Date post: | 11-Feb-2015 |
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Health & Medicine |
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Healthcare IT and Healthcare Services: The New Personalized Medicine Frontier
CONFIDENTIAL 2PMWC 1-23-12
Healthcare Is Undergoing Massive Change
“I’m afraid you’ve had a paradigm shift.”
CONFIDENTIAL 3PMWC 1-23-12
The Consumer Has Arrived
“Whoa—way too much information.”
CONFIDENTIAL 4PMWC 1-23-12
And Where There is an Active Consumer
There is personalization…..
…and a growing demand for micro-segmentation
…and a growing
CONFIDENTIAL 5PMWC 1-23-12
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
CONFIDENTIAL 6PMWC 1-23-12
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
CONFIDENTIAL 7PMWC 1-23-12
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)
CONFIDENTIAL 8PMWC 1-23-12
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
CONFIDENTIAL 9PMWC 1-23-12
HealthEdge/C4C: Population Grouping
Group membership can trigger additional evaluation to refine and personalize.
Biometrics
Claims
PHR
EMR
EPHR
PBM
Devices
Gro
up
ing
Ru
les Group B
Group A Group C
Combination of heterogeneous data sources provides robust data-set for individual evaluation
CONFIDENTIAL 10PMWC 1-23-12
HealthEdge/C4C: Assessment & Refinement
Group B
Group A Group C
General Assessment
Assess
Care Opportunity
Care Opportunity
Care Opportunity
Care Opportunity
Care Opportunity
Care Opportunity
X
X
CONFIDENTIAL 11PMWC 1-23-12
HealthEdge/C4C: Personal Care Plan
Care Opportunity
Care Opportunity
Care Opportunity
Care Opportunity
Care Opportunity
Care Opportunity
X
X
Care Opportunity
Action Barrier
Care Opportunity
Action Barrier
Care Opportunity
Action Barrier
Care Opportunity
Action Barrier
Personalized Care Plan
Barrier Identification
CONFIDENTIAL 12PMWC 1-23-12
HealthEdge/C4C: Outcomes & Feedback
Care Opportunity
Action Barrier
Care Opportunity
Action Barrier
Care Opportunity
Action Barrier
Care Opportunity
Action Barrier
Personalized Care Plan
Biometerics
Claims
PHR
EMR
EPHR
PBM
Devices
Gro
upin
g R
ules Group
B
Group A
Group C
Outcome Tracking
Trend analysis drives rule refinement
CONFIDENTIAL 13PMWC 1-23-12
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
CONFIDENTIAL 14PMWC 1-23-12
SeeChange Health: Making it Work
Subscriber & Spouse voluntarily complete Preventive Health Actions to receive financial incentives
Biometric Screening* Preventive Examination*Health Questionnaire
Health Incentive Account Deposits
Enhanced Benefits Deductible Credit
*Preventive Health Actions are
covered 100% based on age & gender specific
guidelines
=
+ +
CONFIDENTIAL 15PMWC 1-23-12
SeeChange: Schematic of Benefit Design
Fill out PHR
80/20 Benefit and Wellness Incentives
Care Recommendations
Provided
Standard Plan with Deductible reduced by $500
100% Coverage, No Deductible for Chronic
Illness Care
Yes
No Standard Benefit Plan70/30
$200 Deductible
Yes
Bio Metric testing
Completed
Member
Member
Member
ChronicCondition?
Yes
Yes
NoNo
No Followed?
CONFIDENTIAL 16PMWC 1-23-12
SeeChange: Personalized Health Action Plans
CONFIDENTIAL 17PMWC 1-23-12
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%
All in Excluding over $100K$200
$300
$400
$500
$433
$399 $394
$368
Year 1
Year 2
CONFIDENTIAL 18PMWC 1-23-12
PolyRemedy: Integrated IT & Services for Personalized Wound Care
Standardized AssessmentProtocol-driven software tool
Home Delivery of Personalized Dressings
Customized size, shape and function PHMB antimicrobial
Real-Time Alerts, Reports and Outcomes Assessment
CONFIDENTIAL 19PMWC 1-23-12
PolyRemedy: 15% Improved Healing; 48% Reduced Resources
PWS Initial PWS 9 Months0%
10%20%30%40%50%60%70%80%90%
100%
53%
75%
27%
17%
100% Healed Healing Progress
Wound Healing Progress
80%92%
PWS Initial PWS 9 Months0
2
4
6
8
10
12
14
16
8.75.4
1.9
0.3
3.8
1.7
Nurse Aide WOCN
HHA Patient Visits Per Wound
14.4
7.4
* Data as reported in PWS by Customer on a total of 108 wounds. Data summarizes mix of patients, overall health status and wound types.
CONFIDENTIAL 20PMWC 1-23-12
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