preparing for healthcare transformation - john reza

Preparing for Healthcare Transformation - Building the Foundations for Success.

November 9th, 2011

Call-in toll-free number: 1-866-203-7023 (US)Conference Code: 965 798 7901

2© Copyright 2011 Headstrong Confidential and Proprietary Information

Agenda● Introduction and Welcome (11:00 – 11:02 AM) – Eastern

Standard Time : Yatinder Agarwal, Marketing, Headstrong

● Healthcare Industry Transformation Epidemic (11:03 – 11:15 AM) : John Reza, Healthcare Practice Leader, Headstrong

● Impact of the Payment Reform (11:16 – 11:28 AM) : Dr. John Sardelis, Associate Professor and Chairperson, Saint Joseph’s College

● Impact of Mobile Commerce (11:29 – 11:41) : Aaron Kaufman, GM & VP of Healthcare and Life Sciences at Kony

● Process Redesign Mandate (11:41 – 11:54 AM) : Guy Nesbitt, VP at Genpact, Healthcare Global Business Development Leader

● Panel Discussion (11:55 – 11:59 AM)● Closing (12:00 AM) : John Reza

strong opinions

strong resultsBiographies

3© Copyright 2010 Headstrong Confidential and Proprietary Information | www.headstrong.com | Page No.

John RezaPrincipal, Healthcare Practice, HeadstrongMr. Reza is a well-rounded Healthcare and IT professional with 25 years of experience functioning as a hands-on executive and management consultant. He is a former senior manager at one of the Big Four and a Chief Information Officer with significant experience in Healthcare business operations, IT, and management of large-scale systems and business process implementations.

John SardelisAssociate Professor, Associate Chairperson, Saint Joseph's CollegeDr. Sardelis is a full-time faculty member for graduate and undergraduate courses including Health Care Finance and Reimbursement, Managed Care, Legal Aspects of Health Care, Health Care Delivery Systems, Health Care Management, Managerial Statistics, Strategic Health Care Planning, International Health Systems, and Computer Applications in Health Administration. He offers his students a unique blend of a rigorous academic education, practical health insurance managerial experience and an extensive information technology background, providing a multi-dimensional approach to the subject of health care.

Aaron KaufmanGeneral Manager & Vice President of Healthcare and Life Sciences at KonyAaron brings more than 17 years of diversified information technology expertise across several verticals. Prior to joining Kony, Aaron served as the chief technology officer for Cardinal Health, where he focused on patient, provider, supplier and payer based initiatives, especially with mHealth. Previously, he held senior executive roles at numerous organizations, including US Oncology, Global Health Grid, Patrick Soon-Shiong (pronounced Soon Shung) Foundation, Abraxis Bioscience, Cognizant, and Infosys.

Guy NesbittHealthcare BD Leader, GenpactGuy is Genpact's Global Business Development Leader for their healthcare practice. He brings over fifteen years of industry experience in the Provider and Payer verticals, primarily focused on the provision of outsourcing services. Guy's experience includes tenures at a number of Fortune 20 firms. He has served as an Executive Director at McKesson and as a Senior Vice President at Cardinal Health. In addition, Guy led outsourcing sales at First Consulting Group prior to its acquisition by CSC and later as a Senior Vice President at Concentra, where he participated in its successful sale to Coventry Health.

strong opinions

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https://www.caremark.com/wps/portal/!ut/p/kcxml/04_Sj9SPykssy0xPLMnMz0vM0Y_QjzKLd4w39DQCSZnFG8Qbm-pHogk5IkSC9L31fT3yc1P1A_QLckMjyh0dFQH7usmg/delta/base64xml/L3dJdyEvd0ZNQUFzQUMvNElVRS82X0FfMUky

strong opinions

strong resultsHealthcare - A National Agenda


Reduce the growth of cost.

Make care delivery more efficient.

Provide quality care.

Secure and protect PHI.

strong opinions

strong resultsHealthcare Market – Complex


As of Oct, 2010: • A $2.6 Trillion Industry

• $900B hospitals, 900B doctors, 400B RX, 300B lab and imaging, 5% administrative expenses, 4% profit

There are:

• 6000 Hospitals in the U.S.• 815,000 US Licensed Physicians in the U.S.• 1,237 Health Insurance Carriers in the U.S.• 65,000 Pharmacies (40K chain and 25K independent) in the U.S.• 130,000 Pharmacists are employed by Chains only.• 25,084 Pharmaceutical Companies in the U.S.• 61,167 Medical Equipment & Device Companies in the U.S.• 16.4 million U.S. health care employees

strong opinions

strong resultsPain Points – Cost, Coverage, Care


• With a predicated average of 5.8 percent growth a year, the nation is expected to spend $4.6 trillion on health care in 2020, nearly double the $2.6 trillion spent last year.

