mhealth israel conference, rob egan, cmo, aetna healthagen, october 7, 2013
DESCRIPTION
Presentation at the mHealth Israel Conference and Business Contest, October 7, 2013 by Rob Egan, Chief Marketing Officer, Aetna HealthagenTRANSCRIPT
HealthagenPopulation Health Management
Rob Egan | CMO Healthagen October 7, 2013
Confidential and Proprietary2
Purchasers buy health care that is fundamentally more affordable, higher quality, more convenient and satisfying, based on value
The local health care ecosystem is accountable for care of the population holistically, and the care of individuals is collaboratively managed across the care continuum, focusing on quality, affordability and satisfaction
The population’s health needs are well understood, individuals at risk are identified and the health care system’s performance is continuously measured
Providers collaborate to provide patient-centered team-based care and are compensated on performance and value, rather than volume
Individuals and their caregivers are actively engaged, interacting though convenient mobile tools with social support
Healthagen, a division of Aetna, vision for population health
3 Confidential and Proprietary
Key value drivers for population health
Population Health Technology
CARE MANAGEMENT
ACCOUNTABLE CARE
PATIENTENGAGEMENT
OPERATIONALINTELLIGENCE
CLINICALINTEGRATION
PATIENTENGAGEMENT
CAREMANAGEMENT
CLINICAL INTEGRATION
OPERATIONALINTELLIGENCE
ACCOUNTABLE CARE
• Integration with unique EMRs and Health IT systems
• Intuitive collaboration tools and user interfaces
• Community patient records deployment
• Secure message notifications
• Referral management• Transitions in care• System performance
monitoring
• Longitudinal view into a given patient or population
• Evidence-based medicine rules engine and notifications
• Population risk stratification, disease registries
• Gaps in care, alerts• Reporting (cost, utilization,
quality, provider performance)
• Medical care management• Wellness programs• Alternate site care• Medication management
• Patient portal, PHR• Decision support• Access, registration and
appointments• Wellness, disease
management programs• Social caregiving• e-Visits• Education• Financial/bill
management
• Business transformation services
• Value-based contracting• Financial models
alignment and modernization
• TPA administration • Provider-led health plan
insurance products • Marketing and
distribution• Consulting• Patient centered medical
homes • ACO enablement
POPULATION HEALTH TECHNOLOGY & SERVICES
Population health management:products & services
Confidential and Proprietary4
5
Population health management:products & services
HEALTH INFORMATION
EXCHANGE
CAREMANAGEMENT
CLINICAL INTEGRATION
ACCOUNTABLECARE
OPERATIONAL INTELLIGENCE
CLINICALANALYTICS
EMPLOYEEWELLNESS
ACCOUNTABLECARE
PATIENT CENTERED
MEDICAL HOME
EMPLOYERSPONSORED
CLINICS
CARE MANAGEMENT
& WELLNESS
CARECOORDINATION
NEONATALSOLUTIONS
SOCIALCAREGIVING
COSTCOMPARISON
MOBILEHEALTH
NeoCarePATIENTENGAGEMENT
A Healthagen Business
A Healthagen Business A Healthagen Business
A Healthagen Business A Healthagen Business A Healthagen Business
A Healthagen Business A Healthagen Business
A Healthagen BusinessA Healthagen BusinessA Healthagen BusinessA Healthagen Business
POPU
LATI
ON
HEA
LTH
TEC
HN
OLO
GY
& S
ERVI
CES
Confidential and Proprietary
Confidential and Proprietary6
Healthagen population health management entities
Healthagen Business SynopsisComprehensive Population Health Technology and Analytics stack, and largest Health Information Exchange in the U.S.
