Transcript Chronic Disease Management

Industry specific cover image
Oracle Healthcare Consumer Solutions: Provider Retail and
Disease Management
Mary Kilmer, NA Executive Director, Healthcare IBU
April 2009
Oracle Healthcare Mission
Leveraging the power and resources of a top 5 global healthcare care
company to empower you to deliver:
• Operational efficiency and game changing productivity
•
Collaboration and communication across the healthcare community
•
Empowered associates
•
Information management and analytics with real-time information that promote
improvement in outcomes
•
Reaching beyond the artificial boundaries in promoting wellness and safety
•
Providing a holistic healthcare experience for each patient’s needs and
personalizes their care
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Our Client’s Critical Business Issues
• Challenged to improve loyalty and satisfaction with patients, medical staff and
employees
• Inability to develop new sources of revenue
• Struggling to reduce cost of healthcare delivery especially for chronic disease
• Challenged to embrace the rise in healthcare consumerism
• Fragmented consumer delivery value chain
• Improve the patient experience
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Its All About The Relationship
“The quality of the ongoing relationship between the
hospital and its patients (and medical staff) is far and away the
dominant determinant of success.”
Gartner
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What is the Patient Experience for Healthcare?
Healthcare organizations develop successful high-value, relationships
and deliver superior service and more effective experience to their
physician, patient, and community constituents
Establish a patient centered, collaborative, personal experience where
knowledge and care can support the patient, the family,the
community, the medical staff
Establish the provider as the trusted source of all healthcare support
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Why Now?
• Rise in consumerism, demand for a partnership in care
• Increase use of internet and call center
• More effective technology
• Entrants of new “providers”
• Need to capture new revenues with predictable streams
• Recognition that this new business needs a retail focus
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Survey Says:
Patients want to Connect
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What Consumers Say They Want From Hospitals
Aligns With “Retail” Strategies
Quality – Convenience – Lower Cost - Empowerment
•Easy access to care
•More support from trusted provider
•Coordinated treatment
•Better health education access
•Price & Quality information transparency
•Multiple communication pathways
•More collaborative disease management
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Providers Are Challenged to Capture Revenues to Stay Viable
Average Revenue Breakdown of Retail Pharmacies ‘07
General
Merchandise and
Other
18%
Health & Beauty
aids
5%
OTC Medications
and Personal care
10%
Prescription Drugs
67%
Source: Freedonia Healthcare Market Overview 2008, Public Retail Pharmacy corporation annual reports
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... Studies Show Quality & Costs Impacts from Improved
Discharge Planning & Care Coordination
Sources: “Educating Patients Before They Leave the Hospital Reduces Readmissions, Emergency Department Visits, and Saves Money”, AHRQ press release – Feb. 2009.
“Community Benefit Strategies for a Changing Economy”, Jeni Williams, HFM Magazine, Feb. 2009
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Why Oracle?
• World class order to cash and retail solution
• Market leading CRM and Order Management and Fulfillment
• Investment in functionality
• Investment and commitment in healthcare industry
• Successful solution managing mail order pharmacy for last 7 years
• Experience in the retail and payor space
• Experience in provider market
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Thinking outside the box!
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Investment in Healthcare
Oracle FY 2005
Oracle FY 2006
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Oracle FY 2007
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Oracle Healthcare Consumer Solutions
•Mail Order
•Collaborative tracking,
interaction and
education
pharmacy and DME
delivery direct to
consumers or to
regional locations
•Clinical Pathway Post
Discharge
•Document and
communicate online
•CRM, ERP and
Analytics Solution
Disease
Management
Pharmacy
Interaction Center,
and Service
•Workflow alerts
Scalability
•Outcomes improved,
readmissions reduced,
satisfaction increased
•Supply Chain and
Financials
•Pre-Built Analytics
Security
•Interactive tools to
assess patients
complaints
•Determine right venue
•Referrals
•Online FAQ and help
desk
•Reduce cost
•Improve quality
•Improve satisfaction
•Marketing, Sales,
Nurse Triage
Accuracy
Business
Intelligence
Retail
Retail
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• Utilizing the Oracle
Pharmacy solution
• Broaden their
value chain by
offering supplies,
meals,
prescriptions,
DMEs, etc.
•Multiple channels
•Interactive TV
•POS
•Web Store
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Provider Retail
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Insight Review of 550 Bed Hospital
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Oracle Insight Review of Healthcare Retail Opportunity
Oracle Healthcare conducted an Insight review assessing the
Healthcare Retail opportunities for a 550 bed, $300M in revenue
community hospital.
.
