E-Health Networks The New Shape of Public Health

1. E-Health NetworksThe New Shape of Public Health NGA State Alliance for e-Health 2nd Annual State Learning Forum Stephen Goldsmith Daniel Paul Professor of Government Director, Innovations in American Government Program Harvard University John F. Kennedy School of Government Developed in conjunction with Deloitte Center of Health Solutions and Deloitte Research

2. Agency 1 Agency 2 Agency 3 Department Department Department Department Department Department Bureau Bureau Bureau Bureau Bureau Bureau Division Division Division Division Division Division Unit Unit Unit Unit Unit Unit Citizen Traditional Bureaucracy Is Inadequate

3. The New Shape of Government NGOs State Government Health Provider Local Government CCID Organization International NGOs Hospitals Federal Agency

4. Models of Government High Public-Private Partnerships Networkedgovernment Level of public/private collaboration Joined upgovernment Hierarchicalgovernment Low Network mgt. Capabilities Low High

5. Types of Networks Civic switchboard Information dissemination Supply chain Intergovernmental Ad hoc More Less DEGREE OF GOVERNMENT INVOLVEMENT Channel partnership Service contract

6. Networked Organization Models that HIT Can Learn From Hurricane Katrina Response SARS Anthrax Crisis Response

7. Governing by Network has Many Advantages… Improved Speed andflexibility Specialization Networked government benefits Increased reach Innovation

8. What a Health Network Might Look Like

9. State HIE Network Model

10. Health Information Exchanges The “big picture” of the health information network Federal NHIN National Health Information Network State HIE RHIO RHIO Network Health Networks Network Health Networks

11. The Many Roles of Government States Can Play Many Roles in an HIE Network Convener Educator Administrator Policy Maker Initiator/ Catalyst Operator Coordinator States must lead the change. …in collaboration with health consortiums, citizens, payers, providers, and others.

12. Possible Organizations Issues and Delivery Networks Your Role Schools Role of the Private Sector Obesity Mental Health Local Non Profits National Foundations State Health Policy and Finance Information Sharing and Incentives Managing the Network Relation to Other Sectors Public Hospital and Community Health Child Welfare Infant Mortality Information Sharing Needs = Sector 1= Sector 2

13. Key Principles to Create Networked Model • Define of Public Value Carefully Better Health, Not Better Transactions • Design Network Correctly—Understand All Assets • Quality Decision Making • Congruence of Goals • Build Skills and Capacity • Network Leadership

14. 1. New Role for Government: Focus on Public Value After: DC Health Care Networks, From One to Many Before: DC General Hospital

15. Public Value Definition • The point of all activity is for each party to create value • Government role: to transform existing social conditions in collectively desired directions • Demonstrations of value creation lie in evidence showing changes in conditions • Problem: Not everyone sees value in the same way

16. Different Ideas of Value • Satisfy patient demands • Produce Better Health • Reduce Costs • Make a Profit • Meet Social Needs • Achieve a Just Society

17. Four Programmatic Areas Behind The Curve to Reduce Cost and Improve Care

18. Examples of How Electronic Systems Drive Better Outcomes Care Management Improve care while managing costs, maximizing the health care investment. Care management, disease management, and utilization review. Electronic Health Records/Health Information Exchange Improve quality of care and enhance service to individuals. Patient Data Hub, allowing for the integration of disparate healthcare data sources and follow-on analysis to produce actionable information at the point of care. Emergency Department Diversion Prevent overcrowding, promote wellness, and make better use of scarce resources. Proactive medical management. Through data analysis of historical medical claims, access analysis, and education techniques. Lower ED usage. Long-Term Care / Renal Care Audits Detect and correct errors and prevent future overpayments. Make better use of data to improve care to individuals. Nursing Home Diversion Manage ongoing healthcare costs and provide care where it’s needed.

19. 2. Design Network: Map Parties, Understand Tools 2. Design Network: Map Parties, Understand Tools Pennsylvania NEDSS system The development of PA-NEDSS has allowed the Pennsylvania Department of Health to cut the reporting cycle patient cases from3 weeks to fewer than 24 hours.

