Perficient Healthcare Reform and Master Data ManagementSeren ie a technology solutions erlitiant ‘The drive for healthcare reform inthe United States illustrates on a macro level the need for a ‘change in how healthcare information is managed in order to facilitate proposed suggestions for reform. President Obama believes that heathcare needs tobe reformed to reduce long-term growth of healthcare cost for businesses and government. needs to protect families from bankruptcy or ebt and guarantee choice of doctors and heath plans. The President ls believes that the ‘eformed plan needs to invest in prevention and wellnes, improve patent safety and qualy of care and assure afordable, quality health coverage forall Americans Noted Harvard Business School professor Michael Porter believes reform must include requiring insurers to reveal how healthy ther subscribers ae, paying doctors based on the overall health of 2 patent instead of for each procedure, and geting several doctors ~ from primary cate to specialists ~ to work together in an integrated practice, turning a patients care into a team approach. No altruism is required: moving to value-based competition will benefit every participant in the system. Those who act early will benefit mos. Business Value Proposition ‘There isa competitive advantage, profitability and marketshare to be gained by the hospital or ‘consortium of providers who can offer a one-stop point of contact forall medical information and claimsPoling information connected to a medical incident. Patients who can count on this Service are more likely to choose your facilitypractce forthe services they require. Managing medical information and paying medical bills should not be more painful than the medial condition itsel! ‘alters Reform ond Marter Data Management + 2eran (Sane is Perficient Healthcare Management Technology Solutions There are a myriad of technology solutions available to support the healthcare management initiative, The problem is sonting through them ofigue out what works best for your particular Siuation and set of requirements. Choosing 2 sstams integrator thats wel versed inthe following technology solutions i an important step, Clinical Data Analytics A clinical data analytes system can aggregate information from a multitude of providers and provide a “dashboard” or comprehensive picture ofthe procedures performed over lime, medications prescribed and ater services periormed and treatment outcomes fora patient (along with associated billing and claims information) in ahistorical analysis context Business Intelligence and Reporting Tools Business Inteligence (8) applications use data gathered from a warehouse or a data mart to distil and decipher vast amounts of data to support business decisions. Common functions of Bl technologies are benchmarking, predictive analytics and performance: monitoring Master Data Management A Master Data Management (MDM) sytem specializes in managing patient information and product (supply) information and contract (insurance policy) information. A MDM Solution can aggregate information from a mulitude of providers, suppliers and plans to supply a “dashboard” of patient information in a realtime, transactional contest or historical, analytical context, MDM is a sub-clscipline of data architecture within I hat focuses on the management of reference or master data that is shared by several disparate IT systems and groups. MDM is required to enable consistent computing between diverse system architectures and business functions and is a key factor in controlling patient, provider and supplier information in order to enable nationwide healthcare ror, These facors ar critical components in managing healthcare naw and inthe Future, Atypical MDM solution footprint is fen complex and includes data governance, data quali, stealising business processes and integrating with dspaate systems TealicareRclorm and Marter Data Management V3Ey iene ee eo Perficient ‘The importance of integrated data Linking data between providers, plans and suppliers gives patiens and employers a wealth of information with which to make decisions. Providers, plans and suppliers can also use the same linked data to make their own business decisions and stream and processes from claims handling through payor processing, agnosis, weatment selection Builton a SOA foundation, the tools described above are the central mechanism in an enterprise information soation (ES) to connec interna, external and third party systems to share information, Services provide the “hook linking disparate systems iogether and provide the contact of what data i exchanged and wiat policies govem that data exchange Couple MDMWICA! tools with BPM tools for situations such as automating claims handling and payment processing, and you have avery powerful and expedient system, Past experience suggests that mare than 50 Percent of claims and payment requests ‘meet cerlain common criteria and can be processed without human intervention based on standard business logic Tealthvare Reform and Motor Data Management + 4ere ea Cao Porfisieat Patients and MDM. Patents today fae a sea of paperwork from healthcare vss, and even more when dealing with acute care (emergency rooms, surgery, et). Oe, each provider — surgeon, anesthetist, ratiologs, hospital ail, meal suply provide, et. —hasa separate bilng syste. When Patient look to investigate their own physicians and empower themselves, thee i no single place to find official infomation about a provide, ther success ates and the lke. Pains are often let to do their own research, With MDM providing the ink between providers, plans and patient history, patients can ‘Gather information on provider results and experience in medical conditions + Access a single source of information to view and pay medica bills by treatment, provider, and insurance and co-insurance payments Pulnaaaeasans fetes ferrre (aia Medicaid tae Incident Dashboard - John Tsar [oar Rew Sey Geren E Tana [ae TealhcareReforn and Master Oata Management) 5En eet Pea Sco eon Perficieat Providers and MDM Elecronic records and the ability o exchange and share information are indispensable and integral to excellent medical practice, Physicians wil limit effectiveness unless they wholeheartedly embrace 1? With MDM, providers can access: ‘© A dashboard of complete patient history records from all provers and suppliers to obtain a comprehensive history for