Electronic Health Records and Digital Health - Benchmarking and Ecosystem Mapping - September 14th, 2021 - Smart Health Summit
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Electronic Health Records and Digital Health - Benchmarking and Ecosystem Mapping September 14th, 2021
Agenda
Today’s presentation aims to address the following
questions: 1 Brief OAS Introduction
• How well do we understand the current (and
future) eHealth industry solution capabilities? 2 State of the EHR and Digital Industry
• What tools and data would help us understand the
capabilities, how to integrate them in the current
3 Value and importance of monitoring and benchmarking
portfolio and what benefits should we be
expecting? 4 eHealth Map Preview
• To what extent is our approach and strategy
”Digital First”? 5 Potential Value for Ireland
6 Conclusion
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2
Optum is a health services innovation company
®
OUR MISSION
Helping people live healthier lives and helping make the health system work better for everyone
Ranked 5th $257.1B
of the Fortune 500 FY 2020 revenue
A diversified enterprise with
complementary yet distinct business
Health Benefits platforms Health Services
$136.3B
FY 2020 revenue
Our Businesses
OptumInsight OptumHealth OptumRx
Core Capabilities
Consumer Experience Clinical Expertise Embedded Technology Data and Analytics
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
3
Optum Advisory Services Profile
Optum Advisory Services is one of the largest healthcare consulting firms in the U.S. with over 1,400+
healthcare industry focused consultants.
55
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 4
Optum as a Care Delivery Organisation
52,000 primary care and specialty providers and growing.
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
5
Ireland & UK Capabilities
LETTERKENNY
LETTERKENNY
Business Claims Processing 278 Offering the capabilities of ~1,600 highly
Business Excellence 56 Health care claim and billing
operations, quality, clinical, educated & experienced industry experts
Optum Tech 128
reporting, payment operations,
Ireland Support Services 62 consulting and technology
Risk & Quality 33 resources. LONDON
Payment Integrity 97 Advisory 18.7
UHC Benefit Ops 199 Clinical 7.3
United Clinical Services 30 Health System Support 91.3
TOTAL 883 Product 11.8
ScriptSwitch 18.4
Technology 33.7
Dublin
Shared Services 17
Shared Services 34
TOTAL 198.2
Payment Integrity Ops 74
*Total includes FTE not directly aligned to R Sergeant
UHC M&R STARS 24
Automation 33
Risk & Quality 20
LONDON
Optum Tech 174
Providing health care services
OEA Analytic Solutions 48 throughout the UK to the NHS,
Rx (Pharmacy) 85 the UK’s single payer system.
Other (UHC, Global, EAP, Clinical) 48 DUBLIN Services include PHM,
Genomics, Referral Services,
TOTAL 540 Health care operations
Medicine management and
leadership, innovation centres,
optimisation, and Health Services
affordability and pharmacy
and Support.
services leadership teams, R&D,
product development.
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
6
Letterkenny Evolution
Optum Advisory Services driving the next phase
Next Gen.
Clinical Underwriting
The Letterkenny site has evolved over the last EHR
Affordability
20 years to become a leader in the fields of: Appeals &
Grievances
• Business Process Re-engineering
Vendor
• Business Process Outsourcing Management Claim Processing
• Complex Claims Adjudication
• Claims Appeals Processing
Shared
We need to leverage these capabilities as we
Services Enterprise Market
build out the delivery model for the Enterprise
Partnerships Process
Market Partnerships. Payment
Re-engineering
Integrity
Utilise Letterkenny to analyse, re-engineer and Quality
Managed Analytics
automate client processes. Risk
Optum Tech
Adjustment
Business
Excellence
Maintain “near-shore” feel for Automation
difficult-to-globalise operations such as
Underwriting.
Care Coordination
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
7
Digitalisation of Health: The EHR as an operating platform
We recognise the historical progression of EHRs and digital health and their increasingly strategic role as a
clinical, operational and even competitive enablers. Let’s look at how it’s been happening.
