Transforming Healthcare in the Modern Connected World

1. Transforming Healthcare in the Modern Connected World Mary Kilmer Executive Director Oracle Tony Jurek, Director Healthcare Deloitte

2. Oracle Healthcare Mission Most complete and Most integrated Solutions Oracle Solutions for Healthcare Connect, Collaborate, Care Enable – Connect, Collaborate, Care Seamlessly integrate information and processes to drive the continuity of patient care . Maximize efficiency and reduce operating costs Effectively manage both corporate and clinical risk Support effective resource utilization and talent management Improve clinical outcomes through an integrated view of healthcare information

3. Security ACO/Patient Engagement Analytics ICD10 Integration Best Practice Where is Healthcare Going? Shared Services Consolidation Costing

4. Topic Spotlight: Patient Engagement in HealthCare Sept 25, 2013 • Oracle Open World 2013

5. Presenter – Tony Jurek Tony Jurek, MBA, PMP - is a Director in Deloitte Consulting LLP, focusing on Health Plan and Provider clients within Deloitte’s Life Sciences and Health Care Industry Group. Tony provides expertise in information management technologies and business analytics to address the challenges resulting from Healthcare Reform, the move from volume to value based reimbursement models, the need for integrated clinical operations and increasing demand for data. Tony leads the Technology Work Group as part of Deloitte’s Value Based Care (VBC) Solution team. His responsibilities include oversight of the development of Deloitte’s VBC technology planning and implementation frameworks around Accountable Care, and conducting technology assessments, strategic planning and implementations to support our clients move to value based healthcare delivery models. The types of technologies covered by Tony include integrated health and population management systems, health information exchanges, EMR/EHR systems, data integration and information management technologies and physician/patient engagement technologies (e.g. portals). Tony has 24+ years’ experience in delivering large scale technology projects and overall program management. Tony earned his M.B.A. in Information Decision Sciences (MIS) from the University of Minnesota, Carlson School Of Management. • Tony Jurek • Director • Introduction

6. Deloitte has the leading Health Care Consultancy in NorthAmerica Backed by more than 60 years of proven experience, our Life Sciences and Health Care practice consists of nearly 2,500 professionals focused on serving over 75% of Fortune 1,000 clients across all industry segments. Over 80% of the largest managed-care organizations (as ranked by AIS's Directory of Health Plans) Over 70% of the nation's Blue Cross Blue Shield Plans Nearly 80% of Honor Roll hospitals (as ranked by U.S. News & World Report) 10 of the 10 largest Healthcare Systems (as ranked by Modern Healthcare) 8 of the 9 largest For-Profit Healthcare Systems (as ranked by Modern Healthcare) 8 of the 10 largest Secular Not-for-Profit Healthcare Systems (as ranked by Modern Healthcare) 8 of the 10 largest Catholic Healthcare Systems (as ranked by Modern Healthcare) Nearly 70% of the top pediatric hospitals (as ranked by U.S. News & World Report) 10 of the 10 largest pharmaceutical manufacturers (as ranked by Hoover's Inc.) 10 of the 10 largest medical equipment manufacturers (as ranked by Hoover's Inc.) 10 of the 10 largest biotechnology companies (as ranked by Hoover's Inc.) The #1 Life Sciences and Health Care Consulting Organization ~Deloitte Consulting as ranked by Kennedy Information The Largest Health Care Management Consulting Organization ~Deloitte Consulting as ranked by Modern Healthcare magazine Our experience enables us to manage and deliver industry-specific solutions through our aligned service lines.

7. Deloitte Global Oracle Alliance Key Solutions & Initiatives Market Eminence • Diamond Certified Partner - highest number of certifications • Access to 12,000 Oracle-focused practitioners world-wide • Winner of six Oracle Excellence Awards in 2012 • Global Applications Partner of the Year, 2012 • Selected to be Marquee sponsor of OpenWorld for second consecutive year in 2012 • Global Fusion Leader –focus on Human Capital Management, and Distribution Order Orchestration • Selected by Oracle to be partner of choice for three Global Programs: Health Care, Insurance, M&A • SolutionPrint - Repeatable Pre-Configured Industry Solutions: • Financial Services SolutionPrint™ for Risk & Finance • Manufacturing SolutionPrint™ for EBS & JDE • Life Sciences SolutionPrint™ for Oracle EBS, JDE & SOA • Health Care SolutionPrint™ for Oracle EBS • Oil & Gas SolutionPrint™ for Oracle EBS Enterprise Asset Management • High-Tech SolutionPrint™ for Oracle EBS • SolutionPrint™ for On Demand Global Oracle Alliance

8. Industry Overview: The Issue…The Challenge…The Response

9. The healthcare industry has reached a tipping point • The opportunity. Of the $2.7 trillion spent on Healthcare in the U.S., it is estimated that one-third of these costs are driven by inappropriate care and administrative waste • We have reached the tipping point. Further cost reduction under the current system would inherently focus on rate reduction, which is unsustainable. The market and increasing regulatory pressure demand a new approach focused on outcomes and value • The challenge for health care system is create a collaborative care system which means changing many of the existing operating model for health plans, and providers. It also means changing the incentives for patients and the rules established by the regulators and employers. • The size and scale of the change required is daunting, but smart first steps to build effective programs is the best way for the providers and health plans to start this process • Structural challenges undermine the current system. Spiraling costs, substandard quality, and inconsistent access to care can be traced to structural issues in our care delivery and financing system Industry Overview: the issues Fragmented Health System Lack of Evidence Based Care Misalignment of Incentives Sources: Esola, L, ROI Calculations for Wellness Programs Remain Elusive, Workforce.com; Kelley, R, Waste in the U.S. Health Care System Pegged at $700 Billion, Thomson Reuters, 10/26/09; Mythbusters, Association of American Physicians and Surgeons, 7/13/09. Highly-Regulated Market Environment Lack of Transparency Limited Competition

10. Workforce Challenges Rising Costs and Reduced Funding Increasingly Competitive Market Healthcare Providers are facing unprecedented pressure on operating margins Provider Organizations are Experiencing a Number of Business Issues and Trends that are Directly Impacting Operating Margins • Business models continue to evolve calling for improved business analytics, governance, decision making, and effective resource deployment • Organizational strategies need to accommodate for rapid change and fluid transformation • Customers and partners are asking for improved transparency into quality measures, cost, and pricing • Health systems continue to restructure, consolidate or close creating shifts in demand • Growing need for high quality, efficient healthcare to support volume of Baby Boomers • Diminishing pool of experienced talent; especially RNs and Primary Care Physicians • Poor attraction and retention of top talent; losses to competitors and non-provider healthcare industries • Rewards programs are outdated and not aligned with current organizational strategies • Difficulty retooling the workforce to have a more customer-focused mindset • Implications of recent changes in Healthcare reform • Workforce shortages and increasing benefit expenditures have dramatically increased labor costs • Rising indirect expenses (including capital investment to refurbish/build properties, purchase and maintain equipment) • Increased utilization of high cost technology and medical supplies • Recent market volatility has reduced access to capital

11. Regulatory Reforms are Driving a New Normal Industry Overview 2012: Reduced rebates to Medicare Advantage plans Health Plans 2013: Administrative Simplification 2017: Exchanges open for large employers 2011: Minimum Medical Loss Ratio and Rebates 2012: Medicare Advantage Star Quality Based Payments 2014: Exchanges open to individuals and small employers • Market Factors • Quality reporting • Pay for performance • State Regulatory influence • Transparency / Data sharing New Normal / Sustainable Business Model June 2012 Supreme Court decision on PPACA 2013: Episode based payment pilots begin 2012: CMS ACOs begin (Shared Savings & Pioneer) 2015: HITECH penalties begin Providers 2012: Value-based incentives and avoidable readmission penalties Q1 2012: CMS ACO application period

12. Making the “Triple Aim” Possible Industry Overview : The Issue… The Challenge • The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which they call the “Triple Aim”: • Improving the patient experience of care (including quality and satisfaction); • Improving the health of populations; and • Reducing the per capita cost of health care.1 1Institue for Healthcare Improvement

