Presentation by LIsa Suennen co-founder and Managing Partner of Psilos from January 2012 presentation at the Personalized Medicine Conference Silicon Valley CA
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
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.
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
Event driven evaluation of population to identify and assign to one or more group.Each group contains one or more potential opportunities.
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.
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.
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.
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.
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.
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