connecting the physicians — medical home exchange
TRANSCRIPT
Physician
Patient
Consultantor
Employer
Specialist
Hospital
TEST
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PROCEDURE
PROCEDURE
Specialist
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PROCEDURE
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Rx
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The Sourcing of Health Care. Fixing a Broken Delivery System.
281.610.8631 | 1000 Texan Trail, Suite 213, Grapevine TX 76051 | MedicalHomeExchange.com
Uncoordinated, unmanaged supply chain.
Blanket contracting throughout the supply chain, which funnels volume to the highest-cost business models because they have the scope to win the blanket contracts.
What’s Driving the Cost of Health Care?
“Our U.S. health system is not really a system
as much as a bunch of independent players.
When my dry cleaner knows more about the
whereabouts of my shirts than my doctor knows
about the whereabouts of my X-rays, we have
a problem. We have to be able to provide an
infrastructure.”
Mark Bertolini, CEO, Aetna
Sick employees and their dependents in a complex and demotivating health care system.
INVOICE Hospital A INVOICE Hospital B
Colonoscopy$ 1,750
INVOICE Hospital C
Colonoscopy$ 896
Physicians in the dark with no incentive or information to keep people healthy.
281.610.8631 | 1000 Texan Trail, Suite 213, Grapevine TX 76051 | MedicalHomeExchange.com
The only people who can.The business leaders of this country.
And taking back control of your health care supply chain.
And here’s how...
By doing what you do every day
• Understanding what the market needs and wants
• Integrating functional areas
• Integrating key stakeholders and decision makers
• Efficiently aligning resources with need
• Effectively competing in an open market arena
• Achieving a fair return on investment
• Tracking performance with real-time dashboard driven information, adjusting where necessary
Who Will Fix The Problem?
Finally, a way to connect the physicians and move the needle on performance
Patent pending cloud based technology
Connect all suppliers in the health supply chain
Unique pay for physician performance model
Connect any physician with any system anywhere within 2 hours
Real-time performance metrics
Claims
Eligibility
Patient Employee
Employers
Ancillary
Primary Care Physicians
Specialists
Facilities
HRA • Biometrics • VBPDMobile Alerts • Disease Management • Advocacy
Pharmacy
281.610.8631 | 1000 Texan Trail, Suite 213, Grapevine TX 76051 | MedicalHomeExchange.com
We take this information
The tools you already have
• HRA• Biometrics• Claims Data• Physician Network• Health Management• Pharmacy Data
And get it to the primary care physicians, then
• Connect the primary care physicians and specialists, as well as facility direct opportunities with support of the specialist. The primary care physician leads the connectivity of information that allows for maximum transparency and pricing
• Pay physicians for performance
Enhancing your existing system
281.610.8631 | 1000 Texan Trail, Suite 213, Grapevine TX 76051 | MedicalHomeExchange.com
Best Value Facilities
Best Value Specialists
Other Facilities
Other Specialists
Primary Care Physicians1,000 lives500 lives100 lives10 or less lives
Best value providers
YourCo.
Where have your employees been going for medical services?
Medical Home Exchange will contract on your behalf with physicians, specialists and facilities
• Weidentifyandcontractonyourbehalfwiththebestvalueproviders
• Incentivizephysiciansandmemberstousepreferredfacilities
• Physicianssupporteffortsbyguidingmemberstobestvalueproviders
• Local,regionalandnationwideconnectivity
• Wemonitorandcontinuetodriveefficiencies
• Engagement — spending quality time with the patient and their information
• Protocol — the right treatment
• Compliance — we’ll know immediately if patients aren’t adhering to the plan
• Steerage — guiding and educating patients on best value providers and facilities
• Transparency — sharing data and pricing with the system
Connecttoanyphysiciananywhereinthecountry
ConnecttoanyEMRorPracticeManagement
Upandrunningin2hoursorless
Full-timestafftotrain,educateandmanagethephysicians
Physicians are incentivized to perform on employer’s behalf to manage the system. They are paid for:
Employees are incentivized to be accountable for their own health through value-based programs.
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Notices
Karen C. Smith, MD | Email » | 11/01/11
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My Contacts
Your primary care physician is
Karen C. Smith, MD
Your last visit to Dr. Smith was on January 1, 2011 Schedule an appointment » Documents »
Your patient and benefit advocate is
Deanna Azure, RN
Call Deanna at 800-123-4567Email Deanna »
More Contacts
My Team »
XYZ Company
Employees receive their own safe and secure Personal Health Record so they can have access and control over their own health.
281.610.8631 | 1000 Texan Trail, Suite 213, Grapevine TX 76051 | MedicalHomeExchange.com
4% increase in Primary Care expense3% reduction in specialty & ER visits7% reduction in inpatient facility expense15% reduction in outpatient facility expense7% reduction in pharmacy supply chain & formulary accuracy expense3% reduction in ancillary expense
5%est.savingsinthesecategories3%est.savingsonoverallclaims
Category ROI = 1:1
12% increase in Primary Care expense10% reduction in specialty & ER visits23% reduction in inpatient facility expense45% reduction in outpatient facility expense19% reduction in pharmacy supply chain & formulary accuracy expense10% reduction in ancillary expense
16%est.savingsinthesecategories7%est.savingsonoverallclaims
Category ROI = 3:1
ImpactofaPreEmployeeValue-BasedProgram(20-30%employeeengagement)
ImpactofaPostEmployeeValue-BasedProgram(80%+employeeengagement)
Return on InvestmentPhysician Connect
Withthephysiciansengaged,we’llseetheneedlemoveinthesekeyareas
Pay forOutcomes
Bonus Pack!
When Physicians Lead,
Costs Recede.
Physician
Performance
REAL-TIME
METRICS
CONNECT ALL SUPPLIERS
IN THE HEALTH SUPPLY CHAIN
Reverse Trend
Savings
7%
+
281.610.8631 | 1000 Texan Trail, Suite 213, Grapevine TX 76051 | MedicalHomeExchange.com
21
$22
20
19
18
17
16
15
14
13
12
11
10
9
Millions
Current Year
7%Savings
fromPrevious
Year
Year 4Year 3Year 2Year 1
$25M$13.8M
$12.8M
$11.9M
$11.1M
$10.3M
$15.3M
$16.9M
4-Year Savings:
$18.7M
$20.6M
10.51%NationalAverage
Trend
4 Year Projection
Reverse trend
Basedon1,130employeeswithtotalclaimsat$1,022PEPM
281.610.8631 | 1000 Texan Trail, Suite 213, Grapevine TX 76051 | MedicalHomeExchange.com
Need more tools for your medical home?
MedicalHomeExchangecan
providethefollowingadditional
resourcesforyourmedicalhome:
• Claims Negotiation (on average we can save $200-$250k per 1,000 employees)
• Patient and Benefit Advocate
• RN Coaching – one on one coaching where member has the same coach throughout
• Health Risk Assessment (HRA) – unique process where questions change based on members’ answers
• Biometrics – onsite
• Pharmacy review and PBM
• Mobile Alerts
When Physicians Lead, Costs Recede.
281.610.8631
1000 Texan Trail, Suite 213
Grapevine TX 76051
MedicalHomeExchange.com