eQHealth Care Coordination program

1. eQHealth Care Coordination program

2. Q: Can the healthcare system achieve sustainability in today’s climate?

3. We must, however, think outside of traditional solutions We must transition from episodic to streaming care We must go beyond awareness of situation to behavior change A: eQ thinks so.

4. Traditional Solutions • Disease Management • Remote telephonic intervention • Works independently only with patient • Minimal interaction with PCP • Focus on disease condition only • Staffing ratio: 1:250 • Case Management • In-depth patient management • Telephonic and in-person interventions • Episodic patient mgmt • Moderate interaction with PCP • Staffing ratio: 1:70 Patient Physician Office Payor For most part these key components of healthcare delivery are not included in traditional solutions Provider Hospital Proprietary to eQHealth Solutions

5. Connecting the “silos” in health care through local community Identify interventions required to engage the community and drive behavior change Patient Understand drivers behind individual beneficiary Physician Office Payor Local community Provider Hospital Build relationships with physician and providers to drive behavior change Proprietary to eQHealth Solutions

6. Cornerstones of eQCare Coordination Model Embedded Care Coordinator Community Driven • Care coordinators are part of the community • "High touch" interventions • Whole person management • Staffing ratio: 1:150 • Engaging the clinical thought leaders in the community • Engaging the business and industry • Connecting stakeholders Infrastructure • Integrated web application – easy to use and adopt • Provider portal to drive the care outside of physician office • Evidence based guidelines • Cost and quality metrics Proprietary to eQHealth Solutions

7. Care Coordination Programs • Asthma • Pediatric • Adult Childhood Obesity Congestive Heart Failure (CHF) • Maternity • Preconception • Inter-conception • Post partum Diabetes Chronic ObstructivePulmonary Disease Sub programs • Care Transition • Smoking Cessation Sub programs • Medication Adherence • Depression Proprietary to eQHealth Solutions

8. eQSuite of Care Coordination Software • Ability to drive patient care • Easy access to guidelines and educational resources • Practice score card • Communicate with patient & Care Coordinator • Population Risk Stratification • Comprehensive HRA (s) • Patient History (Claims, Utilization) • Issues driver Plan of Care • Communicate with Provider & Care Coordinator • HRA (s) • Health Education Material • Workflow Engine • Provider Channeling • Alerts & Messaging • Nation Clearing House • Milliman Care Guidelines • Financial • Quality • Productivity • Condition specific education • Medication Proprietary to eQHealth Solutions

9. eQHealth Care Coordination Goals Whole person management • Manage the condition and the comorbidities • Manage both clinical and psycho-social needs • Manage and monitor based on a comprehensive plan of care • Manage the care transitions across settings Behavior modification and health coaching of patient for long-term sustainability Provider education and adoption of evidence based practice guidelines Improve cost and quality of care for payor and local community

10. Care Coordination Process and Operations

11. 3 potential means for member identification • Medical and pharmaceutical claims analysis using proprietary algorithms • Utilization Review based member identification • Referral based (Physician, Case Management etc) Two levels of stratification into High, Moderate & Low severity based on: • Algorithms • Comprehensive HRA assessment by the Care Coordinator

12. After member identification patients are assigned to embedded Care Coordinators Each Care Coordinator will have a mix of High, Moderate and Low severity assigned to them • Care Coordinators to Members ratio of 1:150 • Member assignment is based on Geographic location to leverage the local community relationships with all stakeholders involved Care Coordinator works with the members to complete comprehensive HRA(s)

13. Comprehensive HRA(s) have the following dimensions • Clinical • Psychosocial • Physical • Behavioral HRA(s) completed in collaboration with the member in face-to-face visits or telephonically Based on member response to HRA(s) the system will automatically trigger Plan of Care issues • Care Coordinator may supplement with additional issues

14. Care Coordinator provides the member’s PCP with the following information on initial admission: • Role and purpose of care coordination • Providers Rights and Responsibilities whose patient’s are participating in Care Coordination • Care Coordinator’s contact number should the physician need assistance with the patient and/or their prescribed treatment plan. • Instruction related to situations in which the care coordinator may reach out to the PCP

15. Care Coordinator reviews Plan of Care issues and customizes the interventions Interventions based on National Standards of Care • Intensity & Frequency based on stratification • Additional interactions are based on Care Coordinators assessment

16. Member Interventions • Interventions based on whole person model • Clinical • Behavioral • Social • Intensive management of acute events • Co-morbid management • High Severity case management when indicated • Continuous assessment and reevaluation of stratification

17. Example Member Interventions • Post-discharge follow-up • PCP follow-up visits • Medication management • Heath coaching • Behavior modification using motivation training techniques • Screening for depression/coping with chronic conditions • Proactive health and wellness reminders (such as flu vaccination)

18. Face–to–Face Care Coordinator Interventions Examples • Care Coordinator performs assessments (HRA) • Visual assessment of members’ physical environment and social system • Adjust plan of care accordingly • Identify resources required by members • Leverage the opportunity to do health coaching at more personal level for behavior modification and follow-up • Build relationship to increase compliance and adherence to program • Provider brown-bag lunches to discuss local community priorities

19. Physician Interventions • Care Coordinator engages the physician via multiple means • Face-to-face • Telephonically • eQSuite provider portal • Goals of Physician interventions are: • Working with individual physicians to understand their resource constraints and member needs • Discuss with them on individual member Plan of Care • Help them with data on peer-to-peer evaluation

20. Physician Interventions • Care Coordinator engages Physician at multiple levels • Individual members level • Practice level • At individual member level • Care Coordinator will seek guidance\inform on member Plan of Care • Inform\assist physician with non-clinical issues • At practice level • Physician adoption of national evidence based guidelines • Identify and implement practice Quality Improvement initiatives

21. Continue interventions until goals have been met • Short and long term Re-evaluation of members every six months to monitor the progress • Comprehensive assessment • Data analysis Annual surveys for member and provider satisfaction Cost savings and quality measurements, examples include: • Emergency room visits • Hospitalizations • # of provider and member interactions

22. Comparing Care Coordination