Health Care IT Advisor Ready-to-use slides for your

Health Care IT Advisor Ready-to-use slides for your

Health Care IT Advisor Ready-to-use slides for your next IT presentation From the Advisory Board National Meeting: IT in the New Health Care Economy 2 Health Care IT Advisor If youre like many of our IT executive members, youre feeling the pressure to do more with less. And problems with IT-enabled initiatives can threaten the viability of the entire organization. In 2015, we see three imperatives for successful CIOs: Get it donewith limited time, money, and staff. Productively partner with C-suite execs. Give your staff the health care intel they need to know to connect their work to larger system goals Easier said than done. Let us help. Leverage our market analyses in these ready-to-use slides in your next staff, c-suite, or board presentation. And as always, let us know if you have questions. Happy New Year, The Health Care IT Advisor Team 3 Road Map 1 The Twitter Version of our industry 140 Slides or Less 2 The Technologies Needed to Achieve Success 3 2014 The Advisory Board Company advisory.com 29500H The Key Take-Aways for Your Staff & Collegueas 4 SOU Revisiting a Tenuous Business Model Most Hospitals Staying Afloat Through Cross-Subsidization Traditional Hospital Cross-Subsidy Commercial Insurance Public Payers

Above-cost pricing Steady price growth Robust fee-for-service volume growth Only one component of our total business Above Cost Below Cost 149% 86% Hospital Payment-to-Cost Ratio, Private Payer, 2012 Hospital Payment-to-Cost Ratio, Medicare, 2012 2014 The Advisory Board Company advisory.com 29500H Source: American Hospital Association, Trendwatch Chartbook 2014, available at: www.aha.org; Health Care Advisory Board interviews and analysis. 5 SOU The Retail Revolution Four Years Post-Reform, New Paradigm Finally Becoming Clear Major Themes Reshaping Provider Strategy 1 Medicare Reforms and the Transition to Risk 2 Coverage Expansion and the Rise of Individual Insurance 3 Activist Employers and the Primacy of Value 2014 The Advisory Board Company advisory.com 29500H

Source: Health Care Advisory Board interviews and analysis. 6 SOU A Burgeoning Retail Market Disrupting Traditional Channels of Coverage Projected Size of the Potential Retail Market 2018 17 40 87 5 25 Public Exchange ; ; ; 2 1 1) Based on number of lives falling into the Medicaid expansion gap in non-expansion states. 2) Based on the number of Medicare Advantage enrollees. 2014 The Advisory Board Company advisory.com 29500H Source: Congressional Budget Office, May 2013 Estimate of the Effects of the Affordable Care Act on Health Insurance Coverage, available at: www.cbo.gov; Accenture, Are You Ready? Health Insurance Exchanges Are Looming, 2013, available at: www.accenture.com; Kaiser Family Foundation, The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid, April 2, 2014, available at: www.kff.org; Health Care Advisory Board interviews and analysis. 7 SOU Providers Must Win Share at Two Points of Sale Multiple Opportunities to Appeal to Decision-Makers Decision Processes Shaping Provider Choice 1 Secure Enrolled Lives Network Assembly Being chosen by payers, employers, exchange operators, custom network builders, and accountable physician entities to be offered as a network option

2014 The Advisory Board Company advisory.com 29500H 2 Win Share of Volumes Network Selection Being chosen by individuals during plan enrollment Care Decision Being chosen by patients, referring physicians at the point of care Source: Health Care Advisory Board interviews and analysis. 8 SOU Redefining the Value Proposition Delivering Desirable Network Attributes at Low Cost Four Imperatives for Health Systems Low Cost Desirable Network Attributes Competitive Unit Prices Total Cost Control Geographic Reach and Clinical Scope Clinical and Service Quality Strategic Imperatives: Strategic Imperatives: Strategic Imperatives: Strategic Imperatives: Avoid reactive position vis-a-vis price cuts, transparency

Develop population health model to control cost trend Match service portfolios, footprints to target purchasers Clearly communicate total cost advantage to potential purchasers Explore partnership strategies that strengthen market presence Present unimpeachable clinical credentials to wholesale buyers Radically restructure cost structures to sustain lower unit prices 2014 The Advisory Board Company advisory.com 29500H Emphasize access, experience advantages to individual consumers Source: Health Care Advisory Board interviews and analysis. 9 SOU Recipe for Success Becoming Far More Complex Not Immediately Obvious Which Advantages Will Dominate Network Assemblers Network Assembly Traditional Market Retail Market Reach and Scope Clinical and Service

Quality Network Selection Care Decision All providers included in nearly all networks; only compete on price negotiations Employees have little choice of networks Most decisions made by referring physician Low total per-member cost Promise of total cost savings Low premium Low employee contribution Low out-of-pocket cost Broad geographic footprint Comprehensive clinical scope Inclusion of preferred physicians Proximity to access points High clinical process, outcomes performance Adherence to evidence-based care On-demand access options Centralized navigation services Prompt appointment times Extended hours High population health quality ratings High member satisfaction ratings Positive brand association On-demand access options Great care experience On-demand access options Prompt appointment times Extended hours

Threshold Differentiating Factors Factors Cost Individual Consumer Expanding Arena of Competition 2014 The Advisory Board Company advisory.com 29500H Source: Health Care Advisory Board interviews and analysis. 10 SOU Low Total Cost A Difficult Balance to Strike Long-Term Trend Control Requires Short-Term Investments The Tension Between Unit Price and Total Cost Short-Term Investments Long-Term Payoff The Bottom Line IT infrastructure Cost trend control If you cant deliver lower cost, youre out of the running. Care management staff Care coordination programs Improved health outcomes