• Healthcare accounts for 17.3% of GDP, $7,290 per capita (2009). Forecasted to be 20% by 2018.

• US Census estimate (2009) of 50.7 million Americans without Health insurance.

• Cost of insurance increasing - 120% increase since 1999.• 2,500 file for bankruptcy everyday due to health and medical costs.• 54% of U.S. patients do not seek care, fill prescriptions, or visit a doctor

because of health costs. • 12.6 million non-elderly adults were discriminated against due to pre-

existing conditions.• 98,000 Americans die each year as a result of medical errors.• Lack of prescription medication adherence costs between $250 and $300

billion a year. • US ranks last among 6 countries on health system performance -

Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom (quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives).

strong opinions

strong resultsHealthcare Industry Forces


Intercompany Business ProcessesState Governments

United States Government

Healthcare Information Systems

strong opinions

strong resultsMarket Segment Pressure Snapshot

© Copyright 2010 Headstrong Confidential and Proprietary Information | www.headstrong.com | Page No.

- Uncompensated Care - Consolidation - Lower Reimbursements

- Inadequate Reimbursements - Fewer Patients - Increase in Expenses

- Individual Mandate - B2C – Exchanges - MLR- ACO Positioning and Collaboration- Reinvention, M&A

- Cost of Drugs (e.g., Specialty Drugs) - Competition - Uncertainty about Sustained Revenues

PharmacyBenefitManager

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Market Segment Silos – Current State

Hospitals

Doctors

PBM’s

Laboratories

Nursing Homes

Insurance/Self-Funded

strong opinions

strong resultsHealthcare Federal Law


ARRA - $840B(Feb, 2009)

HITECH Act

Office of National Coordinator (ONC) - $2B

Privacy &Security

CMS – $21BEHR Incentive

ProgramState HIT Cooperative Agreement Program

State or Designated EntitiesHealth Information Exchanges

HIT Extension ProgramsRegional Extension Centers

Meaningful use of EHR

Beacon CommunityCooperative Agreement Program

National Health Information Network (NHIN)(Direct Project)

Widens the Scope of HIPPA

PHI Security Breach Notification

Extends Civil & Criminal Penaltiesfor Willful Neglect

Entitles Individuals to their Electronic Health Information

ePrescribing

Electronic Exchange of Information

Report of Clinical Quality Measures

strong opinions

strong resultsImpact on Cost, Coverage, Care , and Privacy


ARRA - $840B(Feb, 2009)

HITECH Act

Office of National Coordinator (ONC) - $2B

Privacy &Security

CMS – $21BEHR Incentive

Program

• Reduces medical errors• Reduce harmful drug interactions• Reduces redundant test and procedures• Promotes Evidence-Based Practice• Reduces claims denials and delays• Remind physicians about preventive care• Better manage patients with complex chronic conditions.• …

• National Standards & a massive injection of funding to local and regional communities and States for electronic exchange of medical records.

• Tracking disease outbreaks and immunizations, population health

• Enhanced communication and collaboration between hospitals, laboratories, pharmacies and physician offices

• The Development of the National Health Information Network (NHIN)

• Business Associates accountability• Raises the stakes of breaking HIPAA security and privacy laws• Puts the patient in control of their medical records.

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strong results


Patient Protection and Affordable Care Act(Mar, 2010)

American Health Benefit Exchanges(State Health Insurance Exchanges)

Shared Savings ProgramAccountable Care Organizations (ACO)

Pay for Performance - the “Star” Ratings

Medical Minimum Loss Ratio (MLR)

Bundled Payments Episode-based Care

Evidenced-based Medicine

Individual Mandate

Impact on Cost, Coverage, Care

strong opinions

strong resultsDelivery of Care - Future State


Nationwide HealthInformation Network

State HealthInformation Exchange

Private HealthInformation Exchange

Community Exchanges

State HealthInsurance Exchange

State HealthInsurance Exchange

IDN

ACO

Electronic Health RecordsIDN

Telemedicine

CPOE

VA

HHSFDA

Health Plans

SSA

PHR

Mobile

Payers

ACO

Chains

The Data-Driven Health Care Organization

Professor John Sardelis, Dr.P.H.Associate Professor

Saint Joseph’s College of NY

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The Guiding Principle

“IN GOD WE TRUST; ALL OTHERS MUST BRING DATA.”