40% $3bn
$6.7bn
Healthcare Digitisation
National
Global Healthcare Digital
Policies
IT Growth 2017-2020 Q1 2020 Q1 2021
Role & Adoption
Innovation
Governments have increasingly Digital Health Funding: 2021
considered digital health as a core funding started on par with 2020
infrastructure component, and as until funding skyrocketed in
such, have increased funding and March 2021.
incentives.
Value & Benefits Source: Polestar Analysis Source: rockhealth.com
Realisation
COVID-19 is pushing the structural
barriers of digital and virtual health
EU:
$ 2-3%
adoption. eHealth has become the
most important technology
investment in our industry.
IRL:
0.6% Healthcare ICT
spending Ireland vs EU
Source: eHealth Strategy for Ireland / HSE Annual Report 2020
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
What’s an EHR?
EHR give clinicians the ability to access, document, and track health-related information throughout the continuum
of care using a centralised electronic system.
Connected
User Experience
Workflows
Data
Analytics
Interoperability
Extensions
The diagram above groups the key module or functions of a typical EHR. EHRs play a pivotal role in the digital
healthcare landscape and are the foundation on which clinical workflows are built. The EHR can help providers navigate
through care processes and pathways.
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
State of the EHR and Digital Health industry
The EHR market has evolved in major waves in the past 10-15 years as illustrated below. Following the
cycle discussed earlier, the EHR and digital health solutions have evolved; fueled by investments driven by
national policies and programs, and by the growing evidence of their benefits and additional potential.
Commercial, Integrated
EHR
From Best of Breed
departmental system and
In-House developed EHR + / EHR-as-innovation
Platform Model
Fueled by $50b EHR adoption incentives,
which has translated to over $1b/year R&D
investments by commercial vendors Fueled by $15b (and growing) / year
investments
Source: Rock Health Funding Report
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 10What will eHealth mean for Ireland in 3-5 years?
Health System of the Future eHealth Enablers
By 2023, up to 70% of ambulatory Integrated EHR will be increasingly augmented
Patients engaged in their health
visits, and 50% of overall encounters by innovative, specialised solutions
and will use technology to
will be virtual manage their health and behavior
More technologies will be
available to self-manage Providers will “prescribe
and diagnose the app” for digital therapy
Health Systems will be Providers will be collaborating in
reorganised to do virtual teams throughout the system
care, virtual hospital, hospital and will have access to
at home and remote patient increasingly sophisticated and
monitoring personalised evidence
Patient-Clinician relationship Chronic diseases
will be personalised monitored in real-time
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.Potential Value for Ireland and its eHealth Programs
The progressive adoption of EHRs and incremental digital tools will enable the current programs
EHR and Digital Health for:
✔ Public health (e.g., pandemic)
• Predictive modeling – capacity management
• Conditions Testing and Tracing
• Immunology administration management
✔ Share health records and care workflows between all facilities
✔ Improve Access Care
✔ Care Management
✔ Wellness and Prevention
Source: HSE Corporate Plan 2021-24, 2021
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 12Deeper Dive
Optum’s Vision for Integrated Care
Many health systems are seeking to provide more integrated care.
Current State Future State
• Siloed clinicians Benefits
• Clinics unable to co-ordinate care Primary Care
• Reduce and shift costs out of the
• Rise in older, sicker patient populations hospital and deliver care closer to
• Lack of access to care Post Acute Care Community Based the home
Providers Services
• Decrease hospital utilisation
Integrated
eHealth • Increase patient access
Primary Acute Specialty
Care Care Clinic Remote • Deliver the best care for patients
Consultations
by providing services in a timelier
Ambulatory Care way
Management
Hospital Based
Specialties
Source: National Service Plan, 2021
Source: Coulter A, et al., “Delivering Better Services for People with Long-Term Conditions,” The King’s Fund,2013 2 Advisory Board, 20183
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 13Importance of Monitoring and Benchmarking
The market for commercial EHRs has been maturing and consolidating, the broader digital health and
solution portfolio has been expanding at an exponential pace. It is challenging for all of us to keep up with
what is available, what is real versus what is aspirational, what works with the current portfolio, and what
benefits we can reliably expect.