13. As a Result, the Market is Shifting from Volume to Value Industry Overview : Changes Driving Towards… Volume Focused • Reimbursed per admission and/or units of work • Physicians seeking employment models for income security and lifestyle reasons • Limited incentives to prevent admissions or coordinate care • Continuum lacks integration • Declining reimbursement for hospitals and physicians • Significant uninsured and underinsured • “Pay-for-compliance” rather than true outcomes-based reimbursement • Limited access to capital for technology investments required to meet HI-TECH • Regulatory issues that restrict integration e.g., Stark, Anti-Kick Back, Private Inurement, etc • Value Focused Health Reform • Competing on quality, patient safety, cost effectiveness, and coordination of care • Episodic/Bundled payments mechanisms • Shift of large groups of uninsured to capitated Medicaid population • HI-TECH dollars technology use and integration • Improved documentation of care and information sharing through HIE’s • Accountable Care Solutions/Medical Homes • Demonstration projects factor more and more into reimbursement and government payments • New focus on prevention and population health

14. Technology is a Key Enabler Industry Overview : The Response… • Information and technology can facilitate care, drive evidence based medicine, reduce cost and identify at risk populations

15. Industry Overview : The Future Technology Roadmap Technology Capabilities for Healthcare Data Integration and Management Data Analytics and Content 3 2 1 Connectivity, Security and Interoperability NaturalLanguageProcessing Core Applications and Workflow/Automation Physician/Patient Engagement 4 Practitioner Practitioner 5 Insurer Insurer Connectivity, Security and Interoperability: connects to all the data producers, provides access to data consumers, and validates access rights. Data Integration and Management: retrieve data from the data producers, in both structured and unstructured form, and transform it to align with core application data requirements as well as end user analytical needs. Data Analytics and Content: using self-actualizing trends and business solution specific heuristics analyzes transactional data and creates enriched information. Data delivery occurs via screen-reports and services/API. Core Applications and Workflow / Automation:Orchestrates the execution of activities the constitute the care continuum, gathering contextual information from both the transactional systems as well as the data-warehouse. Physician/Patient Engagement: Key interfaces for both patients and physicians to facilitate their interactions with the VBC system, leveraging workflow and analytics to enhance engagement and satisfaction for both these stakeholders. Acute IP Acute IP Clinic Clinic Ancillary Ancillary Supplier Supplier Patient Patient

16. Industry Overview : The Future Technology Roadmap Optimal Sequence of Technology Deployment Data Aggregation and Management Data Analytics and Content 4 Connectivity, Security, & Interoperability 3 2 NaturalLanguageProcessing Core Applications and Workflow/Automation Physician/Patient Engagement 5 1 -16-

17. Roadmap Development Criteria Industry Overview : The Future Technology Roadmap 0 2 3 4 5 Note: Given current environments, and the recommended “Release Schedule” approach outlined for a specific client, some of these steps will occur concurrently in order to accelerate time to value. -17-

18. Industry Overview : The Future Technology Roadmap

19. Oracle in Healthcare:Patient Engagement

20. Oracle Healthcare: A Complete Portfolio • Healthcare Management Platform • Health & Disease • Management • Patient & Clinical Portal • eCommerce • Patient Discharge Mgt • Healthcare Retail Solutions • Translational Research Solutions • Healthcare Cost Management • Business Performance • Financials • Supply Chain • Human Resources • Strategic Planning • Talent Management • Advanced Controls • Value Chain Planning • Grants Management • Healthcare Analytics • Financial Performance • Supply Chain Analytics • Human Resources Analytics • Cost Accounting • Translational Research Analytics • Molecular Medicine • Clinical Performance • Operating Room • Care Management and Partners • Epic • Cerner • McKesson • Allscripts • GE • Orion • CareFx • Interoperability • and Integration • Master Patient Index • Healthcare Data Model • Collaboration • HIE Solutions • ACO Solutions- Coordinated Care • NHIN Connect • Medical Device Integration • Infrastructure & Mobility • Security • Care Giver -Mobility • Identity • Exchange • 3CI • Master Data Management

