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Improving the Member Healthcare Journey:
Wellness and Telemedicine Strategy
July 28, 2016
2:00pm EDT
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Improving the Member Healthcare Journey:
Wellness and Telemedicine Strategy
Andrew Lockerbie
Healthx
Vice President, