President and Chief Executive Officer The Taconic Case Study A. John Blair, III, MD President and Chief Executive Officer Taconic IPA, Inc. Fishkill, NY Get Connected Knowledge Forum

Taconic IPA Founded 1989 Mid-Hudson Valley region, New York State 8 counties 2,300 physicians / 500 practices 1 to 70+ physician practice size range 4 physicians – average practice size Over 1 million covered lives Get Connected Knowledge Forum

Taconic IPA NOT a staff model Physicians NOT employed by Taconic IPA NO centralized control Not an IDN Not a Clinic Not a University Get Connected Knowledge Forum

Taconic IPA Independent practitioners 80% of healthcare delivered nationwide in practices with less than 10 physicians (Forrester Research) Get Connected Knowledge Forum

Obstacles Cost Complexity Selection Human Resources Data Silos Get Connected Knowledge Forum

Obstacle: Cost $30,000 - $50,000 Client / Server $1,000 per physician ASP model Practice productivity loss Lack of financial ROI Bates, 2003 Misaligned incentives CITL findings Get Connected Knowledge Forum

Why an EMR? Summary of Benefits Source: “Cost and Benefit Analysis for Electronic Medical Records in Primary Care.” The American Journal of Medicine 2003; 114:397-403. Get Connected Knowledge Forum

Misaligned Incentives Others Providers Substantial savings arise from cost avoidance Formulary compliance/generic substitution Radiology Laboratory ADE Ambulatory Computer-based Provider Order Entry Source: Center for Information Technology Leadership, 2003 Get Connected Knowledge Forum

Strategy: Cost Internet and ASP model Leverage IPA size Aligning incentives Health plans IHA model Technology focus Employers Bridges to Excellence Get Connected Knowledge Forum

Uniqueness of the Incentive Strategy Combines Health Plans and Employers Strict Technology Focus Get Connected Knowledge Forum

Rationale for Technology Focus Health plans currently pay for technology infrastructure within their organization Physician office technology is health plan infrastructure Get Connected Knowledge Forum

Obstacle: Complexity Many small physician offices do not want a full EMR Get Connected Knowledge Forum

Strategy: Complexity Incremental Approach Electronic Results Delivery Most popular Electronic signature for transcribed reports Electronic Prescribing Document Imaging Full EMR Get Connected Knowledge Forum

Obstacle: Selection Greater than 270 vendors selling EMRs Lack of health plan involvement Get Connected Knowledge Forum

Strategy: Selection Independent EMR Expertise Leading annual survey In-depth knowledge of vendors Extensive Vendor Evaluation Process End user group Health plan / Employer group Medical Directors CIOs Get Connected Knowledge Forum

Uniqueness of the Selection Strategy Health Plan / Employer Involvement Evidence-based decision support at point-of-care Registries for population-based disease management Get Connected Knowledge Forum

Obstacle: Human Resources Inadequate staff Inadequate expertise Re-engineering workflows Technology Limited pre-implementation planning Limited systems training Limited post-implementation support Get Connected Knowledge Forum

Strategy: Human Resources MedAllies Change Management Expertise Planning, Training, Implementation, Support Hardware / Network Support Get Connected Knowledge Forum

Strategy: Human Resources Industry Average 7.5 hours per physician – Year 1 Phone support – Post-implementation MedAllies 80 hours per physician – Year 1 40 hours per physician – Ongoing 24/7 Help Desk Local support / trainers 1.5 hours maximum onsite response time Get Connected Knowledge Forum

Uniqueness of the Human Resources Strategy Magnitude of support Local Get Connected Knowledge Forum

Obstacle: Data Lack of complete hospital, laboratory, and pharmacy data populating EMRs Organization-centric mentality Get Connected Knowledge Forum

Strategy: Data Physician Leadership Physician Office Staff Hospital participation Physician Office Staff Laboratory participation Leverage Competing Hospitals Critical Mass Get Connected Knowledge Forum

Uniqueness of the Data Strategy Overcoming organization-centric mentality Competing hospitals and laboratories on one system Get Connected Knowledge Forum

Obstacle: Silos Lack of vendor interoperability Standards Certification Get Connected Knowledge Forum

Strategy: Silos Require vendor interoperability Require standards Require certification Get Connected Knowledge Forum

Uniqueness of the Silos Strategy Requiring competing vendors to work together towards interoperability Get Connected Knowledge Forum

Reference Laboratories PAYORS INCENTIVE MedAllies Portal EMR 2 E Rx PHYSICIANS E-Results EMR 1 PMS QUALITY METRICS PATIENTS TRANSLATOR MASTER PATIENT INDEX Hospitals Reference Laboratories Pharmacies Physician Practice Get Connected Knowledge Forum

Community Health Information Exchange Get Connected Knowledge Forum

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How Did We Get Here? Physician Organization Leadership Hospital / Laboratory Influence Successful Pilot Physician Usage Additional Hospitals and Laboratories Additional Physicians Payers (Health Plans, Employers) Get Connected Knowledge Forum

Available Options/Solutions Health Plan Driven Advantage: Capital Disadvantage: Physician mistrust Hospital Driven Advantage: Technology expertise Disadvantage: Legal (Stark, Anti-kickback) Get Connected Knowledge Forum

Available Options/Solutions Community Advantage: Employer / Consumer Buy-In Disadvantage: Speed of Implementation Employer Advantage: Capital Disadvantage: Employer / Provider Gap Get Connected Knowledge Forum

Recommendations Complete technology solution Strong support Incentives Get Connected Knowledge Forum

Complete Technology Solution Health Information Exchange Hospitals, Laboratories, Pharmacies Portal Multiple Applications Interoperable Clinical Data Repository Get Connected Knowledge Forum

Strong Support Understand physician office operations Clinical knowledge Experts in portal applications Ability to work with all levels of staff (clerk to physician) Reside in local community Get Connected Knowledge Forum

Incentives Multiple payers Uniform metrics Uncomplicated structure Significant technology focus initially Reasonable evolution to outcomes rewards Get Connected Knowledge Forum

Contact Information A. John Blair, III, MD President and CEO Taconic IPA One Summit Court, Suite 200 Fishkill, NY 12524 T (845) 897-6359 F (845) 298-9040 jblair@taconicipa.com www.taconicipa.com Get Connected Knowledge Forum

President and Chief Executive Officer The Taconic Case Study Thanks for your time! A. John Blair, III, MD President and Chief Executive Officer Taconic IPA, Inc. Fishkill, NY Get Connected Knowledge Forum