Improved patient satisfaction Patrick Carter, MD Medical Director for Care Coordination and Quality Improvement, Kelsey-Seybold Clinic New access points Higher Immediate Unit Prices 2014 The Advisory Board Company advisory.com 29500H Lower Future Total Cost Source: Health Care Advisory Board interviews and analysis. 11 SOU The Missing Link for Population Health? Retail, Population Health Strategies Converge Retail Market Closing the Circuit Successful Population Health Management Lower Total Cost Lower Premium Network Selection Experience Engagement 2014 The Advisory Board Company advisory.com 29500H Source: Health Care Advisory Board interviews and analysis. 12 SOU Answer Honestly

Are You Prepared as Health Care Changes? A Straightforward Strategic Assessment 1 Is your growth strategy specifically designed for the new channels of a retail market, or are you shoehorning yesterdays approach into todays circumstances? 2 Does your business model reward care transformation, or will clinical progress mean financial setbacks? 2014 The Advisory Board Company advisory.com 29500H Source: Health Care Advisory Board interviews and analysis. 13 SOU Competing in an IT-Enabled Retail Market IT-Related Capabilities Are Essential in the New Health Care Economy Questions Guiding IT-Related Initiatives ? 1. Do we have a sufficiently robust extended enterprise integration architecture to facilitate integration and dis-integration with loosely-affiliated partners across a proliferation of narrow provider networks? 2. Do we have the right BI architecture, data types, and analytic outputs to help move beyond operational management to organizational transformation? 3. Do we have strong telemedicine capabilities for episodic primary care, chronic disease management, and behavioral health? 4. With so many possibilities for remote patient monitoring, are we asking the right questions about technological feasibility, clinical relevance, and affordability? 5. Are we fully leveraging Meaningful Use to align with and enable our population health management and retail needs? 6. Do we have the right tools, processes, and culture in place to drive patient loyalty and engagement? 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor interviews and analysis. 14 Extended Enterprise Integration Health Reform Continues Full Steam Ahead Pushes Rapid Adoption of Closer Alliances and More Partnerships Exponential Growth in CIN1 Development Number of CI2 Programs Identified Through Research3

Widening Reach of ACOs4 700+ 500+ 626 5 2008 2012 Total number of ACOs across the US 67% Portion of US population living in a primary care service area with an ACO 17% Portion of US population treated by an ACO 2014 E Affiliated with hospitals and health systems of every size (as well as standalone physician groups) Located in markets across the country Range in size from fewer than 100 physicians to several thousand In various stages of development 1) Clinical integration networks; 2) clinical informatics; 3) anecdotal data based on stated interest in CI; may underestimate true number of existing or planned CI networks; 4) accountable care organizations; 5) fee for service. 2014 The Advisory Board Company advisory.com 29500H 5.3M Medicare FFS5 beneficiaries treated by an ACO Sources: Leavitt Partners, Growth and Dispersion of Accountable Care Organizations: June 2014 Update, June, 2014; Oliver Wyman, ACO Update: Accountable Care Organizations Now Serve 17% of Americans, April, 2014; Health Care IT Advisor research and analysis. 15 Extended Enterprise Integration

No Shortage of Extended Enterprise Models Most Partnership Approaches Require Technical Integration Clinically-Integrated Hospital Network Accountable Care Organization Regional Collaborative Clinical Affiliation Description Collection of hospitals contracting jointly in order to support improved coordination, outcomes; modeled after physician CI networks Independent entity, owned by one or several independent organizations, that accepts risk-based contracts and distributes shared savings Flexible umbrella structure, often encompassing many independent organizations of similar geography, that may serve as foundation for further integration Typically bilateral agreement to cooperate around a particular initiative or service line; may involve local or national partners Examples Long Island Health Network Vanderbilt Health Affiliated Network Quality Health

Solutions (WI) Arizona Care Network Accountable Care Alliance Allspire Health Partners Stratus Healthcare BJC Collaborative Noble Health Alliance Health Innovations Ohio EvergreenHealth with Virginia Mason Mayo Clinic Care Network Cleveland Clinic Affiliate Program Partnerships requiring technical integration come in various forms 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 16 Extended Enterprise Integration Technology Should Enable Seamless Integration We Strive for the Ideal Environment . . . But Reality Is Quite Different Ideally More typically mix of EMRs at various levels of sophistication Physician Offices Enterprise EMR, Scheduling, Registration, Billing, Business Intelligence, etc. Long Term Care Facilities Physician Offices Home Health Hospitals

Hospitals Home Health EDW1 FAX SaaS2 EMR EMR CDW3 Typical IT Environment Mix of EMRs and aEMRs4 from multiple vendors and paper-based clinical practices Data standards / interoperability lacking or primitive Multiple tools for clinicians for the multiple venues Limited or no view of longitudinal patient data across care settings Limited or confusing / conflicting clinical decision support Limited use of population health management or disease registries Limited ability to aggregate data for reporting or analysis 1) Enterprise data warehouse; 2) software as a service; 3) clinical data warehouse; 4) ambulatory electronic medical record. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 17 Extended Enterprise Integration Technologys Role in Integration Integration Means More Than Just Flinging Data at Each Other Definition of Interoperability In health care, interoperability is the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively and consistently, and to use the information that has been exchanged. NAHIT, 2005 Three Sets of Requirements for Integration Architectures Access and Aggregate Create interfaces to systems across the entire extended enterprise for transaction support and inclusion in central BI platform 2014 The Advisory Board Company advisory.com 29500H