W. EDWARDS DEMING

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Lack of Data - A Root Cause of Health Care’s Problems

• Excessive cost- Lack of cost control

• Inadequate quality- Lack of information on what works and what doesn’t

• Fragmented industry- Exacerbates cost and quality problems

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Medicare Is A Driving Force

ACO and Shared Savings

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Overview

• Section 3022 of the Affordable Care Act requires the Centers for Medicare & Medicaid Services (CMS) to establish a shared savings program to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs. The Shared Savings Program is designed to improve beneficiary outcomes and increase value of care by:

• Promoting accountability for the care of Medicare FFS beneficiaries

• Requiring coordinated care for all services provided under Medicare FFS

• Encouraging investment in infrastructure and redesigned care processes

• Eligible providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or joining an Accountable Care Organization, also called an ACO.

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Data Will Be Needed to Prosper

• Voluntary Medicare Shared Savings Program

• Must be done in ACO model

• Providers be held accountable for at least 5,000 beneficiaries annually for a period of three years.

• Providers who meet certain quality standards can share in any resulting savings.

• Accountable Care Organizations may share up to 50 percent of the savings under the one-sided model and up to 60 percent of the savings under the two-sided model, depending on their quality performance.

• First ACO agreements start 4/1/2012 and 7/1/2012

• Electronic medical records would be encouraged but not mandated

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A Major Health Systems Roadmap• Profiling attributed patient profiling

• Weighted average claims analysis and trending

• Benchmarks for utilization

• Calculate shared savings

• Project shared savings

• Accommodate 3 years of weighted claims history and robust data warehousing

• Calculate expenditure rates by payor and physicians

• Predictive modeling for patient attribution

• Calculate P4PTrack quality and core metrics

• Population disease and chronic care management tools

• Calculate analytics on an episode of care basis

• Track capitation

• Accommodate bundled payments

• Integrate multiple EMR’s

ALL WILL NEED A DATA SOURCE AND SUPPORTING ANALYTICS!!!! 21

The Data-Driven Health Care Organization

• Health care has been lagging behind in the deployment of IT- Opportunity to utilize lessons learned from other industries

• Government initiatives are funding many infrastructures changes that will provide the data

• Turning the data into a competitive advantage is the next step.

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Kony Mobile Retail

mHealth trends

Aaron KaufmanGM Healthcare & Life Sciences

24Copyright © 2011 Kony Solutions, Inc. CONFIDENTIAL

Trends in healthcare A quick summary How can mobile help?

A framework mTrends for health plans mTrends for providers mTrends for PBMs Why Kony?

24

Agenda

25Copyright © 2011 Kony Solutions, Inc. CONFIDENTIAL 25

Healthcare costs in the US are skyrocketingThe US spends more than twice what comparable countries spend

Things cost more

Because Worse mix of diseases

Rapidly aging population

Poor prevention


The solution? Shift the curve from disease care to disease

prevention

Move site of care from where the physician is to where the patient lives

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Adding to this are the pressures of oncoming reform and regulation

Reform pressures

ACOMedicare reform

P4P

Regulatory pressures

Meaningful use PQRI

30 day readmits ICD-10


And mobile is the key to enabling this transformation91% of US population has a mobile phone

Smartphones will exceed PC sales this year

And mobile doesn’t just mean phones. It also includes tablets (iPad, GalaxyTab and hundreds more)…

PHONES TABLETS



A framework mTrends for health plans mTrends for providers mTrends for PBMs Mobile Chaos Why Kony?

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Agenda


Time spent

Value

L H

H

Reference / Utility Social / Gaming

TransactionalSave money / time

Engaging

L

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A framework to evaluate app capabilities provided

Egs: lookup disease, medications, bill pay

Egs: medication refills, reminders, email provider

Egs: disease forums, social networks for conditions

Egs: ??.Combine gaming, social and healthcare

Don’t pick one quadrant but have apps which fit into as many of these as possible. Each quadrant caters to a need.



mTrends for health plans mTrends for providers mTrends for PBMs Why Kony?

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Agenda


Improve patient education and access is key to patient enablement and mobile provides the best access point to patients

Time spent

Value

L H

H

Reference / UtilitySocial / Gaming Wellness


Engaging

L

Benefits and claims

Drug information

Physician & pharmacy finder


Using mobile to provide medical record access and ensure basic capabilities such as emailing the physician and medication reminders can reduce costs significantly

Patient Self Service

Health record – tests etc.

