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					Personal Health Records


A Strategy for Consumer & Provider
Engagement Through e-Business
Innovation
Antonio Linares, MD
Northern California HIMSS Chapter
December 6th, 2007
Agenda

   WellPoint’s 2010 Strategic Foundation and HIMSS Goals


   Opportunities to Improve Care and Transformation


   PHR is a Key Enabler to Leverage Information


   Interoperable Solutions, Collaboration and HL7


   e-Business Strategy and Consumer Focus in 360 Health



Slide 2   12/6/07
 WellPoint 2010 Strategic Foundation

Vision
WellPoint will transform health care and          Transformation requires initiatives to
become the most valued company in our             address health care’s cost, quality, and safety
industry                                          challenges.


Mission
Improve the lives of the people we serve          Community orientation requires initiatives
and the health of our communities                 that support patient care, regardless of payer


Differentiated Strategy
Most trusted choice for consumers and a           Differentiation requires unique initiatives
leader in affordable quality care                 that allow for competitive gain



           Health I.T. initiatives support improved patient care for communities while
                     offering competitive differentiation for sponsoring plans
 Slide 3    12/6/07
HIMSS Strategic Direction

Vision
Advancing the best use of information and mgt systems for the betterment of health
care.
Mission
To lead change in the healthcare information and management systems field
through knowledge sharing, advocacy, collaboration, innovation, and community
affiliations.
Ambulatory Committee
Working with leaders from large healthcare enterprises ambulatory clinics, medical
practices, military health system, community health leaders plus consulting and
vendor communities, the Ambulatory Information Systems Steering Committee
expands HIMSS’ ability to increase the quality and cost-effectiveness of patient
care by removing barriers to IT adoption, and increasing the use of EMR/EHRs and
promoting business systems integration in the ambulatory setting.
Slide provided by Mary Griskewicz, M.S.,FHIMSS, Senior Director, Ambulatory Information Systems and Jill Redenius,
Coordinator, Ambulatory Information Systems, HIMSS
Slide 4   12/6/07
Sustainable Opportunity to Improve Care

There’s a huge gap between the care doctors provide and the care they
ought to provide
           - 40% of people with chronic disease don’t get recommended care
           - 50% of people don’t receive recommended preventive care
           - 30% receive contraindicated acute care
           - 20% receive contraindicated chronic care
           - >$500B/yr is spent on care that is unnecessary
We have an incredible armamentarium of diagnostic and therapeutic
interventions that is expanding at a faster pace than ever before
The majority of Americans have lifestyles that are unhealthy
Increasing compliance with what we already know to be the right thing to
do is a far bigger challenge today than figuring out what the right thing to
do is.                                        Earl Steinberg
                                                              CEO Resolution Health
                                                              Nationally Known Health Services Researcher
Slide 5   12/6/07
WellPoint’s Unique Information Opportunity


 Multiplicity of WellPoint brands and products result in a uniquely rich data
  environment that can be leveraged for health and business improvements.
 WellPoint is the leading health plan in the U.S. with approximately 34 million
  medical members.
 One in nine Americans receives coverage for their medical care through
  WellPoint's health plans.
 WellPoint is a Blue Cross or Blue Cross Blue Shield licensee in 14 states:
  California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine,
  Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin,
  as well as UniCare, our non-Blue health plan that operates nationwide.
 WellPoint offers a broad range of medical and specialty products including
  pharmacy, dental, life, disability, behavioral health, and workers comp.




Slide 6   12/6/07
Key Enabler: Timely Data & Connected Physicians

     Current care management            Physician-Patient Interaction   Plan Med Mgmt
   strategies influence physician
  and member behavior AFTER a                                           U.M./C.M.
   care decision has been made                                          D.M.
    resulting in abrasion, admin
  costs, and sub optimal impacts                                        PBM
         to cost and quality
                                                                        RHI


WellPoint’s Health I.T. vision is to provide needed, real time management
information to embrace and re-enforce the physician-patient relationship


                Key enabler of this strategy is WellPoint’s integration of
                Personal Health Records (PHR) into the process of care


Slide 7   12/6/07
  Scalable and Interoperable Solutions

             Exchange                             Interact                             Collaborate

 Practice               Claims based              CPOE:                    CCR: Support              Connected
  Mgmt                      PHR              E-Prescribing, Lab          the Continuity of             Health
 Systems                                        Order Entry                Care Record                Record

WLP Program:             WLP Program:            WLP Program:              WLP Program:               WLP Program:
 EDI Support              WebMD PHR            MedPlus, AllScripts         Member Medical        Kettering-CentrifyHealth:
                                                                           History System