Orchestrate Processes Analyze, Learn, and Act Coordinate the flow of patients and information among organizations within the extended enterprise; how to make the right processes occur in the right order Standardize data and processes; translate analytics into action Sources: NAHIT, 2005; Health Care IT Advisor research and analysis. 18 Extended Enterprise Integration A Continuum of Architectural Approaches IT May Need to Support Them All More tightly integrated Varying circumstances may dictate the need to use any or all of these approaches to integrate with your partners. Our case studies showed examples of all of these approaches in use depending on the demands of the situation. Use the same EHR instance Use direct business-tobusiness interfaces Use a clinical data repository 2014 The Advisory Board Company advisory.com 29500H EHR Centric Use the same EHR vendor but separate instances HIE Centric Use an HIE to centrally coordinate all interfaces

Data Centric Use a central data warehouse More loosely integrated Source: Health Care IT Advisor research and analysis. 19 Extended Enterprise Integration Challenges for IT Common Challenges with Extended Enterprise IT 2. Dealing with overlapping technology 3. Overcoming inconsistencies in technology, data, and processes 4. Navigating regulation and compliance X X X X 1. Establishing effective governance ! X 5. Managing dis-integration Regardless of the nature and strategic motivations for the partnership, the same 5 challenges must be overcome. ... 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 20 Business Intelligence How Do We Get from Here to There?

Beyond Management to Transformation Envision the new ends; tie BI efforts to strategic ambition Validate organizational will Create the plan and the teams, engaging all stakeholders Think about the right inputs for the valuable outputs New Data Types and New Analytic Outputs Consolidating and Extending the BI Architecture Extend data collection and models for new inputs Produce the analytic outputs that inform tomorrows decisions 2014 The Advisory Board Company advisory.com 29500H Combine data silos to optimize the power of analytics Accelerate and extend access to data and analytics to the workforce Source: Health Care IT Advisory research and analysis. 21 Business Intelligence Expanding the Data Collection Net It Only Gets More Complex Internal Structured Data External Structured Data

Internal Unstructured Data Progress Notes External Unstructured Data Transaction Data Claims Excel/Access Patient Satisfaction Procedure Notes Social Networks Medical Device Survey Data Email Sensors CDA2 Documents CAD/CAM1 Public Data Diagnostic Images Benchmarks Discharge Summaries Word Documents Online Reviews Scanned Consents Email Contracts 1) Computer-aided design/computer-aided manufacturing. 2) Clinical Document Architecture. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis.

22 Business Intelligence Brownfield BI Most HCOs1 Start with Fragmented Data Stores Centers of Excellence Entrepreneurial Users Regional/CINs2 Expensive and complex to maintain Data inconsistencies Not integrated Redundant processes Sunk costs Mature, high functioning Confidence in the data Appropriate independent decision-making mechanisms Common UI3 Strong data governance Appropriate skills/money Enterprise governance 1) Health care organization. 2) Clinically integrated network. 3) User interface. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 23 Business Intelligence

Options CONSOLIDATE MIGRATE TX DM ! EDW DM2 How entrenched is the current data store? Number of feeds/number of transformations Support staff number and skill Financial commitments/contracts User attachment/trust Source system(s) persistence Data quality REPLACE TX 1 EDW3 TX EDW DM

REBUILD TX EDW DM 1) Transaction system. 2) Data mart. 3) Enterprise data warehouse. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 24 Business Intelligence The Case for Distributed Analytics Self-Service Business Intelligence (SSBI) BI Maturity Model Advanced Analytics BI architecture BI core and self-service infrastructure in place Data sources / data currency ETL1 established for secondary data sources and varied currency including more frequently than daily Types of analysis / use of analytics Predictive, prescriptive analytics, data exploration, and hypothesis generation Data models Multiple, optimized data models Data governance Data normalization, source system changes, and maintenance established Tools Advanced analytic tools including self-service Skills In-depth knowledge of statistics and operations analysis, procedural programming

Culture / enterprise data literacy Training on data literacy, identifying BI opportunities, data exploration, and data-driven changes BI governance / org structure Resources harmonized between central core and stakeholder departments Strong governance processes in place Self-Service BI enables: Transforming the workforce to knowledge workers Localizing performance monitoring and improvement Enabling data exploration 1) Extract transform load. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 25 Business Intelligence Roles and Responsibilities Will Change No Work Reduction Function Notes Tool Evaluation Multiple tools, matched to function Training More users, more tools

Output Accuracy Increased volume and variety Priority Alignment Dept focus must align to enterprise priorities Data Exploration + Hypothesis Generation Data marts to empower all knowledge workers Data Governance Decentralized analysis requires central governance Additional ETL Additional users; new data Architecture More complex architecture data provisioning Data Provisioning ETLs, refreshes, cubes/marts, backups Tool Support Greater number and variety of tools Advanced Analytics + Visualization Central agency assumes responsibility for advanced functions Basic Analytics + Visualization Basics transition out to operations departments Security + Audit More endpoints and knowledge workers must be managed 2014 The Advisory Board Company advisory.com 29500H IT OTHER

Source: Health Care IT Advisor research and analysis. 26 Meaningful Use Why Should I Still Care About MU? Drive Value, Build Volume with MU Value-Based Population Health Management Population segmentation by risk level Care mapping and tracking Evidence-based care delivery Care coordination across continuum Patient and family engagement MU Structured Data Volume-Generated New Health Care Economy Cost management Low-unit price Advanced Clinical Processes

Care Coordination Geographic reach and clinical scope Clinical and service quality Total cost control Patient Engagement Information Exchange Common Strategy - Alignment 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 27 Meaningful Use More Than $25B Paid in Incentives to Date Meaningful Use Payment Status as of September 2014 Number of Eligible Professionals (EPs) That Have Received Incentive Payments 265,460 Number of Eligible Hospitals (EHs) That Have Received Incentive Payments Total Incentive Paid $10,191,234,555 Total Incentive Paid $15,176,403,167 88,903 4,289 249 107 Medicare Only Medicaid Only 11,117 Medicare Medicare Advantage

