Optima - Health 2.0 10th Annual Fall Conference

1. PRECISION
piloting healthcare coordination in
hypertension
© optima integrated health

2. © optima integrated health2
Operations: Loss Due to Avoidable ED Visits and Hospitalizations
For every 1000 patients with HTN, every year:
Patients visiting ED for HTN-related symptoms and complications (50%) 500
Cost of ED Services (500 x $1,233) $600,000
Cost of Hospitalization (35% of ED visits @ $20,000/admission) $3,500,000
Cost of Rehabilitation/Ambulatory Services (50% of Hospitalizations @ $12,000/patient) $900,000
Cost of In-Patient Surgical Procedures (10% of Hospitalizations @ $70,000/patient) $1,050,000
Overall Cost of Care for the 500 Patients visiting the ED $6,050,000

3. optima4BP Demo:
The Naked Analytic Intelligence

4. Medication Optimization Decision Support Workflow
© optima integrated health4
Assessment
Is BP lowering On Track?
Do Nothing
Ongoing Surveillance
ACTION
Generate Treatment
Optimization
Recommendation
SURVEILLANCE
Collection and
Organization of Data
Updates?  YES

NO
ASSESSMENT
Does treatment require
optimization?
YES
NO
YES
NO
ACTION sent to EHR In-Basket
Risk Stratified Patient Roster

5. © optima integrated health5
EHR In-Basket Decision Support Recommendation
Treatment Action:
Consider adding a drug belonging to the class ACE Inhibitors (10.00 mg/day of lisinopril -
gradually increase to 20.00 mg/day after 2 week(s) in the absence of side effects).
Combination pills containing amlodipine & benazepril (ex. Lotrel) are available, for increased
convenience and adherence. The current amlodipine dose is 25% of the maximum
recommended therapy; consider increasing the dose.
Consider discontinuing potassium supplements, if taken. Closely monitor serum
potassium and creatinine.
ACE Inhibitors represent the first line of anti-hypertensive treatment for a patient with chronic
kidney disease.
Implementing this suggestion is estimated to improve the overall treatment efficacy by 140%.
Patient Case and Treatment Modeling
Qardio® BP Arm Monitor Collected Data (38 data points over past 28 days):
Measurement Min Max Average ± STD % of time at Target BP
Systolic BP 147 181 162±21 9%
Diastolic BP 49 104 90±17 38%
Heart Rate 72 176 94±13 N/A

6. Outcomes
6 © optima integrated health
 Interoperability: EHR - data “dump”
 Care Coordination: adoption based on availability of RN support
 Clinical Efficacy:
 Implementation of optima4BP recommendation:  in BP
 Inertia:  in BP/side-effects severity/symptoms

7. Lessons Learned
7 © optima integrated health
 Interoperability: Chasing the Data - built own query and automation tools
 Care Coordination: Risk Stratified Recommendations
 Clinical Efficacy: Trusting the Analytic Intelligence

8. Next Steps
8 © optima integrated health
 Ready to pilot/deploy optima4BP to other sites
 Pipeline Development: optima4heart