1

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

03 16 07

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of the Shared Health Incorporated.

2

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Shared Health Origins

Need for TennCare to lower cost and improve the quality of care in Tennessee

Visibility into patients record across providers was essential

Cost Savings identified in five areas

Tennessee Governor’s call for a solution January 2005

Shared Health Electronic Health Record that spans provider networks

Designed for multi payer / provider model

Facilitate the coordination of care among all stakeholders

1) Medication Management 4) Fraud and Abuse

2) Disease Management 5) Better Care & Oversight / Wellness

3) Clinical Waste

3

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Shared Health Today

Nearly 2 million patients (TN’s Medicaid Program, BCBST Employees, Nissan w/ Employees in MS, BCBST fully insured)

Data from 7 Managed Care Organizations

Links all Providers, Payers, and Consumers to same data set

Accessible by the Internet, NO NEED for special software, hardware or expensive implementation costs at the facility level

Clinical Outreach program supports provider adoption and utilization

On Site staff that work directly with provider community

No grant money supporting the effort

Improving quality and efficiency

4

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Clinical Health RecordTM (CHR)

Expands beyond the four walls of a traditional EMR assuring Providers comprehensive patient-centric data at the point of care which will prevent errors; improve quality and efficiency

Demographic Data – Across all providers and payers

Claims Encounter Data – Across all providers and payers Problems

Procedures

Diagnosis

Medication Histories – Regardless of location of fulfillment

ePrescribe solution – Applies across entire provider customer base

Laboratory Results – Across all providers

Immunizations – One central location for the state

EPSDT (Well-Child management templates) – One central location for the state

Allergies – Any authorized physician can review

Secure Messaging – Secure messaging between providers, consumers, and case managers

Shared Health Content Today

5

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Shared Health’s market role

Clin

ical

N

otes

Imag

ing

Dev

ice

Inte

grat

ion

Phy

sica

l A

sses

smen

t

Inpa

tien

t N

otes

Am

bula

tory

Lab

Provider Data Services

6

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Clin

ical

N

otes

Imag

ing

Dev

ise

Inte

grat

ion

Phy

sica

l A

sses

smen

t

Inpa

tien

t N

otes

Am

bula

tory

Lab

Multi-Provider Encounter Data

Benefits & Eligibility

Complete Meds

Reference Labs

Care coordination

Population BasedCDS

Pay

er D

ata

Ser

vice

s

It takes two data sets to achievePatient Centered

Electronic Health Record

Provider Data Set & Payer Data Set

Provider Data Services

7

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Patient Data HubWorking Together from a Common Foundation

State Data PBMs

User Provisioning & Access Mgt.

Terminology MediationIntegration Hub

Medicaid

“Provider” View

Payer’s

Consumer View

Lab Data

Shared Health Shared Health Payer Portal3rd Party EMR

Decision Support

Provider / Patient Data StoreHL7 v3 RIM

Person Identification / Record Locator Services

Shared Health

8

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

HIE Services provide EMPI, Access & Authentication, Demographics, Encounter Detail, Problems, Labs, Meds, eRx, Allergies, Immunizations, Well Child Screening, Secure Messaging, and P4P programs

Interoperability Strategy

Supportive of: Centralized Federated

Hybrid

HIE Services

RHIO Services

9

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Shared Services

Repository

Registries & Interoperability: Merging Data to Get the Whole Picture

Administrative Plus Data:-Patient Demographics-Claims data

-Diagnoses-Procedures-Admissions

-PBM (Pharmacy) Data-Lab Data (Limited)

Detailed Clinical Data:-All Lab-Detailed Exams

-History-Physical-Assessment and Plan

-All Orders-Images-In-Patient and Surgical Notes

Shared Services

Repository

Performance Measures

Transparency & P4P

Registries & Interop

-Key Outcomes: -Indicators -Results

-Key Process Events:-Disease States-Wellness Care

“Core” Clinical Data

10

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Shared Health: A Case Study

Shared Health’s HIT solutions are connecting clinicians with valuable patient information, quickly, accurately, and at the point of care

Scenario:

EMTs bring a 48 year old woman to the ER following a Motor Vehicle Accident

The patient is drifting in and out of consciousness and has multiple injuries including a compound fracture.

Using the CHR, the ER physician has immediate access to a complete medical history and current medications.

