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Online Care Management – Can it solve some of the challenges faced by the healthcare industry? 2012

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Care Management at a glance Components of Care Management

Analytics (Embedded or Fully Integrated) Predictive Modeling Gaps in Care Behavioral Science Predictive Analytics

Health and Wellness Healthcare Coach Health Risk Assessment Wellness Programs Health Content Decision Support Tools Incentives

Care Management Applications (RuleDriven Workflow and Integrated Applications) Case Management Disease Management Utilization Management

Care Management Applications

Communications Multichannel and Integrated) Letter, Fax, E-Mail, Text Website Provider Portal Consumer Portal Personal Health Record Mobile

• Disease management: Is defined as "a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant“ • Case Management: Purpose of case management is to coordinate, facilitate and follow over time a client's use of an array of health and social services • Utilization management : Is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. Typically it includes new activities or decisions based upon the analysis of a case

Care Management – Key Takeaways 

   

U.S. healthcare payers have long struggled with legacy care management infrastructures that have hampered their ability to streamline care management processes and support an increase of members in care management programs. Complex interfaces are also hindering interoperability and impeding the ability of healthcare payers to manage the quality and cost-effectiveness of care The passage of the U.S. Affordable Care Act (ACA) is forcing organizations to meet key provisions that will require all healthcare payers to place much more emphasis on care management initiatives Healthcare payers will be ill-prepared to meet these provisions and remain competitive, unless they look to invest in a robust care management platform that is centered around an integrated care management application that includes case, disease and utilization management capabilities Care management applications in today's market offer better navigation, less-cumbersome processes, fewer steps to process a case, better integration with core administrative systems and more automation of the care management process There is a high degree of variability with care management product capabilities, resources and the level of customization required to deploy the product

Source: Gartner (January 2011)

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Dynamics of Online Care Management Definition & Overview • Online care is a specific type of telemedicine that uses the Internet to provide consumers with real-time access to a physician licensed within their state. Consumers can visit with a physician using secure live chat, and even see the physician if both are using a Web cam. Unlike e-visits where a person emails a question or concern and has to wait for a response, online care conversations happen in real-time, from anywhere, over the Web • Online care physicians use their clinical judgment to determine the best course of care, refer the patient to another discipline as needed, or direct patients to an in-person tier of care if necessary • Treatment plans may include self-care recommendations, guidance on steps to follow, & even diagnoses or prescriptions (if clinically appropriate) • Online care is designed to be an expanded adjunct delivery setting to complement an office visit, not replace visits with an established primary care physician

Drivers • Multiple factors are converging to make online care a viable solution for resolving many of the health care industry’s challenges. These include: – Rising health care delivery costs and premiums

– Inconsistent quality among providers – The unequal distribution and availability of providers throughout the country – An increasing desire among payers to reimburse for telemedicine-related services to reduce costs

Common Conditions treated with Online Care Management • Acute bronchitis

• Allergic rhinitis

• Acute sinusitus

• Viral illnesses

• Cough

• Insomnia

• Acute pharyngitis (sore throat)

• Acute conjunctivitis (“pink” eye)

• Nausea

• Diarrhea

• Urinary tract infections

• Fever

• Hypertension

• Contact dermatitis

Source: Optum Health whitepaper

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Key Takeaways – Online Care Management Market Size

Pricing & Service Dynamics

Government Support

 As on 2010, the interactive telemedicine business has been growing by almost 10 percent annually, to more than $500 million in revenue in North America. It is part of the $3.9 billion telemedicine category that includes monitoring devices in homes and hundreds of health care applications for smartphones.  Online Care is a branch of tele medicine. The differentiator being; Online care does not need expensive equipments since the medical records are stored on secure Web servers behind multiple firewalls to ensure that doctors and patient need not pay hundreds of thousands of dollars for equipment  The HMSA, Hawaii's largest insurer and an independent licensee of the Blue Cross Blue Shield Association, and American Well have been working on the project since last June, and officials say 85 percent of patients involved in the testing phase were satisfied. Available via the Internet or telephone and to all residents of the state regardless of membership with HMSA, the service offers 10-minute online sessions with a credentialed participating physician for a flat fee ranging from $10 to $45  More than 140 physicians, including those in general and family practice, cardiology, internal medicine, OB/GYN, ophthalmology, pediatrics, psychiatry, surgery and urology, are part of the Online Care network. The service is available day and night, including weekends, and doctors are reimbursed for their time.

