Chandrapur Call girls 8617370543 Provides all area service COD available
Patient Summaries Improve Insurer Risk Assessment
1.
2. Reinforcing the Bridges and Scaling up
EU/US Cooperation on Patient Summary
Trillium IIThis project has been cofunded
by the European Union’s Horizon
2020 research & innovation
programme under grant
agreement No 727745
Catherine Chronaki
Trillium-II Scientific Coordinator
Secretary General
HL7 International Foundation
Brussels
How patient summary
standards can improve
risk assessment for
health insurance?
3. Outline
• Digitization of medicine: implications for eHealth and telemedicine standards
• Changing landscape of health insurance
• Patient summaries as entry point to health information of a person or a
community
• Evaluate the benefits accrued with use of patient summaries in changing the
narrative of health insurance to support value-based care.
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
4. www.estandards-project.eu
eStandards –
eHealth Standards and Profiles in Action for Europe and Beyond
Vision of the global eHealth ecosystem
people have navigation tools for safe and informed health care
interoperability assets fuel creativity, entrepreneurship, and
innovation
eStandards will:
nurture digital health innovation
strengthen Europe’s voice & impact
enable co-creation and trusted provider-user relationships
Base Standards
Use Case based
Standards Sets
Assurance and
Testing
Live
Deployment
Feedback and
Maintenance
Tooling and
Education
Forums and
Monitoring
eStandards
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
4
5. www.estandards-project.eu
Innovation is where standards are most needed:
to unlock data for trust & flow
Today:
• Massive health data accumulated in silo EHR systems serving documentation purposes. We need to
move from passive documentation to active use of information and knowledge creation: activation!
• Patient summaries defined at the macro level: cross-border exchange for emergency or unplanned
care at a national level. Need to address communities and individuals!
• Standards and profiles address a predefined exchange of information. Need flexible use of available
content and structure, recognizing national, regional or local jurisdictions trust & flow!
Shaping the future: Focus on the top level: systems of innovation!
5
Systems of record – documentation systems -EHRs
Systems of differentiation – profile based data exchange
Systems of innovation – unlock data and user experience
+
+
-
-
C
h
a
n
g
e
G
o
v
e
r
n
a
n
c
e
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?" June 1, 2017
6. www.estandards-project.eu
Making Digital Work for health with Trust and Flow
• Co-create
– to make it real using
standards
• Governance
– to make it scale for
large-scale deployment
• Alignment
– to make it flourish in a
sustainable way
6
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?" June 1, 2017
7. Patient summary standards
Think Patient summary as
vaccinations
medications
encounters
Identification
allergies
Implantable
devices
Health team
Security
preferences
Security
preferences
problems
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
8. NHS-Digital Summary Care Record
• The SCR is an electronic record of important patient information
• Access to SCR information means that
• At a minimum, the SCR holds important information about
• The patient can also choose to include additional information in the SCR
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1,
2017
9. ObjectivesTrillium Bridge II (2017-2019)
• Engage and educate stakeholders on the social value of patient summary standards
• Establish a Global Community of Practice
for Digital Health Innovation
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
10. Context, role and adoption of the international
patient summary in the global ecosystem
• Establish the case of the patient summary as a citizen’s right
and enabler, and validate its global role in different contexts
• Consult with key stakeholder groups to identify needs, use
cases, and promote patient summary standards
• Assess key enablers and success factors for adoption of the
international patient summary for benefit realization
• Collect and Revise educational and training material of
relevance to the international patient summary
• Lead the way towards productive and safe use of health data
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
11. Health Insurance in the United States
• Explosion of data and technology offer opportunities for risk assessment
• Shift to provider risk-bearing models e.g. 30 day readmission
• Heightened value of direct relationships with providers
• Greater transparency through readily available information on pricing,
networks, costs, and quality.
• Increasing regulatory uncertainty with health exchanges
• Health management organizations
• Accountable care organizations
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
12. Health insurance in Europe
• Bismarck and "Social Health Insurance" (1883) right of labor
• Beveridge: the National Health Service (1948) right of residency
• Universal Health coverage
• Most countries in Europe use a mix
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
13. Health Insurance in the United States
on the News 2011-2013
• “The end of Health insurance
companies” (NewYorkTimes)
• “The end of private health
insurance in America” (Forbes)
• “Is this the end of health insurers?”
(Washington Post)
• “Insurance companies as we know
them are about to die” (New
Republic)
• “Why health insurance companies
are doomed” (Fortune)
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
14. 2015: Private health insurance:
growing global market of 1 trillion€
• Private health insurance [124bn€ in 2015, from 0.01% to 6.1%]
• Health insurance Industry transformation
• Aging population living with disease
• Increased healthcare consumption
• Rising global disease burden in chronic / non-communicable diseases
• Healthcare systems in trouble unable to match supply and demand
• An opportunity for private insurance to invest!
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
16. Forces shaping health systems: Risk
• Shift of risk and medical expenses
• Misalignment between categories of risk
• Need for a new focused management model
• Need for closer partnership of providers and private payers
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
17. Forces facing health systems: technology
• Rapid progress in analytics and digitization
• Innovation in medicine
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
18. Forces facing health systems: regulation
• Health insurance regulation
• Incentives for private payers
• Possibility to reach low-income segment
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
19. Forces facing health systems: consumers
• Consumers become more health aware
• Insurance companies need to be able to engage directly with consumers
• Support the patient’s health journey:
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
20. New business models for health insurance
• New Roles:
• New Business models:
• Engage the health consumer:
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
21. • Insurers introduce
products that use fitness
data for pricing
• Aspire to be orchestrators
of the healthcare
ecosystem on behalf of
consumers deriving
insights through
advanced analytics and
connectivity
Trust and Transparency
22. Can patient summaries help build trust to sustain
partnership with insurers?
