The Population Health Management Market 2015

3. © 2015 Dr. Gordon Jones | Page #3 Overview of PHM 1. Evolution of Population Health Management (PHM) 2. Why PHM Now 3. Elements of PHM 4. Visualize: Population Health Solution Stack 5. How Technology fits into PHM 6. Patient Outreach Focused PHM 7. Stories of PHM

11. © 2015 Dr. Gordon Jones | Page #11 “Communication is not only important, but without it, human life would be non-existent. We have to be able to communicate on a personal level, both verbally and non-verbally. If we cannot have a face-to-face encounter, then this requires access to clear audible and visual capabilities enabled by technology.” It all Begins with Communication

12. © 2015 Dr. Gordon Jones | Page #12 % of 5,000 internet health users surveyed said they would change doctors to one who would communicate with them over the Internet – at the time that translated into… DHA Research on Health Communication 50 11 $3 %+ Americans not satisfied with the availability of their physicians Billion primary care dollars

13. © 2015 Dr. Gordon Jones | Page #13 % of patients reported that results or medical records were not transferred from one place to another in time for an appt % of patients do not get lab tests, special referrals or follow up care that they need % of adults report problems with care coordination, notification of test results, and communication among their doctors 20 36 50 Current State of Health Communication

15. © 2015 Dr. Gordon Jones | Page #15 % of doctors say non-critical paperwork has caused them to spend less time with patients % of doctors feel they are overextended and overwhelmed, not good non-verbally % of hospital executives said they still gather outcome data by hand, hard to know their patients in a timely manner 63 76 79 Current State of Health Communication

17. © 2015 Dr. Gordon Jones | Page #17 • Categorized by major domains of healthcare communication. • Multi-channel approach for client and patient support. • Connecting patients with the entire healthcare world. Current State of Health Communication

18. © 2015 Dr. Gordon Jones | Page #18 Current State of Health Communication DEVICE SENSOR GATEWAY MOBILE NETWORK CLINICAL DECISION SYSTEM NURSE CALL CENTER DOCTOR EMR PATIENT PHARMACY LAB TEC NODES l i n e a r t h i n k i n g

23. © 2015 Dr. Gordon Jones | Page #23 RPM & Real-time Communications Note: The marketing term “real time”is currently up for debate. Usually this means near real time (hourly or nightly). EHRsandlabs tend to refresh nightly or weekly. However,the overall trend is for faster refresh rates across all data types.

26. © 2015 Dr. Gordon Jones | Page #26 Defining Population Health Management • Population health management is the process of proactively monitoring and caring for defined patient groups and includes these components: • The central role of the primary care provider; • The patient focus of care coordination provided through wellness, disease and chronic care; • The critical importance of patient activation, involvement and personal responsibility.

27. © 2015 Dr. Gordon Jones | Page #27 Evolution of PHM • Payers/Employers deployed elements of PHM: • Hired disease management and HMO firms • Sponsored wellness and cessation programs • Health coaching and alerted people to unmet needs • Obstacles to Success: • Mistrust of Insurance companies • Low level of Physician involvement

28. © 2015 Dr. Gordon Jones | Page #28 Evolution of PHM • Health plans embraced vehicles designed to engage physicians and healthcare organizations: • Shared savings models, IPA, PHO, MSO • Patient Center Medical Homes with financial incentives • Partnering to build Accountable Care Organizations

30. © 2015 Dr. Gordon Jones | Page #30 Why PHM is Needed • Healthcare reform is driving a change in the way healthcare is delivered– forcing providers to focus on improving quality and reducing cost (shift from volume to value). • A plethora of new models: • Meaningful use [of EMRs] is a “carrot and stick” penalty/incentive program for providers who have Medicare and Medicaid contracts.

