Business and revenue model definition for Healthcare business platform

1. HEALTH
INFORMATION
EXCHANGE
Sumit K Jha
jhasumit@gmail.com
Business Idea Commercialization

2. Flow of the Presentation
 HIE Definition
 HIE Stakeholders
 Stakeholder Interaction
 Value Proposition for HIE Stakeholders
 Contribution by Stakeholders
 Commercials for HIE

3. Definition of HIE
 HIE is a platform through which an entity can provide data
aggregated from its Telemedicine centers and also facilitate
one-to-one or one-to-many exchange/s of healthcare related
information among the following stakeholders commercially
and non-commercially:
 Healthcare Seekers
 Healthcare providers
 Pharma / Surgical companies
 Pharmacies/ Chemists
 Wellness providers
 Insurers
 Government
 NGOs
 Institutes
Interactions among and with Government, NGOs and Institutes are critical but will remain mostly non-commercial on the HIE
platform

4. HIE Stakeholders
Healthcare Pharma / Surgical
Providers companies
Pharmacies/
Healthcare Seeker
Chemists
NGOs Government
Institutes Insurers

5. Stakeholders involved
Healthcare Pharma / Surgical Pharmacies/
Healthcare Seeker
Providers companies Chemists
 Individuals (Rural, Urban  Integrated Delivery Networks  Surgical instruments Pharmacies
healthcare seekers)  Hospitals  Drug manufacturers  Wholesalers
 Corporate (through  Nursing homes
reimbursement model of  Device manufacturers  Individual
healthcare delivery)  Clinics
 Chains
 Diagnostic centers/ Pathology
labs  Hospital owned
108 services
Wellness providers
 AYUSH
 Fitness centers
 Skincare & Dermatology Institutes Insurers Government
 Medical & dental colleges  Health Insurers  Central government
NGOs  Pharmacy colleges  State government
 Agents
 Regulatory bodies i.e. MCI
 R$D Institutes  Wealth planners
 NGOs  WHO
 UNICEF
 World Bank
 ADB

6. Interaction Details – Healthcare Seeker
Healthcare Providers
Individual:
Demographic Segment
• Tele-Medicine Clinics
• Urban
• Semi-Urban • Private Doctors
• Rural • Specialist Doctors
• Specialty Hospitals Commercial
Income-Group Segments: • Emergency Services Interactions
• High Income Group
• Middle Income Group
Pharmacy / Chemists
• Low Income Group
Coverage Segment: Insurance Companies
• Covered with Insurance
• No Insurance
Government Agencies
Corporate Segment: Non-Commercial
Interactions
• Reimbursed Healthcare
• Company Provided healthcare NGOs

7. Interaction Details - Others
Healthcare Pharma / Surgical Pharmacies/
Healthcare Seeker
Providers companies Chemists
 Healthcare providers  Healthcare Seekers  Healthcare providers  Healthcare Seekers
 Pharmacies/chemists  Insurers  Pharmacies/ chemists  Healthcare providers
 Insurance Companies  Pharma/ surgical companies
 Government  Pharma / Surgical
 Government  Pharmacies/Chemists companies
 Institutes
 Government  Government
 NGOs
Wellness providers
 Healthcare Seekers
Pharmacies
Institutes Insurers Government
 Healthcare providers  Healthcare Seekers  NGOs
NGOs  Pharma/surgical companies  Institutes
 Healthcare providers
 Healthcare Seekers
 Government  Government
 Healthcare Seekers  Healthcare providers
 Healthcare providers  Pharma/ surgical companies
 Pharma/ surgical companies  Pharmacies/ Chemists
 Government  Insurers

