Improving Health Care Quality and Cost Effectiveness Dean
- Slides: 52
Improving Health Care Quality and Cost Effectiveness Dean Souleles Chief Operating Officer November 21, 2008 RHI - Confidential and Proprietary - Do Not Copy
Resolution Health Our Vision Create a world where each individual achieves their optimal health through the best, most cost effective health care. Our Beliefs It is possible to create that world. Getting patients, doctors and relevant health information together is at the heart of achieving this vision. 2 RHI - Confidential and Proprietary - Do Not
Resolution Health 3 RHI - Confidential and Proprietary - Do Not
Resolution Health Our Mission We send a smarter patient to the doctor. We provide a more informed doctor for the patient. 4 RHI - Confidential and Proprietary - Do Not
The Smarter Patient 5 RHI - Confidential and Proprietary - Do Not
The More Informed Doctor 6 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care ™ One Person at a Time 7 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time Personal Health Picture™ § We assemble and organize personal health data for each health plan member (not just those with “Big 5” chronic diseases) Personal Health Scan™ § We identify specific opportunities for health care quality improvement and cost reduction for the individual Personalized Communications § We provide actionable information to the individual, their physicians and their care managers 8 RHI - Confidential and Proprietary - Do Not
Personal Health Care Guidance Our Expertise Data Analytics Expertise Personal Health Picture ™ 9 RHI - Confidential and Proprietary - Do Not
Personal Health Care Guidance Our Expertise Data Analytics Expertise Clinical Expertise GAP IDENTIFIED ! Personal Health Picture ™ Personal Health Scan ™ 10 RHI - Confidential and Proprietary - Do Not
Personal Health Care Guidance Our Expertise Data Analytics Expertise Personalized Communications Expertise Clinical Expertise GAP IDENTIFIED ! Personal Health Picture ™ Personal Health Scan ™ 11 RHI - Confidential and Proprietary - Do Not
Our Customers Entities at financial risk for health care costs § Health Plans § Self-Insured Employers § Pharmacy Benefits Management Companies § Unions 12 RHI - Confidential and Proprietary - Do Not
Our Customers Entities at financial risk for health care costs § Health Plans § Self-Insured Employers § Pharmacy Benefits Management Companies § Unions Companies that help “at-risk” entities manage their risk § Disease Management Companies § Third Party Administrators § Portal Companies § Benefits Consulting Firms 13 RHI - Confidential and Proprietary - Do Not
Our Customers Entities at financial risk for health care costs § Health Plans § Self-Insured Employers § Pharmacy Benefits Management Companies § Unions Companies that help “at-risk” entities manage their risk § Disease Management Companies § Third Party Administrators § Portal Companies § Benefits Consulting Firms Current Client List § 193 Individual Accounts § 10 Major Health Plans § 2 Major Pharmacy Benefits Management Companies § 1 Major Portal Vendor 14 RHI - Confidential and Proprietary - Do Not
What Differentiates Us Our Business Personal Health Picture™ § Sophistication and breadth of our of data analytics § Focus on individuals in entire population, not just “Big 5” diseases § Analysis of Lab Results, HRA -- moving toward real-time analyses 15 RHI - Confidential and Proprietary - Do Not
What Differentiates Us Our Business Personal Health Picture™ § Sophistication and breadth of our of data analytics § Focus on individuals in entire population, not just “Big 5” diseases § Analysis of Lab Results, HRA -- moving toward real-time analyses Personal Health Scan™ § Comprehensive, cutting edge rules library § Rules which consider individuals’ plan benefit design details § Glide path predictive modeling § Johns Hopkins University School of Medicine relationship 16 RHI - Confidential and Proprietary - Do Not