Medicaid Medicare/Medicaid (Dually Eligible) Average Incentives Received So Far $25,262 $24,378 $29,832 $3.25M Per Medicaid EP Per Medicare EP Per Medicare Advantage EP Per EH 2014 The Advisory Board Company advisory.com 29500H Sources: September 2014: EHR Incentive Program, Centers for Medicare & Medicaid Services, available at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/ September2014_SummaryReport.pdf; Health Care IT Advisor research and analysis. 28 Meaningful Use Willing to Make a $10.6M Bet? No Organization Can Afford to End Up Where They Began Annual Incentive and Payment Adjustment Estimate, Typical Hospital1 2011 First Year of MU Demonstration, in Millions of Dollars Eligible for $12.98M across 4 years of Medicare and Medicaid EHR incentive payments 1.05 2.35 3 years of Medicare payment adjustments ($10.6M) would erode almost the entire incentive collection 2.30 3.50 4.14

4.80 5.44 2011 2012 2013 2014 Medicare and Medicaid EHR Incentives 1) Assumes ~34,000 discharges, 66% Medicare share, 15% Medicaid, and 3% annual market basket update. 2014 The Advisory Board Company advisory.com 29500H 2015 2016 2017 Continues to 2021 Medicare Payment Adjustments Sources: American Recovery and Reinvestment Act, 2009; Health Care IT Advisor research and analysis. 29 Meaningful Use Key Principles Underpin Ongoing Success in MU Adaptation Audit Preparation Organizations must devote resources to react to the ever-changing nature of MU requirements. Organizations must prepare for MU audits from the when, not if perspective. Monitor newly released CMS and ONC MU content for any clarifications and/or modifications (e.g., Stage 3 delay to 20171) Assess the impact of the changes and revise MU work plan Build a robust book of evidence Meaningful Conduct a mock audit and address business

continuity gaps in documentation and response processes Use Alignment Forward-thinking organizations view MU as an enabling agent to health care transformation. Seize an opportunity to align MU with population health management and other quality reporting programs (e.g., IQR 2 and PQRS3) Align tactical approach to MU with the national health priority goals: o Improve quality of care and safety o Improve population and public health o Engage patients and families in their health care o Make care affordable o Improve care coordination o Reduce health disparities 1) Hospitals Federal Fiscal Year 2017 (October 1, 2016 September 30, 2017) and Ambulatory Providers Calendar Year 2017. 2) Hospital Inpatient Quality Reporting Program. 3) Physician Quality Reporting System. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 30 Meaningful Use An Ever-Changing Regulatory Landscape Major MU Policy Changes Since December 2013 At HIMSS3 annual conference, CMS and ONC announce hardship exceptions for EHR upgrade issues DEC JAN FEB MAR December 2013, CMS blog post announces intended delay of Stage 3 start date CMS IPPS4 proposal on CQM reporting options

APR MAY FAQ released that allows for expanded VDT2 access before, during, and after the reporting period 1 JUN JUL CMS and ONC propose alternate 2014 reporting options MU Stage 3 and 2017 EHR Certification Proposed Rule expected AUG SEP OCT Alternate 2014 reporting options Final Rule published NOV DEC EHs in Year 2 or beyond must complete 2014 attestation by November 30 and EPs by February 28, 2015

Potential MU Audit 1) 2) 3) 4) Frequently asked question. View, download, and transmit. Healthcare Information and Management Systems Society. Inpatient prospective payment system. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 31 Meaningful Use Building a Book of Evidence Substantiate Your Attestation: It Can Be Audited Up to 6 Years Later Create Review and Assess Organize Third-party documentation guidance (i.e., checklists) Internal assessment of documentation completeness Objective-by-objective organization scheme Electronic documentation with automated backup Third-party review and executive signoff Define terms, include standard naming convention Challenges LOGO Unable to Show Enabled Functionalitie s

Inaccurate Logic for Performance Reports 1) Protected health information. 2014 The Advisory Board Company advisory.com 29500H Reports Containing PHI1 Lack of Insufficient Reports Consistency Knowledge Without Managemen Vendor Logos with Differing Systems t Source: Health Care IT Advisor research and analysis. 32 Meaningful Use Possible Future MU Scenarios and Their Signposts Seeing into the Crystal Ball, An Estimate of Likelihood Potential News Headlines and Their Likelihood MU Extends Beyond Stage 3 MU is Absorbed or Expanded MU is Repealed Stage 3 proposed rule formalizes later stages through 2021 Proposal to make MU an ACO1 measure Presidential election changes federal agency administration

Act of Congress Health IT Policy Committee considers Stage 3+ requirements 1 May see IPPS or FFS2 proposals include such a provision 1 1 1) Accountable care organization. 2) Medicare Fee for Service Rule. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 33 Patient Loyalty Changing Consumer Expectations Three forces are driving increased health care consumerism More Skin in the Game Increased Transparency Standalone ambulatory care centers, retail clinics, concierge medicine, etc. Improved information about cost, quality, convenience of individual providers IMAGE CREDIT: DOUG THOMPSON. High-deductible health plans, increasing copayments, employers dropping coverage More Choices for Care Delivery Source: Health Care IT Advisor research and analysis.

