Pramod Gaur, Vice President of TeleHealth at UnitedHealth Group, presented on trends and opportunities in US telehealthcare. The presentation covered definitions of mHealth and how it can enable total population management across areas like wellness, acute/chronic care, and living with illness. Key stakeholders in the healthcare ecosystem like patients, providers, payers and regulators were discussed. The presentation also highlighted opportunities for mHealth solutions in medication management, logistics, and care support. Overall, the presentation provided an overview of the mHealth landscape and how it can help improve health outcomes and care delivery in the US healthcare system.

1. Trends & Opportunities in US TeleHealthcare
Pramod K. Gaur, Ph.D.
Vice President – TeleHealth
UnitedHealth Group
Monday, October 7, 2013, Tel Aviv, Israel
Proprietary and Confidential. Do not distribute.
Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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2. Agenda
 Introduction – Background
 mHealth Definition and Market Segmentation
 Why mHealth is Important?
 Obamacare
 Stakeholders in US Healthcare Ecosystem
 mHealth Enabled Total Population Management
 Stay Healthy - Diabetes Example
 Get Healthy -Telemedicine Example
 Living with Illness - RPM Example
 Opportunities to Improve Total Population Management Using mHealth
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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3. A Fortune 25 Health and Wellbeing Company
Mission: Help People Live Healthier Life
Role: Help Make Health Care Work Better for Everyone
Health Benefits
Health Services
Employer & Individual
Medicare & Retirement
Community & State
Military & Veterans
OptumHealth
OptumInsight
OptumRx
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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4. American Telemedicine Association:
SIG or Chapter Name: mHealth
– Chair(s): Steven Dean
– Vice Chair: Pramod Gaur, PhD
– Past Chair: Sunil Hazaray
– SIG Executive Committee Members: Rob Williams MD, Napoleon
Monroe, Bree Holtz, Mohit Kaushal MD, Hon Pak MD
Mission
The mission of the mHealth group is to enhance access to health care
through innovative mobile technologies, including phones, tablets,
applications (apps), sensors, and supporting infrastructure. The mHealth
group represents academia, government, healthcare, and industry. The
group’s mission would be to promote dialogue between all stakeholders,
to improve the understanding and use of mHealth platforms, and to
provide guidance to the ATA Board of Directors regarding mHealth.
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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5. American Telemedicine Association: mHealth SIG
Objectives for 2013-14
Keep a dialogue with the FDA
Conducting a half-day education course at the ATA annual meeting
Facilitate quarterly webinars
Continue outreach and partnerships with other professional organizations (e.g.,
HIMSS)
Develop Practice Guidelines for mHealth
Peer-review of ATA conference abstracts
Increase SIG membership
Update mHealth reference paper
Subgroup Activity – Medication Management
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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6. Proprietary and Confidential. Do not distribute.
Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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7. mHealth – Definition
Defined broadly, mHealth is the ability to allow patients and providers to
easily and quickly connect and exchange health data via information
communication technology from anywhere at anytime to facilitate
continuum of care delivery at lower costs, and improve outcomes.
mHealth Applications and Technologies:
1. Remote Patient Monitoring (RPM): Consumer (home) setting to professional –
use of telemetry for store and forward data (vital signs, images, surveys, etc.) to a
centralized health data management application. Remote professional monitors
patient vital/behavior data and intervenes as necessary.
2. Telemedicine: Use of real time video and/or audio technology for medical
encounter in a professional to professional or professional to patient setting. This
may be used with or without telemetry.
3. mHealth: Telemedicine/RPM with the use of mobile (cellular or Wi-Fi) technology.
Applicable with common off the shelf mobile products.
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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8. Why Important?
Professionally
Entered Patient
Data
M-Health fills an important gap in a patient’s medical
record that exposes health/social aspects in
consumer’s life at home, work, or while on the road
Regulatory
Compliant M-Health
Capability
Hospital
Record
Pharmacy
Record
Self
Entered
M-Health
Record
Doctor’s
Office
Record
Lab
Results
Record
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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9. OBAMACARE
1. Access to Healthcare
2. Quality of Healthcare
3. Patient and Provider’s User
Experience
AFFORDABLE CARE ACT