31. © 2015 Dr. Gordon Jones | Page #31 Why PHM is Needed • Accountable Care Organizations (ACO) are groups of doctors and hospitals banding together with payers to assume responsibility (and risk) for a defined POPULATION. The ACO earns rewards when they demonstrate improved quality, lower costs. –ACO Types: »Medicare ACO »Commercial/Private ACO, or other collaborative

32. © 2015 Dr. Gordon Jones | Page #32 Why PHM is Needed • Medicare ACO requirements and MU requirements both have specific focus on prevention & wellness and chronic disease management…because: – 5% of the POPULATION is driving 49% of the cost (focus on the 5%) – The name of the game here is: keep healthy patient POPULATION healthy and keep the chronically ill patient POPULATION out of expensive ER/hospital stays – High cost chronic disease management: Hypertension, Diabetes, CHF, COPD, etc. – Prevention & Wellness: screenings, vaccinations, immunizations…

33. © 2015 Dr. Gordon Jones | Page #33 Maximizing the Value of PHM Primary Pillars of Population Health Management Data Aggregation Combine patient data from disparate sources to achieve a single view of the patient Risk Stratification Segment population into sub-populations (healthy, chronically ill) to identify & prioritize interventions Care Coordination Combine prioritized patient lists with care plans to facilitate the right interventions with the right patients Patient Engagement & Outreach Add scale & capacity to care coordination & activate patients with omni-channel communications Data Integration  Communication Technology Infrastructure

35. © 2015 Dr. Gordon Jones | Page #35 Elements of PHM Population Stratification and Segmentation Propensityto Engage in Health Programs Enrollment Consent Preferences Care Plans and Work Flows Clinical Care Pathways and Application to Manage Care and Wellness Workflow around Patients Progress Patient Engagement Omni Channel •Voice •Text •Email •Chat with a Nurse •Talk to a Provider •Remote Sensors •Fitness Devices •Video Consults Measurement and Outcomes Improvements in Efficiencies and Health Outcomes Improved Revenue and Cost Reductions Chronically Ill, Wellness and Prevention Data Integrationand Communication Technology Infrastructure GREEN: West solutions and services including inbound/outbound IVR, call routing and notifications, services for deployments and integration to all major PHM platforms Purple: Population healthcare platform functions. (Current partnerships with Healarium, WellCentive,IBM Curam)

45. © 2015 Dr. Gordon Jones | Page #45 Central Themes of PHM Data Aggregation: Combining patient data from disparate sources Risk Management: Segmenting populations to prioritize interventions Care Coordination: Directing providers’ efforts Patient Outreach: Engaged, informed & connected

46. © 2015 Dr. Gordon Jones | Page #46 Population Health – CITI Overview Citi makes a very early effort in the population health managementtrend to identify winners and losers (for their investors),where most of the leaders are starting from an advantageous competitiveposition: • Cerner - well establishedand growing footprint in the EMR market, already building out its vision (Cerner Synapse brand) and population health managementsuite of solutions. • Allscripts – clear vision for delivering a person-centric population health solution and has started to cobble together an impressivecollection of assets. The growth in Population Health Managementcould prove an important pivot point for the new managementteam;client retention remain risks. • McKesson – a smart collection of assets and has a dominant exchange position through RelayHealth. Risks include the company’s ability to retain its EMR and financial systemscustomers and execution at delivering an integrated solution. • Optum (UnitedHealth) – amassedan interesting collection of assets and has advanced payer tools, but a cohesive provider strategy remains unclear. Partnerships with large IDNs and ACOs are an advantage. • Healthagen (Aetna) – assets in exchange and patient engagement, plus in house development and savvy business development initiatives. It remains to be seen if technology will be used to enhance their risk book or if Healthagen can be payer-neutral and sell to ACOs.

47. © 2015 Dr. Gordon Jones | Page #47 Population Health – IDC Overview While a few leaders are identified in the IDC report, the population health managementmarket opportunities are so dynamic that we will likely see new entrants. With the exclusion of just two vendors (Wellcentive and Explorys), the rest of the vendors are owned by companies with multiple healthcare applications or horizontal technology suppliers. As a result, IDC believes consolidation of the market is likely to be slow. Note: PhyTel is not on this list