2014 The Advisory Board Company advisory.com 29500H 34 Patient Loyalty Satisfaction vs. Loyalty Moving from satisfaction to loyalty requires excellence and differentiation How to Move from Satisfaction to Loyalty Satisfaction Loyalty Service Levels Meet expectations, based on past experience with current and other providers Exceed expectations based on past experience Meet underlying, possibly unmet customer needs Response to Service Deficiency Apologize and make it right Apologize and make it right Root cause analysis and process improvement to prevent future deficiencies Differentiation Show no apparent difference between what is offered by current and other providers Show clear difference from what is offered by other providers 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 35 Patient Loyalty

What Providers Should Do Focus on what patients want, and measure loyalty directly Ask open-ended questions Are you gathering the data? Are you analyzing the data? Are you acting on the data? Ask questions about loyalty Measure loyalty directly 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 36 Patient Loyalty Where IT Can Impact Satisfaction and Loyalty Process factors and information sharing have the greatest potential impact More IT Impact on Loyalty 4. Process factors 1. Information sharing & decision making 2. Interpersonal factors 5. Outcome factors 3. Technical factors 7. Systems factors Less 6. Environmental factors Harder 2014 The Advisory Board Company advisory.com 29500H Easier

Ease of adoption Source: Health Care IT Advisor research and analysis. 37 Virtual Medicine Terminology Clarification The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Telehealth Telemedicine Health Resource and Services Administration The use of medical information exchanged from one site to another via electronic communications to improve a patients clinical health status. ATA Virtual Care Patient care encounters employing telemedicine technologies. The Advisory Board 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. Virtual Medicine 38 IT Solutions for Telemedicine Workflow Implementation Difficulty High Workflow Implementation Difficulty and Technological Complexity Real-Time Interventions Remote Monitoring Telepresence Low Texting and Email Telephone

Home Monitoring eICU E-visits Data Exchange Messaging Telesurgery Remote Radiology Interpretation Specialist Consults Dermatology Technological Complexity Low High Telehealth Considerations Technical Feasibility Implementation Timeline 2014 The Advisory Board Company advisory.com 29500H Delivery and Financial Rewards Real Time vs. Legal and Regulatory Communication Strategy and Costs Asynchronous Constraints Source: Health Care IT Advisor research and analysis. 39 Virtual Medicine The New Model: Direct to Consumer Virtual Care From Asynchronous Diagnostic Support to Direct Care Delivery Real-time patient consults

Real-time provider-to-provider Store-and-forward 2014 The Advisory Board Company advisory.com 29500H Real-time virtual visits with patients Examples: e-visits, specialist e-consults Real-time consults between providers Examples: eICU and telestroke Electronic transmission of images, etc. Examples: radiology, dermatology, and pathology Source: Health Care IT Advisor research and analysis. 40 Virtual Medicine Types of Care Typically Handled Virtually Primary Care, Chronic Disease Management, and Behavioral Health Share Capacity Cost Savings Attract unaffiliated, new customers Reduce in-person Episodic appointments for routine care Primary Care Draw patients from retail, urgent by shifting visits online care competitors Appeal to payers and employers with expanded access and cost benefits Engage existing patients with Chronic enhanced access for routine Disease follow-up appointments Management

Provide opportunity for additional touches to complement follow-ups Behavioral Health Reduce appointment duration through online platform Leverage physician marginal capacity with after-hours and down-time visits Appeal to payers and employers by reducing risk factors and acute episodes Increase panel size increasing in-person visit capacity Attract patients with privacy concerns Leverage limited staff through video consults for patients across region Appeal to payers and employers by reducing care costs and absenteeism Divert consumers from ED1 by offering more convenient care alternative Reduce acute episodes, ED utilization, and readmissions Increase treatment plan compliance by enhancing access to follow-up care 1) Emergency department. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis 41 Virtual Medicine Technical Architecture

Telemedicine Infrastructure Basic IT Infrastructure Wireless/cellular networks Computers Networking hardware Data processing and transmission Web cams Medical device monitors Server storage space Wired network dependencies Remote physiologic monitors Real-time locating systems Videoconferencing equipment User devices 2014 The Advisory Board Company advisory.com 29500H Software

Applications for all potential clinical use cases, including static and mobile platforms Mobile device middleware Resource Requirements Technical expertise for technologies employed Strong project managers Help desk Specialists in medical device management Source: Health Care IT Advisor research and analysis. 42 Virtual Medicine Telemedicine Challenges Your Greatest Telemedicine Challenges 1 Integrating with Strategic Plan How does the program fit in with your overall business plan? 3 Demonstrating Value Hampered by unclear ROI/reimbursement

and limited internal resources 2014 The Advisory Board Company advisory.com 29500H 2 Engaging Physicians Concerns about workflow and quality of care in virtual settings 4 Avoiding Fragmentation of Care Virtual care expands access points, could lead to uncoordinated care Source: Health Care IT Advisor research and analysis. 43 Remote Patient Monitoring Remote Patient Monitoring and the New Retail World Advances in Cloud, Mobility, and Sensor Technology Changing the Game Definition of Remote Patient Monitoring (RPM) Remote Patient Monitoring is the periodic or continuous collection and transmission of patient clinical data, often from outside conventional clinical settings (e.g., in the home), to a provider for the purposes of clinical assessment and care management. It includes the monitoring/filtering of that data, analysis, and alerting. RPM increases access to care, can reduce costs, and helps engage and educate patients. The Advisory Board Company (adapted from Wikipedia and the Continua Health Alliance) Geographic Reach and Clinical Scope Clinical and Service Quality Expand care management services beyond office walls Extend better care through monitoring of existing patients Offer new types of care monitoring to patients at a distance Increase capacity for quality care of more patients

