This document discusses chronic diseases as a major problem in New York state and Governor Cuomo's efforts to address it. It outlines New York's Medicaid Redesign Team plan, which focuses on patient-centered medical homes and health homes to improve population health and lower costs. It also discusses the role of integrated care management, telehealth, and technology companies in coordinating care delivery.

2. Chronic Diseases -
The Problem in NY
2

3. 3

4. 4

5. *Governor Cuomo’s vision for collaboration was effectuated through Executive Order #5 5
which created the New York Medicaid Redesign Team (MRT).

6. (New York Ranks 50th In The Country For Avoidable Hospital Use*)

8. New York MRT* Plan
PCMH Leading to Health Homes
Triple Better
Better
Aim
Health for
the Care for
Population Individuals
Lower Cost
Through
Improvement
*Medicaid Redesign Team

9. Value Addition Through Integrated Care
Coordination Management of 7-member
Consortium of Technology and Service
Companies Adopting Tele-Health for Patient
Engagement
Tolven, CH
Mack, Autonomy, Genesis, Carematix,
isansys

10. Architecture
Providers
Ancillary Care
MD / Lab, Radiology,
Providers
Hospitals Pharmacy
(RN, LPN, PA)
TeleHealth Mobile Platform
CH MACK
Tolven
Health / EMR ed
(Web-based) CareMatix Genesis Isansys
MedTech MD
Database
Patients /
Community
Autonomy IDOL 10 Server SHIN - NY

11. Management Service Organization (MSO)
11

12. ACO – Accountable Care Organization
Performance Standards Required
12

13. Telemedicine Solution
―It’ll just be part of the way we practice medicine.‖ (Dr. Jason Mitchell, American
Academy of Family physicians)
―55% of our patients’ medical issues can be solved by phone or email
consultation - no office visit needed‖ (Dr. Alan Dappen, Doc Talker Family
Medicine, Vienna, Va.) (Dr. Dappen also works with a pilot project to show how
doctors deliver care via phone, email, internet & video conferencing)
Telemedicine is key to eliminating at least 1 million office visits / day in US
39% of doctors communicated with patients online in 2009 (an increase from 16%
in 2004) in the US
Aetna, Cigna, Blues, Wellpoint, and Humana now cover digital visits in parts of
the US

14. Market for Services
• 64% of US healthcare costs is generated by 10% of the sickest part of the
population.
• this group is typically seniors and indigent patients that have limited access to
state-of-the-art technology (or do not have the means to afford technology and
telecom plans).

15. Tolven

16. Member Centric Care Management
Reporting Seamless Integration
 UM/UR  Clinical systems
 Case Management  Claims systems
 Disease Management  Industry Std Criteria
 Outcomes  Clinical Data Repositories
UM/UR Case
 Core Measures Management
 Productivity
 Many more
Health Disease
Assessments Member Management
Referrals Performance
Reporting
Pro-Active
HIPAA Care Planning
Electronic Record

17. Business Function Overview
Utilization Management Case Management Wellness Management
 Referral management  Assessment & referral  Health Risk Assessment (HRA)
management integration
 Pre-authorization / Pre-
certification  Care planning  Educational mailing generation
 Auto approvals  Task management  Monitoring of preventive metrics
 Letter generation  Documentation & letter  Scheduled wellness activities
generation  Mobile support
 Medical review process
 Mobile support
 Appeals & grievances
 Third party integration
 Embedded criteria
 Care team coordination
Disease Management Analytics & Reporting Population Health
 Member identification  System consolidated  Opportunity identification
information
 Collaborative Care  Gap in care alerts
 Integration of data from
 Care planning multiple sources  Stratification of members at
risk
 Ongoing monitoring  Ad hoc and standard reports
 Utilization management
 Documentation & letter  Data export capabilities
generation  Health coaching support
 Third party integration

18. Impact of ―Big Data‖
At the World Economic Forum last month in Davos,
Switzerland, Big Data was a marquee topic. A report
by the forum, ―Big Data, Big Impact,‖ declared data a
new class of economic asset, like currency or gold.
―Big Data‖ is significant in fields as varied as science
and sports, advertising and public health — a drift
toward data-driven discovery and decision-making.
“It’s a revolution…we’re really just getting under way.
But the march of quantification, made possible by
enormous new sources of data, will sweep through
academia, business and government. There is no
area that is going to be untouched.”
-Gary King, director of Harvard’s Institute for
Quantitative Social Science.

19. Understanding & Automation Removes Manual Processes
Process Automation
Manual Processes
Notes
Aggregationcontent,
Aggregate
tag & categorize
Database Automatic
categorization to
Hypertext links
similar content
Document Hyperlinking
Personalization from
Management forms/questionnaires,
geodemographic
Profiling
profiling
News
Information Theory and Integration Personalization
Feeds Searching for
Bayesian Through
Understanding information
Inference Collaboration
Email
Delivery
Answering customer
Internet Retrieval via a helpdesk
inquiries
Reformatting for multi-
Files Routing delivery, e.g.
channel
PDF to XML
E-mailing information
Alerting
XML to relevant recipients
Audio/ Media

20. IDOL Platform
$ $$
Big Data Social Graphing Information Cross and Upsell
Governance Sentiment Analysis
Next Generation Platform
Over 400 Connectors
Transactional
Social Media Video Audio Email Texts Mobile Data Documents IT/OT Search Engine Images
Appliance Software OEM Cloud Mobile

22. Blood
Glucose
Meter
Remote Monitor
Using Wireless
Technology

23. Carematix
Uses Zigbee Technology to Collect the Data;
And Land Phone Line or Cellular Technology for Wireless Transmission

24. New Generation Technologies (Skin Sensors)

26. Thank You
For Your Consideration