It’s 2020 and healthcare is at a crossroads. Will this be the tipping point in the transformation of care or are we in for yet-another decade of radical change and resistance? Here's six key trends that I think are likely to tip the scales and shape the healthcare business model of the new era.

1. Six Healthcare Trends to Watch in 2020
January 21st, 2020
©2020 Amitech Solutions1

2. 1. Value-Based Care Reaches a
Tipping Point
As regulatory requirements become clearer and
more stable, and data begins to show tangible ROI,
VBC is poised to reach a tipping point in 2020.
How is the market responding?
Employers as Activists
• Fed up with ever-growing cost-burdensand unclear ROI, a new wave of
"employer activists" have begun to work together to negotiatecontract prices
and set up privateprovider networks to take care of their own employees at
more manageablecosts. Recent researchsuggests nearly half of employers
have already implemented a high-performancenetwork, center of
excellence or private/preferredhealth center or plan to do so by 2022.
Increase in Payor-Provider Partnership
• There is a trend of increased collaboration betweenpayorsand providersto
enter into more risk sharing arrangementsand launch truly innovativeco-
branded products/jointventures. In 2018 alone, of the 27 new products that
hit the market, 70% were joint ventured/co-branded products that are
designed to improve quality and access to care.
Data + Analytics Driving Better Care
• Surveys have shown that hospitalsparticipatingin VBC models are investing
more on data, analyticsand pop health tools than their peers. There is
a significant increase in combining patientdata from all sources and applying
AI and Deep Learning algorithms to spot populationtrends, identify high risk
patientsor measure clinicaloutcomes to improve qualityand cost of care.
Amitech helped one client find success in this area by developing a risk
model to identify patients that are likely to get readmitted within 30 days
and issue a discharge plan that had interventionsto reduce readmissions.
©2020 Amitech Solutions
2 Source: Healthcare Payment Learning and Action Network
23%
29%
34%
35.80%
38.50% 39%
41%
43%
46%
53%
60%
0%
10%
20%
30%
40%
50%
60%
70%
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Value Based Payment Trend (% of total dollars)

3. 2. Retailization of Care
Pressure to Manage Costs and Meet Higher
Patient/Consumer Expectations is Pushing Care out
of Traditional Settings.
The growing demand to provide a more “consumer-friendly” experience
and cut costs is driving care out of traditional,high-cost settings
(hospitals, specialty treatment centers/suites) into less formal and more
affordable options.
How is the market responding?
The Rise of Retail Clinics and Urgent Care Centers
• Largely driven by convenienceand sensitivity to cost, the growth of retail
clinicsand urgent care centers haveskyrocketed in the last decade. It is
projected that their appeal to consumers will continue to grow as they
cement their status as credible providersof care with powerful brand
recognition.Accordingto the NIH, the potential annual cost savings of
shifting care from ER’s to retail clinics and urgent care centers is $4.4B.
Shift to Lower-Cost Facilities
• For their abilityto offer greater convenienceat often-drasticallylower costs,
ambulatorysurgical centers, retail clinicsand urgent care centers are
increasingly replacingthe dominanceof traditionalcare settings for
treatments, procedures and post-acute care. For example,the cost of a
cataract extraction can be 42% less in an AmbulatorySurgery Center than
the same procedurein a hospital outpatient department.
Telehealth
• Today’spatientis increasinglycomfortable with virtual care alternatives
includingvideo chat and mobile applications,which serve as an effective,
convenientand low-cost option.As continuedmergers exacerbate the issue
of access to care in rural areas, telemedicine presents a cost-efficient and
workable middle-ground.In the last several years, Americans’use of
telehealth more than doubled, outpacing growth in use of urgent care
centers, retail clinics, ambulatory surgery centersand ERs.
©2020 Amitech Solutions
3 Source: https://www.ucaoa.org/LinkClick.aspx?fileticket=m3Bg5772Y-Q%3D&portalid=80
6400 6496
7271
7639
8100
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2014 2015 2016 2017 2018
NumberofUCC
Year
Urgent Care Centers Trends
Number of Urgent Care Centers

