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“A good scalpel makes a better surgeon. Good
communication makes a better doctor.”
- Dr. Josh Umbehr
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Agenda
• How I See Market Developing – trends/thesis• Patient Engagement via Extensible Patient Relationship Management vs. Limited/Rigid Patient Portals
• Case studies: Direct Primary Care Medical Home (D-PCMH) – Hidden gem in PPACA
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Trends/observations driving our thesis
• Shift to Patient-centered, Accountable, Coordinated World – Who’s already there?
• Patients: More than a Vessel to Attach Billing Codes to• Communication: The Most Important Medical Instrument• Primary Care Renaissance – D-PCMH, PCMH, Onsite • Nimble Medicine & Fundamentally New Delivery Models• Deflationary Economics Will Drive Healthcare• Decentralization of Healthcare Delivery (Innovator’s
Prescription + Topol CDoM) – Barrier to entry Boat anchor• Technology-enabled Services to enable ACOs, PCMH, etc.
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Thesis: Impossible to Succeed Without Patient Engagement in New Payment Models
Recognize who really makes the decisions influencing outcomes
“Control”
Person’s Location/Acuity
100
0
At Home/Low Acuity Hospital/High Acuity
The “System”Person/Family
EMRPRMKey Enabling Technology
Chronic: 75% of H/C $$
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QUICK DEMO
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PPACA “SECRET” – D-PCMH
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Only Non-Insurance Solution Authorized in Future Insurance Exchanges
Senate Language - H.R. 3590EAS - SEC. 10104 (3). On P. 2068
TREATMENT OF QUALIFIED DIRECT PRIMARY CARE MEDICAL HOME PLANS
• The Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan.
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Nature of Transaction
Provider
Patient
Insurance Admin
High FFS Primary Care Admin CostPromotes Visit Volume vs. Time with Patient
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Efficient Direct Primary Care Medical Homes Promote Time with Patients vs. Visit Volume
Provider
Patient
Ins. Admin
KEY
Schedule Appointment
Sees patientDiagnoses Illness
Take X-ray Onsite
Run CBC Onsite
Patient goes to pharmacy
Dispense RxPatient
recovers
Patient has fever and
cough
Pays cash for Rx
Same Day Appointment
Patient has fever and
cough
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The Qliance Direct Primary Care Medical Home
Preventive Care
Wellness Care
Chronic Disease
Management
Specialist Care
Coordination
Urgent Care
Unrestricted office visits
Same and next day appointments
Unhurried office visits
No co-payments
Extended weekday hours
Weekend office hours
Phone and email access
Flat monthly fee
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79% (Qliance)
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Utilization Data – Qliance Members Under 65 (2010)
Type of ReferralQliance # per year/1000**
Benchmark*
Difference
ER Visits 56 158 -65%
Hospitalizations (visits) 34 53 -35%
Hospitalizations (in days) 105 184 -43%
Specialist Visits 670 2000 -66%
Advanced Radiology 300 800 -63%
Surgeries 22 124 -82%
Primary Care Visits 3540 1847 +92%
*Based on regional benchmarks from Ingenix and other sources.**Based on best available internal data, may not capture all non-primary care claims
Source: Qliance Medical Group non-Medicare patients, 2010 (n=3,088)
2x Primary Care Visits & 2-3x Care/Visit
50% Reduction in Downstream Care
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Not the Usual Processes•Comprehensive assessment and shared care plan
•Daily huddles with entire team
•Lots of non visit based care- email, text, video
•Extensive use of groups- including Stanford Chronic Care Curriculum in 3 languages
•Integrated Mental health, nutrition
•Real time data for management, including daily hospital, ER feeds, pharmacy fills
•Co-management with hospitalists, other specialists
•Proactive care (DM/CM)- based on registry queries, event triggers
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Total spending dropped a net of 12.3%; Driven mostly by large decreases in hospital admissions, ER visits, and outpatient procedures
For all SCC patients enrolled in 2009, relative to control group created using propensity matching.
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Contact: [email protected]
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