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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10. Key Stakeholders for US Healthcare System
Patients Providers
Consumers Doctors, Nurses
Care Givers Therapists, Care
Family Members Managers, etc.
Payers Regulators
Fed Govt. Healthcare Policy
State Govt. FDA – 510(K)
Employers HIPAA
Insurance Co.
Self Pay
Transition from Pilot to Scalable
and Sustainable Program
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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11. PATIENTS/CAREGIVERS
Technologies/Services Sought by Caregivers
Source: Helpfulness of Caregiving Technologies, e-Connected Family Caregiver: Bringing Caregiving into the 21st Century
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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12. PROVIDERS
1. Provider Institutions – Move Towards Integrated Health Delivery
Networks (IDN)
‾ Primary Care
‾ Specialty Care
‾ Out Patient Clinics
‾ Transitional Care
‾ Home Care
2. Provider Professionals – Move Towards Group Practices
‾ Primary Care Physicians
‾ Specialty Care Physicians
‾ NP and PA Support
‾ Nurse Line (24/7 support line)
‾ Nutritionist Coaches
‾ Wellness and DM Coaches
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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13. REGULATORS
1. Healthcare Legislation – Federal/State and Local
2. Medical Board – Each State has its own Medical Board
3. FDA
‾ Medical Device Act and Fees
‾ Mobile Health Guidance
‾ Mobile Healthcare Device
‾ Mobile App
‾ Mobile Health App
4. HIPAA
5. ICD-10
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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14. PAYERS
1. Federal Government – Medicare
•
•
Traditional Medicare
Managed Medicare
2. State Governments – Medicaid
•
•
•
Traditional Medicaid
Managed Medicare
Medicaid - Medicare Dual Eligible
3. Large Employers – Self Insured
•
ASO Contracts with Insurance Companies
4. Insurance Companies
• Risk Based Policies for Individuals and Small Businesses
5. Self Pay – Consumers
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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15. PAYMENT MODELS
1. Traditional Fee for Service
2. Capitated/Negotiated Rates
• ACO
• PCMH
• Bundle Payment
• Episode of Care
3. Employer Wellness/Prevention Incentives
4. Pre-Tax Spending Accounts
• Health Savings Account
• Flexible Savings Account
5. Over the Counter - Self Pay
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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16. M-Health Innovation: Total Population Management
Goal is to Improve Overall Health and Wellbeing of Populations and Individuals
by Providing Comprehensive and Integrated Care Across the Care Continuum
Stay
Healthy
Wellness and
Prevention Care
Mobile Health
Goal
Improve
Overall
Health and
Wellbeing
Living with
Illness
Chronic Disease
End Of Life Care
Remote Patient Monitoring
Get
Healthy
Acute and
Sub-Acute Care
Telemedicine
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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17. M-Health Enabled Stay Healthy:
Helping people live healthier lives
PAYERS ARE PAYING FOR THIS SEGMENT WITH DEMONSTRATED OUTCOMES
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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18. M-Health for Get Healthy:
Consumer to Physicians Via Two-Way Video, Secure Chat Or Phone
CONSUMERS AND SOME PAYERS ARE PAYING FOR THIS SEGMENT WITH DEMONSTRATED OUTCOMES
“The doctor will see you now”
It’s time that technology allowed just that.
• A technology for bringing healthcare services online
• Live interaction between patients and available network physicians
9725551212
• Extends traditional healthcare into people’s homes
• Upholds care continuity
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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19. M-Health for Living with Illness:
PAYERS ARE PAYING FOR THIS SEGMENT WITH DEMONSTRATED OUTCOMES
Heart Failure Program
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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20. Opportunities for mHealth Solutions
Medication Related




Prescriptions aren’t filled
Medication isn’t taken
Overlap/confusion of medication
Allergic reactions are not identified
Logistics/Transport Related




No follow-up visit with PCP
No transportation
Can’t get appointment
PCP is not notified of admission or discharge
Support/Management Related
 Patient health deteriorates
 Lack of care giver support
 Home not conducive to post acute environment
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Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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21. THANK YOU
Pramod K Gaur, PhD
Vice President TeleHealth
Optum, a UnitedHealth Group Company
Rye Brook, NY 10573
Tel: 914-933-4610
pramod.gaur@optum.com
Proprietary and Confidential. Do not distribute.
Disclaimer - Contents of this presentation are the personal views of Pramod Gaur and not an official view of UnitedHealth Group or its affiliated companies
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