each patient over a given time period Each dashboard entry is linked to the specific records for deeper information Health plan information can also be linked to each upcoming procedure to ensure the procedure is covered (and to what limit by the patent's health plan, andlor any associated limitations ERGs waseysen = Pete Geomatics fie te fe Patient Dashboard = John Smith oe ea ee [a fees TialhcreRoforn ed Maver Data Management + &Experts in delivering tame Cech ee Pertitieat eae For enhanced decision making when prescribing medication, a dashboard of clinical tral information across pharmaceutical and medical device suppliers provides comparison information coupled with patient history fr those types of drugs!supplies PROVIDER PERSPECTIVE ter fice Medication alternatives ~ Arthritis, a a cams [em me | om Genes Tae fm |e | om | ew istony yf |B om see nosis va Tiealthare Reform and Marter Gata Management + 7Perfici Health Plans and MDM? Pay providers for performance Wan fos (ete Goes + Simply, standardize, and eliminate paperwork and transactions = Use cross provider and cross plan claim templates for submiting claims and receiving consolidated payments. Eliminate proprietary, plan-provded claims: handling systems in use at each provider ‘+ Assist in managing members’ medical record by being able to share historical member claim information with providers + Move to single bls for episodes and cycles of care, with single prices = For example: A person building 2 home doesnt pay each sub contractor individually for each and ever task completed, but would pay a general contractor ‘who manages all he sub contractors, once the house is complete. So should medical treatment also be billed asa completed single job and paid accordingly Teac Reform and Maar Data Management + @Ear Teen) bs a Peace eo Perticieat Pete fant foe te ee Incident Dashboard — John Smith Tamar [oa ay] i [a p Tee ae sae Ye irs a ts ag [a] | Fe ie [eons [ew [Ow En Te [oes [amo Ye mw fea ee as ae Visitas Reform and Master Data Management > 3Suppliers and MDM* ‘Healthcare supplier can use evidence of long-term clinical outcomes and cost demonstrate value compared to alematve therapies + Suppliers can support provider ers to measure and improve result atthe medical concition level \With ICA, providers can analyze historical clinical dat to provide benchmarks for hospitals and medical group practices that enable meaningful comparisons of healthcare costs and outcomes ‘Operations and quality management Healthcare research using randomized clinical tials ATs sais Se Providers Tiealhcare Reform and Waster Data Management + 10Pertlcie Employers and MDM ‘+ With MDM, employers can select plans and plan administrator based on heath ests = A centralized data warehouse of detailed health plan data provides employers the ability o select plans based on factors suchas covered preventative care, whether ‘members of one plan withthe same concitions fare beter than members with another plan with ciferent coverage + Employers can provide independent information and advising services to employees + By tapping into provider and plan data warehouses using Bl and MDM, employers can provide employees a cental web-based dashboard of independent information Een ata aaa 3 fee a Sones Mecicare feed Employers Pian Comparison Dashboard Tie Toa [Oo Gene Tealthcare Reform apd Miter Dota Management + 71Ere te) cnetity technology solutions Pertigieat Government and MOM + Enact mandatory results reporting + Establish information collection and dissemination infastucture = Tools and fameworks such as ICA, Bl and MDM are essential to the information collection and dissemination process and providing Yone true source of data” + Develop standards for interoperability ofharcvare and software and standard for medical data ~ Messaging standards and vocabulary (1-7) ~ Laboratory Logical Observation Identifier and Name Codes (LOINC), _Systematized Nomenclature of Medical Clinical Terms (SNOMED-CT) = HIPAAT codes and messaging slandards forthe electronic data interchange of billing and administrative dat; national drug codes National Library of Medicine RxNorms + By using Extract, Transform, Load (ETL) features ofthe ICA, Bl and MDM frameworks, algorithms can be prepared to homogenize the data being shared between systems + Provide incentives for adoption of information technology. Smart cormpanies know they don't have to wait for government incentives; they know that tis just smart business to be prepared forthe requirements of healthcare reform Perficient Health Care Solution Benefits Through the use of innovative business process and technical service solutions, Perficient can dramatically enable your healthcare organization to realize is full potential and benefits and therefore enable the delivery of world-class healthcare services to your clients. Perficient wocks with you to examine where you are spending resources on handling inconsistent maser data, and then collaborates with business operations, physicians, insurers and IT to define smaser data and metrics. We have the experience to deliver results critica for success that can help your organization: ‘Create an enterprise “system of record” thal establishes master data asa corporate asset ‘© Make accurate decisions faster + Provide a single version ofthe truth that cries the dimension for healthcare reform + Create more cost-effective patientproviderinsurer relationships ‘ealthcare Reform and Waster Data Management + 2Pertisieat Start your journey in Patient Provier/Plan'SupplirEmployer (P3+SE) data integration today. CContact Perficient to find out more about our services in the followin + Information integration across hes architecture (SOA) standards and best practices care providerfplan sources using service-oriented + Reporting (dashboards, ad hoc, forecasting, etc) + Data Migration (data conversion, commissioning and decommissioning, system reconciliation) + Data Architecture data modeling, architecture design) «+ Program Management readiness assessments, requirements gathering, strategy) + Data Lifecycle Management The Author Lisa Moisi a Technical Architect in Perficient’ IBM Advanced Technology Solutions (ATS), practice. She isan SOA and MOM architect and designer with more than 25 yeas’ IT industry experience perticien.com (810) 659.8515 "pies ik apni "hpi etc "inp edateupiesk * inpiwwesadufenplyetaa * pw binadtcpenmentn Tealthcare Reform aed Manor Data Management 13