What Differentiates Us Our Business Personal Health Picture™ § Sophistication and breadth of our of data analytics § Focus on individuals in entire population, not just “Big 5” diseases § Analysis of Lab Results, HRA -- moving toward real-time analyses Personal Health Scan™ § Comprehensive, cutting edge rules library § Rules which consider individuals’ plan benefit design details § Glide path predictive modeling § Johns Hopkins University School of Medicine relationship Personalized Communications § Focus on engaging and motivating individuals § Consumer communications, behavioral science expertise § Coordination of individual, physician and care manager messaging § Personalized “tailoring” of messages and delivery methods 17 RHI - Confidential and Proprietary - Do Not
What Differentiates Us Our Impact Matched-Control Study § Proved member-targeted messaging increases compliance with evidence-based guidelines and formulary preferences. Randomized Control Test § Proved physician-targeted messaging increases compliance with evidence-based guidelines. 18 RHI - Confidential and Proprietary - Do Not
The Personal Health Picture RHI - Confidential and Proprietary - Do Not Copy ™
Creating the Personal Health Picture ™ Personal Health Picture 20 RHI - Confidential and Proprietary - Do Not
Creating the Personal Health Picture ™ Demographic § Age 62 § Male § Married 21 RHI - Confidential and Proprietary - Do Not
Creating the Personal Health Picture ™ Demographic § Age 62 § Male § Married Medical History § Atrial Fibrillation (Jul 22 2007) § Diabetes (Mar 01 2006) § Office Visit Dr. Lynn (May 23 2008) § Office Visit Dr. Wilson (May 17 2008) § Office Visit Dr. Jones (Apr 12 2008) 22 RHI - Confidential and Proprietary - Do Not
Creating the Personal Health Picture ™ Demographic § Age 62 § Male § Married Medical History § Atrial Fibrillation (Jul 22 2007) § Diabetes (Mar 01 2006) § Office Visit Dr. Lynn (May 23 2008) § Office Visit Dr. Wilson (May 17 2008) § Office Visit Dr. Jones (Apr 12 2008) Prescriptions § Metformin 500 mg (May 01 2008) § Metformin (Dec 01 2007) § Lipitor 20 mg (Feb 10 2008) § Lipitor 20 mg (Jan 18 2008) § Accupril 20 mg (Mar 28 2008) § Accupril 20 mg (Feb 18 2008) § Accupril 20 mg (Jan 12 2008) § Nexium 20 mg (Feb 12 2008) § Nexium 20 mg (Jan 10 2008) 23 RHI - Confidential and Proprietary - Do Not
Creating the Personal Health Picture ™ Demographic § Age 62 § Male § Married Medical History § Atrial Fibrillation (Jul 22 2007) § Diabetes (Mar 01 2006) § Office Visit Dr. Lynn (May 23 2008) § Office Visit Dr. Wilson (May 17 2008) § Office Visit Dr. Jones (Apr 12 2008) Prescriptions § Metformin 500 mg (May 01 2008) § Metformin (Dec 01 2007) § Lipitor 20 mg (Feb 10 2008) § Lipitor 20 mg (Jan 18 2008) § Accupril 20 mg (Mar 28 2008) § Accupril 20 mg (Feb 18 2008) § Accupril 20 mg (Jan 12 2008) § Nexium 20 mg (Feb 12 2008) § Nexium 20 mg (Jan 10 2008) Lab Tests § Cholesterol Panel (May 23 2008) § Metabolic Panel (Mar 28 2008) § CT X-Ray Sinuses (Feb 04 2008) 24 RHI - Confidential and Proprietary - Do Not
Creating the Personal Health Picture Demographic § Age 62 § Male § Married Medical History § Atrial Fibrillation (Jul 22 2007) § Diabetes (Mar 01 2006) § Office Visit Dr. Lynn (May 23 2008) § Office Visit Dr. Wilson (May 17 2008) § Office Visit Dr. Jones (Apr 12 2008) ™ Lab Test Results § Total Cholesterol 214 (May 23 2008) § LDL Cholesterol 109 (May 23 2008) § HDL Cholesterol 85 (May 23 2008) § Triglycerides 100 (May 23 2008) § Fasting Blood Sugar 123 (Mar 28 2008) Prescriptions § Metformin 500 mg (May 01 2008) § Metformin (Dec 01 2007) § Lipitor 20 mg (Feb 10 2008) § Lipitor 20 mg (Jan 18 2008) § Accupril 20 mg (Mar 28 2008) § Accupril 20 mg (Feb 18 2008) § Accupril 20 mg (Jan 12 2008) § Nexium 20 mg (Feb 12 2008) § Nexium 20 mg (Jan 10 2008) Lab Tests § Cholesterol Panel (May 23 2008) § Metabolic Panel (Mar 28 2008) § CT X-Ray Sinuses (Feb 04 2008) 25 RHI - Confidential and Proprietary - Do Not
