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Healthcare IT and Healthcare Services:
The New Personalized Medicine Frontier
Healthcare Is Undergoing Massive Change




                 “I’m afraid you’ve had a paradigm shift.”

PMWC 1-23-12                       CONFIDENTIAL              2
The Consumer Has Arrived




                                      “Whoa—way too much information.”


PMWC 1-23-12                  CONFIDENTIAL                               3
And Where There is an Active Consumer

   There is personalization…..




                                                …and a growing
                                                demand for
                                                micro-
                                                segmentation

PMWC 1-23-12                     CONFIDENTIAL                4
Personalized Medicine:
                    Not Just for Ph.D.s Anymore

    Traditionally considered the bailiwick of biotech
     pharma and genetics

    Becoming a core focus of the healthcare
     services and healthcare information technology sectors
               –   Customized delivery systems
               –   Care management programs
               –   Analytics and ―big data‖
               –   Mobile health and consumer engagement
               –   Quantified self—where worlds collide




PMWC 1-23-12                               CONFIDENTIAL       5
Personalized Medicine is Conceptually
                  Aligned with Health Reform
        Engages consumer in the healthcare process--a good thing
               − Healthcare exchanges will engage consumer in cost considerations
               − Consumers will buy personalized health plans (UHG diabetes health plan)
               − Fosters prevention and wellness incentives
        Reduces use of unnecessary resources (e.g., lowers cost) to assist in
         payer/provider risk management
               − Faster, better screening & diagnosis
               − Advances prevention and chronic care management strategies
               − Potentially reduces hospitalization and re-hospitalization
        Aligned with concepts of:
               − Pay-for-performance
               − Comparative effectiveness
        Reinforces value of healthcare IT
               − Electronic, integrated patient record
               − Analytics and decision support

PMWC 1-23-12                                    CONFIDENTIAL                           6
Personalized Medicine in the
               Healthcare IT/Services world

   Systems that:
    Allow for multiple points of access to the healthcare system based
     on specific consumer circumstances (clinic, home, office, hospital,
     assisted living, you name it)
    Rely on input from patients and providers to create fuller user
     experiences
    Track symptoms and use predictive analytics to predict trends/risks
    Enable tracking/monitoring of exactly what is desired
    Enable personalized treatment plans, highly tunable based on
     continuous loop feedback
    Foster community around target diseases and behaviors
    Customizable security to enable sharing with your posse
    Accessible anywhere (especially mobile)


PMWC 1-23-12                       CONFIDENTIAL                            7
3 Case Studies

                        The challenge: Disease management has failed
                        to reduce costs, improve outcome
                        The solution: Personalized chronic care
                        management

                        The challenge: Benefit design has been one-size-
                        fits-all
                        The solution: Personalized dynamic benefit
                        design that incentivizes better health

                        The challenge: Wound care undermanaged,
                        highly variable in sub-acute settings
                        The solution: Customized would care program

PMWC 1-23-12                     CONFIDENTIAL                          8
HealthEdge/C4C: Population Grouping

                Claims


                  PHR




                                                      Grouping Rules
                  EMR                                                                                            Group B


                 EPHR


                  PBM                                                                                Group A                   Group C


               Biometrics


                Devices



               Combination of heterogeneous data                       Group membership can trigger additional evaluation to
               sources provides robust data-set for                    refine and personalize.
               individual evaluation

PMWC 1-23-12                                                                  CONFIDENTIAL                                               9
HealthEdge/C4C:
               Assessment & Refinement


                                                                     Care Opportunity



                         Group B                                     Care Opportunity



                                                                     Care Opportunity

               Group A             Group C                  Assess

                                                                     Care Opportunity



                                                                     Care Opportunity
                       General
                     Assessment
                                                                     Care Opportunity



PMWC 1-23-12                                 CONFIDENTIAL                               10
HealthEdge/C4C: Personal Care Plan


                                                          Personalized Care Plan
               Care Opportunity
                                                           Care Opportunity

                                                             Action       Barrier
               Care Opportunity
                                                           Care Opportunity