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Primary Service Lines Studied :
These areas were agreed on with senior management at the outset
of the project
• Discharge-related DME, pharmacy and other services “bundled” to
increase revenues & patient satisfaction in the following areas:
– OB/GYN
– Oncology
– Psychiatric
– E.D.
– Cardiology
– Sleep Lab
• Retail / Out-Patient Pharmacy
– Potential for re-fill & “smart-switch” business related to discharges
– Related OTC business
– Employee prescription service
– Possible pharmacies in MOB’s or other remote locations
– Other
• Expanded Gift Shop products & services
– Existing gift shop
– Greatly expanded web offerings
– Additional retail shops
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Patients were Surveyed to Validate Patient/Consumer
Receptivity & Interaction Preferences for the Contemplated
Services
•
The great majority of patients indicated they would use these services – if offered:
•
•
•
•
84% said they’d purchase DME/HME items if offered
84% said they’d purchase discharge medications if offered
75% said they were comfortable ordering via in-room interactive TV devices
66% said they’d order refills of medications initially purchased at discharge
•
Patients view hospital as a trusted source of medical information, second only to
their physician!
•
Preferences for communication & information exchange lend strongly to
anticipated program execution plans
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Extremely Conservative Estimates Used
We used lower anticipated business capture rates & margin estimates than
both industry & patient survey data prove are likely
Product / Service
% Capture
of Available Business Assumed Gross Margins
Industry Hosp Pts. We Used
Industry We Used
DME & Daily Living Products
60%
84%
40-70%
50%
25 – 35%
Discharge Medications
60%
84%
30-70%
24%
22%
Refills on above
40%
66%
35-50%
10-20%
7%
Employee Medications
80%
10%
7%
60%
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Detailed Opportunity Summary Example: Women’s Health Services
New Products / Services
Annual Revenues
Gross Margins
Related DME/HME sales
$0.9 – 1.5 M
$0.6 – 0.9 M
- Breast pumps/rentals, bras, diapers, 15% bottle feeder items (Note current pump sales/rentals only 320/yr. – vs. 34000 total!)
Related Pharmacy sales
$0.5 – 1.9 M
$0.05 – 0.15 M
- Percoset, Lanolin, “Easy Switch Conversion”
Other products & services
$0.6 – 1.2 M
$0.3 – 0.5 M
- Specialty formula, car seats, Baby Registry Services
$ 2.0 – 4.6 M
Total Annual Revenue Potential
Reimbursable = $0.7-1.7 M
Non-Reimbursable = $1.2 -2.3 M
$0.95 – 1.5 M
Home Service Related = $0.6 -.08 M
Key enablers:
•
•
•
•
•
•
End-to-end re-design of communication & coordination activities with physicians & patients
Clinical system integration to trigger appropriate workflows based on diagnosis, procedural, or other drivers.
Standardized discharge order sets for target groups, with physician buy-in.
Modified nursing discharge procedures to accommodate.
Potential use of interactive TV offerings to enable easy patient education & ordering.
Proposed retail system components to manage orders, fulfillment, billing, collections, reporting, etc.
Dependencies:
•
•
•
•
Gaining physician support outside core advisory group.
Additional retail & education space
Coordination of “sales” efforts at all touch points.
Related “Discharge” pharmacy dependencies.
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Executive Summary - Key Findings for Hospital
 Increase annual revenues of $21 to 40 M per year, with margins
~$8.1M (additional $20-30M in areas we didn’t study)
 Extrapolated to Health System level, between $500M and $1B annually
 Most attractive areas to start will be additional DME sales in Women’s
services, Pulmonary, Cardiology, Sleep Lab and E.R. –
 Discharge pharmacy sales is next most attractive opportunity
 These new services will also satisfaction
 Enhance hospital comprehensive patient care & service innovation
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OHCS Retail Footprint:Order-To-Cash Flow
Applications
Channels
Shared
Components
Analytics
Disease
Mgt
Customer Relationship
Management
Order placed
Telephony
eMail
Supply Chain Management
Order managed and fulfilled
Web
SOA Suite
Task Manager
Business Intelligence/Reporting
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Mobile
Financials
Order paid for
Fax
The Right “Retail” Strategy Can Bring Multiple Positive Outcomes
• New revenues with higher margins
• Improved patient care & wellness
• Improved patient satisfaction and physician
• Lower total cost of care
• Building of “Brand” loyalty
• Reduced operating costs
• Improved disease management
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Oracle Healthcare Consumer Solution
• Supports: the ordering and fulfillment of
– Pure retail
– eCommerce gift shop
– Pharmaceuticals, discharge and refill
– DME discharge and refill
• Also supports:
– Disease Management
– Marketing and Branding
– Loyalty
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Multiple Channels Can Deliver the Message
• Personal Content Delivery Tool
• Interactive TV
• Patient Concierge
• Discharge Planner/Nurse
• Fax
• Call Center
• Email
• Portal
• Paper/Mail
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Nurse Concierge is one way hospitals can utilize OHCS
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Nurse Concierge can offer personalized discharge support
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Nurse is assigned patient and provided physician directed
prescription and supply recommendations
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Interactive Medication Education
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Medication Ordering Support
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Disease Management Program Invitation
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Hospital’s eCommerce Website
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Patient Sees the Ease of Use and Ordering
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One-Click Ordering
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Disease Management
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Disease Management
What is DM
• Health Screening
• Health Education
• Health Coordination
• Health Choices
• Health Support in and out of the
Hospital
Who Is it for?
