Sustainability, Health IT and Social Security Disability ... · March 3, 2016 Gina Clemons, PhD...
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Sustainability, Health IT and Social Security Disability March 3, 2016 Gina Clemons, PhD Associate Commissioner Office of Disability Policy Social Security Administration
Transcript of Sustainability, Health IT and Social Security Disability ... · March 3, 2016 Gina Clemons, PhD...
Sustainability, Health IT and Social Security Disability
March 3, 2016
Gina Clemons, PhD
Associate Commissioner
Office of Disability Policy
Social Security Administration
Conflict of Interest
Gina Clemons
Has no real or apparent conflicts of interest to report
Agenda
• Just The Facts
• It’s All About The Individual
• What’s In It For You
• We Need Your Help
• Q&A
Learning Objectives
• Describe the Social Security Administration value
proposition
• Describe how Social Security Administration and its
partners are exchanging data across the eHealth
Exchange
• Identify how healthcare organizations receive
benefit/value from exchanging clinical data with the
Social Security Administration
Benefits Realized for the Value of Health IT
http://www.himss.org/ValueSuite
• Patient Satisfaction,
Electronic Secure Data and
Savings
o Potential for claimants to
receive benefits sooner
o Reduced initial disability case
processing time by ~50% for
claims involving only health IT
sources (FY2016 to date)
Our Mission and Goals
• Mission:
o Provide timely benefits to the right individuals in the right
amount
• Goals: o Deliver services that meet the changing needs of the public
o Empower individuals with a disability
o Minimize financial hardship
o In line with the statutory intent
We must stay in step with changes in medicine, healthcare delivery, world of work, and technology
SSA Disability Programs
• Social Security Disability Insurance (SSDI)
o Pays benefits based on earnings
• Supplemental Security Income (SSI)
o Pays benefits based on financial need
• An approval of a disability claim leads to:
o Monthly cash benefits
o Potential quicker access to Medicare and Medicaid
o The difference between living in poverty or not
SSA Definition of Disability
• "Disability" under Social Security is defined as:
o The inability to perform substantial gainful activity
o Due to a medically determinable physical or mental impairment
o Which has lasted or is expected to last for at least one year or is expected to result in death
It’s all about the individual
By The Numbers
• 38 million people or 1-in-10 Americans live with severe disabilities
• 1-in-4 20-year-olds become disabled before retirement
• 14 million people get a Social Security disability benefit
• At the age of 55 within five years of the onset of their disabilities: o 1-in-5 men die
o 1-in-7 women die
No Two People Are Alike… Example of potential claimant (multiple chronic conditions):
• Recent Kidney and Liver Transplant
• Connective tissue disease
• Raynaud’s Disease
• Cystic Liver Disease with Esophageal Varices
• Polycystic Kidney Disease
• Uncontrolled Hypertension
• Cardiac complications
• Chronic Anemia
• Stage 5 End Stage Renal disease
• Ehlers Danlos Syndrome
No Two Medical Records Are Alike… • Specialists
o Nephrologist
o Cardiologist
o Geneticist
o Rheumatologist
• Complications o Hospital System
o ENT
o Optometrist
o Infectious Disease
• Routine Care o Primary Care
o GYN
o Chiropractor
o Acupuncturist
Annual Disability Statistics
• 3 million initial disability applications per year
• 1 million additional medical disability decisions
• Over 15 million requests for medical information each year
• 500,000 sources: doctors, hospitals
• $500 million in payment for medical information
Health IT is an Effective and Efficient way to do business
SSA Disability Determination Workflow
Claimant Social
Security Administration
Providers
Medical Information
Request
Medical Information File Disability Claim
Claim Determination
Disability Determination Process
Request
for
Medical
Records
Receipt &
Review
of
Medical
Records
Manual Process (Mail, Fax, Scan)
Weeks to Months
Application
Filing
Decision
Request
for
Medical
Records
Receipt &
Review
of
Medical
Records
Health IT Process
Seconds
to Minutes
Application
Filing
Decision Waiting
for
Medical
Records
Waiting
for
Medical
Records
SSA Commitment to Health IT
• SSA’s Vision 2025
“Through secure, direct access to electronic
medical records, we make a substantial number
of our disability determinations in only one day”
• Already realized on a small scale through our current
health IT partnerships
• Aim to make this the norm through expansion of health
IT partnerships
Health IT at Work in SSA
• Started leveraging health IT in 2008
• Interoperating with healthcare facilities in a majority
of states
o Healthcare Organizations
o Health Information Exchanges
o Federal Agencies
• Steady growth as we add health IT partners
What benefits has SSA seen by using Health IT?
• Automates request and receipt process
• Automates the payment process
• Displays medical evidence in standardized format
• Enables decision support
• Empowers data analytics
Enhances the accuracy and speed of our
disability decision-making processes
What does this mean to a healthcare provider?
• Payment for medical information
• Automated request and payment
• Potentially faster access to Medicare and Medicaid
may lead to recovery of uncompensated care
What could this mean to a patient?
• Faster disability claim determinations
• Quicker access to monthly cash benefits
• Earlier access to Medicare and/or Medicaid
• Potentially better health outcomes
What does it take to interoperate with SSA?
Rapidly growing network for securely sharing health information over the Internet
Shared Governance and Trust Agreement Common Standards, Specifications & Policies
Vendors
Federal Govt
States HIEs
Care Facilities
Where are we going?
• Support Our Existing Partners
• Partner Expansion
o Existing Partners
o New Partners
o Nationwide Saturation
• Expanding Our Capabilities
o Utilize technology to leverage information
o Quicker access to information
The individuals we serve could be all around you!
If you are interested in learning more
Visit SSA’s health IT website at
www.socialsecurity.gov/hit
Contact our health IT team at
Summary of Benefits Realized for the Value of Health IT
http://www.himss.org/ValueSuite
• Patient Satisfaction
o Potential for claimants to receive
benefits sooner
• Electronic Secure Data
o Enhances the accuracy and speed
of our disability decision-making
processes
• Savings
o Reduced initial disability case processing time by ~50% for
claims involving only health IT sources (FY2016 YTD Data)
Thank You
Gina Clemons, PhD
Associate Commissioner
Office of Disability Policy
Social Security Administration