4. 3. Care Model Innovation
Rising Focus on Quality & Value Makes Promoting
Wellness and Care Management a Win-Win for
Payors.
By helping members become healthierand preventingthe onset of
sickness and disease in the first place, payorsface lower risk of
incurring expensive costs while commanding more in
reimbursements as a result of betteroutcomes.
How is the market responding?
Digital Healthcare Innovation
• Innovation intechnologywith AI powered chatbots, video visits,
teleconferences and physicianaccess to datavia connected devices are
helping to fuel the trend to deliver more health care in the home rather
than in the hospitaland doctor’soffice. We will see a continued increase
in VC funding in 2020 for startups like Doctolib, Babylon Health and
Wedoctor in the digital health space to make healthcare more
accessible and continue to change the care model.
Social Determinants of Health
• An increasing number of the US health systems and commercial payors
will utilize "social determinant"dataof some type in making risk
assessments, patient outreach and health decisionsfor patients. Denver
Health is partnering with the Denver Housing Authority to convert a
shuttered 10-story building on the hospital campus into affordable
senior housingto transition homelesspatients out of the hospital and
provide a case manager to assist patients with their physical and
behavioral health needs.
Focus on Well-Care
• Providers will need to continueto redesign their care delivery model to
align the services they offer and the team that deliversthem with the
focus on well-care and spending more time with patients, havingtimely
coordination ofcare—from primary care to specialist to nutritionsupport
to physicaltherapy—andkeeping the health issues in front on the right
provider.
©2020 Amitech Solutions
4 Source: Milken Institute
$0
$10
$20
$30
$40
$50
$60
$70
$80
Cancer Heart DiseaseHypertension Mental
Disorder
Diabetes Pulmonary
Conditions
Stroke
Avoidable ChronicConditions TreatmentCosts
Projectionfor 2023 in Billions – Total $217.6B
Avoidable Chronic Conditions Treatment Costs Projection for 2023

5. 4. Ever-Growing MA Market
A Unique Combo of Factors make the Medicare
Advantage Market a Key Opportunity for Growth.
With 22 million MA enrollees in 2019 and continuedgrowth in
the aging baby boomer population,rare bi-partisansupport and
comparablyfavorablemarginsmake the Medicare AdvantageMarket
a key opportunityfor growth.
How is the market responding?
Medicare for All will Give Way to Medicare Advantage for All
• Enrollmentin MedicareAdvantage(MA) has nearly doubledin size in the
last decade and gained popularity.In this election year, more candidates
are going to pivot from controversial“Medicarefor All” to a compelling
alternativeof Medicare Advantagefor All.
Innovation in MA (SDOH + Chronic Illness)
• CMS announcedthat starting in 2020, MA planswill be allowedto offer
supplemental,“non-primarilyhealth-related”benefitsto help certain
eligiblechronicallyill patientswith unmet social needs. Thiscould play a
big role in managing the healthof seniors and lowering utilizationcosts.
For example,Alignment Healthcare has announced new options that
include Grandkids on demand, $10-$20 per month grocery benefits and
free transportation via Uber or Lyft to get to Doctor’s appointments.
Proactive Risk Management – Primary Care for Seniors
• New clinicalmodels in MA that take full risks and operate as a physicianled
primary care practice are improving qualityof care, increasing access and
lowering utilizationcosts. We expect an increasein this new kind of
senior-centeredprimarycare facility designed to manage Senior patients
with high risksand chronic conditions and improve care-coordination.For
example ChenMed, Iora Health, and CareMoreHealth are seeing
tremendousgrowth and are having a significant impact on quality and
cost of care.
©2020 Amitech Solutions5 Source: Kaiser Family Foundation’s analysis of CMS Office of Enterprise Data and Analytics
https://www.kff.org/medicare/fact-sheet/medicare-advantage/
15.7
16.8
17.6
19
20.4
22
0
5
10
15
20
25
2014 2015 2016 2017 2018 2019
Enrolleesinmillions
Year
Medicare Advantage Enrollment Trends
Medicare Advantage Enrollment

