2. Workshop Agenda: 8am Registration 8:10am Welcome & Intros 8:20am Presentation/Q&A 8:40am Presentation/ Q&A 9am Broader Group Discussion 9:35am Closing Remarks 9:40 am Networking

3. Population Health and the US Healthcare System: What role can IT play in Indiana? Nir Menachemi, PhD, MPH Professor and Department Head Health Policy and Management nirmena@iu.edu R ICHARD M. F AIRBANKS S CHOOL OF P UBLIC H EALTH INDIANA UNIVERSITY - IUPUI

4. Agenda Describe the changing US healthcare system Focus on Indiana Health Indicators Population health management Define and describe Role of IT in population health management

5. Fact about the US Healthcare System We spend $3+ trillion (2014)

6. Fact about the US Healthcare System We spend $3+ trillion (2014) Our health indicators are worse than much of developed world

7. Fact about the US Healthcare System We spend $3+ trillion (2014) Our health indicators are worse than much of developed world Hoosiers at the bottom

8. Fact about the US Healthcare System We spend $3+ trillion (2014) Our health indicators are worse than much of developed world Hoosiers at the bottom Indiana is #41 Low per capita public health funding (#48) High levels of air pollution (#47) High prevalence of smoking (#44) High levels of obesity (#44) Cancer deaths (#42) Child immunizations (#42) Preventable hospitalizations (#42) Physical inactivity (#41) Substance Abuse challenges

9. We spend $3+ trillion (2014) Our health indicators are worse than much of developed world Hoosiers at the bottom Focus of our spending is on “sick care” Fact about the US Healthcare System Source: Bipartisan Policy Center (2012) available at: http://bipartisanpolicy.org/library/what-makes-us-healthy-vs-what-we-spend-on-being-healthy/ Workshop #2: Leveraging Health IT for Wellness Feb 23, 2016

10. Fact about the US Healthcare System We spend $3+ trillion (2014) Our health indicators are worse than much of developed world Hoosiers at the bottom Focus of our spending is on “sick care” $1.2 trillion (~40%) is “waste” Waste from: Behaviors: e.g., obesity, smoking Clinical: e.g., defensive medicine Operational: e.g., ineffective IT

11. Fact about the US Healthcare System We spend $3+ trillion (2014) Our health indicators are worse than much of developed world Hoosiers at the bottom Focus of our spending is on “sick care” $1.2 trillion (~40%) is “waste” “Volume to Value” Historic: Do more, bill more Updated: Do better, receive more $$

12. Volume to Value Value-based care Pay for performance Bonuses for meeting quality benchmarks No payments for “never events” Accountable Care Healthcare organizations in a community partner to assume responsibility for the coordination of care for a given patient population Reimbursement based on outcomes & averted unnecessary costs

13. Expectations of Accountable Care Explicit: Do a better job at managing the population of patients you care for Explicit: Reduce waste and improve outcomes for very sick Implicit: Keep healthy folks healthy “Public Healthification of the US Healthcare System”

14. Source: Care Continuum Alliance (2012) PHM Framework Population Monitoring Health Assessment Risk Stratification No or Low Risk High Risk Health Promotion, Wellness Health Risk Management Care Coordination/ Advocacy Disease/Case Management Psychosocial Outcomes Financial Outcomes Productivity, Satisfaction Behavior Change Clinical & Health Status

15. PHM Framework Source: Care Continuum Alliance (2012) Population Monitoring Health Assessment Risk Stratification No or Low Risk High Risk Health Promotion, Wellness Health Risk Management Care Coordination/ Advocacy Disease/Case Management Psychosocial Outcomes Financial Outcomes Productivity, Satisfaction Behavior Change Clinical & Health Status Need data warehouse, disease registry, access to clinical data Data warehouse Registries

16. Source: Care Continuum Alliance (2012) PHM Framework Population Monitoring Health Assessment Risk Stratification No or Low Risk High Risk Health Promotion, Wellness Health Risk Management Care Coordination/ Advocacy Disease/Case Management Psychosocial Outcomes Financial Outcomes Productivity, Satisfaction Behavior Change Clinical & Health Status Need Analytics Software Data warehouse Analytics Registries