 Office staff              Member                Plan Cost of            Increased patient            Optimal patient
 productivity            Engagement             Care savings;               safety; cost             safety, costs and
                    +                    +                           +                       +
                           Strategy           Increased patient           savings, Quality              productivity
Administrative                                 safety, physician               gains                  reduced cost of
  Efficiency             Possible cost             workflow                                            medical errors
                         reductions or          improvements                                            and liability
                         quality gains



                        Scale Interoperable                                        Pilot Solutions for
                            Solutions                                              Interoperable Care
  Slide   12/6/07
Interoperable Systems Yields Interoperable Care

                                   Each component of the
                                   Health Care delivery
                                   system is already linked to
                                   an aggregating entity: the
                                   health plan

                                   A real world approach that
                                   leverages existing
                                   investments in I.T. and
                                   incrementally builds on
                                   production infrastructure
                                   offers a much higher
                                   likelihood of success

                                   Interoperable Health Care
                                   supplants and enhances
                                   interoperable billing and
                                   finances


Slide 9   12/6/07
Information Management Framework Overview

                    Account Reporting              Health Management


                   Provider Metrics                    Member Analytics


                                                            •   Tools/Toolkit     •   Standards
                                                            •   Governance        •   Processes
                                                            •   Platform          •   Training
                                                            •   Architecture      •   Helpdesk
    Enterprise IM                                           •   Strategy          •   Data Definitions
                                  Enterprise Data Layer:    •   Operating Model   •   Development Support
    Framework                      financial and clinical   •   Data Management   •   Change Management
                                                            •   Data Quality      •   Communications
                                                            •   Environments      •   BI Competency Center




                      Consolidated Data from All WellPoint Brands


Slide 10 12/6/07
360°Health Enterprise Clinical Data Mart


            Clinical Data                                    Administrative Data
              lab, PHR, HRA,                                      Claims, eligibility,
            carved out services                                    demographics




         PHYSICIAN COMPONENT                        CONSUMER COMPONENT




      E-Health        E-Prescribing    Clinical   Personal     Individualized   Integrated Care
      Records                         Research     Health        Messages         and Disease
                                                  Records        (MyHealth        Management
                                                                 Advantage)


Slide 11 12/6/07
HL7 Overview of the PHR-S FM Standard

By consensus agreement, a PHR system should:
    •   Be consumer-oriented
    •   Provide a Longitudinal collection of personal health information
    • List the functions that PHR systems shall, should, or may do
    • Provide immediate electronic access to the consumer and to those
      authorized by the consumer
    • Serve as an anchor point for system interoperability
    • Provide a certification framework

…The resulting PHR-S FM standard is:
    • Consensus-based
    • Internationally-oriented
Source: John Ritter, Intel and HL7 EHR TC co-chair & PHR Work Group co-facilitator
Presentation at HIMSS PHR Roundtable 11-27-07
Slide 12 12/6/07
HL7 Overview of the PHR-S FM Standard

                                                                                   Five Chapters:
                                                                                   1. Overview
                                                                                   2. Conformance
                                                                                      Clause
                                                                                   3. Personal Health
                                                                                   4. Supportive
                                                                                   5. Information
                                                                                      Infrastructure




Slide 13 12/6/07
             Source: John Ritter, Intel and HL7 EHR TC co-chair & PHR Work Group co-facilitator
             Presentation at HIMSS PHR Roundtable 11-27-07
HL7 Categorization of the PHR-S FM Functions

 High-Level Functions:
     • Core Functions
     • Health History Functions
     • Other Relevant Information Functions
     • Planning Functions
     • System Functions
     • Optional Services




    Source: John Ritter, Intel and HL7 EHR TC co-chair & PHR Work Group co-facilitator
    Presentation at HIMSS PHR Roundtable 11-27-07

Slide 14 12/6/07
WellPoint Personal Health Record (PHR)

  • A repository of information that pre-populates data
    from multiple sources and organizes it in a
    consumer friendly manner
  • Accessed via secure website
  • Controlled by the individual, who decides what to
    include or not include in his/her PHR and how to
    use, enhance or share that information
  • May be shared with the physician’s office through a
    secure web portal or PIN
  • Integrates data from WellPoint’s Health Risk
    Assessment, Medical claims, Rx, labs and worksite
    biometric screening results.