Scale-up use of patient summaries
• Listening to the patient and the family
• Quality assurance
• Health goals
• Early warnings
• Transitions of Care: Smooth discharge, transitions, and hand-offs
• Emergency or Urgent episodes: Safe care
• Risk Assessment
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
23. How can patient summary standards help insurance with
risk assessment?
Raising the bar for Patient
Summaries
• Understood
• Easy
• Desirable
• Rewarding
• A Habit
Is that enough for the era of
health?
Patient summaries can be the key to
unlocking health information
• Know consumers and what drives their
behaviors
• Guide consumers toward the information they
need to make better decisions
• Engage consumers to help prepare them for
and enable behavior change
• Inspire consumers to build loyalty
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
24. Embracing the digital:
Prescribing mobile health apps
• Could patient summaries offer a minimum data set that all health apps
could readily and with minimum cost comply to?
• Would that also benefit health insurance companies?
Establish basic level of interoperability globally with the International
patient summary collaboration of CEN/HL7
How can the patient summary improve risk assessment for insurers?
In "Digital health and insurance: a perfect partnership?“ June 1, 2017
25. Global Community of Practice for
Digital Health Innovation
Let’s join forces to make digital health happen.. Apply to become an
Ambassador!
Please Contact us:
mhm@medcom.dk
euoffice@HL7.org
www.trilliumbridge.eu
@trillium_II
EvaluateBridge
HarmonizeGuide
Hinweis der Redaktion
Good morning ladies and gentlemen.
We have a problem with health data. My premise is that patient summaries can serve as the entry point to health information.
The health information of an individual or a community.
My talk today will be on Trillium II – an initiative that aims to create a community of innovation for the practice of digital health starting from the notion of patient summaries.
And my premise here for you to think about is that patient summaries can serve as the entry point to navigate through a person’s health data offering essential data and links to find additional information.
Systems of record – SQL / CDA/CCD /
Systems of differentiation – IHE Profiles / PCHA/Continua Profiles
Systems of innovation – FHIR / OpenEHR Archetypes
To develop, deliver, test and deploy standards sets which are properly adapted to a dynamic healthcare system, we need a constant flow of interaction between three types of activities:
Co-creation between all relevant stakeholders
to make it real using standards
A supportive and appropriate governance system
to make it scale toward large-scale deployment
The flexibility to adapt and align as needs and requirements change
to make it stay in a sustainable way
From 3% Europe, 14%, North America (15bn/12bn), 0.1% Africa (10bn/12.5bn), 5% Asia Pacific (15bn/10bn), 5% LatAm (30bn/25bn).
Explosion of data and technology have implications for risk
Shift to provider risk-bearing models e.g. 30 day readmission
Heightened value consciousness among both consumers and employers, which often leads to more direct relationships with providers
Greater transparency through readily available information on pricing, networks, costs, and quality.
Increasing regulatory uncertainty
Health management organizations
Accountable care organizations
Aging population 65+ 3.1% per year according to World population prospects, UN
In the US one third of healthcare expenditures are related to chronic disease 19 to 23% according to McKinsey
OECD 2000-2012
communicable diseases 31/23/12/5 low-lower middle- upper middle – high income
Non-communicable diseases 65-71-81-87
Injuries 4-5-7-8
Growing market with excellent prospects in eastern Europe
Romania (p27%), Turkey (p3%), Ukraine 16%
US (p13%) 6%, Germany (p11%), Switzerland, Netherlands 2%, Italy (p4%) 1%, Czech Republic (p25%), Slovakia (p17%)
The portion of healthcare spending devoted to classic insurable medical risk is decreasing (28%)
Governments might impose regulations that eliminate core aspects of the insurance market e.g. flexibility in underwriting and pricing or replance insurance with public programs so that private insurance offers only supplementary products
Need for new business models:
e.g. risk impaired annuity from chronic disease
Risk category, Consumer discretion, Consumer ability to absorb risk/expense, Potential financial approach, Potential reimbursement
Routine, H, H, Saving, credit/prepaid cards, fee for services
Preventive, H, H, Free, Fee for services
Chronic Care, H, M (Catastrophic H, L) Insurance with incentives for proper management and risk impaired annuity, nested episodes with population health models
Discretionary, H, M, Savings and credit cards, Episodes
Purely elective, H, M, Savings and credit cards, Episodes
Catastrophic non chronic, L, L, Insurance, Episodes
End of Life, L, M, Savings, viatical, reverse mortage, Episodes
The transparency into care dlivery performance makes possible very different payment and risk intermediation models: expansion of episode and bundled payment modesl, incentives baded on population health, complete capitated risk, transfer levels of financial risk to providers.
Potential for transparency in the care delivery performance can test bundled payment modes, incentives based on population health, eliminate 30 day -readmission costs
Wearable trackers quantify personal activity generating valuable data for private payors: measures collected, fully automated visualization and longitudinal evaluation, comparison with family, friends, and the online community.
AXA partner with Samsung to provide discounts for healthy behavior
John Hancock uses fitbit for life insurance offering 15% discound
Generali uses discovery health, and offers vouchers and gifts for activity and prevention exams
In case of Emergency, the patient summary is there in our mobile phone and can be understood anywhere in the world
Emergency response teams can use the patient summaries to capture accurately the aggregate and individual needs of a community hampered by disaster.
Insurance companies have a lot of data
Reciprocity: Trust and sharing can walk hand in Hand
insurers could populate some Patient Summary data elements
since they pay for most medical care regardless of who provides it, they know about meds and problems at a minimum)
Sometimes, create complete Patient Summaries to improve the care of their insured patients during transitions of care. (US)