               Care Opportunity                              Action       Barrier
                                     Barrier
                                  Identification
                                                           Care Opportunity
               Care Opportunity                              Action       Barrier



               Care Opportunity                            Care Opportunity

                                                             Action      Barrier

               Care Opportunity



PMWC 1-23-12                               CONFIDENTIAL                             11
HealthEdge/C4C: Outcomes & Feedback

        Personalized Care Plan
                                     Trend analysis drives rule refinement
           Care Opportunity

               Action    Barrier                         Claims

                                                          PHR
           Care Opportunity




                                                                             Grouping Rules
                                                          EMR
                                                                                                  Group
               Action    Barrier                                                                    B
                                   Outcome
                                                          EPHR
                                   Tracking
          Care Opportunity                                PBM
                                                                                              Group       Group
                                                                                                A           C
               Action    Barrier                        Biometerics


                                                         Devices

          Care Opportunity

               Action    Barrier




PMWC 1-23-12                                             CONFIDENTIAL                                             12
SeeChange: Value-Based Benefit Design

              The Value-Based Benefit Design program is designed to foster
               customized health plans that encourage prevention and wellness.

               − Comprehensive health risk analysis of a client population

               − Creation of customized Health Action plans for individuals regardless of
                 current health status

               − Identification of high risk chronic conditions (pre-diabetes, diabetes,
                 asthma, etc.) coupled with condition-specific Health Action plans

               − Incentive and engagement platform that offers financial rewards for
                 completing assigned actions

               − Online portal that informs, engages, and motivates individuals




PMWC 1-23-12                                      CONFIDENTIAL                              13
SeeChange Health: Making it Work

    Subscriber & Spouse voluntarily complete Preventive Health
    Actions to receive financial incentives




                                          +
                                                                                                  *Preventive Health




               Health Questionnaire       Biometric Screening*
                                                                    +    Preventive Examination*
                                                                                                      Actions are
                                                                                                    covered 100%
                                                                                                   based on age &
                                                                                                    gender specific
                                                                                                      guidelines




           =          Enhanced Benefits       Health Incentive Account        Deductible Credit
                                                      Deposits

PMWC 1-23-12                                         CONFIDENTIAL                                               14
SeeChange: Schematic of Benefit Design

                 Member

        Member          Member



                               No                   Standard Benefit Plan
               Fill out PHR                                 70/30
                                                       $200 Deductible                                                      100% Coverage, No
                                                                                                                           Deductible for Chronic
               Yes                                                                                                             Illness Care


           Standard Plan with
        Deductible reduced by $500
                                                                                                                                       Yes

  No
                                                                                                                   Followed?



               Bio Metric        Yes                                                       Yes         Care
                                        80/20 Benefit and               Chronic                  Recommendations
                testing
                                       Wellness Incentives             Condition?                    Provided
               Completed



                                                                        No                                            No




PMWC 1-23-12                                                                CONFIDENTIAL                                                            15
SeeChange:
               Personalized Health Action Plans




PMWC 1-23-12                   CONFIDENTIAL       16
SeeChange: Employer Success Story

              Despite increased utilization of these services, overall employer costs per
               member per month dropped 8.9% from Year 1 to Year 2

              Excluding claims in excess of $100,000, claims PMPM dropped 7.7%

                $500                                                                          Year 1
                                                                                              Year 2
                                 $433

                                                 $394                    $399
                $400
                                                                                     $368




                $300




                $200
                                        All in                         Excluding over $100K




PMWC 1-23-12                                            CONFIDENTIAL                                   17
PolyRemedy: Integrated IT & Services for
                     Personalized Wound Care




                                               Standardized Assessment
                                               Protocol-driven software tool




               Real-Time Alerts, Reports and                                         Home Delivery of
                  Outcomes Assessment                                              Personalized Dressings
                                                                               Customized size, shape and function
                                                                                      PHMB antimicrobial

PMWC 1-23-12                                              CONFIDENTIAL                                               18
PolyRemedy: 15% Improved Healing;
                   48% Reduced Resources

