Collaborating for Patient Centric Healthcare - Atos|Syntel

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Collaborating for Patient Centric Healthcare - Atos|Syntel
APPLICATIONS
                A   WHITE    PAPER    SERIES

          PATIENT CENTRIC CARE IS AT THE CORE OF NEARLY
          EVERY DEBATE IN HEALTHCARE. THIS PAPER
          TALKS ABOUT THE CHANGES THAT INDUSTRY
          STAKEHOLDERS NEED TO UNDERGO IN ORDER TO
          ACHIEVE THE GOAL OF TRUE PATIENT CENTRICITY.

Collaborating for Patient Centric Healthcare
Collaborating for Patient Centric Healthcare - Atos|Syntel
TABLE OF CONTENTS
1    INTRODUCTION
2    HEALTHCARE REFORMS – USHERING REAL CHANGE
3    RELOOK AT THE CARE ECOSYSTEM – A FUTURISTIC OULOOK
4    ATOS SYNTEL SERVICES ALIGNED FOR CARE ENABLERS
5    MARKET MAP
6    CONCLUSION
7    REFERENCES

    Introduction

     “Is the change in healthcare for real?” is a question that has become a refrain in the US healthcare
     community for a while now. At the first look the answer seems like there is no real change as US
     healthcare expenditure is rising and is likely to reach 21% of GDP by 2021.1 In fact, the Federal
     Healthcare spending is expected to increase to 28% by 2016, up from the current 23% (2012).2 A
     certain segment of the industry continues to believe that a lot of current initiatives are nothing but
     ‘old wine in a new bottle’. However, deeper analysis shows that the cost curve has started bending
     – as National health expenditures rose just 3.8 percent from August 2011 to August 2012, and
     Medicare spending increased by only 3.2 percent (significantly lower than the four decade average
     of 10%) in the fiscal year ending September 2012.3 We can hence conclude that some change is
     happening in patient care.

     ©2018 SYNTEL, INC.
Collaborating for Patient Centric Healthcare - Atos|Syntel
The difference lies in the approach with which healthcare is being handled. Since long healthcare stakeholders are working within well defined
boundaries and have strict definitions of roles each stakeholder has to play. Careful analysis of recent trends indicate that the tenets of patient
centricity (access, enhanced care delivery, member and provider engagement and transparency ) have been established by the industry and
collaborative efforts are being put to achieve that. Efforts are mooted to transform from transactional B2B model to a more holistic B2C model.
Processes are being viewed from an enterprise level instead of individual system level. The focus is now on service value than volumes. In addition,
a truly disruptive change is the cross industry collaboration in the form of Payer-Provider, Payer-Government or Payer-Employer coming together
for an effective change.

2. Healthcare Reforms – Ushering Real Change
American Healthcare is experiencing a rapid change which is likely to redefine the way business is conducted and services are delivered. Current
trends could be termed as disruptive of the old order and the near future could see many basic definitions rewritten and adopting new meaning.
These contemporary trends are redefining the way business is conducted, giving a big thrust to Patient Centric care.

   • New models of care delivery like Accountable Care Organization (ACO) and Patient Centred Medical Homes (PCMH) are emerging as
     competition to traditional business. By 2014, it is estimated that nearly 30% of private payers will acquire provider arms, which would boost
     these emerging delivery models. Adoption of newer payment methodologies that reward quality, as against volumes and ones that reflect
     more outcome based payment structures will gain wider acceptance.
   • Reforms led thrust towards retail business, driven largely by individual market growth, is estimated to grow significantly between 2010 and
     2019. Shift from defined benefits to defined contribution model is yet another thrust towards individual business.
   • The shift in focus from B2B to B2C model is pushing payers to develop expertise around ‘know your member initiatives’ by deriving
     intelligence from clinical, non clinical, social and behavioural data streams.
   • Opening up of Exchange driven market is pushing payers to create differentiation in terms of pricing, service, quality, and provider network.
   • Leveraging alternative channels of care including Retail Clinics, Primary Care Outfits, Triage, and Telemedicine is on the rise.
   • Shift from transactional to transformation business model is helping business create market differentiation as compared to commodity
     services player
   • Expanding service portfolio by diversifying into related businesses; member experiences and perceptions would be influencers here.
   • Greater adoption of technology, for example, meaningful use driven adoption of Electronic Medical Record (EMR) technologies.
   • New delivery models focused on outcomes and cost/ quality based reimbursements driving intense focus on drug efficacy (unregulated
     pharmaceutical market) and results. For example, cut in expected spend of branded drugs by 4.3%.

