Avado CEO Dave Chase's presentation to the Collaborative Health Consortium's weekly Pilots and Collaborations Webinar. Dave is doing some leading edge thinking on collaborative care.

1. CONFIDENTIAL
“A good scalpel makes a
better surgeon. Good
communication makes a
better doctor.”
- Dr. Josh Umbehr

2. 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

3. 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.

4. CONFIDENTIAL
Thesis: Impossible to Succeed Without Patient
Engagement in New Payment Models
Recognize who really makes the decisions influencing outcomes
100 Person/Family The “System”
Key Enabling Technology
PRM EMR
“Control”
0 Chronic: 75% of H/C $$
At Home/Low Acuity Hospital/High Acuity
Person’s Location/Acuity

5. CONFIDENTIAL
QUICK DEMO

6. CONFIDENTIAL
PPACA “SECRET” – D-PCMH

7. 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.

8. CONFIDENTIAL
High FFS Primary Care Admin Cost
Promotes Visit Volume vs. Time with Patient
Nature of Transaction
Provider
Patient
Insurance Admin

9. CONFIDENTIAL
Efficient Direct Primary Care Medical Homes
Promote Time with Patients vs. Visit Volume
Patient goes
to pharmacy
Patient has Patient has
Schedule Same Day Sees patient Patient
fever and fever and Dispense Rx
Appointment Appointment Diagnoses Illness recovers
cough cough
Run CBC Take X-ray Pays cash
Onsite Onsite for Rx
KEY
Provider
Patient
Ins. Admin

10. CONFIDENTIAL
The Qliance Direct Primary Care Medical Home
Preventive
Care
Unrestricted office visits Extended weekday hours
Unhurried office visits
Urgent Wellness
Care Care
Phone and email access Same and next day appointments
Weekend office hours No co-payments
Flat monthly fee
Specialist Chronic
Care Disease
Coordination Management

11. CONFIDENTIAL
79% (Qliance)

12. CONFIDENTIAL
2x Primary Care Visits & 2-3x Care/Visit
50% Reduction in Downstream Care
Utilization Data – Qliance Members Under 65 (2010)
Qliance # per Benchmark
Type of Referral Difference
year/1000** *
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)

13. 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

14. CONFIDENTIAL
Total spending dropped a net of 12.3%; Driven mostly by large
decreases in hospital admissions, ER visits, and outpatient
procedures
-12.3% Total spending
For all SCC
patients
-37% Hospital days
enrolled in
2009, relative
-41% Hospital admits
to control
group created
Rx fills 40% using
propensity
-23% Outpt procedures matching.
-48% ER visits
-4% Office Visits
-60% -50% -40% -30% -20% -10% 0% 10% 20% 30% 40% 50%

15. CONFIDENTIAL
Contact: dave@avado.com