1 Massachusetts HealthCare System Transformation through Technology 2005 Progress Report Ed Esposito, Vice President Blue Cross Blue Shield of Massachusetts PEP-2400 (3/05)

2 Highlights From Last year Healthcare Costs vs. Quality of Outcomes Tradition HealthCare Technology –Stovepipe Applications –Inadequate Data Standards –Isolated Infrastructure – Benefits not aligned with Costs Opportunity “To foster unbounded Clinical Collaboration within all aspects of Care.”

3 The Challenge Fundamentally change health care for providers, payers, employers, and patients Why Now? Advances in technology Increasing cost and quality pressures Climate of collaboration exists Today’s Health Care System

4 eHealth Initiatives Strategic Alignment  Improve the health of our members  Improve the quality of care our members receive  Moderate the health care cost trend  Be a community leader BCBSMA 2005 Goals: BCBSMA Collaborative Community Collaborative eVisits (RelayHealth TM ) e-Prescribing (eRx Collaborative) MedsInfo MDS Pilots Mass eHealth Collaborative (MAeHC) Transformation of the Healthcare System

5 e-Health Vision Create a multi-faceted eHealth Program focusing on the use of technology to improve the quality and efficiency of the health care system at large. The Goal Bring together the state, health plans, providers, and employers to create change Drive the adoption of common technologies to improve data gathering, information sharing & decision making Identify technology adoption and health care quality incentives to create a sustainable system

6 eHealth Vision The Approach: Achieve exceptional quality, safety, access, and affordability – for all of Massachusetts citizens – through intensive commitment to and promotion of technological innovation at the point of care –ePrescribing (eRx) –Medical Decision Support (MDS) –Electronic Medical Records (EMR) –Community Wide Initiatives (MAeHC,MEDSinfo – ER) Achievable only through collaboration

7 The e-Rx Collaborative Goals: Widely introduce point-of care technology in physicians’ offices and promote ePrescribing in Massachusetts Provide multiple ePrescribing options Enhance patient safety, office efficiency and RX affordability Participants: Health Plans: BCBSMA, Tufts Health Plan, and Neighborhood Health Plan Technology Vendors: ZixCorp and DrFirst

8 Adoption Progress Q Highlights Technology has been rolled out to over 3300 prescribers through the Collaborative 613 new deployments in Q3 896% year to date script increase from /1/05-10/1/05: 1,768,082 1/1/04-10/1/04: 177,512 Over 64,000 scripts sent electronically per week

9 ePrescribing Benefits Improved Quality of Care! Prescriber (Clinical Perspective)  Mobile Rx writing  Access to patient’s Rx history  Drug-drug interaction alerts  Allergy alerts  Drug reference guide  Reporting capabilities Prescriber (Administrative Perspective)  Quicker refill process  Reduced pharmacy calls  Access to plan specific formulary  Access to prior authorization forms  Personalized frequently used Rx lists  Electronic pharmacy address book Patient  Access to patient’s Rx history  Increased safety  Reduced pharmacy wait times  Increased level of confidence  Improved medication compliance  Predictable co-pay Health Plan  Control increasing healthcare cost trends  Improved formulary adherence

10 My Health Records

Massachusetts eHealth Collaborative (MAeHC) The Proposal Bring together a large number of existing stakeholders including State Government to assemble the technology required to provide critical clinical information in a number of patient care settings throughout the state. The Approach Develop a secure, state-wide electronic information utility that puts medical information in the hands of the providers when and where they need it dramatically improving patient safety, healthcare quality and outcomes, and the overall efficiency of the health care system. The Goal Launch a community initiative to transform the state’s health care system and serve as a model for other states across the country.

12 MAeHC Participating Organizations Alliance for Health Care Improvement Associated Industries of Massachusetts Baystate Health System Beth Israel Deaconess Medical Center Blue Cross Blue Shield of Massachusetts Boston Medical Center Caritas Christi Executive Office of Health and Human Services Fallon Clinic, Inc. Fallon Community Health Plan Harvard Pilgrim Health Care Health Care for All Lahey Clinic Medical Center Massachusetts Association of Health Plans Massachusetts Business Roundtable Massachusetts Chapter American College of Physicians Massachusetts Coalition for the Prevention of Medical Errors Massachusetts Council of Community Hospitals Massachusetts Group Insurance Commission Massachusetts Health Data Consortium Massachusetts Health Quality Partners Massachusetts Hospital Association Massachusetts League of Community Health Centers Massachusetts Medical Society Massachusetts Nurses Association Massachusetts Taxpayers Foundation Massachusetts Technology Collaborative MassPRO, Inc. New England Healthcare Institute Partners Healthcare Tufts Associated Health Maintenance Organization, Inc Tufts-New England Medical Center University of Massachusetts Memorial Medical Center

13 Electronic Medical Records (EMR) Medical Decision Support Clinical Data Exchange Standardized Reporting Must replace paper-based records Deliver the latest evidence-based medicine protocols to physicians at the point of care Must be implemented to share patient information 24/7 regardless of where care is received Give consumers and providers information on provider outcomes and best practices Massachusetts eHealth Collaborative (MAeHC) Vision

14 MAeHC Pilots Initiate three community-based demonstration pilots to understand impact of a comprehensive electronic health care system 24+ month pilots supported in part by $50 million BCBSMA commitment Analyze return on investment to all stakeholders. Produce recommended business plan

15 Electronic Health Record Data Exchange Lab reports Radiology reports Medication lists Computerized Physician Order Entry support Integration of new & legacy systems Hardware/Software Data exchange connectivity & infrastructure Vendor selection/ contracting assistance Systems integration Workflow integration Evaluation What must communities provide? Leadership and Enthusiasm for: Adoption Collaboration Evaluation Systems change What will MAeHC provide?

16 Adoption THREE KEYS TO PILOT PROGRAM What are the most significant adoption barriers? What are the best ways to overcome them? What are the costs (direct and indirect) of adoption of IT? What are the benefits? How are the costs and benefits distributed across payers, providers, government, patients, ancillaries, etc? How much money will be required to implement statewide? What is general framework of incentives to implement and sustain the model? What are the most effective management strategies for implementing and sustaining in communities? What are the most effective organization models and tactics for implementing and sustaining statewide? Value Replication

17 3 DOWN, (AT LEAST) 32 TO GO

18 Q and A