6. 5. Rx Price Pressure
The use of Prescription Drugs in the United States
is a Critical Factor Affecting Health Outcomes of
Americans.
Net total spending on prescription drugs is expected to reach $405-
$435 billionin 2023 up from $344 billionin 2018. Patient out-of-
pocket costs have been rising as well from $56 billionin 2014 to $61
billionin 2018, increasing abandonmentrate to 31.2% in commercial
and 27.1% in Medicare patientswith a more than $50 out-of-pocket
expense.
How is the market responding?
Price Transparency
• In May 2018, the Trump administrationintroducedthe Patient First BluePrint
for drug price transparency to bring down drug prices. Even though the courts
ruled that HHS didn’t haveauthority to mandate that drug manufacturers
disclose list price on TV ads, 22 states have introduced legislation promoting
greater transparencyfrom drug manufacturers aroundtheir drug pricing
method.
Specialty Pharmacy
• Specialty pharmacy is growing rapidlyand becoming a significant consideration
for health systems and manufacturersacross the United States. Specialty
pharmacy spend is expected to reach $500B by 2020 and is getting a lot of
attentionfrom payors. New payorstrategies include increases in pre-
authorizationrequirements,tightening limits on which specialty drugs they’ll
pay for, where and how patientscan receive their specialty prescriptions.
From Volume to Value - “Beyond the Pill”
• A move toward value-basedarrangements in pharmaceuticalsis a positivestep
toward creating a more sustainablehealthcaresystem. But this will require
broader changes in pharmaceuticalbusiness modelsthan many anticipate. As
an example, Amgen entered a collaboration in 2017 with Humana to facilitate
researchon real-world evidence. The program has since expanded with other
Cancer Institutes, Cancer Centersand Universitiesto enhance cancer symptom
management support via connected technologies.
©2020 Amitech Solutions
6 Source: CMS national health expenditure data for private health insurance
IQVIA Formulary Impact Analyzer; IQVIA Analysis, Dec 2018
2% 1.90%
3.20%
4.40%
5.00%
5.80%
0%
1%
2%
3%
4%
5%
6%
7%
2018 2019 2020 2021 2022 2022
Retail Prescription Drug Spending Growth
Retail Prescription Drug Spending Growth

7. 6. The Changing Future of Work
Data, Analytics and Automation Technologies are
Transforming How Healthcare Works for Patients,
Payors and Providers.
How is the market responding?
Man and Machine Working Together in Patient Care
• As automationbegins to lift the administrativeburden on clinical
providers, nurses and physicianswill be able to devote more time and
attentionto patient care and advocacy. RPA-driven improvementsin
quality,speed and accuracy of documentation andadministrativetasks in
care settings can make a life-saving difference. One study found that
increased automation of medical recordsand documentationin hospital
stays led to a 15% decrease in the odds of in-patient deaths.
AI and ML in Care Management
• Advancedanalytics and machine learning solutionsare hitting back
against some of the most persistent and challengingissues in healthcare.
New predictive modelsoffer providersa powerful new way to identify
high-risk factors in time to make a meaningful difference for patients.
Through a custom developed ML model to predict pregnancies at riskfor
low birthweight, Amitech was able to identify 2,600 more at-risk
pregnancies per year for a potential medical cost-savings of $8.3M.
Expanding Access with AI
• Using AI for virtual visits and pre-visit information collectionwith patients
is already expandingaccess to an increasinglylimited number of
clinicians.Providing more timely and convenientaccess for patients
means improved care, higher volumes and increased patientsatisfaction.
In the rural communitiesserved by Winona Health, RPA and AI provide
a convenient way for more than 1,000 patients to use Smart Exams and
increase access to services without any increases in staffing.
©2020 Amitech Solutions7 Source: https://www.aha.org/system/files/media/file/2019/09/Market_Insights_AI_Workforce_2.pdf
https://www.uipath.com/solutions/whitepapers/robotic-process-automation-in-healthcare-sector
of healthcare executives
say that by 2022, every
employee will have bots
to help them do their
work
Research suggests
up to
60% of task-based work in
healthcare can be
automated
68%

8. Recap
1. Value-Based Care Reaches a Tipping Point
2. Retailization of Care
3. Care Model Innovation
4. Growing MA market
5. Rx Price Pressure
6. The Changing Future of Work
©2020 Amitech Solutions
8

9. Questions & Answers
©2020 Amitech Solutions9

10. ©2020 Amitech Solutions
10
Thank You!
Amit Bhagat - Amitech
Chief Executive Officer
Amit.Bhagat@AmitechSolutions.com
Paul Boal - Amitech
Vice President of Delivery
Paul.Boal@AmitechSolutions.com