She notices that her patient has been seen for Systemic Lupus and is on maintenance prednisone.

She avoids an intra-operative adrenal crisis by advising the surgeons that the patient requires cortisone during surgery.

11

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

12

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

13

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

14

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

EPSDT & Wellness Exams for Children

EPSDT ComponentsComprehensive Health (Physical and Mental) and Developmental

History

Comprehensive Unclothed Physical Exam

Vision Screening

Hearing Screening

Laboratory

Immunizations

Health Education/Anticipatory Guidance

15

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Utilizing Registries (EPSDT)

16

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Initial Assessment

Required Fields

17

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Feet InchesHeight: 6 2DATE: 1/13/07 3/26/07 4/30/07 6/1/07 9/10/07 12/8/07 GOAL TO CHECK ADDPulse 80 88 75 85 90 80 ADDSystolic 115 133 122 118 127 120Diastolic 86 80 78 73 84 75Resp 20 18 22 14 18 20 ADDWeight 155 165 170 178 170 ADDBMI 19.90 21.18 21.82 22.85 21.82 ADDHbA1C 7.00% 9.00% 7% ADDTot. Chol. 120 160 <145 ADDHDL-C 130 ADD

LDL-C ADD

ACT Score ADDADDADD

Microalbuminuria: Foot Exam: Dilated Retina Exam:

Date __/__/__ __/__/__ __/__/__

ADD

DIABETES EVALUATION

Claim received, but no resultCPT-II code in desired rangeCPT-II code in borderline rangeCPT-II code out of ideal range

UPDATE

Female HypertenAsthma COPDDiabetesMale

Microalbuminuria:Foot Exam: Dilated Retina Exam:

Date __/__/__ Date __/__/__ Date __/__/__

Claim received, but no result

CPT-II code in desired rangeCPT-II code in borderline rangeCPT-II code out of ideal range

Longitudinal Care Registries (mock-up screen)

18

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Feet InchesHeight: 6 2DATE: 1/13/07 3/26/07 4/30/07 6/1/07 9/10/07 12/8/07 GOAL TO CHECK ADDPulse 80 88 75 85 90 80 ADDSystolic 115 133 122 118 127 120Diastolic 86 80 78 73 84 75Resp 20 18 22 14 18 20 ADDWeight 155 165 170 178 170 ADDBMI 19.90 21.18 21.82 22.85 21.82 ADDHbA1C 7.00% 9.00% 7% ADDTot. Chol. 120 160 <145 ADDHDL-C 130 ADD

LDL-C ADD

ACT Score ADDADDADD

Microalbuminuria: Foot Exam: Dilated Retina Exam:

Date __/__/__ __/__/__ __/__/__

ADD

DIABETES EVALUATION

Claim received, but no resultCPT-II code in desired rangeCPT-II code in borderline rangeCPT-II code out of ideal range

UPDATE

Female HypertenAsthma COPDDiabetesMale

Microalbuminuria:Foot Exam: Dilated Retina Exam:

Date __/__/__ Date __/__/__ Date __/__/__

Claim received, but no result

CPT-II code in desired rangeCPT-II code in borderline rangeCPT-II code out of ideal range

B/P Trend

40

60

80

100

120

140

160

Jan-07

Feb-07

Mar-07

Apr-07

May-07

Jun-07

Jul-07

Aug-07

Sep-07

Oct-07

Nov-07

Dec-07

Systolic

Diastolic

Longitudinal Care Registries: Track/Trend Outcomes (Graphing)

19

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Recent Analytic Highlights

Enrollees looked up in Shared Health:

Are “sicker”.

Have a lower admission rate.

Have higher generic use and better formulary compliance.

Enjoy higher wellness care rates for mammography screening, colon cancer

screening, post partum urine cultures and flu vaccination (50 – 64).

ER visits for Shared Health enrollees reflects Shared Health’s targeting Eds for adoption.

20

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Shared Health Demonstrating HIE Value Today

• Providers are using Shared Health to evaluate patients with high illness burden and complicated cases.

• Shared Health patients and purchasers reaping improvements when compared to controls:

Greater compliance with nationally recognized guidelines for wellness care.

Lower admission rates.

When admitted, lower length of stays.

Higher rates of generic and formulary compliant prescriptions.

