2. Confidential and Proprietary2
Purchasers buy health care
that is fundamentally more
affordable, higher quality,
more convenient and
satisfying, based on value
The local health care ecosystem is accountable for care of the population
holistically, and the care of individuals is collaboratively managed across
the care continuum, focusing on quality, affordability and satisfaction
The population’s health needs
are well understood,
individuals at risk are identified
and the health care system’s
performance is continuously
measured
Providers collaborate to provide
patient-centered team-based
care and are compensated on
performance and value, rather
than volume
Individuals and their caregivers
are actively engaged, interacting
though convenient mobile tools
with social support
Healthagen, a division of Aetna, vision for
population health
3. Confidential and Proprietary3
Key value drivers for population health
Population Health Technology
CARE
MANAGEMENT
ACCOUNTABLE
CARE
PATIENT
ENGAGEMENT
OPERATIONAL
INTELLIGENCE
CLINICAL
INTEGRATION
4. PATIENT
ENGAGEMENT
CARE
MANAGEMENT
CLINICAL
INTEGRATION
OPERATIONAL
INTELLIGENCE
ACCOUNTABLE
CARE
• Integration with unique
EMRs and Health IT
systems
• Intuitive collaboration
tools and user interfaces
• Community patient
records deployment
• Secure message
notifications
• Referral management
• Transitions in care
• System performance
monitoring
• Longitudinal view into a
given patient or
population
• Evidence-based medicine
rules engine and
notifications
• Population risk
stratification, disease
registries
• Gaps in care, alerts
• Reporting (cost,
utilization, quality,
provider performance)
• Medical care
management
• Wellness programs
• Alternate site care
• Medication management
• Patient portal, PHR
• Decision support
• Access, registration and
appointments
• Wellness, disease
management programs
• Social caregiving
• e-Visits
• Education
• Financial/bill
management
• Business transformation
services
• Value-based contracting
• Financial models
alignment and
modernization
• TPA administration
• Provider-led health plan
insurance products
• Marketing and
distribution
• Consulting
• Patient centered medical
homes
• ACO enablement
POPULATION HEALTH TECHNOLOGY & SERVICES
Population health management:
products & services
Confidential and Proprietary4
5. 5
Population health management:
products & services
HEALTH
INFORMATION
EXCHANGE
CARE
MANAGEMENT
CLINICAL
INTEGRATION
ACCOUNTABLE
CARE
OPERATIONAL
INTELLIGENCE
CLINICAL
ANALYTICS
EMPLOYEE
WELLNESS
ACCOUNTABLE
CARE
PATIENT
CENTERED
MEDICAL HOME
EMPLOYER
SPONSORED
CLINICS
CARE
MANAGEMENT
& WELLNESS
CARE
COORDINATION
NEONATAL
SOLUTIONS
SOCIAL
CAREGIVING
COST
COMPARISON
MOBILE
HEALTH
NeoCarePATIENT
ENGAGEMENT
A Healthagen Business
A Healthagen Business A Healthagen Business
A Healthagen Business A Healthagen Business A Healthagen Business
A Healthagen Business A Healthagen Business
A Healthagen BusinessA Healthagen BusinessA Healthagen BusinessA Healthagen Business
POPULATIONHEALTHTECHNOLOGY&SERVICES
Confidential and Proprietary
6. Confidential and Proprietary6
Healthagen population health management
entities
Healthagen Business Synopsis
Comprehensive Population Health Technology and Analytics stack, and largest Health
Information Exchange in the U.S.