Slide 15 12/6/07
WellPoint Personal Health Record in Operation


                   • Update Medical Histories via HRA
                                                         Request
                   • Update Health Risks/Allergies
                                                         Hardcopy
                                                         or access
                                                         via PIN
                                               PHR
                                  • Lab Results
                                  • Physician Visits
                                  • Hospital Stays
 Member                           • Diagnoses
                                  • Prescriptions
                                  • Clinical Alerts
                                  • Interventions

                                                        Provider


Slide 16 12/6/07
WellPoint e-Business Strategy & Consumer Focus
   • WellPoint will provide innovative online decision
     support tools and targeted information and
     messaging based on health events and online
     transaction capabilities – connecting members,
     providers and care programs to improve healthcare
     decisions and outcomes!
   • WellPoint’s eBusiness will become the health
     industry info-mediary and industry leader in driving
     adoption of personal health records through
     360°Health.
   • WellPoint’s eBusiness will leverage new and
     emerging eBusiness technologies, including
     wireless and broadband, to provide greater
     convenience and real time information at point
     of care.


Slide 17 12/6/07
eBusiness – Our FOCUS


• Personalization & Customization
• Engagement of the Consumer
• Usability
• Easy To Use – Relevant Information
• Expansion/Integration of eHealth
• Transparency
• Consumerism
• Product & Web Innovation
• Leveraging New Technologies
      Online Communities
      Blogs

Slide 18 12/6/07
eBusiness – Our Online Consumer Tools


Member ePortal
• Innovative portal technology for
  high performance, usability and
  scalability
• Integrated online personal health
  record in partnership with
  WebMD
• Integrated online decision
  support tools in partnership with
  Subimo
• Strong online eRetail offering



Slide 19 12/6/07
MyHealth Assessment


       Identify Your Health
       Risks and how to lower
       them


       Like many services
       on the site, the HRA is
       available in Spanish.


       HRA data from the
       WebMD HRA feeds into
       the MyHealth Record -
       personal health record
       (PHR)

Slide 20 12/6/07
MyHealth Assessment - The NEW User
Experience - 2007




Slide 21 12/6/07
MyHealth Record - Personal Health Record

• The Personal Health Record is an easy to
  use tool that includes the medical
  information you provide in your Health
  Assessment and Health Trackers.
  You can even have your Anthem Blue
  Cross and Blue Shield claims automatically
  added.
• By adding a few more details like family
  history and over-the-counter medications,
  you’ll have an up-to-date personal and
  secure record, at your fingertips, anytime
  you need it.
• Member/Provider Connectivity allows your
  Provider to ADD notes within your personal
  health record (NY Pilot).
• In fact, you can print a neatly organized
   summary that’s ready to share with doctors
   and family at any time – even in an
   emergency!
Slide 22 12/6/07
WellPoint - A Leader in Innovation and Strong
Web Foundation


                   Industry Recognition
                     • eWeek Fast Track 500
                     • Distinguished Web Site - Healthcare Leadership Award for
                       five consecutive years
                     • B to B NetMarketing 100
                     • Praise Worthy Web Site – Consumer WebWatch
                     • Gold – World Wide Web Health Awards
                     • WWW Webby – Distinction for Medicare Part D



                   Trust
                    • Consumer Web Watch Certification – Consumers Union
                    • VIPPS Certification - Compliance with VIPPS
                    • HON accreditation - For aiming to improve the quality of
                      medical and health information online
                    • URAC Certification – For promoting quality and efficiency
                      of health care delivery

Slide 23 12/6/07
Innovations In Health Care

  • Consumers want to take the web and their information with
     them wherever they go – WellPoint’s innovative strategy
     delivers content and tools to today’s wireless consumer
     devices through mobile MyHealth
  • WellPoint’s innovative web based system for consumers
     allows them to download information, tools, health records,
     prescription data and cost information
  • Portable personal health records allow access to claim,
     prescription and financial information across multiple
     technologies
  • New online communities on specific disease conditions
     create new communication and information for members
  • New message boards and online tutorials create an
     informed member

Slide 24 12/6/07
Consumer-Centric Care Brings People Closer to
Their Medical Home and Care Givers

Trusted                                                                              Timely High Quality
Online Health Tools                                                                  Health Care
                                Seek                                          Seek
                                Info                                          Care     Physicians
• Health Assessment Profile
• Health Library & News                                                                Hospitals
                                                                                       Pharmacy
• Self Care Tools
                                                                                       Lab/Ancillary
• Physician/Hospital Profiles




                                                     Seek Help




   Personal Health Record              Personal & Empathetic Advisors                Claims, RX & Hospital
   & HRA Contributed Data                                                                Review Data



Slide 25 12/6/07
                                   Proactive Risk Management
                                          Identification and Stratification

				
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