8. HIE Value Proposition
Healthcare Pharma / Surgical Pharmacies/
Healthcare Seeker
Providers companies Chemists
 Access to care  Improve care quality  Increase volume  Greater access to the
 Reduce care/insurance cost  Access to EMR  Improve service market
 Improve services
 Drug research & information  Increase direct sales  Product knowledge
 Support health of family members
 Knowledge sharing  Accelerate clinical trials at  Procurement/ inventory
 Improved healthcare awareness
lower cost planning
 Technological advancements
 Access to end-consumer and
 Increased visibility impacting
market intelligence
top-line
Wellness providers
 Access to competition focus
 Tie-ups with other
areas
 Access to a more organized stakeholders
platform to showcase their  Greater access to the market
capabilities
 Easier access to customer Institutes Insurers Government
base
 Clinical trials and studies  Increase membership by  Improve wellbeing- Social
targeted marketing mandate
NGOs  Research feed
 Better & transparent funding
 Direct sales
 Use data to refine the course
 Government focus and budget  Reduce care costs
allocation material  Easier claim settlement
 Improve reach & access
 Opportunity to tie-up with the best fit  Funding/sponsorship  Informed premium
care providers or pharmacies calculation  Improve services
 Attracting private/public  Reduce fraud & abuse
funding/sponsorship  Better product design

9. HIE Value Proposition
Healthcare Pharma / Surgical Pharmacies/
Healthcare Seeker
Providers companies Chemists
 Access to care  Improve care quality  Increase volume  Greater access to the
 Reduce care/insurance cost  Access to EMR  Improve service market
 Improve services
 Drug research & information  Increase direct sales  Product knowledge
 Support health of family members
 Knowledge sharing  Accelerate clinical trials at  Procurement/ inventory
 Improved healthcare awareness
lower cost planning
 Technological advancements
 Access to end-consumer and
 Increased visibility impacting
market intelligence
top-line
Wellness providers
 Access to competition focus
 Tie-ups with other
areas
 Access to a more organized stakeholders
platform to showcase their  Greater access to the market
capabilities
 Easier access to customer Institutes Insurers Government
base
 Clinical trials and studies  Increase membership by  Improve wellbeing- Social
targeted marketing mandate
NGOs  Research feed
 Better & transparent funding
 Direct sales
 Use data to refine the course
 Government focus and budget  Reduce care costs
allocation material  Easier claim settlement
 Improve reach & access
 Opportunity to tie-up with the best fit  Funding/sponsorship  Informed premium
care providers or pharmacies calculation  Improve services
 Attracting private/public  Reduce fraud & abuse
funding/sponsorship  Better product design

10. Stakeholders Contribution to HIE
Healthcare Pharma / Surgical Pharmacies/
Healthcare Seeker
Providers companies Chemists
 Generic personal information  Location List of products  Location
 Medical Records  Service provided  Patent information  Demographic profile of their
region
 Healthcare provider information  Doctor information  Research
 Product sales information
 Healthcare spending behaviour  Patient records  Formulations
 Preferred healthcare provider
Payment for Services availed  Diagnosis best practices/  Technological advancements
knowledge
 Drug efficacy
Wellness providers
 Healthcare spending
 Alternative & economic behaviour
treatment
 Care for lifestyle diseases
Institutes Insurers Government
 Clinical trials and studies  Insurance schemes  Demographic information
(Census, UID)
NGOs  Research  Insurance coverage
 Development Schemes
 Courses offered  Medical history
 Profiles- focus areas  Funding
 Claims history  Consultation papers
 Knowledge
 Client list
 Epidemics
 Plans & funding

11. HIE is projected to acquire critical mass by 2015
Type Stakeholders Stakeholder paying to HIE For transacting with
Individuals Healthcare Providers
Commercial
Healthcare Providers Individuals Pharmacies & Chemists
Pharmacies & Chemists Wellness care providers
Wellness care providers Healthcare Providers Individuals
Insurers Individuals
Pharmacies & Chemists
Pharma & Surgical Companies Healthcare Providers
Government Wellness care providers Individuals
commercial
Non-
Institutes Insurers Individuals
NGOs Pharma & Surgical Companies Pharmacies & Chemists
Revenue in INR Crores
2012 2013 2014 2015
Individuals 5.2 12.3 30.1 95.6
Healthcare Providers 2.9 7.1 18.1 61.4
Pharmacies & Chemists 0.9 2.0 4.7 13.2
Wellness care providers 0.3 0.6 1.6 4.8
Insurers 0.3 0.9 2.3 7.0
Pharma & Surgical
0.6 3.3 13.2 55.0
Companies
Total Revenue Projection 9.7 26.3 70.0 237.0