• Impressive efficiency improvements recognized Shared Health measures total cost for managing various episodes of care.

All costs - in-patient, out-patient, lab, imaging and pharmacy – are included for each type of episode and costs are benchmarked.

Clinicians using Shared Health in evaluating and treating patients show a marked efficiency improvement (lower costs) over controls.

21

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Shared Health

Anticipated Cost Savings Projection Model Details of Benefits

Fraud and Abuse

Medications Reduce adverse drug events(ADEs)

Increase formulary-driven savings

Promote problem-driven medication ordering

Reduce medication waste

Clinical Waste Reduce inpatient admissions due to

incomplete data in the E.D.

Reduce repeat outpatient visits due to incomplete patient data

Lower E.D. expenditures

Decrease diagnostic tests

Reduce defensive medicine

Better Care and Oversight Disease Management Resource

Increase patient safety

Preventative Care Increase participation rates for Well-Child

checks and Adult Immunizations

(Based on $170.00 PMPM in Year#1) Year 1 Year 2 Year 3

Projected Healthcare Spend $1.020 BN $1.170 BN $1.330 BN

Savings -to-Total Expense 0.7% 1.2% 1.6%

$0

$10,000,000

$20,000,000

$30,000,000

$

1 2 3

Year

Benefit Projections

Preventative Care

Fraud & Abuse

Clinical Waste

Better Care and Oversight

Medications

Total Benefit Savings Year 1 Year 2 Year 3Medications $1,908,669 $4,699,549 $7,986,910Better Care and Oversight $1,264,168 $4,383,047 $8,890,155Clinical Waste $1,374,937 $2,385,950 $4,124,995Fraud & Abuse $2,776,186 $3,494,223 $1,346,469Preventative Care $113,055 $171,111 $294,066

TOTAL $7,437,015 $15,133,881 $22,642,596

Example of 500,000 member population

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

22

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Question # 1 – As a result of using the Shared Health Clinical Health Record, did you modify or eliminate a prescription?

Question # 1 Repsonses

3%

76%

21%

N/A

YES

NO

RESPONSE KEY:

Y - YESN - NON/A - Not Applicable

•After reviewing the Clinical Health Record, a provider in Knoxville refused to give another pain medication to a patient who had received four recent scheduled prescriptions within a two week period.

23

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Question # 2 – Did the Shared Health Clinical Health Record assist you with providing high quality, cost effective care?

•A provider in Knoxville, uses the system in conjunction with her EMR system. She inputs any missing information into her EMR until the two systems are integrated.

Question # 2 Repsonses

81%

19%

YES

NO

RESPONSE KEY:

Y - YESN - NON/A - Not Applicable

24

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Question # 3 – The information I retrieve from the Shared Health Clinical Health Record is useful and helps clinicians make more informed treatment decisions.

•One location stated that all of the providers look at the printed Clinical Health Record before making any medical decisions.

Question # 51

16%

26%

39%

432%

528%

69%

N/A0%

1 2 3 4 5 6 N/A

RESPONSE KEY:

1-Strongly Disagree2-Disagree3-Somewhat Disagree4-Somewhat Agree5-Agree6-Strongly Agree

Question # 3 Responses

25

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Question # 4 – Shared Health ePrescribe enhances efficiency during the medication prescribing process.

•A user from Gordonsville Clinic stated she was able to catch many drug seekers.

Question # 8

13% 2

15%

33%

418%

66%

N/A21%

534%

1 2 3 4 5 6 N/A

RESPONSE KEY:

1-Strongly Disagree2-Disagree3-Somewhat Disagree4-Somewhat Agree5-Agree6-Strongly Agree

Question # 4 Responses

26

Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated. Shared Health Confidential and Proprietary. All rights reserved. This document contains confidential and proprietary information, which may not be reproduced or transmitted without the express written consent of Shared Health Incorporated.

Health Information Technology and Its Role in Medicaid

HIT plays a critical role in Medicaid because… HIT allows continuity among consumers and clinicians

Continuity drives more informed decisions and better quality

Continuity enables better clinical decision support

HIT provides significant opportunities to achieve higher-quality healthcare, especially for chronically ill and high-utilizing populations

HIT facilitates real consumer empowerment and responsibility

Medicaid has the ability to lead reform across the nation because it has Critical Mass at both the state and national level

QUESTIONS ?