Transformation: Collective Impact, Data and Innovation PriME Health Collaborative and Society of Physician Entrepreneur

1. Transformation: Collective Impact, Data and InnovationPriMEHealth Collaborative and Society of Physician Entrepreneurs Meet-UpOctober 4, 2012

2. Today’s Discussion • Healthcare Economics Primer- Fiscal Cliff • Megatrends • CIVHC: Triple Aim and Collective Impact • Transparency and Performance Measurement: • Metrics and All Payer Claims Database (APCD) • Disruptive Innovation • Discussion/Q&A 2

3. Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted. 3

4. What does $2.8 Trillion Buy? • Quality: U.S. 37th in overall quality, between Costa Rica and Slovenia (World Health Organization, 2000) • Medical Inflation 2-3 X the general rate of inflation • Experience: Patient Satisfaction inversely correlated with regional spending Note: Estimated waste of $750 Billion (25% of spend) per Institute of Medicine, 2012 4

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6. Megatrends: Disruptive Innovationnot Incremental Change • Consumerism/free markets (health care as service industry): • Retail clinics /Commercial telemedicine/Concierge medicine • Disruptive Technology Supports Disruptive Innovation • Marketplace won’t be recognizable in 5-7 years • Transparency and Big Data- Business Intelligence Becomes Critical A Fiscal Cliff Changes Everything 6

7. CIVHC: Catalyst for Transformation Backbone Organization for Collective Impact • Consensus on statewide common agenda • Metrics and data to measure progress on agenda • Non-Partisan connector, convener and communicator • Promote business case for change • Drive implementation and create sense of urgency • Do (e.g., All Payer Claims Database) 7

8. Our Vision: Achieving The Triple Aim + 1 Improve Population Health Highly Integrated Delivery System Fully Engaged, Informed and Empowered Consumer/Patient Partners Risk-adjusted, Performance-based Global Payments Triple Aim Vibrant, Integrated Public/Community Health System Improve Patient Experience Reduce Per Capita Costs 8

9. Essential Elements for Improving Quality and Lowering Costs 9

10. CIVHC’s “+1” : Data and Performance Reporting Big Data and Informed/Demanding Consumer Will Transform Healthcare 10

11. Why Data Matter 11

12. Bending the cost curve 12

13. Historical Trend Dashboard Medical Trend Relative to CPI – Large Group Market 13

14. Sample Metrics: Improved population health 14

15. Patient-centered experience 15

16. Colorado’s All Payer Claims Database (APCD) • State mandate • CIVHC- Administrator; Private Non-Profit • Collect claims data from all public/private payers • Generate first aggregated public reports in Q4 2012 • Build towards increased transparency of the data over the next 2 years • No general funds… sustainability model • Utilize Treo Solutions technology and analytics 16

17. Files submitted to the APCD • Discharge status • Service provider info • Type of bill and facility • Diagnosis codes • Payment amounts • Payer info • Insurance type • Patient info/demographics • Admission type • Medical Claims: • Pharmacy Claims: • Medical Eligibility File: • Provider File: Name, ID numbers; Organization, Specialty, Location • Payer/Plan info • Patient info/demographics • Pharmacy info • Prescriptions details • Payment details • Physician info • Patient info/demographics • Coverage type/category • Subscriber info • Payer • Insurance type 17

18. Schedule for Adding Data to the APCD 18

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20. Resources for Patients SOURCE: New Hampshire APCD 20

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22. Consumer Reports- Patient Survey Consumer Reports MQHP Health Insert July 2012 22

23. Possible Public Reporting of Relevant Cost and Quality Information – Minnesota 23

24. Colorado Health Data InitiativeCreating an Ecosystem of Innovation for Colorado 24

25. Health Data InitiativeA self propelled, open ecosystem of innovation using data to improve health and create jobs of the future 25

26. Transformation Opportunity Less of: More of: Moving beyond Kano III to offer solutions to enhance health care experiences, contain costs, and improve the health of Coloradans. 26

27. Opportunities for Innovation Coverage + Coordination + Collaboration • Clinica Family Health Services | Access • Providing high-quality treatment in small groups, plus: • Education • Screening • Answers • Support • 90-minute session with coordinated team of caregivers • Improved outcomes, better adherence + Connection? What would it take to offer a new level of interactions and support to patients using the channels they’re already using? 27

28. Opportunities for Innovation Connection + Performance Improvement Interventions impact adherence Medication adherence leads to lower health care costs Adherence is a $290 Billion/year problem* * New England Healthcare Institute. Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease, 2009. 28

29. Impact of Disruptive Innovation • Look beyond disintermediation…the entire market and value chain is transforming • Most of core skills of the traditional insurer will go the way of the horse and buggy • Integrated systems provide the networks • Traditional underwriting disappears • Technology will put many of the medical management tools in the hands of consumers and providers (think iPhones) • Business Intelligence and Big Data Will Rule…still and opportunity 29

30. Contact Information • Phil Kalin, President and CEO pkalin@civhc.org Join our Voices on Value blog www.civhc.org Follow us on Facebook and Twitter (@CIVHC_News) 30