                   Wound Healing Progress                                        HHA Patient Visits Per Wound
100%                                          92%
                                                                         16
                                                                                  14.4
 90%                  80%                                                14
 80%                                          17%
                                                                         12         3.8
 70%                  27%
 60%                                                                     10         1.9
 50%                                                                      8                                   7.4
 40%                                          75%                         6                                   1.7
                                                                                                              0.3
 30%                  53%                                                           8.7
                                                                          4
 20%                                                                                                          5.4
 10%                                                                      2
  0%                                                                      0
                   PWS Initial          PWS 9 Months                           PWS Initial            PWS 9 Months
               100% Healed       Healing Progress                                Nurse        Aide      WOCN


  * Data as reported in PWS by Customer on a total of 108 wounds. Data summarizes mix of patients, overall health status
    and wound types.

PMWC 1-23-12                                              CONFIDENTIAL                                                     19
In Conclusion

    Personalization is a trend that will touch every part of
     healthcare
    Healthcare IT and healthcare services are primary
     tools in fostering personalized medicine…and we
     don’t have to wait for any scientific discovery
               – In other words, little to no FDA risk
               – Broad opportunity to impact quality and cost right now
    Market potential is the entire universe of Americans,
     particularly as 30 million new people enter the ranks
     of the insured
    Success stories are already starting to accumulate


PMWC 1-23-12                              CONFIDENTIAL                    20

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Healthcare IT and Healthcare Services: The New Personalized Medicine Frontier