Creating the Personal Health Picture Demographic § Age 62 § Male § Married Medical History § Atrial Fibrillation (Jul 22 2007) § Diabetes (Mar 01 2006) § Office Visit Dr. Lynn (May 23 2008) § Office Visit Dr. Wilson (May 17 2008) § Office Visit Dr. Jones (Apr 12 2008) Prescriptions § Metformin 500 mg (May 01 2008) § Metformin (Dec 01 2007) § Lipitor 20 mg (Feb 10 2008) § Lipitor 20 mg (Jan 18 2008) § Accupril 20 mg (Mar 28 2008) § Accupril 20 mg (Feb 18 2008) § Accupril 20 mg (Jan 12 2008) § Nexium 20 mg (Feb 12 2008) § Nexium 20 mg (Jan 10 2008) ™ Lab Test Results § Total Cholesterol 214 (May 23 2008) § LDL Cholesterol 109 (May 23 2008) § HDL Cholesterol 85 (May 23 2008) § Triglycerides 100 (May 23 2008) § Fasting Blood Sugar 123 (Mar 28 2008) Biometrics § Height 6’ 2” (May 23 2008) § Weight 215 (May 23 2008) § BMI 27. 6 (May 23 2008) § Abdominal Girth 39 in (May 23 2008) § Blood Pressure 145 / 90 (May 23 2008) Lab Tests § Cholesterol Panel (May 23 2008) § Metabolic Panel (Mar 28 2008) § CT X-Ray Sinuses (Feb 04 2008) 26 RHI - Confidential and Proprietary - Do Not
Creating the Personal Health Picture Demographic § Age 62 § Male § Married Medical History § Atrial Fibrillation (Jul 22 2007) § Diabetes (Mar 01 2006) § Office Visit Dr. Lynn (May 23 2008) § Office Visit Dr. Wilson (May 17 2008) § Office Visit Dr. Jones (Apr 12 2008) Prescriptions § Metformin 500 mg (May 01 2008) § Metformin (Dec 01 2007) § Lipitor 20 mg (Feb 10 2008) § Lipitor 20 mg (Jan 18 2008) § Accupril 20 mg (Mar 28 2008) § Accupril 20 mg (Feb 18 2008) § Accupril 20 mg (Jan 12 2008) § Nexium 20 mg (Feb 12 2008) § Nexium 20 mg (Jan 10 2008) ™ Lab Test Results § Total Cholesterol 214 (May 23 2008) § LDL Cholesterol 109 (May 23 2008) § HDL Cholesterol 85 (May 23 2008) § Triglycerides 100 (May 23 2008) § Fasting Blood Sugar 123 (Mar 28 2008) Biometrics § Height 6’ 2” (May 23 2008) § Weight 215 (May 23 2008) § BMI 27. 6 (May 23 2008) § Abdominal Girth 39 in (May 23 2008) § Blood Pressure 145 / 90 (May 23 2008) Health Participation § Disease Mgt Program – Enrolled (Mar 17 2008) § Wellness Program - Targeted § Wt Loss – Targeted § Smoker – Targeted Lab Tests § Cholesterol Panel (May 23 2008) § Metabolic Panel (Mar 28 2008) § CT X-Ray Sinuses (Feb 04 2008) 27 RHI - Confidential and Proprietary - Do Not
Creating the Personal Health Picture Demographic § Age 62 § Male § Married Medical History § Atrial Fibrillation (Jul 22 2007) § Diabetes (Mar 01 2006) § Office Visit Dr. Lynn (May 23 2008) § Office Visit Dr. Wilson (May 17 2008) § Office Visit Dr. Jones (Apr 12 2008) Prescriptions § Metformin 500 mg (May 01 2008) § Metformin (Dec 01 2007) § Lipitor 20 mg (Feb 10 2008) § Lipitor 20 mg (Jan 18 2008) § Accupril 20 mg (Mar 28 2008) § Accupril 20 mg (Feb 18 2008) § Accupril 20 mg (Jan 12 2008) § Nexium 20 mg (Feb 12 2008) § Nexium 20 mg (Jan 10 2008) Lab Tests § Cholesterol Panel (May 23 2008) § Metabolic Panel (Mar 28 2008) § CT X-Ray Sinuses (Feb 04 2008) ™ Lab Test Results § Total Cholesterol 214 (May 23 2008) § LDL Cholesterol 109 (May 23 2008) § HDL Cholesterol 85 (May 23 2008) § Triglycerides 100 (May 23 2008) § Fasting Blood Sugar 123 (Mar 28 2008) Biometrics § Height 6’ 2” (May 23 2008) § Weight 215 (May 23 2008) § BMI 27. 6 (May 23 2008) § Abdominal Girth 39 in (May 23 2008) § Blood Pressure 145 / 90 (May 23 2008) Health Participation § Disease Mgt Program – Enrolled (Mar 17 2008) § Wellness Program - Targeted § Wt Loss – Targeted § Smoker – Targeted Lifestyle § Exercise – 3 X per week (Feb 18 2008) § Smoker (Feb 18 2008) 28 RHI - Confidential and Proprietary - Do Not