21. Oracle Healthcare Focus Analytics Connected Health Operational Efficiency

22. Analytics for Integrated Healthcare Knowledge through Structured and Unstructured Data Translational Research and Genomics Analytics

23. Human Capital and Workforce Management Process Efficiency and Effectiveness Finance and Business Strategy Profitability and Cost Management Operational Efficiency

24. Health Information Exchange • Patient Engagement and Population Health • Vendor Neutral Storage and Content Management • Patient Monitoring and Data Management • Health Management Platform • Patient Engagement • CX for Healthcare Connected Health

25. NEW WAYS TO ENGAGE WITH PATIENTS patient satisfaction patient experience quality of care

26. Trends Leading to Patient Engagement

27. ONC Sets Sights on Stage 3 Meaningful Use Last week, the Office of the National Coordinator (ONC) for Health Information Technology Policy Committee (HITPC) released guidance about its stage 3 meaningful use (MU) requirements that go in effect in 2016. “The stage 3 vision includes a collaborative model of care with shared responsibility and accountability, building upon previous MU objectives. While the committee appreciates and recognizes today’s challenges in setting up data exchanges, it is the committee’s recommendation that stage 3 is the time to begin to transition from a setting-specific focus to a collaborative, patient- and family- centric approach.”

29. Major Challenges Effecting Health Engagement Provide a single, consistent content platformaccessible to all using all channels Single source of information and history of customers Create sophisticated web content tools with highly personalized content Provide disease management tools to orchestrate care coordination/education Communicate automatically with patients/citizens, family members & care-givers Measure & report on the effectiveness of promotions & campaigns Offer truly comprehensive identity management for all Effective enterprise marketing and outreach to engage and assess risk Support TeleHealth and Medical Home

30. Social Media Requirements Rising in HealthcarePatients /consumers want social media: poll online research influenced the treatment decisions - chronic conditions affects their choice of a provider or organization affects their decision to get a second opinion influences decision about taking a medication affects their choice of health insurance plan want to communicate with their doctors via e-mail 75% 40% 45% 34% 32% 55%

31. Oracle Health Management Platform: CRM Platform with Integrated Supporting Tools Full marketing and campaign management Rules Engine OPA Marketing Security Workflow Integration and Interoperability Oracle Integrated Healthcare CRM Phone Web Chat Email Social Knowledge Multi Channel Healthcare SOA MDM Business Intelligence Data quality Predictive Analytics Dashboards & Analytics Data Warehousing Analysis

32. Oracle Health Management Platform • Health Engagement • Identify, engage, enhance the relationship with person/patient and referring physicians • Improve experience • Accountable Care • Active Long-term • Care • Case Management of long term conditions • Disease management • Telehealth • Medical Home • Population Health • Programs • Screening, risk, campaign management • For defined population • Care • Transition Management • Active management, care coordination, between health organizations • Discharge coordination

33. Sentara Healthcare  Headquartered in Norfolk, Virginia  10 hospitals  3 medical groups  3,680-provider medical staff  Health plan (Optima Health)  Outpatient campuses Enterprise commitment to Relationship Management

34. Oracle’s Health Management Platform Post Discharge Video https://vimeo.com/70655451

35. Oracle CX Connects Every Engagement Your Customer Has with Your Brand • Leader in CRM Lead Management • Leader in E-Commerce • Leader in Sales Force Automation • Leader in CRM Web Customer Service • Leader in CRM for Large Organizations • Leader in CRM Customer Service Contact Centers • Leader in CRM Suite for Customer Service Solutions In Store Contact Center Social Field Service Mobile Direct Sales Channel Sales Oracle Commerce OracleSales Oracle Marketing Web Oracle Service Oracle Social Foundational Tools Oracle Cloud Infrastructure and Platform Services Oracle Integration and BPM/SOA Tools Oracle Mobile, Portal and Content Tools Oracle MDM, BI and Decisioning Tools

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