  Fast Facts
      • An estimated 31 million Americans are said to be taking care from ACOS.4
      • Individual Market will triple between 2010 and 2019. 10
      • Approximately $214 billion cuts in Medicare expenditure
      • Beginning in 2015, a 300-bed hospital with poor quality metrics could be penalized by more than $1.3 million per year. 10
      • Pharmaceutical industry though an unregulated market, Health reform changes will cut into expected spending on brand-name drugs
        by 4.3%.10
      • An estimated $5 billion savings is expected from the Medicare Shared Savings Program through 2013 – 2019 as per the Congressional
        Budget Office. 11
Collaborating for Patient Centric Healthcare - Atos|Syntel
3. Relook at the Care Ecosystem – A Futuristic Outlook
Current systems of care delivery are throwing up multiple interpretations of how best to address the demands exerted by:
  • Efficiency, cost and quality linked directives by the government
  • Accountability sought by employers
  • Discerning member to select best suited options of care
Primary stakeholders continue to drive internal efficiencies, but inter-stakeholder collaboration will be required to drive outcomes and business
sustenance. Payers are emerging as key protagonists in the new scenario and assume the role of “care enablers” where they are the primary drivers
of care delivery.

            Government                    Cost and Quality                                      Employee progress               Employer
 •   Exchange led competition             Control Outcomes                                           Report           • Cost and Quality conscious
 •   ICD led specificity                                                                                                treatment
 •   MLR driven efficiency                                                                                            • SLA based Care Management
 •   Universal Coverage                                      Payers (Care Enablers)                                   • Defined Contribution
 •   Subsidy driven Compliance                       • Consolidated Member View
 •   Reduced payouts for Medicare                    • Efficient BAU operations
 •   Focus on accountable treatment                  • Focus on Individuals
                                                     • Technology Adoption in Provider networks
                                                     • Alternate channels of Care - Retail Clinics,
                                                       Primary care outfits, Triage,
                                                     • Innovative Reimbursement models

                                                         EMR                           • Drug Efficacy
                                                         Performance                   • Market
                                                         Data Care                       Segmentation
                                                         Enablement                    • Member
                                                                                         Health
                                                                                         Outcomes
                                              Providers                 Patient                       Pharmaceutical and
                                            (Care Owners)                                                Life Sciences
                              •   Transparency in Care reporting                         •   Integrating Medical devices in
                                                                       • Medical
                              •   Meaningful use driven adoption of      Device              Care Management
                                  EMR                                    Utilization     •   Outcomes research to showcase
                              •   ACO driven Provider consolidation    • Drug                long term savings
                              •   Incentive based reimbursement          Efficacy        •   Newer channels of marketing and
                              •   Shift in ownership of the Care                             communicating to Providers and
                                  Continuum - Primary to Tertiary                            Members
                                                                                         •   Greater Market segmentation
                                                                                             and drug research
                                                                                             customization

                                                     Futuristic Outlook of the Healthcare Ecosystem

There are various issues that need to be considered in order to assess the preparedness towards meeting the goals of patient centric care such as:
Is my core engine ready to scale up to meet the growing needs of the market?
With growth in individual line of business along with influx of Medicare and Medicaid population, systems need to be scalable, have streamlined
operations, capable of managing new models of delivery and payment reimbursement.

Steps towards system modernization and / or consolidation efforts would be required to address these challenges. Additionally, it calls for
equipping “care owners” with appropriate infrastructure by rendering integrated network management, performance management, and enrolment
management solutions.

 “Move work to the experts” could be a useful process change to streamline utility functions such as medical coding compliance, HCC audits etc.
Do I know my member well, or do I need more data for better insight?
From constructing a wellness program to successfully managing interventions and care management programs, the need for reliable, insightful,
comprehensive and actionable is critical. The data points to the acute need of a consolidated member view spanning across multiple data sources
- clinical, non clinical, drugs related, social media, behavioural information, medical device feeds extensible to future data sources.
Is my member view dictated by LOB considerations?
Collaborating for Patient Centric Healthcare - Atos|Syntel
Payers need to ensure that they break down the Line of Business (LOB) silos across their systems, thereby enabling an Integrated Care
Management approach in terms of intervention programs, disease management, case management and wellness programs.

It is the same with providers irrespective of inpatient, outpatient or speciality services, there needs to be an integrated member service line.

Are my partners enabled to service member better – are they technology / data enabled?
Health information exchanges provide an opportunity for an integrated EMR system to establish a patient-centric environment thereby
promoting better communication and collaboration among clinicians and staff throughout the organization. This coupled with evidence based
medicine act as effective enablers driving care quality

Acknowledging the view that specialty drug costs have to be seen in the context of overall health outcomes, it is important that pharmaceuticals
companies be privy to data outcomes to enable delivery of better products tuned to the market segment being served.

Sharing of outcomes and trends data between pharmaceutical industry and other stakeholders to enable customized and targeted drug research.

Have I tapped into alternate channels of treatment?
With rising cost pressures, payers need to track and measure the effectiveness of wellness programs and intervention management programs.
Available alternative channels of care include retail clinics, primary care outfits, triage, home medical devices and telemedicine; moving towards
24x7 services.

All pervasive implementation will support early warning signs ensuring timely care intervention and effective utilization of provider services

Am I reporting on outcomes?
The success of care initiatives depends on outcomes based approach and an effective tracking and reporting mechanism of member’s health
progression. This allows for required intervention at appropriate stages.

