Connecting the Physicians — Medical Home Exchange

Physician

Patient

Consultantor

Employer

Specialist

Hospital

TEST

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TEST

TEST

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PROCEDURE

PROCEDURE

Specialist

TEST

PROCEDURE

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.


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


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


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

The Sleep Center | Email » | 11/01/11

New XYZ Co Clinical Rewards program | Video » | 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.


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%

+


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


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

http://www.medicalhomeexchange.com

http://www.medicalhomeexchange.com

Connecting the Physicians — Medical Home Exchange

Documents

Transcript of Connecting the Physicians — Medical Home Exchange