Leading mobile patient engagement platform, providing decision support and tools for individuals to access and navigate the health care system
One of largest providers of care management, disease management, health and wellness services; driven by clinical intelligence and active analytics
Decision support tools for consumers to select a provider based on transparent cost information
Social caregiving platform; allows elderly and debilitated patients to remain independent longer by enabling caregiver support and collaboration
Social caregiving platform for families of NICU babies that integrates care management and social support during NICU stay and post-acute phase
Personalization framework to integrate wellness programs around the unique needs of the individual
Accountable Care enablement and management services
Patient-centered Medical Home enablement and management services
Neo
Wellness 2.0
Confidential and Proprietary7
Population health clients & goals
EmployersReduce growth in health care costsHigh-value insurance products for their membersSatisfied, loyal members
Government
Accessible, affordable and efficient delivery systemHigh quality careReduce cost and burden of chronic diseasesPromote healthy behaviors
Providers
Assume accountability and risk under accountable care and value-based financial incentives, and remain financially viableProvide high-quality and efficient clinically integrated careAttract and retain new patient populations
GoalsClients
Confidential and Proprietary8
Foundation for population health delivery:a clinically integrated care system
Organized health care “ecosystem”
Governance structure in place
Care collaboration and management
Electronic health care records with the ability to aggregate and exchange data
Holistic, patient-centered focus and engagement
Business and financial models that align accountability and incentives– ACOs– PCMHs– Care Bundles
Clinically Integrated Delivery System
Confidential and Proprietary9
Actionable clinical intelligence: identify gaps in care & actively engage patients & providers
Cost and utilization
Quality and outcomes
Avoidable services
Preventable leakage
Individuals at risk
Gaps in care
System operating and financial performance
Confidential and Proprietary10
Embedded team-based care management services: superior impact when delivered by providers
Multi-disciplinary provider teams are embedded in the practices– MD, RN, PA, MA, Social Services, Nutritionist, Pharmacists, Behavioral Health
Care management technology is integrated with local EHRs in real time
Patients are engaged and activated
Providers have ownership of process and accountability for outcomes
Medical leadership drives results
High-Value Provider-driven Care Management Activities
Utilization Management
Referral managementER managementExtended office hoursNurse advice lineConcurrent reviewDischarge planning
Care / Case Management
Care Navigator (coordinator)Complex case management / extensivist programTransition in careHome & Post-acute carePalliative Care & HospiceCare bundlesMedication therapy management
Disease Management
Asthma / COPDCHFDiabetesIHDHigh-risk OBOncology
Confidential and Proprietary11
Wellness programs: focus on healthy lifestyles, disease prevention
Long-term goals are to reduce the burden of chronic diseases, avoidable injuries, depression and suicide
Engagement must be personalized and use compelling approaches– Mobile apps that are easy and compelling– Social networking– Game mechanics (neural-behavioral feedback)– Incentives and rewards
Health and Wellness Programs
— Diet — Workplace and school education and safety
— Exercise — Stress reduction— Smoking cessation — Biometric screening / monitoring— Education — Public health actions (immunizations,
etc.)
ATTRACTENGAGE RETAININFORM
LET’S SIMPLI
FY
+
Confidential and Proprietary13
Engaged patients: more active and satisfied in their care
Patients increasingly demand a satisfying, retail-like experience, where quality = convenience
With high-deductible insurance, they have skin in the game and are active decision makers
They are well informed by the Internet, social media and crowd sourcing
They expect to interact through mobile devices and digital media
When engaged by their physician and “activated”, outcomes are better
We need to re-think the patient experience– Access to my health care record– Transparent information and decision support– Ease of accessing my doctor and getting appointment– Getting to know your Navigator and Care Team– Communicating electronically via mobile device or email– Help staying fit and healthy, and enjoying it– Help managing my chronic condition, and being motivated– Social support from my care givers and others like me– Reducing complexity and burden of managing it all
Confidential and Proprietary14
Accountability & Risk
Accountable Sponsor Accountable Provider
Value created through pricing, via competition, in narrow networks.
Collaboration
Managing risk and accountability by aligning incentives for financially sustainable health care
Value created through efficiency, reducing waste, cost restructuring and keeping patients healthier.
Financial sponsor assumes accountabilityEpisode-based payment to providersFragmented, uncoordinated care — left to sponsor’s centralized DM, CM, UM (telephonic & mail)Payer provides traditional insurance services in adversarial relationship with providers
Providers assume accountability and risk for populationPayment based on value in terms of total cost, quality and satisfactionCare coordination and management longitudinally by providersPayer becomes an enabling partner
Confidential and Proprietary15
Healthagen’s population health experience
> 1,100 Hospitals> 250,000 Physicians> 8 RHIOs
> 22M Lives > 8M Lives > 10M downloads> 2.5M mobile
users> 4M portal users
> 30 ACOs> 100 PCMH/Collab.> 22M lives
CARE MANAGEMENT
ACCOUNTABLE CARE
PATIENTENGAGEMENT
OPERATIONALINTELLIGENCE
CLINICALINTEGRATION