Medication reminders

Time spent

Value

L H

H

Reference / Utility

Social / GamingWellness


Engaging

L


Engaging patients in innovative ways around nutrition, goal setting, patient to patient communications etc. can empower patients to make better decisions

Time spent

Value

L H

H

Reference / UtilitySocial / Gaming

Wellness


Engaging

L

Optumize Me

Mayo Community

Nutrition




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Agenda


Using mobile to provide basic lookup and reference information is useful in patient education and empowerment.

Time spent

Value

L H

H



Engaging

L

Physician finder, Lookup

Reference

Providers (except large systems eg. KP) have been choosing to partner with other service providers


Time and cost saving functionalities such as providing medical record access and ensure basic capabilities such as emailing the physician and appointment scheduling are extremely popular with patients

Time spent

Value

L H

H

Reference / Utility



Engaging

L

ZocDoc

Health record – tests etc.

Providers seem to prefer to provide this through partners or their websites. Mobile is increasing mindshare.


Kaiser Permanente and others.

Other use cases Discharge

instructions 30 day re-admit

prevention Active/Passive

messaging

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Patient engagement and networking is where providers could really make a big difference

Time spent

Value

L H

H

Reference / Utility



Engaging

L

Mayo Community

Patients assign a lot more attention to messages and directions from their physicians.




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Agenda


Using mobile to provide basic lookup and reference information is always useful

Time spent

Value

L H

H



Engaging

L

Very few PBMs or pharmacies offer this surprisingly (or perhaps difficult to find on the various app stores). Is not essential as there are several options available as described earlier.

ID cards

Drug information


Cost saving opportunities are large around drug spend. Medication adherence solutions have also been proven to reduce healthcare costs significantly.

Time spent

Value

L H

H

Reference / Utility



Engaging

L

Using mobile to provide cost saving options (generic replacements, switching to mail order etc.), simplifying the refill process etc. have been the primary areas of focus.

Cost Savings

Refills


Social and network based engagement through PBMs still remains to be explored.

Time spent

Value

L H

H

Reference / Utility



Engaging

L

Can PBMs truly play a significant role here?

Other players like Vitality are beginning to play in this space




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Agenda


… because we’ve been in mobile for awhile..

2007 2009 20102008 2011

R&D

Founded Launch RevenueCash Flow

PositiveCompany

Platform

Launch 4 OS

Mobile WebSMS

1.02 more OS,

Web Gadgets, Palm Pre

2.0 iPad,

Social Media, HTML5

650 Employees

2.5iOS4,

BB OS6, Windows Phone 7

1 555 15

700M

Annual User Sessions

10M 50M 140M 300M

Global 2000Customers

3.0Symbian,

Inline Debugger,Native Code Gen

R&DVertical Apps

Banking, Brokerage,

Retail

Media, Insurance,Healthcare

Hospitality, Airlines,

Automotive


…because we have some very large, very demanding customers and consumers

• 55 Major Global Brands and Growing

• 50 Countries, 18 Languages


7 Browsers Types / 8,500

devices

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Your Application

January 2010

Kony Platform

Your ApplicationNo changes required

December 2010

Kony Platform

Tablets Blackberry OS 6

Windows Phone 7

Note: Icons display only the most popular platforms supported. In January 2010, Kony supported optimized mobile web for 6 distinct devices ranging from WAP to WebKit, iPhone, Android, BlackBerry, Palm, Windows Mobile, and J2ME.

Note: In 2010 Kony added mobile web and native support for iPad, BlackBerry OS 6, Windows Phone 7 and HTML5 on a number of platforms among other improvements.

HTML5 iOS 4

6 Native OSs Browser Types Added

Device Updates Added

Android 2.1, 2.2,

2.3

…because we try to minimize TCO for our customers


Kony Platform [Write Once – Deploy Everywhere]

Healthcare ModulesProvider / Pharmacy Finder

Medication Center

Account Management

Patient Self-Service Transactions

Messaging &eVisits

Personal Health Record

Benefits & Claims Management

Marketing & Engagement

ePrescribing

Reminders & Alerts

Healthcare ApplicationsPayer PharmaProvider / HIT Suppliers

…and because you never start from scratch


Contact Information

U.S. Headquarters7380 W. Sand Lake Rd. Ste. 390Orlando, FL 32819Tel: 1-321-293-KONY (5669)Toll free: 1-888-323-9630

San Mateo

Toronto

New York

Hyderabad

SingaporeBangalore

ParisCologne

[email protected] www.kony.com

mailto:[email protected]

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strong results

Thank You! [email protected]

preparing for healthcare transformation - john reza

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