trust is medicine - ebpa accola… · 5/6/2014 · the nuka model of care . who makes the...
TRANSCRIPT
© Accolade, Inc. 2014 Proprietary & Confidential
June 5, 2014
Trust is Medicine
Influencing More Care Decisions through Relationships and Empowerment
© Accolade, Inc. 2014 Proprietary & Confidential
It’s About Our Employees
The last thing we want our
employees to have to focus on
is healthcare.
How do we enable them, empower them, help them and keep them focused on their job and the people they love
©Accolade Inc. 2014 Proprietary & Confidential
The Healthcare Dilemma
Employers & Consumers struggle to balance demands of lowering healthcare
costs while increasing program and member value
THE RESULT:
30% Annual health care spend
results in
unnecessary or unproductive care
What’s working to lower costs:
Improvements to provider networks
Negotiated administrative costs
Shifting costs to employees & families
Risk mitigation due to exchange options
What has resulted:
X Consumers are frustrated and confused
X Low engagement and satisfaction results
X Benefit leaders are overwhelmed
X Costly care mistakes
X ROI from existing programs are minimal
X Partners are not accountable
3
©Accolade Inc. 2014 Proprietary & Confidential 4
Effective Population Health Management requires proactively engaging &
influencing care decisions of the entire population
Decision making effecting outcomes
The NUKA Model of Care
Who Makes the
Decisions?
Doctor Patient
Staying Healthy No Yes
Deciding to Seek
Medical Help
No Yes
Diagnosing Yes Yes
Treating an Illness Yes Yes
Complying with
Therapy No Yes
©Accolade Inc. 2014 Proprietary & Confidential
Staying healthy Reacting
to symptoms
Diagnosing symptoms
Choosing a treatment
Complying with
treatment
Families need help navigating their care
Errors Errors Errors Errors Errors
• Not current with screenings
• Unhealthy lifestyle choices
• Inappropriate ER use
• Unnecessary doctor visit
• Specialist visit instead of PCP
• Wrong specialty
• Unproductive MD visits
• Wrong diagnostic option
• Incorrect staging of visits or tests
• Duplicate tests
• Incorrect treatment option
• Inappropriate inpatient or outpatient setting
• Wrong drug therapy
• Lack of care plan • Care plan not
followed • Uncoordinated
inpatient stay • Poorly planned
discharge
Incentives aligned: Providers, employers & employees want the right care the first time
Poor consumer decisions drive
unnecessary and unproductive
care
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©Accolade Inc. 2014 Proprietary & Confidential 6
The Usual Industry Approach to “Managing Care”
The Conventional Medical Model Industry Standard for Care Management
Adjust for severity and risk
Assess for gaps in
care
Identify from data
Leverages standard data algorithm
Unproven results
> Reaches small fraction of > population; sickest 6-10%
> Transactional & > fragmented; adds to > frustration
> No relationship or trust; > lost opportunity for impact
Marginal reach = lost impact opportunity
©Accolade Inc. 2014 Proprietary & Confidential 7
Trust-based Relationship Approach Influences Care Accolade’s psycho-social model starts with the entire population
Po
pu
lati
on
healt
h d
ata
Enable
s p
ers
onalized c
are
pla
n
Leverages natural human behavior
Entire population = more impact
Person/family at center; individual assessment
Data for assessing care gaps & severity
Proprietary stage-of-care medical management model
Validated assessment
tools
Proven savings & satisfaction
> Recognizes that everything takes time
> Addresses care transitions
> Based on influence and trust
©Accolade Inc. 2014 Proprietary & Confidential
Trust in Healing Relationships
WHAT FOSTERS TRUST?
OPEN, FULL ENGAGEMENT
Judgment-free conversation
Boundaries respected
Discussion between equals
No hidden agendas
©Accolade Inc. 2014 Proprietary & Confidential
Trust in Healing Relationships
WHAT IS GAINED WITH TRUST?