17. Source: Care Continuum Alliance (2012) PHM Framework Population Monitoring Health Assessment Risk Stratification No or Low Risk High Risk Health Promotion, Wellness Health Risk Management Care Coordination/ Advocacy Disease/Case Management Psychosocial Outcomes Financial Outcomes Productivity, Satisfaction Behavior Change Clinical & Health Status Email, Patient Portals, Health Apps Registries Analytics E-mail Patient portals Data warehouse

18. Source: Care Continuum Alliance (2012) PHM Framework Health Info Exchange Population Monitoring Health Assessment Risk Stratification No or Low Risk High Risk Health Promotion, Wellness Health Risk Management Care Coordination/ Advocacy Disease/Case Management Psychosocial Outcomes Financial Outcomes Productivity, Satisfaction Behavior Change Clinical & Health Status HIE, Data Integration Registries Analytics E-mail Patient portals Data warehouse

19. Source: Care Continuum Alliance (2012) PHM Framework Health Info Exchange Analytics E-mail Patient portals Population Monitoring Health Assessment Risk Stratification No or Low Risk High Risk Health Promotion, Wellness Health Risk Management Care Coordination/ Advocacy Disease/Case Management Psychosocial Outcomes Financial Outcomes Productivity, Satisfaction Behavior Change Clinical & Health Status Care Management Software, Decision Support Decision SupportCare Mgt Software Registries Data warehouse

22. The US Healthcare System is Transforming… (Titus will soon discuss Indiana’s Health IT assets)

23. Discussion

24. The Hoosier Informatics Platform: Putting Our Assets to Work Titus Schleyer, DMD, PhD &Shaun Grannis, MD, MS Indiana’s Opportunities to Lead in Digital Health January 26, 2016

25. Thank youfor being here today.

26. Where we are #1 …

27. What is health information exchange? No matter where you go for care, your clinician has all necessary healthcare information about you.

28. What is health information exchange? February 8, 2016 6 ‑ 8 PM Keystone Art Cinema, 8702 Keystone Crossing Indianapolis, IN 46240 www.nomatterwherethemovie.com

29. Where we are #1 … Health Information Exchange (HIE) Indiana Network for Patient Care (INPC)

30. Where we are #1 … Health Information Exchange (HIE) Indiana Network for Patient Care (INPC)

31. … and many others. Thank you!

32. The Indiana Network for Patient Care (INPC) established in 1988 developed by Regenstrief, now maintained by the Indiana Health Information Exchange (IHIE) clinical data from over 80 hospitals, the state and local public health departments, labs, etc. uniquely valuable for observational research … and many other things

33. The INPC by the numbers > 13m unique patients (over time) 27.5m registration events > 4b discrete results > 1.7b clinical observations > 840m encounter events > 580m claims observations (procedures, prescriptions, etc.) 118m text reports > 2.5m emergency department visits per year from over 100 Indiana hospitals > 2m new transactions processed per day IT IS BIG! Answer questions like: Who is sick from what? Where are they? Why are people sick? What interventions have worked and how well?

34. Example: Population EHR Data for Assessment at the Local Level (PEDAL)

35. Good things that already have come out of the INPC State-wide EHR (Careweb) State-wide clinical messaging (Docs4Docs) Notifiable Condition Detector (http://1.usa.gov/1nqavgs)http://1.usa.gov/1nqavgs Statewide syndromic surveillance disease outbreak detection (http://1.usa.gov/1PrWQeC)http://1.usa.gov/1PrWQeC Public health broadcast alerting (http://1.usa.gov/1PI4stO)http://1.usa.gov/1PI4stO ED admission notification (http://bit.ly/1lAUDGa)http://bit.ly/1lAUDGa In-ambulance EHR access Reduced healthcare costs (http://1.usa.gov/1Wzu3dS)http://1.usa.gov/1Wzu3dS Providing data to support Accountable Care Organization management processes SSA disability verification Support of VA’s lifetime Electronic record (VLER) (http://1.usa.gov/1Tb5UdX)http://1.usa.gov/1Tb5UdX

36. The opportunities The data are already assembled. We can (and must) create value for all participants. Some specific ideas: data mining/analytics HIE-based patient portal data integration (eg health, environment, behavior) routing data into the clinical workflow HIE-based clinical decision support team-based care management the next HIE-based app …

37. Thank you! Let’s work together! We foster strategies, tools, technologies and people to support to create pathways for better health.

38. Discussion

39. Join us at our next workshops: February 23: Can we do better at achieving wellness? Leveraging HIT March 22: It’s all about YOU(r health): Personalizing care