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We – the US Healthcare Ecosystem do NOT know how to play as a team. . .

Empowering Healthcare Consumers Martin S. Kohn, MD, MS, FACEP, CPE Associate Director of Healthcare Analytics IBM Research August 13, 2010. We – the US Healthcare Ecosystem do NOT know how to play as a team.

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We – the US Healthcare Ecosystem do NOT know how to play as a team. . .

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  1. Empowering Healthcare ConsumersMartin S. Kohn, MD, MS, FACEP, CPE Associate Director of Healthcare AnalyticsIBM ResearchAugust 13, 2010

  2. We – the US Healthcare Ecosystem do NOT know how to play as a team. . . “ We don't have a healthcare delivery system in this country. We have an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited micro systems, each performing in ways that too often create sub-optimal performance, both for the overall health care infrastructure and for individual patients.“ George Halvorson, from “Healthcare Reform Now

  3. World Health Report 2008 Global Issues (WHO) • Demand for primary care • Equitable, inclusive and fair systems • Universal coverage and universal access • Service delivery reforms • Integrating public health and primary care • “Put people at the centre of health care”

  4. Common Global Themes Despite differences among health care systems, large proportions of citizens across the five countries report dissatisfaction with their health care system and serious problems including: • medical and medication errors • faulty patient-physician communication • poor care coordination RJ Blendon, et al Health Affairs, May/June 2003; 22(3): 106-121

  5. A value-based health system must appropriately balance resources expended in keeping people healthy EarlyClinicalSymptoms Active Disease Healthy / Low Risk High Risk At Risk Health care spending Health Status Early Symptoms 20% of people generate 80% of costs Value-based Health Care System Source: IBM Global Business Services and IBM Institute for Business Value 5

  6. Moving towards a more coordinated system A long-term comprehensive relationship with your Personal Physician empowered with the right tools and linked to your care team can result in better overall family health… Patient Centered Medical Home • Cooperating in new efforts to better coordinate care • Accountable Care Organizations • Community Health Teams • HIT • Working with innovative reimbursement structures • Bundled payments • Expanded Pay for Quality • Readmission Prevention Incentives • Outlier Reductions • Improving health outcomes • Prevention (primary and secondary) • Chronic Disease Management • Patient engagement and education • Data transparency 6

  7. IBM’s Collaborative Care Solution enables the patient centered medical home, and empowers the consumer with information, tools and access to a care team so they actively engage in their own health care choices and programs Ambulatory EMRS Roles Based Portal Health Plans Labs Pharmacy PHR CDA or CCR Custom Adapters (if required) HITSP defined PIX/PDQ Adapter Client Adapter Layer XDS Adapter Patient Hospital EMRs Data Transformation Services Format, terminology, de/re-ident Primary Care EMR / PM Subject-ID ManagementProofing, arbitration, lookup Data Storage, Query & Retrieval Employers Domain Logic Layer PATIENT Access Consent Managementand Enforcement Provider-ID ManagementProofing, credentials, lookup Registration Servicesand Management Resource Adapter Data Management Layer Quality Reporting Fraud & Abuse Best Practices Hospitals Access-Consent Policy Server CDA Repository Audit Repository Terminology Server Patient Registry Primary Care Disease Registry InterCommunity Service Bus Nationwide Health Information Network State Programs Specialists

  8. IBM’s Collaborative Care strategy delivers Patient-Centered Medical Home best practices through holistic solutions Holistic Systems Personal Relationship with Care Team Proactive Focus + + IBM Solution Components • Care Delivery Processes tailored specifically to PCMH • Multi-state Hosted Health Information Exchange • Medical (Accountable Care) Services Organizations as an enabler of individual physician practices • ISV specific enablers to drive hospital and practice clinical transformation • Comprehensive analytics to capture and provide insight into structured and unstructured EMR data • Open, “Cloud” based architecture to leverage business partners, drive efficiency and promote scalability • No other firm currently offers the fully integrated solution that is needed

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