 Medicare, Medicaid and other government health programs have been reimbursing doctors and hospitals that provide care remotely to rural and underserved areas.  Now a growing number of big insurance companies, like the UnitedHealth Group and several Blue Cross plans, are starting to market interactive video to large employers. The new federal health care law provides $1 billion a year to study telemedicine and other innovations.

Source: Press Releases

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Key Trends Driving Online Care Adoption

Issues

Trends

Access to Care

• • • • • • • •

Although 20 percent of Americans live in rural areas, only 9 percent of the nation's physicians practice there ii There are 65 million Americans living in areas with a shortage of primary care physicians. It would take an additional 16,643 physicians to meet the needs of those areas, assuming a patient-to-physician ratio of 2000 to 1 iii One-third of Americans report having difficulty getting timely appointments for routine care iv Primary care physician offices are available to patients only 25 percent of the time (40 of 168 hours per week) v The United States continues to face a physician shortage that limits access to care. By 2014, the Bureau of Labor Statistics predicts that there will be 212,000 physician job openings due to population growth and the need to replace retiring physicians As a result of Health Care Modernization, an additional 32 million Americans entering the market with insurance are expected to further stretch the capacity of primary care physicians Many consumers use the emergency room as their primary access to care, but the average total waiting time in a U.S. emergency room in 2010 was 4 hours and 7 minutes, making it not only time consuming, but also inconvenient Vi According to the Institute of Medicine: "Substituting other forms of care, such as electronic communication, for some face-to-face visits presents an opportunity not only to improve care - make it safer, more effective, patient-centered, and timely - but also make it more efficient“ vii

Continuity of Care

More than 1,200 retail clinics are now in 27 states, yet patient information from retail clinics gets back to the patient’s primary care physician less than 25 percent of the time viii

Affordability of Care

• •

Of America's $2.4 trillion annual health care spend in 2008, as much as $1.7 trillion (70 percent) was spent on avoidable services ix Many consumers over utilize emergency rooms for non-urgent care. The average emergency room visit costs more than $1,000 x

Quality of Care

• •

Americans get less than 55 percent of the recommended health care xi Telemedicine has the potential to improve patient outcomes by expanding the health care delivery network to increase the access to care xii Online care also provides a medium to promote preventive care messages to consumers

Source: Gsrtner & Press Releases

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Vendor-wise Care Management Product Information and Implementation partnerships Care Management Product Information

Vendor

Product Name

Implementation Partnerships

Total Number of Clients that Purchased the Product

Contracts Signed in 2010

15*

6

4 5

2

Altruista Health

GuidingCare

Casenet

TruCare Intellicare

CH Mack

MedCompass Q Continuum System

1 64*

2

Click4Care

Click4Care

14

3

HP Enterprise

Atlantes

9

2

ikaSystems

ikaMM

13

2

Landacorp

CareRadius maxMC

4 17

2

McKesson

CCMS

76*

4

MEDecision

Alineo CarePlanner

6 45

2

Pegasystems

Care Management Solution

12

4

TCS

Acuity Wisdom

28* 11

12

TriZetto

CareAdvance

25

3

ZeOmega

Jiva

15*

2

*May include third-party administrator (TPA), disease and care management companies, managed service organizations, or community health systems.

Vendor

Implementation Partnerships

Altruista

• Cognizant, CECSoft

Casenet

• FluidEdge Consulting, Clinton Rubin

CH Mack

• CSC, SAIC

Click4Care

• FlexTech, Cognizant

HP

• None

ikaSystems

• Accenture, Deloitte and other consulting companies

Landacorp

• None

McKesson

• None

MEDecision

• Invoyent, LiquidHub

Pegasystems

• Accenture, Cognizant

TCS

• None

TriZetto

• None

ZeOmega

• FlexTech, McCormack Consultants

Care management application implementations are complex and require skilled implementation resources with extensive experience in care management processes. Some vendors are analyzing partnerships with consulting firms and/or system integrators to augment implementation services.

The number of signed care management application contracts by U.S. healthcare payers continues to be strong: 40 contracts in 2007, 41 in 2008, 49 in 2009 and 46 in 2010.

