Telehealth reimbursement models for non-medical services
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Telehealth Failures & Secrets to Success Conference 2017 by VSee Speaker: Brenda Schmidt Founder & CEO of Solera Health More info here: vsee.com/conference
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Telehealth reimbursement models for non-medical services
- 1. SoleraNetwork.com | 1 Changing Lives by Connecting People to Healthcare Solutions the Work A New Model for Chronic Disease Prevention and Management
- 2. SoleraNetwork.com | 2 SOLERA INTEGRATES NON-MEDICAL PROVIDERS TO TACKLE CHRONIC DISEASE CHRONIC CONDITIONS: HUGE PROBLEM NEEDS MULTI-MODAL APPROACH 1:2 Adults have at least one Productivity in the workplace Quality of life of patient & family 86% of $3T healthcare spend Focuses Treatment Medical Coping Non-Medical SupportPrevention
- 3. SoleraNetwork.com | 3 PROBLEM: DIFFICULT TO SCALE HIGHLY FRAGMENTED PROGRAMS Health Plan 1 Health Plan 2• No one community or digital / virtual provider can meet demand in a highly fragmented delivery network • Physicians do not have capacity to determine “best fit” program provider for each patient • No visibility to program quality and satisfaction data • Lack of seamless referral and reporting processes Employer 1
- 4. SoleraNetwork.com | 4 1 Diverse Populations 0% 50% 100% Ethnicity Age Sex 3 Choice Drives Engagement Choice has to: • Be easy / convenient • Provide options aligned with interests & goals • Meet buyer values Sources: The Henry J. Kaiser Family Foundation, State Health Facts, Timeline: 2015, Psychology today, HBR; Katz el al 2006 1000s of Programs 2 CHALLENGE FOR PAYORS... HOW DO YOU CHOOSE JUST ONE VENDOR?
- 5. SoleraNetwork.com | 5 Community Pharmacy / Retail Worksite Telehealth WITH 1 DIGITAL TOOL Patients are matched with the program provider that best meets their needs Digital Proprietary and Confidential. Not for Distribution Telephonic Patients access hundreds of program providers Community Pharmacy / Retail Digital YOU DON’T… YOU CHOOSE SOLERA TO MANAGE A NETWORK 1 CONTRACT SUPPORTS PATIENT CHOICE Employer 1 Health Plan 1 Health Plan 2 Telehealth
- 6. SoleraNetwork.com | 6 SOLUTION – PLATFORM SUPPORTING A NON-MEDICAL VALUE- BASED NETWORK PATIENTS SOLERA NETWORK PARTNERS Claims Management Engage & match Track satisfaction & success Receive patients and payments Submit activity & outcomes One contract Performance- based medical claims Enroll&Track Network Mgt & Quality Oversight Solera Platform PAYER ID Patients Refer to Solera4me Receive reports PHYSICIAN Screenand Refer
- 7. SoleraNetwork.com | 7 NETWORK MODEL EASES ADMINISTRATION AND SUPPORTS INNOVATION Privacy & Security Compliance Network Development Program Matching Claims Management Quality Oversight A B C Solera’s network model drives performance and sustainability of non-medical programs
- 8. SoleraNetwork.com | 8 Solera has implemented standard milestone-based quality metrics paid through medical claims Claim Submission Partner Payment Claim Submission Partner Payment Claim Submission Partner Payment Claim Submission Partner Payment INNOVATION – PERFORMANCE MILESTONES PAID THROUGH MEDICAL CLAIMS
- 9. SoleraNetwork.com | 9 Solera is a single source solution connecting patients to an integrated network of community and digital providers of non-medical prevention, coping and support services
- 10. SoleraNetwork.com | 10 1 in 3 is at risk for diabetes. More than 86 million Americans today have prediabetes. . . and most don’t know it. 86M DIABETES PREVENTION: 1st MARKET DUE TO ITS SIZE AND CLEAR ROI High Prevalence Clear ROIStructured Program Cited a savings per DPP participant who attended four sessions by the Center for Medicare and Medicaid Services (CMS) $2,650 20% PMPM decrease for pre- diabetics who completed DPP and lost 5+% (Florida Blue) Diabetes Prevention Program (DPP) 16 Weekly Group Sessions 6 Monthly Maintenance Sessions Standardized Curriculum Trained Lifestyle Coach CDC Recognition GOAL: 5-7% Weight Loss Diabetes Prevention Characteristics
- 11. SoleraNetwork.com | 11SoleraNetwork.com | 11 33% 33% 15% 19% DIGITAL SOLERA MEETS THE NEEDS OF 100% OF THE TARGET POPULATION DIGITAL / VIRTUAL COMMUNITY SITES GROCERY PHARMACY @WORK Proprietary and Confidential. Not for Distribution
