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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:

Published in: Healthcare
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Telehealth reimbursement models for non-medical services

  1. 1. | 1 Changing Lives by Connecting People to Healthcare Solutions the Work A New Model for Chronic Disease Prevention and Management
  2. 2. | 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. 3. | 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. 4. | 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. 5. | 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. 6. | 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. 7. | 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. 8. | 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. 9. | 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. 10. | 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. 11. | | 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. 12. | | 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. 13. | 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. 14. | 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. 15. | | 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. 16. | 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. 17. | | 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. 18. | | 18 Patient visits or engages by phone to qualify for the DPP Patient qualifies
  19. 19. | | 19
  20. 20. | | 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. 21. | 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. 22. | | 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. 23. | 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 | 23
  24. 24. | 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.