Louisville Health Information Exchange, Inc'

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Louisville Health Information Exchange, Inc.

• General Presentation August 22, 2006

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Vision

• To contain rising costs and improve quality of
  healthcare in the Louisville area by providing
  consumers and their providers anytime, anywhere
  access to complete healthcare information and
  decision-support.

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Healthcare Challenges
Rising Costs
Sub-Par Outcomes

• US spending almost twice what most developed
  counties spend (15 GDP) but ranks 37th in
  health factors (longevity etc.)
• Rising type II diabetes incidence.
• Rising untreated asthma incidence
• Rising un and under-insured populations.
• emergency room over-utilization

Medicare / Seniors Medicaid/Safetynet Employers
and Employees
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Substantial Cost Containment Potential through
eHealth While improving Quality

• For a 1.1 million population metro as much as
  480 million of current healthcare costs could
  potentially be contained. Examples
• 22 million hospitalizations (caused by adverse
  drug reactions).
• 50 million of unnecessary prescriptions.
• 44 million in duplicate tests/procedures.
• 50 cents per transaction on tens of millions of
  fax/paper/phone messages.
• Millions through incentivizing smarter consumer
  behaviors.
• All of these savings could also improve care
  quality and outcomes.

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Proposed Business Model Approach

• Health Record Banking Model
• Central Data Repository
• Two types of services
• Consumer services
• Consumer gets card which can receive money
• Payment for service bundled into benefits
  pricing.
• Consumer accesses/owns data, HIPAA is our friend.
  
• Financial incentives from payers/employers to
  consumers (aligned with consumer driven
  healthcare trend)
• Commercial Services (to Providers, payers,
  researchers, etc.)
• Clinical Messaging, data exchange services, etc.
• Help physicians get eHRS ASAP with discounted
  eHRS, incentives/support from Payers/Employers.
  
• All of Louisville metro included. Go big
  launch with 500,000 people Medicaid, Medicare,
  Employers/Employees all co-fund
• Phased start-up strategy
• Services to payers/providers/physicians to start
  - to build infrastructure leading to consumer
  services.

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A Vision for Louisville
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LouHIE Business Model v. 7-30-06
Consumer Benefits Discount on mthly benefits
contribution Rebates for healthy
behaviorsRebates for smart health shopping (e.g.
discounted MRIs) Use card to pay co-paysFree
personalized health reminders Discounts/coupons,
etc. (e.g. fitness club)
Healthcare Consumer
Benefits Sponsor (Employer, Insurer/ASO,
Medicaid, Medicare)
Data Withdrawals
Data Deposits
Svc. Fees Incentives
Incentives
Electronic Data Interface
Researchers Pharma, Public Health, Etc.
Consumer Permission
Electronic Drugs (PBMs) Lab Radiology Hosp Disch.
Summary Physician Visit Record eVisit Claims
LouHIE
Administrative TPAs, Processors, Employers
Health Record Bank
Providers Physicians Hospitals Clinical Pharmacie
s eVisit Disease Mgmt Web Portals

Provider Permission
Fax Data Interface
Fax/Scan Lab Radiology Physician Visit Record


Incentives
Operating Revenues
Bank Svc. Fees
Physician/Hosp. Benefits Better info at point
of care Better after-visit communications
incentives for using EMRs for care Reduced cost
of chart storageEMR volume pricing/incentives
Cost of Operations
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Start-up Plan
Mth 25
Mth 1-6
Mt 7-12
Mth 13-24
Organize Est 375,000
Install Infrastructure TBD
Drugs, Labs Radiology
Consumer Services

• Organize Staff
• Legal Framework
• Physician eHR Program
• Start-up Plan

• Choose vendor
• Launch service
• Pre-populate consumer records
• Prepare for next phase

• Implement drugs, labs, radiology services
• Pre-populate consumer records
• Prepare for next phase

• Bundle services payment into benefits plan
• Offer service free
• Start rebates/ incentives

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Start-up Funding Approach

• Employers/Payers (who will save money), pay
• Platinum, Gold, Silver Memberships (special
  deals/discounts on service in future)
• Fees for services
• For-Profit Operating Partner Company
• Pays part of LouHIE operating costs.

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Who is LouHIE?

• 501(c)4 not-for-profit (KY)
• Community-based board of directors
• Research and facilitation by UofL SPHIS
• Website www.louhie.org

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Appendix Examples of Potential Cost Containment
for Louisville