• Patients
• Families
• Communities
• Providers
• Payors
• Provinces
• States
• Countries
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Why Focus on Chronic Conditions?
As of 2006, patients with chronic conditions accounted for:
83% of US healthcare spending
81% of inpatient stays
91% of prescriptions
76% of physician visits
98% of home healthcare visits
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Why Focus on Disease Management?
Chronic
Disease
Management
•Cost of CDM in the US 2008 -$1.3 Trillion with and
estimated increase to $4.2 Trillion in 2023
•80 Million people have multiple CDs
•Canada’s annual spend for CDM is over $80 Billion
•CD accounts for 44% of the population but 78% of all
healthcare expenditures
•CHF the number three admission due to lack of
coordination of care at home
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What is the Cost of Chronic Disease?
Chronic
Disease
Management
•Frequent readmissions
•Burden on patient who has to manage complicated
treatments and medications on their own
•CHF the number three admission due to lack of
coordination of care at home
•Burden on family and healthcare system
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Oracle is Invested in Supporting Chronic Disease Management
Chronic
Disease
Management
Health
Awareness
and
Prevention
Connected
Healthcare
OHCS: CDM Solution
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Implications for Clinical Quality
• OHCS supports Disease Management initiatives to help push the clinical
pathways post discharge or after initial diagnosis
– Channel for provider/patient/caregiver collaboration with access for
patient interaction thru portal, email, phone etc.
• i.e.Daily glucose check with workflow based on tolerances to
physicians
• i.e. track daily weight of CHF patients
– Supports more directly the treatment plan with direct control of
medication, meals, DMEs, services
– Meals for CHF patients
– Supports pathway management thru Online Learning tool to support
compliance
• Comprehensive analytics and reporting to track and improve patient and
aggregate clinical outcomes
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The Right Consumer/Disease Management Strategy Can Bring
Multiple Positive Outcomes
• Improved patient care & wellness
• Improved patient satisfaction and physician
• Improved support to patient and family
• Closer relationship between provider and patient
• Lower total cost of care
• Improved health awareness and prevention
• Health prevention and population screening
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OHCS Retail Footprint:Order-To-Cash Flow
Applications
Channels
Shared
Components
Analytics
Disease
Mgt
Customer Relationship
Management
Order placed
Telephony
eMail
Supply Chain Management
Order managed and fulfilled
Web
SOA Suite
Task Manager
Business Intelligence/Reporting
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Mobile
Financials
Order paid for
Fax
OHCS: DM Solution Footprint
Disease
Management
• OHCS: Disease Management
– Siebel Interaction Center
• Web
• Email
• Call Center
• Smart Scripting
– Siebel Marketing
– iLearning
– Oracle Technology
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Oracle Disease Management
• Utilizing CRM Interaction Center and learning to establish a more
collaborative relationship between Patients and Providers and
between the care team
– Programmatic approach to Disease Management thru Marketing and
Interaction Center
• Call Center
• Email
• FAQ
• Portal support
• Learning
• Expansion of outreach
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Oracle Disease Management
• Chronic Disease Management
– Diabetes
• Classes
• Glucose communication
• Education
• Meals, pharma, DMEs, etc support
• Call Center support
• FAQ online
• Email
• Communities
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In conclusion
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Our Client’s Critical Business Issues
• Challenged to improve loyalty and satisfaction with patients, medical staff and
employees
• Inability to develop new sources of revenue
• Struggling to reduce cost of healthcare delivery especially for chronic disease
• Challenged to embrace the rise in healthcare consumerism
• Fragmented consumer delivery value chain
• Improve the patient experience
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OHCS is the Only Solution That Will Bring Results and Build the
Relationship
• New revenues with higher margins
• Improved patient care, disease management, & wellness
• Improved satisfaction and experience
• Lower total cost of care
• Building of “Brand” loyalty
• Reduced operating costs
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