- 12. SoleraNetwork.com | 12SoleraNetwork.com | 12 SOLERA DPP NATIONAL COVERAGE MAP • Solera: Over 7,000 in-person DPP community locations • 3,000 mobile community lifestyle coaches • Virtual or digital DPP providers cover 100% of the nation • Changes (expands) daily, particularly as we implement new clients in new geographies and ramp for Medicare DPP Current Solera DPP Network Coverage Pipeline Solera DPP Network Coverage
- 13. SoleraNetwork.com | 13 SOLERA CALIFORNIA COMMUNITY DELIVERY INFRASTRUCTURE > 700 CA Solera DPP community locations • Solera has enrolled over 10,000 Californians in DPP in 2017 • Community / Virtual DPP Network - Performance and satisfaction transparency • Integrated with FQHC / health plan / physician for referral and reporting
- 14. SoleraNetwork.com | 14 OPPORTUNITY: MENTAL WELLBEING, SLEEP AND STRESS/RESILIENCE Correlated to Health IssuesHigh Prevalence Proprietary and Confidential. Not for Distribution Costs You Lots of Money (per employee) Reduces Productivity Stress Sleep 56% 36% High 6 hrs or less Health Issue: Risk Increase: Depression: 1.5x - 10x Obesity: 1.3x - 7.5x Hypertension: 1.2x - 4x Diabetes: 1.2x - 3x Heart Attack: 2.1x Smoking: 2.7x XS eat, drink: >2x Poor Sleep High Stres s Poor Sleep High Stres s Missed 2-4 days more work 4% self-reported poorer performance 57% disengagement (vs. 10%) Missed 2+ days more work 60% worse in presenteeism Poor Sleep High Stres s $3-5K ~2/3rd HC costs $2-3K ~2/3rd Productivity Sources: CDC, Hui & Grandner 2015, HealthAffairs 2012 on modifiable risk factors, ComPsych StressPulse 2015, Banks & Dinges, J Clinical Sleep Med 2007, Vgontzas & Yun Li, Sleep 2017, Ejaz, Khawaja et al, Innov Clinical Neuroscience, 2011
- 15. SoleraNetwork.com | 15SoleraNetwork.com | 15 SLEEP / RESITANCE APPROACHES: OPPORTUNITY TO PREFERENCE MATCH Solera selects partners based on financial viability, clinical/evidence based foundation, history of outcomes, structure of offering, compliance 40% COMMUNITY Proprietary and Confidential. Not for Distribution Coach/Teacher All Digital Mindfulness Meditation More structured Cognitive Behavioral Therapy More Freeform
- 16. SoleraNetwork.com | 16 PARTICIPANT MATCHING PROCESS: DRIVES STRONG FIT PREFERENCE-BASED MATCHING Patients are matched with one of our industry-leading network partners based on their needs and preferences. CBT style Structured Mediation Style Explore Any Time Program A Program B BEST MATCH Program C Scheduled Coach or Peer Support Self driven
- 17. SoleraNetwork.com | 17SoleraNetwork.com | 17 EXAMPLE PATIENT EXPERIENCE Proactive Customized Engagement and Enrollment Employee learns about the Sleep, Stress, Resilience Options • Direct mail • Email • Phone • Direct to Consumer Proprietary and Confidential. Not for Distribution
- 18. SoleraNetwork.com | 18SoleraNetwork.com | 18 Patient visits Solera4me.com or engages by phone to qualify for the DPP Patient qualifies
- 20. SoleraNetwork.com | 20SoleraNetwork.com | 20 All qualified patients are matched with their “best fit” DPP provider based on their needs and preferences. Patient begins their program • Proactive coach outreach • Virtual participants receive a digital scale • All participants receive a Fitbit at week 4
- 21. SoleraNetwork.com | 21 PROGRAM RESULTS: BETTER FROM MATCHING AND MANAGEMENT Age Distribution by DPP Intervention Type Servicing diverse population Driving strong outcomes 100,000s Enrolled 1.5-15% Engaged week 4 77% Engaged week 9 81% 5%+ weight loss 46%* * Have 12 months to achieve Conversion 0% 20% 40% 60% 80% 100% 18-24 25-34 35-44 45-54 55-64 65+ Digital / Virtual Weight Watchers DPP Community Organization
- 22. SoleraNetwork.com | 22SoleraNetwork.com | 22 SOLERA TECHNOLOGY: CENTRAL DATABASE FOR ALL DPP DATA Data science translates data from across Solera’s network into actionable business intelligence Proprietary and Confidential. Not for Distribution
- 23. SoleraNetwork.com | 23 TOUCHING PEOPLE MULTIPLE TIMES THROUGHOUT THEIR LIFE 20 30 40 50 60 70 SUSAN: Lives in TX Works in accounting Three kids JOHN: Lives in WA Works on docks Two kids I just tackled SLEEP & STRESS now I can focus on LOSING THAT WIEGHT. I feel like a new person after the DPP PROGRAM “A Matter of Balance” (FALLS) has kept me out of a nursing home. My lifestyle coach helped my reduce my HEART ATTACK RISK via exercise and diet. HEALTHY FOOD assistance really helped me eat better. With Solera’s support, I got my ALOCHOL USE under control You really helped me overcome my FEELINGS OF ISOLATION after my wife died. SOLERA Changing lives Lowering costs Improving productivit y SoleraNetwork.com | 23