  • 1. Healthcare IT and Healthcare Services: The New Personalized Medicine Frontier
  • 2. Healthcare Is Undergoing Massive Change “I’m afraid you’ve had a paradigm shift.” PMWC 1-23-12 CONFIDENTIAL 2
  • 3. The Consumer Has Arrived “Whoa—way too much information.” PMWC 1-23-12 CONFIDENTIAL 3
  • 4. And Where There is an Active Consumer There is personalization….. …and a growing demand for micro- segmentation PMWC 1-23-12 CONFIDENTIAL 4
  • 5. Personalized Medicine: Not Just for Ph.D.s Anymore  Traditionally considered the bailiwick of biotech pharma and genetics  Becoming a core focus of the healthcare services and healthcare information technology sectors – Customized delivery systems – Care management programs – Analytics and ―big data‖ – Mobile health and consumer engagement – Quantified self—where worlds collide PMWC 1-23-12 CONFIDENTIAL 5
  • 6. Personalized Medicine is Conceptually Aligned with Health Reform  Engages consumer in the healthcare process--a good thing − Healthcare exchanges will engage consumer in cost considerations − Consumers will buy personalized health plans (UHG diabetes health plan) − Fosters prevention and wellness incentives  Reduces use of unnecessary resources (e.g., lowers cost) to assist in payer/provider risk management − Faster, better screening & diagnosis − Advances prevention and chronic care management strategies − Potentially reduces hospitalization and re-hospitalization  Aligned with concepts of: − Pay-for-performance − Comparative effectiveness  Reinforces value of healthcare IT − Electronic, integrated patient record − Analytics and decision support PMWC 1-23-12 CONFIDENTIAL 6
  • 7. Personalized Medicine in the Healthcare IT/Services world Systems that:  Allow for multiple points of access to the healthcare system based on specific consumer circumstances (clinic, home, office, hospital, assisted living, you name it)  Rely on input from patients and providers to create fuller user experiences  Track symptoms and use predictive analytics to predict trends/risks  Enable tracking/monitoring of exactly what is desired  Enable personalized treatment plans, highly tunable based on continuous loop feedback  Foster community around target diseases and behaviors  Customizable security to enable sharing with your posse  Accessible anywhere (especially mobile) PMWC 1-23-12 CONFIDENTIAL 7
  • 8. 3 Case Studies The challenge: Disease management has failed to reduce costs, improve outcome The solution: Personalized chronic care management The challenge: Benefit design has been one-size- fits-all The solution: Personalized dynamic benefit design that incentivizes better health The challenge: Wound care undermanaged, highly variable in sub-acute settings The solution: Customized would care program PMWC 1-23-12 CONFIDENTIAL 8
  • 9. HealthEdge/C4C: Population Grouping Claims PHR Grouping Rules EMR Group B EPHR PBM Group A Group C Biometrics Devices Combination of heterogeneous data Group membership can trigger additional evaluation to sources provides robust data-set for refine and personalize. individual evaluation PMWC 1-23-12 CONFIDENTIAL 9
  • 10. HealthEdge/C4C: Assessment & Refinement Care Opportunity Group B Care Opportunity Care Opportunity Group A Group C Assess Care Opportunity Care Opportunity General Assessment Care Opportunity PMWC 1-23-12 CONFIDENTIAL 10
  • 11. HealthEdge/C4C: Personal Care Plan Personalized Care Plan Care Opportunity Care Opportunity Action Barrier Care Opportunity Care Opportunity Care Opportunity Action Barrier Barrier Identification Care Opportunity Care Opportunity Action Barrier Care Opportunity Care Opportunity Action Barrier Care Opportunity PMWC 1-23-12 CONFIDENTIAL 11
  • 12. HealthEdge/C4C: Outcomes & Feedback Personalized Care Plan Trend analysis drives rule refinement Care Opportunity Action Barrier Claims PHR Care Opportunity Grouping Rules EMR Group Action Barrier B Outcome EPHR Tracking Care Opportunity PBM Group Group A C Action Barrier Biometerics Devices Care Opportunity Action Barrier PMWC 1-23-12 CONFIDENTIAL 12
  • 13. SeeChange: Value-Based Benefit Design  The Value-Based Benefit Design program is designed to foster customized health plans that encourage prevention and wellness. − Comprehensive health risk analysis of a client population − Creation of customized Health Action plans for individuals regardless of current health status − Identification of high risk chronic conditions (pre-diabetes, diabetes, asthma, etc.) coupled with condition-specific Health Action plans − Incentive and engagement platform that offers financial rewards for completing assigned actions − Online portal that informs, engages, and motivates individuals PMWC 1-23-12 CONFIDENTIAL 13
  • 14. SeeChange Health: Making it Work Subscriber & Spouse voluntarily complete Preventive Health Actions to receive financial incentives + *Preventive Health Health Questionnaire Biometric Screening* + Preventive Examination* Actions are covered 100% based on age & gender specific guidelines = Enhanced Benefits Health Incentive Account Deductible Credit Deposits PMWC 1-23-12 CONFIDENTIAL 14
  • 15. SeeChange: Schematic of Benefit Design Member Member Member No Standard Benefit Plan Fill out PHR 70/30 $200 Deductible 100% Coverage, No Deductible for Chronic Yes Illness Care Standard Plan with Deductible reduced by $500 Yes No Followed? Bio Metric Yes Yes Care 80/20 Benefit and Chronic Recommendations testing Wellness Incentives Condition? Provided Completed No No PMWC 1-23-12 CONFIDENTIAL 15
  • 16. SeeChange: Personalized Health Action Plans PMWC 1-23-12 CONFIDENTIAL 16
  • 17. SeeChange: Employer Success Story  Despite increased utilization of these services, overall employer costs per member per month dropped 8.9% from Year 1 to Year 2  Excluding claims in excess of $100,000, claims PMPM dropped 7.7% $500 Year 1 Year 2 $433 $394 $399 $400 $368 $300 $200 All in Excluding over $100K PMWC 1-23-12 CONFIDENTIAL 17
  • 18. PolyRemedy: Integrated IT & Services for Personalized Wound Care Standardized Assessment Protocol-driven software tool Real-Time Alerts, Reports and Home Delivery of Outcomes Assessment Personalized Dressings Customized size, shape and function PHMB antimicrobial PMWC 1-23-12 CONFIDENTIAL 18
  • 19. PolyRemedy: 15% Improved Healing; 48% Reduced Resources Wound Healing Progress HHA Patient Visits Per Wound 100% 92% 16 14.4 90% 80% 14 80% 17% 12 3.8 70% 27% 60% 10 1.9 50% 8 7.4 40% 75% 6 1.7 0.3 30% 53% 8.7 4 20% 5.4 10% 2 0% 0 PWS Initial PWS 9 Months PWS Initial PWS 9 Months 100% Healed Healing Progress Nurse Aide WOCN * Data as reported in PWS by Customer on a total of 108 wounds. Data summarizes mix of patients, overall health status and wound types. PMWC 1-23-12 CONFIDENTIAL 19
  • 20. In Conclusion  Personalization is a trend that will touch every part of healthcare  Healthcare IT and healthcare services are primary tools in fostering personalized medicine…and we don’t have to wait for any scientific discovery – In other words, little to no FDA risk – Broad opportunity to impact quality and cost right now  Market potential is the entire universe of Americans, particularly as 30 million new people enter the ranks of the insured  Success stories are already starting to accumulate PMWC 1-23-12 CONFIDENTIAL 20