Creating the Personal Health Picture Demographic § Age 62 § Male § Married Medical History § Atrial Fibrillation (Jul 22 2007) § Diabetes (Mar 01 2006) § Office Visit Dr. Lynn (May 23 2008) § Office Visit Dr. Wilson (May 17 2008) § Office Visit Dr. Jones (Apr 12 2008) Prescriptions § Metformin 500 mg (May 01 2008) § Metformin (Dec 01 2007) § Lipitor 20 mg (Feb 10 2008) § Lipitor 20 mg (Jan 18 2008) § Accupril 20 mg (Mar 28 2008) § Accupril 20 mg (Feb 18 2008) § Accupril 20 mg (Jan 12 2008) § Nexium 20 mg (Feb 12 2008) § Nexium 20 mg (Jan 10 2008) COMPLETE Lab Tests § Cholesterol Panel (May 23 2008) § Metabolic Panel (Mar 28 2008) § CT X-Ray Sinuses (Feb 04 2008) ™ Lab Test Results § Total Cholesterol 214 (May 23 2008) § LDL Cholesterol 109 (May 23 2008) § HDL Cholesterol 85 (May 23 2008) § Triglycerides 100 (May 23 2008) § Fasting Blood Sugar 123 (Mar 28 2008) Biometrics § Height 6’ 2” (May 23 2008) § Weight 215 (May 23 2008) § BMI 27. 6 (May 23 2008) § Abdominal Girth 39 in (May 23 2008) § Blood Pressure 145 / 90 (May 23 2008) Health Participation § Disease Mgt Program – Enrolled (Mar 17 2008) § Wellness Program - Targeted § Wt Loss – Targeted § Smoker – Targeted Lifestyle § Exercise – 3 X per week (Feb 18 2008) § Smoker (Feb 18 2008) 29 RHI - Confidential and Proprietary - Do Not
The Personal Health Scan RHI - Confidential and Proprietary - Do Not Copy ™
Guiding the Way to Better Health Care… ™ One Person at a Time PERSONAL HEALTH SCAN Rx Safety Scan § Drug-Drug Interaction § Drug-Condition Interaction § Drug-Age Interaction § Drug-Lifestyle Interaction § Drug FDA Recall/Black. Box § Has Condition Needs Drug § Need Test to Optimize Drug Dose § Need Test to Assess Drug Side Effect § Test Result Indicates Dose Adjust § Non-Compliance Drug Regimen § Over-use of Drug § Need Doctor Visit to Follow Start New Med § Need Drug to Prevent Condition 31 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time PERSONAL HEALTH SCAN Rx Safety Scan § Drug-Drug Interaction § Drug-Condition Interaction § Drug-Age Interaction § Drug-Lifestyle Interaction § Drug FDA Recall/Black. Box § Has Condition Needs Drug § Need Test to Optimize Drug Dose § Need Test to Assess Drug Side Effect § Test Result Indicates Dose Adjust § Non-Compliance Drug Regimen § Over-use of Drug § Need Doctor Visit to Follow Start New Med § Need Drug to Prevent Condition 32 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time PERSONAL HEALTH SCAN Rx Safety Scan § Drug-Drug Interaction § Drug-Condition Interaction § Drug-Age Interaction § Drug-Lifestyle Interaction § Drug FDA Recall/Black. Box § Has Condition Needs Drug § Need Test to Optimize Drug Dose § Need Test to Assess Drug Side Effect § Test Result Indicates Dose Adjust § Non-Compliance Drug Regimen § Over-use of Drug § Need Doctor Visit to Follow Start New Med § Need Drug to Prevent Condition Evidence-Based Care Scan § Has Condition Needs Drug § Has Condition Needs Test § Need Test Event Follow-up § Need Preventive Test-Age § Need Doctor Visit Follow-up ER § Need Preventive Info Condition § Need Info Warning Signs § Need Info Lab Result Ranges 33 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time PERSONAL HEALTH SCAN Rx Safety Scan § Drug-Drug Interaction § Drug-Condition Interaction § Drug-Age Interaction § Drug-Lifestyle Interaction § Drug FDA Recall/Black. Box § Has Condition Needs Drug § Need Test to Optimize Drug Dose § Need Test to Assess Drug Side Effect § Test Result Indicates Dose Adjust § Non-Compliance Drug Regimen § Over-use of Drug § Need Doctor Visit to Follow Start New Med § Need Drug to Prevent Condition Evidence-Based Care Scan § Has Condition Needs Drug § Has Condition Needs Test § Need Test Event Follow-up § Need Preventive Test-Age § Need Doctor Visit Follow-up ER § Need Preventive Info Condition § Need Info Warning Signs § Need Info Lab Result Ranges 34 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time PERSONAL HEALTH SCAN Rx Safety Scan § Drug-Drug Interaction § Drug-Condition Interaction § Drug-Age Interaction § Drug-Lifestyle Interaction § Drug FDA Recall/Black. Box § Has Condition Needs Drug § Need Test to Optimize Drug Dose § Need Test to