12. Appendix

13. Learning from NoMoreClipboard …1/3
NoMoreClipboard Overview
 The founders of NoMoreClipboard got their start in healthcare IT when they created one of the first commercially viable
health information exchanges in the United States. The wires and pliers effort required to connect hospitals, physicians and
other healthcare providers embedded the importance of practical and affordable interoperability into our organizational
DNA. This same team developed a web-based electronic health record platform widely used by physicians, Fortune 500
companies operating on-site health clinics and safety net healthcare providers.
 In 2003, NoMoreClipboard was formed as a separate legal entity to provide consumers with a portable, patient-managed
personal health record platform designed to interoperate with virtually any other healthcare IT application. NoMoreClipboard
is built on a robust electronic health record architecture developed for clinicians – with a consumer-friendly user interface.
While much of the underlying clinical functionality is "turned off" for consumer use, it can be enabled for enterprise clients.
 NoMoreClipboard is recognized as one of the top personal health records on the market, based largely on our ability to help
consumers compile, manage and share personal health information with physicians and other care providers.
NoMoreClipboard is able to deliver PHR data directly from the application in a format that integrates with existing provider
workflow. PHR data can be delivered electronically using secure, interoperable data standards, or on the specific paper
registration forms used by each individual provider. Physicians receive information that is more legible, accurate and
complete – improving communication and coordination of care, and reducing medical errors and unnecessary costs.

14. Learning from NoMoreClipboard …2/3
NoMoreClipboard Milestones
 NoMoreClipboard.com is integrated on the Google Health platform, enabling Google Health users to
deliver their health information and medical records to physicians without electronic connectivity
 NoMoreClipboard.com has a strategic relationship with Microsoft HealthVault, enabling consumers to
compile, manage and share health records, delivering data from HealthVault to care providers
 Howard University Hospital is providing diabetes screening and treatment on a mobile van that visits the
Washington D.C. community – after the visit, the Howard EMR populates a NoMoreClipboard.com PHR
account
 NoMoreClipboard.com collaborated with NCHICA and IBM to demonstrate PHR interoperability as part
of the Consumer Access to Clinical Information use case at the National Health Information Network
(NHIN) demo sponsored by HHS
 Medicare beneficiaries in Arizona and Utah can populate their NoMoreClipboard.com accounts with
CMS claims data as part of a the Medicare PHR Choice Pilot program
 Indiana University students can create an IU branded PHR and send their information to the campus
student health center – information from NoMoreClipboard.com populates existing health center
registration forms
 NoMoreClipboard.com serves as the consumer gateway at the 2009 HIMSS Interoperability showcase
in Chicago
 Bon Secours Health System in Virginia is offering a branded version of the NoMoreClipboard.com PHR
to its patient population as part of an online patient portal offering- Meridian Health in New Jersey is also
offering a branded PHR to its patients – the PHR will include integration with innovative home monitoring
devices including MDMouse

15. Learning from NoMoreClipboard …3/3
NoMoreClipboard Innovations
 The NoMoreClipboard FroozHIE tool is a user-friendly, interoperable application that
intelligently translates, compares and helps clinicians reconcile clinical patient data from
disparate sources including PHRs, EMRs, HIEs and health care IT platforms such as
Google Health and Microsoft HealthVault. Further, FroozHIE supports data between
platforms utilizing different data standards including CCR, CCD, CDA and HL7.
 NoMoreClipboard forms definition technology enables practice-specific patient registration
forms to be scanned and defined – matching the fields on paper registration forms with the
contents of the NoMoreClipboard PHR. Clinical information is SNOMED-CT coded so that
information in the PHR corresponds to matching questions on practice forms (e.g. CHF
entered in the patient PHR automatically indicates a history of heart disease on the
practice form). With this technology, physicians receive a printed version of their own
forms that is more legible, accurate and complete than the same form filled out in a
practice waiting room.
 NoMoreClipboard is able to create a branded patient portal experience that integrates the
brand identity of the sponsoring organization with the benefits of the personal health
record. Portals can incorporate additional functionality including secure messaging,
appointment requests and prescription refill requests.
 NoMoreClipboard functionality can be tailored for enterprise level clients to automate
health risk assessments, integrate with other applications, and incorporate organization-
specific modules

