Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem

1. Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/2010 1

2. Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem A Health Plan Perspective Context For Health Plans Trends Obligations Expectations MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/2010 2

3. Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem Trends Michigan Economy Aging Population �Retailing� of Health Care Purchasing Movement from Employers to Individuals Increasing role of government Value Based Purchasing and Delivery of Health Care in an Increasingly Diversified Market MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/2010 3

4. Leveraging a Single Platform - Connecting a Statewide Healthcare Ecosystem Trends (continued) Consolidation of State and National Health Plan Markets� Increasing Reliance on Technology to Transact Business and Deliver Health Care MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/2010 4

5. Issues in Healthcare Quality Lack of information at the point of care Clinical Decision Support Patient Centered Medical Home MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/2010 5 Quality Lack of information- does not allow physicians to make the best decisions Clinical decision support- no one physician can know everything there is to know about �best practices�; computerization can facilitated good decision making Patient Centered medical home- IT allows the ability to communicate with patients outside of the traditional 4 walls of the office and facilitate improved care delivery, and the empowerment of the patient Process To insure clean billing, proper care, timely interventions by all members of the healthcare industry, we need to have the information when it is needed, where we need it and be able to act on it at the right time Physicians are struggling to stay afloat, much of this is due to the massive overhead that has been created by policy and bureaucracy. Creating improved efficiencies in the office can help to decrease overhead and free up support staff time to make them more productive Administrative simplification- has many definitions, but I see this as tying directly into the last bullet. By improving efficiencies in the office with multi-payer eligibility, SSO into all the plans for claims information, decreasing the amount of time on the phone and having the right information available at the staff�s fingertips will greatly enhance care and satisfaction of all participants, including the patient Efficiency Paper based processes- we will not be getting away from paper anytime soon, so we need to leverage other mechanisms to facilitate HIT adoption; this can be accomplished by using one common denominator in the physician�s office- the fax machine. We will talk about how to accomplish this a little more later. Segmented data sources- data is scattered across the healthcare horizon, in many different locations and to date has been very difficult to pull together. We are the at the crux of solving this problem, of assembling patient information with a single point of access. Lack of integration- ties directly to the above bullet point; the data is scattered and in many different forms. We need to be able to pull all the data together, but just as important is to pull it together and be able to make sense of it Security- for any of this to be viable, it must have strong security behind it Data is available from many potential sources, but must be accessed in a highly secure manner to protect patient privacy and confidentiality Central vs. federated vs. hybrid Reduced unsecured printed information- (paper in the office story) Quality Lack of information- does not allow physicians to make the best decisions Clinical decision support- no one physician can know everything there is to know about �best practices�; computerization can facilitated good decision making Patient Centered medical home- IT allows the ability to communicate with patients outside of the traditional 4 walls of the office and facilitate improved care delivery, and the empowerment of the patient Process To insure clean billing, proper care, timely interventions by all members of the healthcare industry, we need to have the information when it is needed, where we need it and be able to act on it at the right time Physicians are struggling to stay afloat, much of this is due to the massive overhead that has been created by policy and bureaucracy. Creating improved efficiencies in the office can help to decrease overhead and free up support staff time to make them more productive Administrative simplification- has many definitions, but I see this as tying directly into the last bullet. By improving efficiencies in the office with multi-payer eligibility, SSO into all the plans for claims information, decreasing the amount of time on the phone and having the right information available at the staff�s fingertips will greatly enhance care and satisfaction of all participants, including the patient Efficiency Paper based processes- we will not be getting away from paper anytime soon, so we need to leverage other mechanisms to facilitate HIT adoption; this can be accomplished by using one common denominator in the physician�s office- the fax machine. We will talk about how to accomplish this a little more later. Segmented data sources- data is scattered across the healthcare horizon, in many different locations and to date has been very difficult to pull together. We are the at the crux of solving this problem, of assembling patient information with a single point of access. Lack of integration- ties directly to the above bullet point; the data is scattered and in many different forms. We need to be able to pull all the data together, but just as important is to pull it together and be able to make sense of it Security- for any of this to be viable, it must have strong security behind it Data is available from many potential sources, but must be accessed in a highly secure manner to protect patient privacy and confidentiality Central vs. federated vs. hybrid Reduced unsecured printed information- (paper in the office story)

7. Information Technology: Obligation for Health Plan Participation �Meaningful Use� Incentives for Providers Medicaid IT Strategy (Medicaid Health Plans Role) State Information Technology Plan (MiHIN) MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/2010 7

8. Federal Reform: Health Plan IT Administrative Simplification Existing Requirements to be implemented: HIPAA (5010 Transaction Codes) ICD-10 Standard Operating Rules Eligibility Verification/Claims Status Health Claims Standard for EFT, Claims Remittance MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/2010 8

9. Leveraging a Single Platform The MAHP Vision (MAHP) is partnering with members and Covisint to simplify collaboration through a centralized web solution, called �MAHP Connect.� This solution enables the sharing of information from MAHP and MAHP members to their respective communities. Base Solution Offering: Centralized MAHP Portal with Security and Messaging 24/7 Support and Help Desk On-boarding Support for new members Multi-Payer and Medicaid Eligibility Validation Multi-Payer Claim Status Check Federated SSO from MAHP Portal to participating Members Portals Secure File Exchange Services Directed Bulletin Services Secure E-Mail for all users Self Service User Registration 6/23/2010 MICHIGAN ASSOCIATION OF HEALTH PLANS 9

10. Leveraging a Single Platform The MAHP Vision (continued) MAHP Connect Target Services Targeted Services: Medicaid COB 1500 Solution Referrals and Authorizations One-off Claims Entry Electronic Claims Attachments Expose virtually any 3rd party application Admission Notifications Appeals Processing Documentation Requests/Response Consent Forms Processing Integration to emerging Health Information Exchanges in Michigan Tools for delivery of MAHP Member specific information and services 6/23/2010 MICHIGAN ASSOCIATION OF HEALTH PLANS 10

11. MAHP Connect: Extending Services 6/23/2010 MICHIGAN ASSOCIATION OF HEALTH PLANS

12. MAHP Connect: Laying the Foundations MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/2010 12

13. Successful Health Plans will need to� Offer exceptional value in the marketplace to purchasers. Employers Government Individuals Meet the value expectations of many different purchasers with diverse needs. Quality (including Patient Safety) Cost Effectiveness Access and Flexibility (product design, information systems, etc.) Health and Productivity Management Is health care an expense or investment? Shift the focus from treating illness to include maintaining wellness. Move individuals to taking personal accountability for maintaining health Recognize the value of relationships. Maximize the value of technology. MICHIGAN ASSOCIATION OF HEALTH PLANS 6/23/2010 13