Q1 top funded On-demand healthcare services
value Research and development catalysts
propositions Population health management
Treatment of disease
Consumer health information
Fitness and wellness
Q1 top funded Mental health
clinical Primary care
indications Substance use disorder
Oncology
Musculoskeletal
Gastrointestinal
Source: Rock Health Digital Health Venture Funding Database and analysis, data through
March 31, 2021
Most of the existing tracking and monitoring tools have been focused on the investments and financial aspects.
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 14Overview of Optum’s eHealth Ecosystem Mapping and
Benchmarking
Building on Optum’s collective assets and investments, we have been developing a registry and corresponding
tool that will help the industry stakeholders continuously monitor the available solutions and how they could be of
value to them.
Patient Experience
Chronic Care
Schedule Virtual Mngt
Encounters
Value Generation Care
Coordination Referrals
Direct and
Management
Guide
Adoption Tracking
Onboard & EHR Platform Connected
Solution Design Engage
Care
RPM
Capability (Solution) Wellness
Evidence &
Finances
Analytics
Existing: Investment
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.What it means for future of Ireland eHealth
One could anticipate that Ireland will follow a similar path as other countries and will accelerate the adoption of
EHR and digital health solutions.
Innovation and
Growth eHealth
Integrated Platform
eHealth
Program
Portfolio of eHealth
Solutions
Source: HSE Corporate Plan 2021-24, 2021
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 16Thank you
To discuss any of these topics further, please reach out.
CAROL CHOUINARD PAULA MULLEN
VP Digital Transformation Director of Consulting – Business Development
Optum Advisory Services Optum Advisory Services
chouinac@optum.com paula.mullen@optum.com
@cchouinard / @Global_HIT Mobile: 087-132-2219
Advancing care delivery innovation in 2021: C-suite executives share views on health care disruptions
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 17Appendix
Optum Partners with Health Systems in the eHealth Space
Overseeing capabilities in eHealth include -
Project Governance Organisational Workflow Analysis Clinical Leadership Virtual / In-Person ‘at Strategy Achieving Business
and Project Readiness and Walk Through and Sponsorship the elbow’ support Development and and Clinical Benefits
Management for EHR Implementation
implementation Planning
✔ Provide Physician IT ✔ Financial & Partnership ✔ Build out business
Leadership to work Models cases
with medical staff • EHR ✔ Value realisation for
around adoption and as-a-service expected benefits
change management • Affordability from EHR
Models
Clinically Led
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 19How We are different
Holistic, exclusive focus on health care Unparalleled data asset
We have deep relationships across the industry and We are uniquely positioned to align providers,
are committed to making the health care system work health plans and consumers using deep health
better for everyone. care intelligence.
9 out of 10 100K providers 4 out of 5 216M lives 222M+ ≈24,000 analytics
hospitals and practices and health of clinical lives of experts, spanning clinical,
count on us to other health care plans are and claims consumer financial, actuarial and
design and facilities are served served by OPTUM data data technology domains
deploy by our teams our teams ADVISORY
solutions SERVICES Innovative, end-to-end solutions
Combination of real-world and and partnerships
consulting experience Our services range from strategy and capabilities
Our team brings together both consulting expertise assessments to implementation support and
and extensive background in positions at provider technology, as well as outsourced analytics and
and payer organisations and includes data scientists, managed services. We work with you to design a
finance and C-suite executives, process engineers, customised, integrated suite of solutions. We view
clinicians and the only actuary practice in the United our partnerships as long-term collaborations and
States dedicated to the health system. are committed to performance transparency and
accountability.
1,135+ experts 110+ actuaries 25+ clinicians
As part of Optum, the Advisory Services team can draw on wide ranging experts, resources and capabilities.
HEALTH CARE STRATEGY AND OPERATIONS • HEALTH CARE DELIVERY • PHARMACY CARE SERVICES • LIFE SCIENCES • POPULATION HEALTH MANAGEMENT
© 2021 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 20Optum® is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions. All other brand or product names are the property of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer. © 2021 Optum, Inc. All rights reserved.
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