Source: Gartner (February 2011)

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Deployment Model for Care Management Vendor

Product

Deployment Model

Concurrent Users

Altruista Health

GuidingCare

• All clients use ASP

200+

Casenet

TruCare

• All clients self-host; in negotiations with client that will be hosted by Casenet

1,800

CH Mack

MedCompass

• 50% of Q Continuum System clients are hosted by ASP. MedCompass is available on any model

1,200+

Click4Care

Click4Care

• 9 clients SaaS; 5 clients selfhosted

1,200+

HP

Atlantes

• 6 clients license; 1 client BPO

1,200

ikaSystems

ikaMM

• 10 clients SaaS; 1 client BPO

270

Landacorp

CareRadius

• All clients license; can support ASP

3,000+

McKesson

CCMS

• All clients license, can support ASP

500 to 600

MEDecision

Alineo

• 12 clients ASP; 17 iExchange clients are hosted; 5 use SaaS

1,000+

Pegasystems

Care Management Solution

• Majority of clients license; 2 clients purchased cloud/SaaS

1,200

TCS

Acuity

• 32 clients license; 3 use ASP; 4 use SaaS

152

TriZetto

CareAdvance Enterprise

• 15 clients license; 10 clients are hosted

1,000

ZeOmega

Jiva

• 40% of clients use SaaS; 60% license

4,200

User scalability of care management applications has become paramount. Although many approaches can be used to facilitate highly scalable solutions, the internal design of the software determines the application's ability to scale. The software needs to support large numbers of simultaneous case managers efficiently and effectively

Deployment Model: • The majority of care management application vendors offer a licensing model and are augmenting it with application service provider (ASP) and softwareas-a-service (SaaS) options. • Healthcare payers whose capital budgets are slim are looking at ASP and SaaS models as viable options. The promise of lower cost of ownership by avoiding infrastructure maintenance and software upgrade cycles is appealing. • Over the past couple of years, the number of ASP and SaaS implementations has increased, while the license model has been realizing a slow decline. This is also the first year in which Business Process Optimization is being offered and accepted by a couple of healthcare payers. Source: Gartner (February 2011)

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Most of the care management vendors provide minimal to moderate customisation in their products

Level of Customization Vendor

Implementation Partnerships

Altruista Health

• 100% minimal customization

Casenet

• 100% no customization

CH Mack

• Q Continuum System: 50% minimal customization; 50% moderate customization

Click4Care

• 100% no customization

HP

• 100% minimal to no customization

ikaSystems

• 100% minimal to no customization

Landacorp

• 100% minimal to moderate customization

McKesson

• 80% no customization; 15% minimal customization; 5% moderate customization

MEDecision

• 10% no customization; 40% minimal customization; 40% moderate customization; 10% extensive customization

Pegasystems

• 100% moderate to extensive customization

TCS

• 100% no customization

TriZetto

• 10% minimal customization, 70% moderate customization; 20% extensive customization

ZeOmega

• 20% no customization; 50% minimal customization; 30% moderate customization

Extent of Customisation • The level of customization that a product requires during implementation is a key consideration • While all solutions are "configurable," the level of customization can increase the allocated budget for the project. • There were a few vendor solutions that reported no customization or minimal customization: • No Customisation: Altruista Health, Casenet, Click4Care, HP, ikaSystems and TCS. • Minimal to moderate levels of customization were CH Mack, Landacorp, McKesson, TriZetto and ZeOmega. • The two vendors that had clients requiring some level of extensive customization were MEDecision and Pegasystems. • Healthcare payers need to weigh the trade-off between the risk of customization and the cost of conformity with the solution. • Many healthcare payers that are currently in the vendor selection process are seeking an out-of-the box, configurable solution that requires little, if any, customization.

Source: Gartner (February 2011)

© 2012 Sutherland Global Services Inc., All rights reserved. Privileged and confidential information of Sutherland Global Services Inc.

www.sutherlandglobal.com May 9, 2013

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End of Presentation

Š 2012 Sutherland Global Services Inc., All rights reserved. Privileged and confidential information of Sutherland Global Services Inc.

www.sutherlandglobal.com May 9, 2013

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Online care management can it solve some of the challenges faced by the healthcare industry  
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