Low Unit Price Reduce unnecessary provider visits Total Cost Control Increase care management staff effectiveness Reduce patient Supports Population Health hospitalization rates and Management decrease readmission rates Providers should begin to deploy limited pilots of RPM for specific subsets of patients as the ROI1of such initiatives continue to be established. 1) Return on investment. 2014 The Advisory Board Company advisory.com 29500H Sources: Wikipedia; Continua Health Alliance; Health Care IT Advisor research and analysis. 44 Remote Patient Monitoring Three Key Questions for an RPM Initiative Each of Them Could Be a Show Stopper (for Now) You Need to Find Out Answers to These Questions Can We Physically and Technically Capture the Data? Is It Clinically Relevant? Is It Cost Effective? Although there are continual bioscience, IT, and technical advances, there can be many problems Just because patient data may be obtainable does not mean it will be clinically useful If it is not affordable or without a sufficient ROI, it wont matter how feasible or

clinically useful If not If not Wont Work 2014 The Advisory Board Company advisory.com 29500H Clinicians Ignore It If not Cant Afford to Deploy It Source: Health Care IT Advisor interviews and analysis. 45 Remote Patient Monitoring Technical and IT Decisions for RPM Lots to Consider Decisions Concerns RPM Component Complexity Determine component needs (e.g., sensors, aggregators, monitoring stations, repositories, clinical systems) and connectivity requirements Sensor Technologies and Companies Investigate what kinds of sensors, attachment points, and science will be employed and from what kinds of companies and sources Wireless Connectivity Note what kinds of wireless technologies will be utilized and how interference, bandwidth, range, etc., will be addressed Standards and Platforms for Integration Choose solutions that meet existing and emerging standards and that utilize a platform based on an established ecosystem Retail Options Determine if needs can be met by less expensive consumer-oriented solutions (and to what degree they can be integrated)

Data Model, Filtering, and Storage Determine how the solution will filter, store, and provide access to data without overburdening other systems or providers Regulation Ensure that the solution will meet current and anticipated regulation regarding the FDA, FCC1, ONC, HIPAA, etc. Manageability and Security Develop a plan for how to manage and secure the solution, including device install/de-install and ongoing maintenance 1) Federal Communications Commission. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 46 Remote Patient Monitoring Discrete Value Difficult to Isolate Complex Set of Interventions Masks Benefits of Remote Monitoring Representative Services Contributing to Readmission Prevention Health Coaching Home Visits Remote Monitoring Care Transitions Enhanced Access Phone Visits Readmission Avoided Patients frequently enrolled based on

chronic on Specific impact of remote monitoring diseasecost diagnosis, willingness to participate management difficult to teaseinout, program ; psychosocial needs remain particularly for programs lacking a unevaluated dedicated data analyst 2014 The Advisory Board Company advisory.com 29500H Sources: Marketing and Planning Leadership Council research and analysis; Health Care IT Advisor research and analysis. 47 Road Map 1 The Twitter Version of our industry 140 Slides or Less 2 The Technologies needed to achieve success 3 2014 The Advisory Board Company advisory.com 29500H The Take-Aways for Your Staff & Colleagues 48 48 Extended Enterprise Integration Integration Technologies Key to Redefining Value Examples of Key Integration Capabilities for the Four Retail Imperatives Low Cost Desirable Network Attributes

Essential Nice to Have Future Need Geographic Reach and Clinical Scope Clinical and Service Quality Site-specific CDS1 Clinical registries Direct messaging Standardized CDS Centralized care management system Master patient portal Low Unit Price Financial data integration Centralized financial analytics Referral management system Total Cost Control Centralized data pool Standardized performance measurement Standardized PHM2 scorecards Standardized dashboards Real-time risk identification Real-time referral analytics Clinical data integration EMPI Physician directory

Extended enterprise MPI Physician portal Telemedicine Vendor neutral archive (VNA) Record locator service Business process management (BPM) software Centralized patientreported data pool Centralized patientreported outcomes 1) Clinical decision support. 2) Population health management. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis 49 Business Intelligence Technology Key to Redefining Value Examples of Key IT-Enablers for the Four Imperatives Low Cost Desirable Network Attributes Essential Future Need CDS on integrated data Analytics to assess network opportunities PHM2 scorecards Shared patient registries Population-based planning Geographic Reach and Clinical Scope

Clinical and Service Quality Performance scorecards Optimizing access and schedules Adding patient-reported data to analytics Self-service BI3 tools Patient stratification Targeted wellness interventions Adding streaming data to analytics Adding genomics to analytics Low Unit Price Supply chain analytics Price monitoring and benchmarks Advanced supply chain analytics Resource optimization Supply locationing added to analytics Total Cost Control CDS Cost dashboards Event-driven workflow Clinical utilization measures Risk segmentation Common KPI1 measurement Service line planning Nice to Have

1) Key performance indicator. 2) Population health management. 3) Business intelligence. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis. 50 Meaningful Use Technology Key to Redefining Value Examples of Key IT-Enablers for the Four Imperatives Nice to Have Future Need Geographic Reach and Clinical Scope VDT Transitions of Care Optimized patient portal Order tracking from (scheduling, billing, ambulatory to close patient-generated health diagnostic and data) treatment feedback loop Care notifications to Telemedicine known patient care team members Clinical and Service Quality CQMs Patient list e-Prescribing Optimized CQM data capture to ensure accuracy and electronically report Real-time registry Evidence-based medicine Low Unit Price CDS, specific to