A SAFE PLACE
FOR TAKING
PERSONAL RISKS
MAKING IMPORTANT DECISIONS
SOMETIMES CHANGING COURSE
©Accolade Inc. 2014 Proprietary & Confidential
Trust in Healing Relationships
• Research on “contextual errors” and “contextualization of care”
• Asking “fearless” questions to explore context:
– Shows caring
– Builds trust
– Improves health care outcomes
– Reduces errors – and costs
©Accolade Inc. 2014 Proprietary & Confidential
One Place For Families To Go
A Personal Health Assistant who knows families, knows their benefits and supports them at all stages
Any Question,
Big or Small
Health & Benefit Answers
CONTACT ACCOLADE
Engage Earlier & More Often
Build Relationships, Earn Trust
Influence & Enhance Care
© Accolade, Inc. 2014 Proprietary & Confidential 12
Engaging families at the right time
60+% of all families engaged 85+% of high cost families engaged 67% engagement before a care event
Contacts & paid data from 4/12 – 3/13
©Accolade Inc. 2014 Proprietary & Confidential
Reduced program fragmentation = greater engagement
More Engagement vs. Other Programs**
ENGAGEMENT WITH ACCOLADE*
*Accolade engages 60% of families annually, **Time Warner Cable experience
© Accolade, Inc. 2014 Proprietary & Confidential 14
Consistently driving the right care
$0
$20
$40
$60
$80
$100
$120
HospitalInpatient
HospitalOutpatient
PhysicianSurgical
PhysicianMedical
Behaviorial X-Ray/Lab Rx Other
Avg PMPM Accolade Effect
Increases in outpatient MHSA utilization and drug compliance (including preventive visits)
-23%
-8%
Core Accolade customer savings areas
-16%
-3%
-7%
+75%
+10%
UTILIZATION
IMPROVEMENTS
underlying the
savings are also
consistent across
the populations we
serve
© Accolade, Inc. 2014 Proprietary & Confidential 15
Driving Better Health Outcomes
15
1. Slowing the natural migration of poorly managed chronic conditions
High cost
2. Accelerating regression to the mean as condition is brought under control
A significant savings opportunity exists with lower cost members by addressing the depression, anxiety and uncertainty that accompany the condition or episode of care
Only 20% of chronic client’s spend is on their chronic disease. Accolade accelerates the regression to the mean of high cost members by assisting with all health issues.
Low cost
Mean costs
1
2
Chronic conditions include: Asthma, Coronary Artery Disease, CHF, and Diabetes
Chronic Cost
Chronic Population
© Accolade, Inc. 2014 Proprietary & Confidential 16
Accolade’s impact - significant & immediate
$240
$260
$280
$300
$320
$340
$360
$380
$400
Oct2008
Dec2008
Feb2009
Apr2009
Jun2009
Aug2009
Oct2009
Dec2009
Feb2010
Apr2010
Jun2010
Aug2010
Oct2010
Dec2010
Feb2011
Apr2011
Jun2011
Aug2011
Oct2011
Dec2011
Trai
ling
12
mo
nth
s p
mp
m c
ost
Accolade launch
Control Population
*Third Party Validation: Dr. Clyde Schechter, Einstein Medical Center
>8% real savings 3rd party validated savings*
Roll out to additional
regions
Accolade population had consistently been ~$8 pmpm
higher than control for previous few years
©Accolade Inc. 2014 Proprietary & Confidential
Accolade’s impact – most recent results
Positive impacts are consistent with other customer results
$10 PMPM less expensive after 18 months
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$50B Retailer
$245
$255
$265
$275
$285
$295
$305
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$325
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$345
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Trailing 12 Month PMPM
Pilot TTM PMPM Control TTM PMPM
Pilot TTM Pre-Accolade Control TTM Pre-Accolade
Linear (Pilot TTM PMPM) Linear (Control TTM PMPM)
Linear (Pilot TTM Pre-Accolade) Linear (Control TTM Pre-Accolade)
Pilot population nearly $14 PMPM more expensive than the control group
Accolade launch
© Accolade, Inc. 2014 Proprietary & Confidential 18
The Accolade effect is consistent in all populations
• Launch date for each is end of blue line • Charts show all Accolade populations w/year or more of results
40K lives 45K lives 25K lives
75K lives 60K lives 50K lives
© Accolade, Inc. 2014 Proprietary & Confidential 19
Deep relationships = meaningful influence
-5
70
Health Plan Industry Average
Accolade's Net Promoter Score vs. Health Plans & Other Brands
56
74
Delighted Employees
98%+ Employee satisfaction
World-class
70+ Net Promoter Score
71