Notes de l'éditeur

  1. One thing everyone knows is that consumer are becoming far more active in the purchasing and decision-making of healthcare. For the first time beginning to take a more active role, whether forced through financial circumstance (employers adopting HRAs), legislation (HIX) or through abundance of communicationMore HRA/HSA means more knowledge of how dollars are spent; it is well documented that patients make choices with economic considerations in mind when the money is “theirs”Explosion of consumer-directed health programs, websites, applications, etc Even home genetic testing is beginning to change the way patients think about their encounters with the healthcare system. Recent discussions about PSA testing were very interesting as every article featured consumers on both sides of the issue.Development of insurance products that more actively engage the consumer are showing signs that they actually work (SeeChange Health)Rise of mobile health market offers promise as business models evolve (PSS goes to the home)—new study says that 26% of adults have used their smart phone to access health information within the past 12 months.
  2. HealthEdge/C4C:SeeChange: Health care costs and premiums continue to rise. On average, workers pay $4,129 and employers pay $10,944 toward annual premiumsShort-term savings from cost shifting adversely affects long-term population healthCurrent system does not always encourage use of high value medical servicesApproximately 70% of all health care costs are due to lifestyle choices and are therefore preventableFour conditions account for 74% of American health care costs: cardiovascular disease, cancer, diabetes, and obesity
  3. Event driven evaluation of population to identify and assign to one or more group.Each group contains one or more potential opportunities.
  4. A group in this case is a group of people with common identifying markers and/or disease states (rules can be used to define anything as a group).  A person can be in more than one group. The  markers and disease groupings trigger opportunities based on clinical rules. Rules aren't restricted to disease state, but can be arbitrarily defined by the rule. Each group contains one or more assessment to be administered by a clinician.The clinician activates appropriate opportunities from identified group, and adds more based on interview and evaluation of level of need.The activated Opportunities create the basis for a personalized plan of care.
  5. Each opportunity has associated goals and actions designed to meet the goal. This is the plan of care.Further interaction with the participant and additional data mining identifies an individuals barriers to goals (e.g. transportation or physical limitation). Barriers identified result in personalized opportunities and actions to alleviate barriers.The collection of an individuals opportunities for disease states and gaps in care, and the plans to alleviate associated barriers creates a plan of care tailored to the needs of the individual.
  6. Completion of actions within a care plan defines the outcome of a given opportunity. Outcome tracking provides a feedback loop to the grouping rules to dynamically adjust group participation. Analytics performed on outcomes provides trend and “what if” analysis to further refine identification and intervention rules.
  7. Value-based insurance is intended to meaningfully integrated wellness + prevention with insurance benefit in a tightly integrated way.Lots of a la carte programs out there, but nothing else quite like this.
  8. 100% of beneficiaries encouraged to see their doctor for a check up; becomes the basis for data in the system.Ideas is to get people to use their prevention + wellness benefits.
  9. PWS integrates three components to standardize clinical work flows, driving consistency Care nurse uses web-application to conduct standardized assessment. Protocol defines optimal properties, size and shape of advanced dressingDressing can be optimized for absorbancy, oxygenation and other factors Personalized dressing is fabricated, labeled single unit dose for patient, FedEx to patient’s home Protocol consistency enables quality data in mini-registry to drive quality improvement and alerts to escalate outliers