CONFIDENTIAL

“A good scalpel makes a better surgeon. Good

communication makes a better doctor.”

- Dr. Josh Umbehr

CONFIDENTIAL

Agenda

• How I See Market Developing – trends/thesis• Patient Engagement via Extensible Patient Relationship Management vs. Limited/Rigid Patient Portals

• Case studies: Direct Primary Care Medical Home (D-PCMH) – Hidden gem in PPACA

CONFIDENTIAL

Trends/observations driving our thesis

• Shift to Patient-centered, Accountable, Coordinated World – Who’s already there?

• Patients: More than a Vessel to Attach Billing Codes to• Communication: The Most Important Medical Instrument• Primary Care Renaissance – D-PCMH, PCMH, Onsite • Nimble Medicine & Fundamentally New Delivery Models• Deflationary Economics Will Drive Healthcare• Decentralization of Healthcare Delivery (Innovator’s

Prescription + Topol CDoM) – Barrier to entry Boat anchor• Technology-enabled Services to enable ACOs, PCMH, etc.

CONFIDENTIAL

Thesis: Impossible to Succeed Without Patient Engagement in New Payment Models

Recognize who really makes the decisions influencing outcomes

“Control”

Person’s Location/Acuity

100

0

At Home/Low Acuity Hospital/High Acuity

The “System”Person/Family

EMRPRMKey Enabling Technology

Chronic: 75% of H/C $$

CONFIDENTIAL

QUICK DEMO

CONFIDENTIAL

PPACA “SECRET” – D-PCMH

CONFIDENTIAL

Only Non-Insurance Solution Authorized in Future Insurance Exchanges

Senate Language  - H.R. 3590EAS - SEC. 10104 (3). On P. 2068

 

TREATMENT OF QUALIFIED DIRECT PRIMARY CARE MEDICAL HOME PLANS

• The Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan.

CONFIDENTIAL

Nature of Transaction

Provider

Patient

Insurance Admin

High FFS Primary Care Admin CostPromotes Visit Volume vs. Time with Patient

CONFIDENTIAL

Efficient Direct Primary Care Medical Homes Promote Time with Patients vs. Visit Volume

Provider

Patient

Ins. Admin

KEY

Schedule Appointment

Sees patientDiagnoses Illness

Take X-ray Onsite

Run CBC Onsite

Patient goes to pharmacy

Dispense RxPatient

recovers

Patient has fever and

cough

Pays cash for Rx

Same Day Appointment

Patient has fever and

cough

CONFIDENTIAL

The Qliance Direct Primary Care Medical Home

Preventive Care

Wellness Care

Chronic Disease

Management

Specialist Care

Coordination

Urgent Care

Unrestricted office visits

Same and next day appointments

Unhurried office visits

No co-payments

Extended weekday hours

Weekend office hours

Phone and email access

Flat monthly fee

CONFIDENTIAL

79% (Qliance)

CONFIDENTIAL

Utilization Data – Qliance Members Under 65 (2010)

Type of ReferralQliance # per year/1000**

Benchmark*

Difference

ER Visits 56 158 -65%

Hospitalizations (visits) 34 53 -35%

Hospitalizations (in days) 105 184 -43%

Specialist Visits 670 2000 -66%

Advanced Radiology 300 800 -63%

Surgeries 22 124 -82%

Primary Care Visits 3540 1847 +92%

*Based on regional benchmarks from Ingenix and other sources.**Based on best available internal data, may not capture all non-primary care claims

Source: Qliance Medical Group non-Medicare patients, 2010 (n=3,088)

2x Primary Care Visits & 2-3x Care/Visit

50% Reduction in Downstream Care

CONFIDENTIAL

Not the Usual Processes•Comprehensive assessment and shared care plan

•Daily huddles with entire team

•Lots of non visit based care- email, text, video

•Extensive use of groups- including Stanford Chronic Care Curriculum in 3 languages

•Integrated Mental health, nutrition

•Real time data for management, including daily hospital, ER feeds, pharmacy fills

•Co-management with hospitalists, other specialists

•Proactive care (DM/CM)- based on registry queries, event triggers

CONFIDENTIAL

Total spending dropped a net of 12.3%; Driven mostly by large decreases in hospital admissions, ER visits, and outpatient procedures

For all SCC patients enrolled in 2009, relative to control group created using propensity matching.

CONFIDENTIAL

Contact: dave@avado.com