improving health efficiency CPOE used only by those licensed to enter orders (basic top of license functionality) CPOE with CDS reinforces top-of-license practice EMR optimization provides all clinicians to practice at top of license Total Cost Control Structured, coded MU data sets Descriptive and predictive BI1 Prescriptive BI at the point of care Low Cost Desirable Network Attributes Essential 1) Business intelligence. 2014 The Advisory Board Company advisory.com 29500H Source: Health Care IT Advisor research and analysis 51 Patient Loyalty Technology Key to Redefining Value Examples of key IT-enablers for consumer service quality Essential* Clinical and Service Quality Well-integrated PHR1/portal with MD notes, labs, messaging, etc. E-visits and/or phone consults Optimized EMR linked

to other providers and data sources (EHR) Ability for all providers and staff to use existing technology (e.g., EMR) with competence, ease Pre-delivery pricing and online bill pay Nice to Have* Future Need* Plain language software that simplifies medical jargon for consumers Shared decision-making aids ED capacity info available online Enterprise/same-day scheduling Remote monitoring/ telemedicine Integrated population health management capabilities Speech recognition in patient portal *What is essential, nice to have, and a future need depends on the patient (archetype). It is important to understand what YOUR patients want and need from you before you select IT investments. 1) Personal health record. Source: Health Care IT Advisor research and analysis. 2014 The Advisory Board Company advisory.com 29500H 52 Virtual Medicine Technology Key to Redefining Value Low Cost Desirable Network Attributes Examples of Key IT-Enablers for the Four Imperatives Essential Nice to Have Geographic

Reach and Clinical Scope High bandwidth enterprise connectivity Identity resolution services Remote testing/support for user technical platform Applications for multiple platforms, devices Clinical and Service Quality Clinical knowledge management process Service standards for virtual care Future Need Virtual care options Analytics-based seamlessly integrated evidence of optimal into continuum of care virtual, traditional care options combinations for care quality Remote testing/support for user technical platform Low Unit Price Virtual/asynchronous care capabilities Standardized algorithms Integration into validated for top 20 conditions: cross-continuum acute; chronic disease; pathways behavioral health Total Cost Control

Self-service diagnostic support for common conditions Virtual/asynchronous care capabilities 2014 The Advisory Board Company advisory.com 29500H Analytics-based formula, options for care yielding optimal utilization Source: Health Care IT Advisor research and analysis 53 Remote Patient Monitoring Technology Key to Redefining Value for RPM Key IT-Enablers for the Four Imperatives Low Cost Desirable Network Attributes Essential Nice to Have Future Need Geographic Reach and Clinical Scope Landlines MDDS (medical device data systems) Wi-Fi and Broadband Connectivity anywhere In-home data aggregators Location-aware Video IoE Clinical and Service Quality Clinical expert monitoring

Basic analysis and alerting Reporting system Automated patientspecific algorithmic monitoring and alerting Dedicated medical device data repository EHR interfaces Low Unit Price Single-purpose sensors Central monitoring system Total Cost Control Process management for install/deinstall Dedicated application and device management Outsourced options App store for patients Mobile medical device management 2014 The Advisory Board Company advisory.com 29500H Robotic AI assistance Context/genetic sensitive alerting Environment aware Care coordination system interfaces Multi-model sensors Disposable or embedded sensors Smart-phone attachments Cloud-based, virtual Consumer portals IVR Automated intelligent enrollment Commodity monitoring Mobile app management

Source: Health Care IT Advisor research and analysis. 54 Road Map 1 The Twitter Version of our Industry 140 Slides or Less 2 The Technologies Needed to Achieve Success 3 2014 The Advisory Board Company advisory.com 29500H The Take-Aways For Your Staff & Colleagues 55 Extended Enterprise Integration Key Takeaways for Extended Enterprise Integration How Extended Enterprise Integration Can Deliver Value Key IT-Related Points for This Topic and Imperative Four Imperatives for Health Systems Geographic reach and clinical scope 1 Meet minimum network adequacy demands Clinical and service quality Differentiate to consumers, network assemblers Low unit price Radically restructure to accept low unit prices 2 The imperatives of the new health care economy will Graphic require integration beyond the enterprise. Expect an increasing number of partnerships over time. The architectural approach must vary with the unique circumstances of the partnership.

3 Establish IT governance for the extended enterprise. Plan for the long term but build to current needs. Total cost control Develop population health model to control cost trend 4 Both EHR and data warehouse integration are critical to support the imperatives. Have a strategy for disengagement. Source: Health Care IT Advisor research and analysis. 2014 The Advisory Board Company advisory.com 29500H 56 Business Intelligence Key Takeaways for Business Intelligence How BI Supports Target Network Attributes Key IT-Related Points for This Topic and Imperative Four Imperatives for Health Systems Geographic reach and clinical scope 1 Meet minimum network adequacy demands Clinical and service quality Differentiate to consumers, network assemblers Low unit price Radically restructure to accept low unit prices Total cost control Develop population health model to control cost trend 2 3 4 Aggregate data across entities for measurement, Graphic monitoring, and driving workflow. Assess affiliation and

service line opportunities. Analytics to improve access, increase patient engagement, and create personalized medicine protocols. Analyze utilization along clinical, staff, and location dimensions to identify opportunities for improvement Support risk segmentation and best practice interventions. Monitor overall performance on riskbased contracts. Source: Health Care IT Advisor research and analysis. 2014 The Advisory Board Company advisory.com 29500H 57 Meaningful Use Key Takeaways for Meaningful Use Key IT-Related Points for This Topic and Imperative Four Imperatives for Health Systems Geographic reach and clinical scope 1 Meet minimum network adequacy demands Clinical and service quality Differentiate to consumers, network assemblers Low unit price Radically restructure to accept low unit prices Total cost control Develop population health model to control cost trend 2 3 4 Patient engagement and care coordination efforts Graphic provide data to assess geographic reach and clinical scope. Continuous quality improvement initiatives to encourage network connections and increase patient satisfaction.