4. Atos Syntel Services Aligned for Care Enablers
Aos Syntel services can help strengthen the goal of
improved Patient Centric Care through its range of
services and solutions for care enablers. Some of
                                                                                                                                         Regulatory
these offerings include:
                                                              Legacy             iTAP                  COBO           nSure10              Signa One
                                                            Modernization      Integrated             Automated ICD10 Business            MU Compliance
                                                                                  Test                 Migrator and Technology             Dashboard
                                                                               Accelartor                 of       Solutions
                                                                                Platform               Cogns
                                                                                                       Reports

                                                                              BPTR                      PTF
                                                                              Business              Performance
                                                                              Process                  Testing
                                                                                Test                 Framework
                                                                             Repository

                                                                            Clinical Data             ElicitAR       Smart Move
                                                                            Provenance               Healthcare    Cross Platform
                                                                                                       Claims       Technology
                                                                                                    Data Analytics                                        Know your
                                                                            HL7 Gateway                                                                   Consumer
                                                                                                                                    Consumer 3600
                                                                                            Dicom

                                                                            Smart Map               Smart Data                             ConText
                                                                          Automated                  Data Quality                          Sentiment
                                                                         Documentation              Enriching Tool                        Analysis Tool
                                                                             Tool

                                                                               Data
                                                                            Enablement

                                                                                                          Atos Syntel Services Aligned for Care Enablers
5. Market Map
Critical enablers to patient centric care and readiness (as available from public sources) of WellPoint and Aetna towards them have been
compared in the below table

                                                       WellPoint (Known
     Enablers to Patient Centric Care                                                              Aetna (Known Initiatives)
                                                          Initiatives)
                                Primary Care      Launched the PC2 Initiative         Collaborating with Nova Health
  Collaboration with Care      Secondary Care Acquired Care More                      Collaborating with Carilion Clinics
         Owners
                                                  Launched multiple ACO               Collaborating with Baylor Health,
                                Teritary Care
                                                  initiatives                         Aurora Health etc
 Health information Exchange Enabler              Not known from Public Sources       Medicity to enabled data exchange and integration
 Triage                                           Not known from Public Sources       iTriage enabled
                                                                                      iNexx can support care coordination exchange of
 EMR/EHR Enablement for Provider                  Not known from Public Sources
                                                                                      office notes
 Evidence Based Medicine                          Collaborating to enable EBM         Not known from Public Sources
 Detailed Member View                             Not known from Public Sources       Not known from Public Sources
 Central Population health Management             Not known from Public Sources       Active Health Management
 Back End Service Support                         Not known from Public Sources       Providing back end support to collaborating Providers
 Collaboration with Pharmaceutical Industry       Not known from Public Sources       Not known from Public Sources

                                                          Collaboration         Acquisition

6. Conclusion
Though the churn has begun, the goal of patient centricity would remain a distant dream, unless there is a metamorphosis of the roles of each
stakeholder in the industry.

Government is playing the role of primary stimulator instead of being just regulator of healthcare. Working example of this is the shared savings
program, which has been a big push for tiered models of care to get prominence in the industry.

Similarly, healthcare payers will have to take up the role of ‘care enablers’. They being the goldmines of data, knowhow and having the intent.

Providers now need a technology enabled transformation from their traditional role to a more encompassing role of ‘care owners’.

While the pharmaceutical industry is not yet governed by a central drug pricing body, it will need to be more responsible and transparent on drug
research and pricing. Collaboration with other stakeholders especially, in light of new model of delivery and reimbursement is vital to ensure the
right drug reaches the right patient.

Employers will take up the role of secondary stimulators to ensure that employees receive the required health cover bending the healthcare cost
curve.
7. References
 •   Health-Care Spending to Reach 20% of U.S. Economy by 2021
 •   Federal Spending Estimates
 •   Health Sector Economic Indicators, Center for Sustainable Health Spending
 •   ACOs deliver care to 31 million Americans
 •   Healthcare Payers Must Embrace a New Business Model to Manage Disruptive Change, Robert Booz, 2012
 •   Predicts 2012: U.S. Healthcare Payers Must Focus on Business Models, Consumer Outreach and Analytics, Christina Lucero, Robert
     Booz, 2012
 •   Findings: Healthcare CIOs Must Ensure That Data Warehouse Skill Gaps Don't Derail This Key Priority, Vi Shaffer, 2010
 •   Framework for Making Patient-Centered Care Front and Center, Sarah M Greene, 2012
 •   Hype Cycle for Healthcare Payers, Robert Booz, 2012
 •   Health reform: Prospering in a post, PwC Health Research Institute
 •   ACOs: Controlling Costs while Improving Care
 •   Aetna Building National ACO Network
 •   Aetna Accountable Care Solutions
 •   Accountable Care Organizations: Overview and Pilots
 •   WellPoint to Buy CareMore Health Group for $800 million
about Us:
                                   Atos Syntel is a leading global provider of integrated information
                                   technology and knowledge process services. Atos Syntel helps global
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                                   with deep domain knowledge.

                                   To learn more, visit us at www.atos-syntel.net

For more information, visit us at www.atos-syntel.net
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