Leading mobile patient engagement platform, providing decision support and tools for
individuals to access and navigate the health care system
One of largest providers of care management, disease management, health and wellness
services; driven by clinical intelligence and active analytics
Decision support tools for consumers to select a provider based on transparent cost
information
Social caregiving platform; allows elderly and debilitated patients to remain independent
longer by enabling caregiver support and collaboration
Social caregiving platform for families of NICU babies that integrates care management and
social support during NICU stay and post-acute phase
Personalization framework to integrate wellness programs around the unique needs of the
individual
Accountable Care enablement and management services
Patient-centered Medical Home enablement and management services
Ne
o
Wellness 2.0
7. Confidential and Proprietary7
Population health clients & goals
Employers
Reduce growth in health care costs
High-value insurance products for their members
Satisfied, loyal members
Government
Accessible, affordable and efficient delivery system
High quality care
Reduce cost and burden of chronic diseases
Promote healthy behaviors
Providers
Assume accountability and risk under accountable care and
value-based financial incentives, and remain financially viable
Provide high-quality and efficient clinically integrated care
Attract and retain new patient populations
GoalsClients
8. Confidential and Proprietary8
Foundation for population health delivery:
a clinically integrated care system
Organized health care “ecosystem”
Governance structure in place
Care collaboration and management
Electronic health care records with
the ability to aggregate and
exchange data
Holistic, patient-centered focus and
engagement
Business and financial models that
align accountability and incentives
– ACOs
– PCMHs
– Care Bundles
Clinically Integrated Delivery System
9. Confidential and Proprietary9
Actionable clinical intelligence: identify gaps in
care & actively engage patients & providers
Cost and utilization
Quality and outcomes
Avoidable services
Preventable leakage
Individuals at risk
Gaps in care
System operating and
financial performance
10. Confidential and Proprietary10
Embedded team-based care management services:
superior impact when delivered by providers
Multi-disciplinary provider teams are embedded in the practices
– MD, RN, PA, MA, Social Services, Nutritionist, Pharmacists, Behavioral Health
Care management technology is integrated with local EHRs in real time
Patients are engaged and activated
Providers have ownership of process and accountability for outcomes
Medical leadership drives results
High-Value Provider-driven Care Management Activities
Utilization Management
Referral management
ER management
Extended office hours
Nurse advice line
Concurrent review
Discharge planning
Care / Case Management
Care Navigator (coordinator)
Complex case management /
extensivist program
Transition in care
Home & Post-acute care
Palliative Care & Hospice
Care bundles
Medication therapy management
Disease Management
Asthma / COPD
CHF
Diabetes
IHD
High-risk OB
Oncology
11. Confidential and Proprietary11
Wellness programs: focus on healthy
lifestyles, disease prevention
Long-term goals are to reduce the burden of chronic
diseases, avoidable injuries, depression and suicide
Engagement must be personalized and use
compelling approaches
– Mobile apps that are easy and compelling
– Social networking
– Game mechanics (neural-behavioral feedback)
– Incentives and rewards
Health and Wellness Programs
— Diet — Workplace and school education and safety
— Exercise — Stress reduction
— Smoking cessation — Biometric screening / monitoring
— Education — Public health actions (immunizations, etc.)
13. Confidential and Proprietary13
Engaged patients: more active and satisfied in
their care
Patients increasingly demand a satisfying, retail-like experience, where quality = convenience
With high-deductible insurance, they have skin in the game and are active decision makers
They are well informed by the Internet, social media and crowd sourcing
They expect to interact through mobile devices and digital media
When engaged by their physician and “activated”, outcomes are better
We need to re-think the patient experience
– Access to my health care record
– Transparent information and decision support
– Ease of accessing my doctor and getting appointment
– Getting to know your Navigator and Care Team
– Communicating electronically via mobile device or email
– Help staying fit and healthy, and enjoying it
– Help managing my chronic condition, and being motivated
– Social support from my care givers and others like me
– Reducing complexity and burden of managing it all
14. Confidential and Proprietary14
Accountability & Risk
Accountable Sponsor Accountable Provider
Value created through pricing,
via competition, in narrow networks.
Collaboration
Managing risk and accountability by aligning
incentives for financially sustainable health care
Value created through efficiency, reducing waste,
cost restructuring and keeping patients healthier.
Financial sponsor assumes accountability
Episode-based payment to providers
Fragmented, uncoordinated care — left to
sponsor’s centralized DM, CM, UM
(telephonic & mail)
Payer provides traditional insurance services
in adversarial relationship with providers
Providers assume accountability and risk for
population
Payment based on value in terms of total cost,
quality and satisfaction
Care coordination and management
longitudinally by providers
Payer becomes an enabling partner
15. Confidential and Proprietary15
Healthagen’s population health experience
> 1,100 Hospitals
> 250,000 Physicians
> 8 RHIOs
> 22M Lives > 8M Lives > 10M downloads
> 2.5M mobile
users
> 4M portal users
> 30 ACOs
> 100 PCMH/Collab.
> 22M lives
CARE
MANAGEMENT
ACCOUNTABLE
CARE
PATIENT
ENGAGEMENT
OPERATIONAL
INTELLIGENCE
CLINICAL
INTEGRATION
Notes de l'éditeur
Pete: If I understand this slide correctly, it starts with image of actual iTriage App and builds to tell the broader story of iTriage’s benefits. This slide gives the audience a good sense of total iTriage package before zeroing in on physician office on the next slide.
Discuss how we are a workflow company for the consumer and the provider…we are a a full platform that meets the consumer and helps them navigate their healthcare… wherever they are.