State Government

With healthcare becoming one of the highest fixed operating costs for businesses it has become a critical issue facing state governments. They face the challenge of working to achieve both the improved quality of healthcare delivered to citizens and the economic interests of the businesses that provide employment opportunities. States can use healthcare challenges and the attention it is receiving to support economic development focused on building healthcare innovations and create services that reduce costs. States now have the opportunity to establish themselves as the new homes for innovation in the growing industry developing around translational medicine to replace jobs lost to global competition and improve the quality of life for the citizens of their state.

Building an environment for healthcare innovation

States need to invest in the creation of a competitive clinical research infrastructure to attract funding from federal grants like the Clinical and Translational Science Awards (CTSA), become better sites for conducting clinical trials and investment by pharmaceutical companies, and to attract the leading scientists and physicians to their medical schools and academic medical centers. States who invest resources in the establishment of research infrastructure like data repositories and medical informatics programs can pursue significant returns in terms of establishing new tax revenue from medical and pharmaceutical companies as well as an increase in resources available to improve healthcare quality issues.

Most patient care is managed by independent private for profit and non-profit institutions, but state governments and associated institutions like state medical schools hold the key to creating a collaboration by managing the governance and resources to establish secure research infrastructures that cross boundaries while providing alignment of patient rights and the interests of participating providers.

Recombinant By Deloitte can help states to establish state wide research infrastructure projects:

• Creating and operating clinical research data repositories and tissue bank systems centered around state medical schools or research facilities that allow patient data and samples collected during the course of care to be included into an overall research process.
• Delivering implementations and support of open source translational research tools and genomic analysis applications that can make public and private repositories accessible to researchers working to make medical discoveries and bring new therapies and medical interventions to market.
• Supporting the legal and organizational issues needed for multi-site Institutional Review Board (IRB) processes and data governance challenges that come from crossing institutional boundaries
• Training local resources who manage, operate and support translational research infrastructure
• Establishing relationships between state initiatives and commercial entities like pharmaceutical companies looking to sponsor university research or execute clinical trials.

Supporting Quality Initiatives

Healthcare quality improvement at the state level requires broad collaboration among healthcare stakeholders including hospitals, health plans, purchasers, consumers, physicians and state agencies. By bringing together these organizations, tools can be established that use clinical data to measure quality, incent improvements, and communicate quality publicly to help consumers make more informed decisions. For example, each state should have reports publicly available that compare how different medical groups across the state treat the same type of illness or condition. With better visibility through surveillance and public Department of Public Health (DPH) reporting initiatives they can also establish state campaigns across stakeholders that are focused on the major health care issues facing their populations. Programs are dependent on a reliable clinical data repository. Recombinant By Deloitte can help establish and support these repositories and integrate them with research initiatives where appropriate.

State quality solutions include:

• Establishing quality data repositories and public web-based reporting tools to help measure care across sites and share information about effective quality improvement efforts.
• Most health care providers don't have an effective mechanism for using their electronic clinical data to improve quality. Programs like Doctor's Office Quality Information Technology (DOQ-IT) were established to support investment into Electronic Medical Record (EMR) applications. Recombinant By Deloitte can provide technologies and infrastructure to provide sufficient and secure analytic resources and standards for managing care for high cost populations and conditions.
• Creating state wide registries for chronic care and uninsured populations can reduce state costs by following evidence based practices

Driving Economic Development

• Attract clinical trials and pharmaceutical industry investment

• Participate in more federal research and quality improvement grants

• Reduce state health care costs per citizen

• Improve healthcare quality expectations and productivity of citizens

• Recruit leading scientists and physicians to universities and hospitals

Consortiums within states can establish consolidated data repositories by both integrating existing data warehouses at mature hospital sites and establishing new warehouses at sites to feed information into the consortium repository.

Using collaboration interfaces allows organizations to establish virtual repositories both with organizations outside of state boundaries and within organizations that are not able to combine data because of governance restrictions.