16. Lessons from Google’s failure
 Google also proved that a consumer PHR service requires widespread, aggressive advertising. It will not spread virally, at
least not at this nascent point in the PHR market. Google did not advertise the service widely, so hardly anyone realized
Google Health existed. The few consumers who knew about it were not entranced, and did not recommend it to their
friends. Google Health was too hard to use, too complicated.
 Then the PHR must be explained and advertised to consumers so they crave it.
 Given the lessons of Google’s failure, should we abandon visions of successful PHR systems for at least five years? The
United States cannot afford that. There is little hope of controlling healthcare costs until we educate consumers about
managing their health and dealing efficiently, as buyers, with physicians and hospitals. Consumers need their own health
records on their own screens. They need help using those records with Internet tools and games, and on social networks
 ONC’s experiment with NwHIN (Nationwide Health Information Network) Direct may be the way for consumers to get copies
of their data easily, and sooner rather than later. If hospitals and physicians were required simply to write to, and read from,
a standardized central communications backbone, there would be hope that commercial PHR systems could succeed.
 The write-read backbone design relies on existing infrastructure and requires only the minimum standards necessary for the
job. It is attractive because it is realistic using today’s technology, and because the “publish-subscribe” backbone can be
made smarter and otherwise more capable over time.
 As a bonus, that architecture makes it easy for patients to get digital copies of their records for hassle-free input to their PHRs.
 None of this is as fancy as pie-in-the-sky dreams of universal structured data interchange, semantic interoperability, or
comprehensive metadata tagging. But it is possible to do in the short-term, affordable, acceptable to physicians and the rest
of the health industry, and very much worth doing.
 Those are systemic lessons all of us can draw from Google Health’s demise.
 http://www.himss.org/ASP/ContentRedirector.asp?type=HIMSSNewsItem&ContentId=78818

17. Lessons from Google’s failure
 At the opening Google decided that they would support CCR (Continuity of Care Record) from ASTM and AFFP rather than
the much more complex CDA/CCD from HL7. The CCR vs CCD debate has been one of the most controversial and long-
standing arguments in Health IT. HealthVault, the Microsoft product which survives Google Health has always elected to
support both standards. But Google insisted that the CCD standard was too complex, and not only insisted on CCR, but a
smaller subset of that standard.
 http://www.fredtrotter.com/category/hie/

18. A word or two of caution
 "The HIE market is extremely volatile," states Lynne A. Dunbrack, program director, IDC Health Insights, "and will
change dramatically in the next 12–18 months as HIE technologies become a commodity and dominant players
acquire their way into a crowded market currently made up of many small, privately held vendors.“March, 2010,
IDC Health
 “The exchanges could help consumers and small businesses compare competing health plans” and “they also
could increase price competition by requiring health insurers to offer more standardized plans and by providing
consumers with better information about what they are buying.
 HIEs are taking root across the country, despite technical, governance, institutional and funding challenges. Currently, there
are more than 150 HIE projects in varying stages of maturity and employing several types of business models.
Unfortunately, many of these HIEs may not exist long enough to realize their full potential because their business model is
not financially sustainable. The key to sustainability is working with stakeholders to define and develop a business
model that addresses the near term needs of individual stakeholders, yet is flexible enough to accommodate the
diversity and evolution of these needs. Source: Deloitte Center for Health Solutions

19. Thank You