Assess Drug Side Effect § Test Result Indicates Dose Adjust § Non-Compliance Drug Regimen § Over-use of Drug § Need Doctor Visit to Follow Start New Med § Need Drug to Prevent Condition Evidence-Based Care Scan § Has Condition Needs Drug § Has Condition Needs Test § Need Test Event Follow-up § Need Preventive Test-Age § Need Doctor Visit Follow-up ER § Need Preventive Info Condition § Need Info Warning Signs § Need Info Lab Result Ranges Rx Cost Savings Scan § Brand Switch to Generic § Brand Switch to Formulary Preferred § Formulary-Preferred to Generic § Pharmacy Purchase to Mail Order § Test Result Indicates Doctor Follow-up 35 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time PERSONAL HEALTH SCAN Rx Safety Scan § Drug-Drug Interaction § Drug-Condition Interaction § Drug-Age Interaction § Drug-Lifestyle Interaction § Drug FDA Recall/Black. Box § Has Condition Needs Drug § Need Test to Optimize Drug Dose § Need Test to Assess Drug Side Effect § Test Result Indicates Dose Adjust § Non-Compliance Drug Regimen § Over-use of Drug § Need Doctor Visit to Follow Start New Med § Need Drug to Prevent Condition Evidence-Based Care Scan § Has Condition Needs Drug § Has Condition Needs Test § Need Test Event Follow-up § Need Preventive Test-Age § Need Doctor Visit Follow-up ER § Need Preventive Info Condition § Need Info Warning Signs § Need Info Lab Result Ranges Rx Cost Savings Scan § Brand Switch to Generic § Brand Switch to Formulary Preferred § Formulary-Preferred to Generic § Pharmacy Purchase to Mail Order § Test Result Indicates Doctor Follow-up 36 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time Adam is at risk for stroke. 37 RHI - Confidential and Proprietary - Do Not
Personalized Communications RHI - Confidential and Proprietary - Do Not Copy
Guiding the Way to Better Health Care… ™ One Person at a Time Adam is at risk for stroke. 39 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time 40 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time 41 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time 42 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time 43 RHI - Confidential and Proprietary - Do Not
Guiding the Way to Better Health Care… ™ One Person at a Time 44 RHI - Confidential and Proprietary - Do Not
Making a Difference Adam Achieves “optimal health” Risk of stroke reduced Avoids Emergency Room visit Avoids hospital stay Avoids compromised lifestyle Adam’s Employer Adam remains at work A productive employee Avoids finding, training new employee Adam’s Health Plan Avoids medical claim Avoids short / long term disability claim Avoids post-stroke medical costs 45 RHI - Confidential and Proprietary - Do Not
Resolution Health Message Types Health Alerts Urgent information about your health Health Tips Ways to help improve your health Money Savings Ways to save money on prescription drugs and other health care services 46 RHI - Confidential and Proprietary - Do Not
Reaching The Individual 47 RHI - Confidential and Proprietary - Do Not
Coordinated Communications To Patient and Physician 48 RHI - Confidential and Proprietary - Do Not
Patient / Physician Communications Strong Results and Reaction Success / Compliance Rate 44% On Clinical Issues “It’s wonderful that my health plan does such a thing. These communications make me proud to be a health plan member. ” “Compiling the patient's information in this easy-to-read format makes communication between the physician and the patient more interactive…a better feeling. ” – Personal Care Note Recipient – Family Practice Physician 49 RHI - Confidential and Proprietary - Do Not
Resolution Health Questions? 50 RHI - Confidential and Proprietary - Do Not
Resolution Health Thank You 51 RHI - Confidential and Proprietary - Do Not
Improving Health Care Quality and Cost Effectiveness Dean Souleles Chief Operating Officer November 21, 2008 RHI - Confidential and Proprietary - Do Not Copy