- 24. SoleraNetwork.com | 24 SOLERA HEALTH NETWORK Every individual deserves an opportunity to achieve their full health potential. At Solera, we strive to make that goal a reality.
Editor's Notes
- Solera has established an integrated national network of community organizations and digital DPP providers. All have full or pending recognition by the CDC, and we are continuing to build out the network, Community is critically important - 50% of participants across markets select an onsite option. One payment model for all DPP partners – let’s members select or find the “best fit” provider. Solera can offer a more narrow network based on documented outcomes for each provider. (Explain how we onboard and review efficacy). Ability to integrate with Humana programs.
- Solera has established an integrated national network of community organizations and digital DPP providers. All have full or pending recognition by the CDC, and we are continuing to build out the network, Community is critically important - 50% of participants across markets select an onsite option. One payment model for all DPP partners – let’s members select or find the “best fit” provider. Solera can offer a more narrow network based on documented outcomes for each provider. (Explain how we onboard and review efficacy). Ability to integrate with Humana programs.
- If you a FQHC – everything together under 1 umbrella
- What are we: Preventive Care Benefits Manager Why is that valuable: Allows for prevention programs to scale and meet their goal of keeping people healthy and saving HC $$s by making sure people get the right program for them and only quality programs stay in network How are we different: Use a network and program matching to solve problem vs. tailoring Prevention = health promotion, disease prevention, limiting disease progression. Ideally 100% covered benefit Solera has established an integrated national network of community organizations and digital DPP providers. All have full or pending recognition by the CDC, and we are continuing to build out the network, Community is critically important - 50% of participants across markets select an onsite option. One payment model for all DPP partners – let’s members select or find the “best fit” provider. Solera can offer a more narrow network based on documented outcomes for each provider. (Explain how we onboard and review efficacy). Ability to integrate with Humana programs.
- Solera brought together a wide group of DPP delivery organizations who have agreed to work together because it is in the best interest of the member. Members will always do well in DPP programs that they self-select. Across all demographics – Medicaid, Medicare and Commercial. Based on CDC data as of July 2016, 83% of the 8,000 people who have successfully completed DPP across the country and all providers are white females over the age of 45. Bringing the DPP partners together, we can do better.
- Already working with many health plans in CA and dozens of DPP delivery partners in CA. The DPRP list includes many parent organizations but the number and locations of hyper-local delivery sites are not included.
- Solera has established an integrated national network of community organizations and digital DPP providers. All have full or pending recognition by the CDC, and we are continuing to build out the network, Community is critically important - 50% of participants across markets select an onsite option. One payment model for all DPP partners – let’s members select or find the “best fit” provider. Solera can offer a more narrow network based on documented outcomes for each provider. (Explain how we onboard and review efficacy). Ability to integrate with Humana programs.
- At Solera Health, we provide the SAAS-based infrastructure for connecting patients with DPP providers and we manage the enrollment and the reimbursement by working directly with the health plans. Let’s take a look at how this works.