Becker's Hospital Review

51 "The way we deliver and pay for healthcare is unsustainable. Payers, pro- viders and employers — we all contributed to the problem, but we're all part of the solution." — John Santelli, CIO, UnitedHealth Group, and Executive Vice President, Optum Technology CIOs can lead the move to value By John Santelli, Chief Information Officer, UnitedHealth Group, and Executive Vice President, Optum Technology T he way we deliver and pay for healthcare is u n s u s t a i n a b l e . Payers, providers and employers — we all contributed to the problem, but we're all part of the solution. Health care can only get better if we're all working together. As the chief information officer at Eden Prairie, Minn.-based UnitedHealth Group and Optum®, I'm feeling what other CIOs are feeling. Cost trends, regulatory changes and consumer demands have changed the way my organization operates. We have always encouraged our payer and provider businesses to collaborate. But now more than ever, as quality and value-based care become more important, payer-provider collaboration is critical for success. CIOs can help make that collaboration a reality. Risk sharing between payers and providers doesn't work without data sharing, and CIOs are uniquely positioned to promote data sharing. Strategic CIOs are essential for today's health care industry Expectations for health care CIOs are changing. Our executive colleagues count on us to take on a larger leadership role. They look to us to extract value from our data in ways we haven't before and to be more strategic in our investments. Forward-thinking CIOs put consumers first, get better outcomes and actively manage risk. They require IT departments to think strategically in order to help their organizations develop an understanding of risks within their patient populations. This is what we have done here at Optum. We openly share longitudinally rich payer data as well as clinically deep provider data to identify and manage our members who need the most attention. Provider and payer CIOs face similar challenges Providers are still reeling from large EMR implementations. In many cases, these have been multiyear, multimillion- dollar efforts. Choosing an EMR can be a high-risk move, so CIOs invest a significant portion of their time to ensure its success. But the EMR effort has forced some provider CIOs into a transactional focus. To be more strategic, CIOs need to concentrate on getting good data into their systems and making the most of that data. Payers don't have the same kinds of "shop floor" challenges as providers. Payer CIOs deal with data management, data integration, data cleansing and data quality issues. Plus, their data is typically siloed in several platforms — medical benefits systems, pharmacy benefits systems and authorization systems — creating a fragmented view of the patient. Add to this the regulatory, privacy and turf-related issues of sharing data, and it's easy to see why payer- provider collaboration is rare. Given the challenges CIOs from both parties, it's clear why partnership is needed. CIOs can spark provider-payer collaboration When we focus on what brings the most Sponsored by:

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