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mHealth Israel Conference, Rob Egan, CMO, Aetna Healthagen, October 7, 2013

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Presentation at the mHealth Israel Conference and Business Contest, October 7, 2013 by Rob Egan, Chief Marketing Officer, Aetna Healthagen

Presentation at the mHealth Israel Conference and Business Contest, October 7, 2013 by Rob Egan, Chief Marketing Officer, Aetna Healthagen

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  • Pete: If I understand this slide correctly, it starts with image of actual iTriage App and builds to tell the broader story of iTriage’s benefits. This slide gives the audience a good sense of total iTriage package before zeroing in on physician office on the next slide.Discuss how we are a workflow company for the consumer and the provider…we are a a full platform that meets the consumer and helps them navigate their healthcare… wherever they are.

mHealth Israel Conference, Rob Egan, CMO, Aetna Healthagen, October 7, 2013 mHealth Israel Conference, Rob Egan, CMO, Aetna Healthagen, October 7, 2013 Presentation Transcript

  • Healthagen Population Health Management Rob Egan | CMO Healthagen October 7, 2013
  • Healthagen, a division of Aetna, vision for population health Purchasers buy health care that is fundamentally more affordable, higher quality, more convenient and satisfying, based on value Providers collaborate to provide patient-centered team-based care and are compensated on performance and value, rather than volume The population’s health needs are well understood, individuals at risk are identified and the health care system’s performance is continuously measured Individuals and their caregivers are actively engaged, interacting though convenient mobile tools with social support 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 2 Confidential and Proprietary
  • Key value drivers for population health CLINICAL INTEGRATION OPERATIONAL INTELLIGENCE ACCOUNTABLE CARE CARE MANAGEMENT Population Health Technology 3 Confidential and Proprietary PATIENT ENGAGEMENT
  • Population health management: products & services CLINICAL INTEGRATION OPERATIONAL INTELLIGENCE ACCOUNTABLE CARE CARE MANAGEMENT PATIENT ENGAGEMENT • Integration with unique EMRs and Health IT systems • Longitudinal view into a given patient or population • Business transformation services • Medical care management • Patient portal, PHR • Value-based contracting • Wellness programs • Intuitive collaboration tools and user interfaces • Evidence-based medicine rules engine and notifications • Financial models alignment and modernization • Alternate site care • Access, registration and appointments • TPA administration • Secure message notifications • Population risk stratification, disease registries • Social caregiving • e-Visits • Referral management • Gaps in care, alerts • Provider-led health plan insurance products • Transitions in care • Reporting (cost, utilization, quality, p rovider performance) • Community patient records deployment • System performance monitoring • Medication management • Marketing and distribution • Consulting • Patient centered medical homes • ACO enablement POPULATION HEALTH TECHNOLOGY & SERVICES 4 Confidential and Proprietary • Decision support • Wellness, disease management programs • Education • Financial/bill management
  • Population health management: products & services POPULATION HEALTH TECHNOLOGY & SERVICES CLINICAL INTEGRATION HEALTH INFORMATION EXCHANGE A Healthagen Business CLINICAL ANALYTICS ACCOUNTABLE CARE A Healthagen Business A Healthagen Business ACCOUNTABLE CARE OPERATIONAL INTELLIGENCE EMPLOYEE WELLNESS PATIENT CENTERED MEDICAL HOME EMPLOYER SPONSORED CLINICS A Healthagen Business A Healthagen Business A Healthagen Business CARE MANAGEMENT & WELLNESS PATIENT ENGAGEMENT 5 Confidential and Proprietary A Healthagen Business A Healthagen Business SOCIAL CAREGIVING CARE MANAGEMENT CARE COORDINATION NEONATAL SOLUTIONS A Healthagen Business A Healthagen Business COST COMPARISON MOBILE HEALTH A Healthagen Business A Healthagen Business NeoCare
  • Healthagen population health management entities Healthagen Business Synopsis Comprehensive 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 Ne o Wellness 2.0 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 6 Confidential and Proprietary
  • Population health clients & goals Clients Goals Reduce growth in health care costs Employers High-value insurance products for their members Satisfied, loyal members Accessible, affordable and efficient delivery system Government High quality care Reduce cost and burden of chronic diseases Promote healthy behaviors Assume accountability and risk under accountable care and value-based financial incentives, and remain financially viable Providers Provide high-quality and efficient clinically integrated care Attract and retain new patient populations 7 Confidential and Proprietary
  • 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 8 Confidential and Proprietary Clinically Integrated Delivery System
  • 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 9 Confidential and Proprietary
  • 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 management ER management Extended office hours Nurse advice line Concurrent review Discharge planning 10 Confidential and Proprietary Care / Case Management Care Navigator (coordinator) Complex case management / extensivist program Transition in care Home & Post-acute care Palliative Care & Hospice Care bundles Medication therapy management Disease Management Asthma / COPD CHF Diabetes IHD High-risk OB Oncology
  • 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 — — — — 11 Diet Exercise Smoking cessation Education Confidential and Proprietary — — — — Workplace and school education and safety Stress reduction Biometric screening / monitoring Public health actions (immunizations, etc.)
  • + INFORM ENGAGE ATTRACT LET’S SIMPLIFY RETAIN
  • 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 – – – – – – – – – 13 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 Proprietary
  • Managing risk and accountability by aligning incentives for financially sustainable health care Accountable Provider Accountable Sponsor Accountability & Risk Collaboration Value created through pricing, via competition, in narrow networks. Financial sponsor assumes accountability Episode-based payment to providers Fragmented, uncoordinated care — left to sponsor’s centralized DM, CM, UM (telephonic & mail) Payer provides traditional insurance services in adversarial relationship with providers 14 Confidential and Proprietary Value created through efficiency, reducing waste, cost restructuring and keeping patients healthier. Providers assume accountability and risk for population Payment based on value in terms of total cost, quality and satisfaction Care coordination and management longitudinally by providers Payer becomes an enabling partner
  • Healthagen’s population health experience CLINICAL INTEGRATION > 1,100 Hospitals > 250,000 Physicians > 8 RHIOs 15 Confidential and Proprietary OPERATIONAL INTELLIGENCE > 22M Lives ACCOUNTABLE CARE > 8M Lives CARE MANAGEMENT > 10M downloads > 2.5M mobile users > 4M portal users PATIENT ENGAGEMENT > 30 ACOs > 100 PCMH/Collab. > 22M lives