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Massachusetts HealthCare System

Transformation through Technology

2005 Progress Report

Ed Esposito, Vice PresidentBlue Cross Blue Shield of Massachusetts

PEP-2400 (3/05)

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Highlights From Last yearHighlights 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.”

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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 SystemToday’s Health Care System

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eHealth Initiatives

Strategic AlignmentStrategic 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 BCBSMA 2005 Goals:Goals:

BCBSMA

Collaborative

CommunityCollaborative

eVisits (RelayHealthTM)

e-Prescribing (eRx Collaborative)

MedsInfo

MDS Pilots

Mass eHealth Collaborative

(MAeHC)

Transformation of the Healthcare System

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e-Health Visione-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

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eHealth VisioneHealth 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

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The e-Rx CollaborativeThe 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

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Adoption ProgressAdoption Progress

Total eRx Collaborative Electronic Scripts Per Month

050000100000150000200000250000300000350000

Elec

troni

c Scr

ipts

Q3 2005 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 2004

•1/1/05-10/1/05: 1,768,082•1/1/04-10/1/04: 177,512

•Over 64,000 scripts sent electronically per week

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ePrescribing BenefitsePrescribing 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

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My Health My Health RecordsRecords

Massachusetts eHealth Collaborative Massachusetts eHealth Collaborative

(MAeHC)(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.

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MAeHC Participating OrganizationsMAeHC 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

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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 Massachusetts eHealth Collaborative (MAeHC) Vision(MAeHC) Vision

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MAeHC PilotsMAeHC 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

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• 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?

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Adoption

THREE KEYS TO PILOT THREE KEYS TO PILOT PROGRAM 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

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3 DOWN, (AT LEAST) 32 TO GO3 DOWN, (AT LEAST) 32 TO GO

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Q and AQ and A