August 26, 2010

Transparency in Healthcare Miriam Paramore, SVP Strategy & Government Affairs

2

Emdeon: A Leader inToday’s National Health Information Network

Providers

HealthcareInformation

PBM Services ePrescribing

RCM & PaymentDistribution

Payers

Patients

Pharmacies

350,000

55,000

1,200

155 million

5 billion

Emdeon – We make healthcare efficient.

efficient healthcare

Emdeon – We make healthcare efficient.

1. Reduce Cost

2. Improve Quality

Transparency in Healthcare

Emdeon – We make healthcare efficient.

What is Transparency Hard?

Price

1. Healthcare is not retail – there is no price at the point of service

2. What a hospital charges is not the “price”

3. What an insurance company pays is the “price”

4. But the consumer can’t buy at that “price”

Quality

1. Data is not digital

2. Lack of standards means even digital data is meaningless

3. There is no good clinical information exchange

4. Consumer-friendly communication of medical terms is difficult

Everybody is asking the same question…

HIMSS Financial Systems Steering Committee

6 Public-Private Collaborations

7 State & Local Initiatives

5 Value Driven Healthcare Initiatives

3 Business Coalitions

Total = 21 separate initiatives

Biopsy 11000 Average Rates by State

Analysis data metricsERAs from 31 payers, Dec2007-Feb 2008 36 million claims $23 billion in charges 146,841providers 13.5 million insured 101,450 procedure / modifier combinations 725 average good estimates per state

Key rounded to nearest $10

YEA219

NAY212

March 21, 2010

HIT Over the Next 5 Years

Oct. 2010

Hospitals will receive payments from Medicare and Medicaid for the successful implementation and effective use of EHRs.

J an. 2011

Adoption incentives will be activated for eligible healthcare providers

J an. 2011

Covered entities should begin

internal activities.

The Secretary shall promulgate a final rule to establish a unique health plan identifier.

Oct. 2012

Oct. 2013

The compliance deadline for all

covered entities

Eligibility for a Health Plan and Health Care Claim Status Operating Rules effective.

J an. 2013

J an. 2014

Electronic funds Transfers and Health Care Payment and Remittance Advice Operating Rules effective.

J an. 2016

All remaining HI PAA Transaction Operating Rules effective.

The Secretary shall promulgate a final rule to establish a standard for electronic funds transfers.

J an. 2014

J an. 2016

The Secretary shall promulgate a final rule to establish a standard and single set of operating rules for health care claims attachments.

Covered entities should begin internal testing.

J an. 2010

Covered entities should achieve Level 1 compliance and begin Level 2 activities and deployment.

Dec. 2010

The compliance deadline for all covered entities.

J an. 2012

2010 2011 2012 2013 2014 2015 2016-2022

Begin High Level Activities

(awareness, communication,

education, impact assessment,

strategy)

Internal Activities -Development, internal testing, production, readiness

Begin I nternal Testing Begin External Testing and move to

production Initiate payment reduction to Medicare hospitals and eligible professionals that fail to adopt

EHRs

Adopt new versions of standards and operating rules in more timely manner. Current thought is ~ 3years as needed.6020 could be adopted in ~ Nov. 2010.

EHR Timeline PPACA TimelinesICD-10 Timeline5010/ D.0 Timeline

Quick Poll

How many of you can email your doctor?

Name 2 other people that you can’t email…

Emdeon is a Ubiquitous Platform for the NHIN

Emdeon – We make healthcare efficient. 10

NHIN Direct

Emdeon

X

I’ll take an e-copy of my records please…

http://www.youtube.com/watch?v=UlGXTyIipZA&feature=player_embedded