48. © 2015 Dr. Gordon Jones | Page #48 Population Health – KLAS Overview The most prominent market analysis is provided by KLAS who interviewed 78 providers about their use of 23 vendors. Points of note: • Remains manual • Patient reminders needed • Limited stafffor PHM • No consistent communication • EMRs getting into PHM Best of Care Coordination* Strongest Owned Portfolio** **PHYTEL **MCKESSON (MEDVENTIVE) */**I2I SYSTEMS **HEALTHAGEN **PREMIER **WELLCENTIVE *EXPLORYS OPTUM: HUMEDICA THE ADVISORY BOARD COMPANY CONIFER HEALTH SOLUTIONS OPTUM: CARE SUITE & IMPACT ECLINICALWORKS VALENCE HEALTH ALLSCRIPTS (DB MOTION) COVISINT *FORWARD HEALTH GROUP TRUVEN HEALTH VERISK HEALTH ATHENAHEALTH EPIC NEXTGEN CARADIGM CERNER EARLY LEADERS PROVEN POTENTIAL EMERGING STORIES

49. © 2015 Dr. Gordon Jones | Page #49 Aetna Aetna Optum Advisory Board Humana Humana CareFX Medtronic Axolotl Care Coordination and Patient OutreachFormation & Advisory Data Aggregation and Intelligence Risk Management & Clinical Analytics End-to-End Population Health – End-to-End Overview

60. © 2015 Dr. Gordon Jones | Page #60 Private HIE Venders KLAS Report Leaders: • EPIC Care Everywhere • Orion Health Collaborative Care • Siemens MobileMD • Covisint • Cerner • eClinicalWorks • RelayHealth • Medicity • Optum HIE • Dell

65. © 2015 Dr. Gordon Jones | Page #65 Consumer Buying Habits for PHM Frequent credit card purchases at pizza shops and fast-food outlets Cigarette purchases at grocery stores by consumers with bronchial problems Frequent purchases of large amounts of alcoholic beverages No vehicle ownership registration on file May need advice on weight control or diabetes and high blood pressure risks Increased chance of visiting an ER to an asthma attack Possibly a sign of depression or alcoholism Could presage difficulty in reaching schedule care appointments Fallout in the frequency of drug refills shown on a charge card May require a reminder notification from the PHM or a call from a nurse The Data The Analysis

66. © 2015 Dr. Gordon Jones | Page #66 Hospitals Are Mining Patients' Credit Card Data to Predict Who Will Get Sick No need in trying to hide anything fromme, I know about your 2am Papa John’s deliveries Predicting Patient Health Risks for PHM

69. © 2015 Dr. Gordon Jones | Page #69 Defining Patient Engagement • Patient engagement is the process by which patients become invested in their own health. Health systems with effective patient engagement programs provide patients with the information and tools needed to take control of their care.

73. © 2015 Dr. Gordon Jones | Page #73 Myth #3: It’s Expensive A 5% reduction in admissions, readmissions and ER visits can drive an additional $25M in shared savings in a patient-population of 100,000.

82. © 2015 Dr. Gordon Jones | Page #82 Market Segments for PHM •Hospitals and Medical Centers •Health Plans/Insurance Companies •Home Healthcare •Disease Management/Care Coordination •Pharmacy and Pharma •Accountable Care Organizations •HMO | PHO| IPA | CIN | AN

83. © 2015 Dr. Gordon Jones | Page #83 Executives to Engage about PHM •CEO | CFO | CMO •Chief Medical Officer •Chief Information/Technology Officer •Chief Transformation Officer •Chief Nursing Officer •Director of Patient Discharge •Director of Case Management •Office of Patient Outreach

84. © 2015 Dr. Gordon Jones | Page #84 Some questions to ask on PHM •What does it mean to you to engage a population? •Who in your market is responsible for managing the population? •How are you looking to use PHM to promote your corporate strategy, it’s scalability and sustainability of the system expansion?

85. © 2015 Dr. Gordon Jones | Page #85 Some questions to ask on PHM •How will you be using PHM to improve coordination and information exchange across all sites of care? •Are you planning to use PHM to drive process improvement, better patient outcomes, minimize cost growth, stabilize existing costs structures while improving efficiency of the health system?

86. © 2015 Dr. Gordon Jones | Page #86 Technology Strategies for PHM 1.Have a comprehensive technology Vision and Strategy; 2.One Size Does Not Fit All: A single method of physician- patient communication will miss a lot of patients; 3.Leverage Technology for Provider Efficiency: Providing a comprehensive view of all patients and efficient tools to manage the care each population needs; 4.Workflow Integration: Align People, Process, and Technology; 5.Security and Compliance Risk Mitigation: Manage liabilities with the right security framework.

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