Healthcare IT and Healthcare Services: The New Personalized Medicine Frontier

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Healthcare Is Undergoing Massive Change

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

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The Consumer Has Arrived

“Whoa—way too much information.”

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And Where There is an Active Consumer

There is personalization…..

…and a growing demand for micro-segmentation

…and a growing

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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

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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

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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)

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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

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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

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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

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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

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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

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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

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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

=

+ +

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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?

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SeeChange: Personalized Health Action Plans

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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

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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

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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.

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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