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2. Today’s Presenters
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Paula Hedlund Brian Higdon
Chief Innovation Officer
Upper Peninsula Health
Plan
Ms. Hedlund, Chief Innovation Officer at Upper Peninsula
Health Plan, has also worked with Upper Peninsula Health
Care Network, which is a collaboration between Upper
Peninsula hospitals and providers to facilitate access to high
quality healthcare at a reasonable cost. Hedlund has been
with the organizations since their inception in 1998 and
was responsible for implementing the IT infrastructure for
health plan operations, claims processing, and in-house
Third Party Administrator capabilities. She currently directs
and oversees all IT operations for both UPHP and UPHCN.
Vice President
Client Services
ICA –
Interoperability
Experts
Brian Higdon is Vice President of Client Services, for ICA,
responsible for the implementation and support of the
ICA solution across the country. His area of expertise is
client services and implementation strategies, with a
proven history of client satisfaction. Mr. Higdon has
more than 22 years of experience in both military and
civilian sectors, with strong leadership skills. He most
recently ran Client and Member Services for Affinion
Group, a $1.5B international marketing company where
his teams developed and delivered client solutions for
4,500 institutions and more than 30 million customers.

3. What Do We Mean by Interoperability?
Connect Share
Sending data from EMR to
EMR; Device to EMR; EMR
to Care Management
Application, etc.
Connect Understand:
Beyond basic
Connectivity
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4. Transitions of Care from the Caregiver Point of View
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LTC
Home
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5. The Overriding Concept to Solve –
Address Risks Associated with Transitions of Care
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6. What’s Standing in the Way of Better Managing Risks?
Payment Model Lack of
Coordination
Fragmented
Systems
Patient
Identity &
Security
Business
Challenges
Technical
Challenges
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7. Solving the Challenges –
Getting the Stars to Align
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Solve Transitions of Care Challenges – provide real-time
notifications to care team members on high-risk
patients for Unplanned Patient Encounters.
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9. Upper Peninsula Health Plan –
The breadth of providers has forced us to deal with how to most
effectively communicate
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10. Upper Peninsula Health Plan –
Michigan’s Uniqueness
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11. Getting Started – UPHP Populations
MIHealth Link
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Advantage SNP

12. UPHP Challenges
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13. UPHP Challenges
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14. What We Needed
More timely
information
around patient
admits,
discharges and
ER visits
More efficient way to get that
information – the status quo
was not scalable as our
populations continue to grow
More effective way
to share that
information to
improve patient care
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15. Frequency
Connections
across care
settings
Scope of Alerts Rules
How often
do we need
to send
alerts?
Who needs
to get which
alerts?
Which
high-risk
patients?
How do we
get the
alerts
delivered?
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16. Alerts
Introduce Technology – Real Time Alerting
Alert
Technology
Platform
Distribution
• Real time
alerts
• Digest
• Application
Feed
• Secure FTP
• Direct
Care Team
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Triggers
Risk
Rules
Logic

17. The Aftermath – Lessons Learned
Real-time alerts are
overwhelming.
Send fewer, but more
high-value alerts.
Specify the risk attributes to
more closely define the
population.
Make sure care
coordinators know
what to do with alerts
– modify workflow.
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18. Where Are We Heading with Population
Management
Average
cost per ETG
(episode
treatment
group) Diagnosis
Based
Alerts
Risk-based
analysis of
future
members
by product
line
Calculation of
High/Med/Lo
w Alert Alert
MDS ADT CCD
Alerts
Platform
Care
Coordinator
Primary Care
Provider
Ancillary
Organizations
Service
Frequency
Based
Alerts
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19. Take Aways
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20. The Future of Rules-Based Alerts
Fee for
Service
Fully at
Risk
Increasing intelligence, increases value…
Surveillance & Targeted Event Notification
Clinical Stratification and Workflow Automation
Tailored Content Delivery
Process Progression Detecting adverse
events
Prevention-based
interventions
Functional Progression Event Notification Predictive Alerting
Data Progression Administrative data Predictive algorithms and
risk indexing
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What to Consider in an Alerting Solution
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22. Question and Answer Session
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Paula Hedlund Brian Higdon
Chief Innovation Officer
Upper Peninsula Health
Plan
Vice President
Client Services
ICA –
Interoperability
Experts

23. Our Thanks for Attending
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Brian Higdon
Vice President Client Services
brian.higdon@ica-carealign.com
Thanks to Paula for her time today in sharing their success story and to UPHP
- a great client on the cutting edge of the power of interoperability.
Innovating the way care teams connect
and healthcare is delivered