Standardization and efficiency driven through CDS. Voluminous amounts of MU data and data analytics identify care management needs to control cost trends. Source: Health Care IT Advisor research and analysis. 2014 The Advisory Board Company advisory.com 29500H 58 Patient Loyalty Key Takeaways for Patient Loyalty IT can help improve service levels and gain patient loyalty Key IT-Related Points for This Topic and Imperative Four Imperatives for Health Systems Geographic reach and clinical scope 1 Patients expect to play a greater role in provider selection and treatment decisions Meet minimum network adequacy demands Clinical and service quality Differentiate to consumers, network assemblers Low unit price Radically restructure to accept low unit prices Total cost control Develop population health model to control cost trend Patient expectations changing due to greater cost exposure, alternatives to traditional providers, more Graphic transparency 2 3 4 Patients have many underlying wants and needs not met by most health care providers Patient satisfaction is important, but not sufficient to gain patient loyalty Gaining patient loyalty requires excellent service different from that of other providers

Patient loyalty has a direct financial pay-off to provider, greater than that from other business strategies Typical patient satisfaction surveys and market research methods do not fully address the issue of patient loyalty Seven aspects of care are associated with patient satisfaction and loyalty Information technology offers many ways to go beyond typical, satisfactory service to surprise and delight patients and gain their loyalty Source: Health Care IT Advisor research and analysis. 2014 The Advisory Board Company advisory.com 29500H 59 Virtual Medicine Key Takeaways for Virtual Medicine How Virtual Medicine Delivers Desirable Network Attributes at Low Cost Key IT-Related Points for This Topic and Imperative Four Imperatives for Health Systems Geographic reach and clinical scope 1 Meet minimum network adequacy demands Clinical and service quality Differentiate to consumers, network assemblers Low unit price Radically restructure to accept low unit prices Total cost control Develop population health model to control cost trend 2 3 4 It is the basic function of virtual medicine to extend the Graphic geographic and clinical scope of health care organizations. Studies and telehealth practice guidelines have established that virtual care should provide the same clinical quality as in-person care. The convenience of virtual care also improves a health systems service quality.

Virtual medicine, particularly asynchronous e-visits, can reduce the cost of providing care. Virtual medicine increases a health systems capacity to care for populations by improving access to services. Source: Health Care IT Advisor research and analysis. 2014 The Advisory Board Company advisory.com 29500H 60 Remote Patient Monitoring Key Takeaways for RPM Using RPM to Deliver Desirable Network Attributes at Low Cost Key IT-Related Points for This Topic and Imperative Four Imperatives for Health Systems Geographic reach and clinical scope 1 Meet minimum network adequacy demands Clinical and service quality Differentiate to consumers, network assemblers Low unit price Radically restructure to accept low unit prices Total cost control Develop population health model to control cost trend Prepare for an environment in which more care is delivered outside of provider walls and patients are Graphic more self-reliant aided by technology Ensure you can answer the 3 questions of feasibility, clinical relevance, and value 2 3 Stratify patients by risk and get sophisticated with analytics to identify types of data to capture and look for in various patient populations Consider expanding RPM solutions to patients beyond those with chronic disease or the elderly, such as your quantified self patients or the masses of not-so-healthy average Americans

Find ways to embrace the bottom-up consumer movementdont view it as a nuisance 4 Develop a RPM strategy that meshes with other related initiatives, such as clinical quality, telemedicine, patient engagement, and PHM Track the ROI of RPM initiatives carefully to see whats having a positive impact and whats not Source: Health Care IT Advisor research and analysis. 2014 The Advisory Board Company advisory.com 29500H 62 The Health Care IT Advisor Empowering IT We see three key imperatives for the IT executive in 2015 : 1 Getting it all donewith limited time, money, and staff Every budget season I have to answer the same question: When is this IT thing going to end? 2 Productively partnering with C-suite execs 3 Giving your IT staff the health Im a CEO; I know IT is important. Im just not comfortable participating in IT-related decisions. care know-how to actualize system goals Its hard enough to find certified staff. Now they have to be experts in health system strategy, too. The Health Care IT Advisor helps achieve each of these imperatives. Work faster and smarter Teach IT essentials to non-IT C-suite executives Keep your IT staff up-tospeed on industry strategy Decision guides

Presentations and facilitated discussions for CIOs to learn how to successfully communicate the role and value of IT to non-IT execs Health Care Delivery Boot Camp Series Tools Templates Budget statistics 2014 The Advisory Board Company advisory.com 29500H Special IT Summit for you and your C-Suite Buddy Health Care Cheat Sheets 63 Why Health Care IT Advisor? Ways We Deliver Value Unbiased Research Drive Organizational Change The breadth as well as depth of research was very obvious and you provided both the IT leaders and the other executives exceptional insights through the day [of an executive education onsite]. Chief Information Officer Peer-reviewed, short-form research noteswithout vendor sponsors Insights written for consumption by CIOs and non-IT executives alike Analysis of key market events, Actionable 2legislation and Advice regulatory mandates impacting IT Assessment of emerging technologies and key drivers Translate Insight into Answers I could not have hoped for better results Nice work and kudos to great research and help for our industry.

Chief Information Officer Tips to maximize existing vendor relationships and optimize current systems Former CIOs serving as trusted advisors Years of collective health care IT experience 2014 The Advisory Board Company advisory.com 29500H 3Business On-Callanalysis Health tools Careto ITplan Experts budgets and investments 1 What Our Members Are Saying Provide Support When You Need It Credibility of the Advisory Board is high among our executives. Timely responses to our questions limited delays in decisionmaking and project progress by building executive confidence so that a decision could be approved. Chief Information Officer

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