Collaboration Is the Key for Health Plans in a Shared Risk Environment Information Sharing Enables Health Plans to Leverage Data and Analytical Assets to Deliver Sustained Value

Executive Summary The Quest for Healthcare Value The shared-risk payment models that are central to health reform all require tight coordination among payers, providers, and patients if they are to succeed. As payers and providers enter into more and more such agreements, they need to enhance success by communicating and collaborating more effectively with their partners and actively engaging, supporting, and empowering their members. Healthcare payment reform is a widespread movement to create incentives that will produce greater value throughout the U.S. healthcare system. Value is generally...

Objective: Get Ahead of Risk to Achieve Value Obstacles to Collaboration and Engagement The challenge inherent in risk-sharing models is that patient status is constantly changing. Emergency room visits, acute illnesses, admissions, discharges, and other factors alter risk profiles and can happen at any time. The same holds true for changes to medication lists, new laboratory data, and shifting adherence to care plans. Therefore, in any risksharing arrangement, communication and access to comprehensive patient data are critical so that all parties can respond appropriately, in a coordinated fashion....

Connected Care Communities Are Built on a Foundation of Information Sharing Payer and provider organizations generally have made extensive investments in both operational and analytical information technologies. Many of these systems are capable of sending documents and data to one another, yet none is designed to bring together and share the full complement of health information required for collaboration and engagement, much less in a timely fashion compatible with care management workflows. Just as a bridge requires the right foundation to effectively connect physical communities, care communities...

Manage Care To manage care efficiently, whether for an individual or for a population, you need to automate information gathering and present the results to the care provider in a way that makes sense. The information exchange should enable this by including the following: Connections across the health and social care continuum — Traditionally, efforts to increase interoperability have concentrated on physician-office and hospital data exchange. A robust information exchange should also include prescription data, lab results, behavioral health records, claims, home care documentation, remote...

Mitigate Risk Optimize Engagement Risk comes in many forms — clinical, financial, and technical. It cannot be eliminated, but it can be mitigated. A health informatics platform should provide visibility to existing and potential risk, insight to manage it, and technology to limit it. Engagement is the active participation and collaboration that comes with genuine partnership across the care community. For providers, partnership strengthens relationships with patients, increases efficiency, and delivers meaningful measurements of value. For patients, partnership implies a culture of respect, transparency,...

InterSystems HealthShare The promise of healthcare reform is a healthcare system that delivers value for everyone involved. Transformation requires more than just technology, but care communities built upon a foundation of shared information have the power to deliver that vision and create sustained value. In KLAS’s Interface Engines Performance Report – May 2015, InterSystems performs above average in every performance category measured by KLAS, including implementation quality and timeliness. InterSystems technology powers: n InterSystems HealthShare software is designed for health plans and...

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