20. Working Example : Extending Existing Public Health Systems to Serve as HIE channels; All Actors Work Toward Same Goal PA-NEDSS – An HIE Making a Difference Local & StateHealth Departments Patient Centric System Health Information Technology Physicians 700+ Privacy Centric & Secure Point ofCare DataEntry Investigators HL7 based HIE EDR App Integrated Data Collection, Management, Analysis, Transmission, and Dissemination Epi-X Rapid reporting and discussion of health events, 24/7 access to key officials and expert assistance Linked Disease Reports More Complete Patient View Real-time Data Collection Master Patient Index Hospitals Patient Search & Match 400+ More Timely Intervention Health Alert Network DOH Central Office De-duplication Bio-terrorism Rapid Detection RapidResponse Enabler Laboratories CDC 170+ 20

21. Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor PrimeContractor Government Government Government Government Government Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor Contractor Contractor Contractor Contractor Subcontractor Third Party Private Provider Government Government Government Government Government Decide Who Should Do the Integrating Subcontractor 1 Government Contractor Subcontractor Subcontractor Contractor Contractor Government Subcontractor Subcontractor Contractor Subcontractor Subcontractor 2 Prime Contractor 3 Third Party

22. Do Use multiple levers to build and activate networks Don’t Manage each network the same way Your Role Role of Other Government Agencies Role of the Private Sector Education and Rhetoric Money Managing the Network Information Sharing and Incentives Relation to Other Sectors Regulations Capacity to Convene Sector Scale Information Sharing Needs = Sector 1= Sector 2

23. 3. Quality Decision Making: Numerous Challenges • Driving network governance vision down the organization • Training and recruiting for the new skill sets (and cultural change) needed • Treating partners as real partners • Developing and enforcing shared outcome goals • Horizontal management in a vertical government • Government as 800 pound gorilla

24. 4. Aligned Values and Incentives Congruence of Goals: Develop the Network Design 4. Aligning Values and IncentivesCongruence of Goals: Develop the Network Design • What • Goal of network? • How • Levers used to initiate and sustain network? • Type of network? • Identify each parties goals • Who • Partners in the network? • Who integrates network?

25. Guidelines for Sharing Risk Which network partners are best at managing which risks? Who is bringing the bulk of innovation to the table? How much control does the public sector have over the network and/or over the particular risk involved? Are the contract costs of the risk shifting worth it? Are the risks actually regulatory in nature? Share - Don’t offload risk

26. Assuring the Performance of Networked Arrangements Which have Worked? Define Best Practices Public Health “Networks” Characteristics of “Networks” What Could Work Better? Future “Networks” Monitor Performance

27. A Life Cycle Approach to Performance Set Goals/Align Values Structure Incentives/ Share Risk Achieving results from networks Manage Change Measure Network Performance

28. 5. Build Capacity: New Networks and Extend Existing Ones 5. Build Capacity: New Networks and Extend Existing Ones • Federal and State agencies working together can: • Provide backbone services for other participants to build their networks • Provide process, monetary, policy, interoperable standards, and other support for these participants to get on the network • Extend existing health and human services networks and infrastructure • Coordinate across networks and improve data sharing and decrease redundancies HIE networks that will enable a unique unprecedented combination of public (federal and state), non-profit, commercial, and citizen networks to come together and get connected as part of one large integrated network to provide quality outcome based healthcare transformation

29. Open Source Innovation: Tapping into the “Wisdom of the Crowds” • A large group of people is better at solving complex problems than an expert, no matter how brilliant • What are the implications for government?

30. Unlocking information unleashes the power of networks to fulfill public services and discharge government duties. Governments can use IT tools to facilitate this result in five ways: Keys to Unlock the Kingdom • Coordinating activities • Synchronizing responses • Enabling a single client view • Sharing knowledge • Measure performance

31. 6. Networked Leadership: Encourage Behaviors that Promote the Networked Approach Do Invest resources to ensure cultural alignment is achieved within your organization. Don’t Expect changes to happen overnight.

32. Attributes of Highly Effective Network/Relationship Managers Successful network managers have the ability to: Attributes Work across sector boundaries Develop and Manage Relationships & Strategy Identify the Network Participants Best Placed to Meet Goals Understand What Each Partner/ Stakeholder Needs in order to Perform Role in Network Thrive in Highly Fluid Environment with High levels of Discretion Embrace mission change from doer to enabler, from rowing to steering Recruit managers who can excel in this new environment

33. Key Principles to Create Networked Model • Define of Public Value Carefully Better Health, Not Better Transactions • Design Network Correctly—Understand All Assets • Quality Decision Making • Congruence of Goals • Build Skills and Capacity • Network Leadership

34. A Change of Thinking Needed… “People are very open minded about new things. As long as they are exactly like the old ones.” - Charles Kettering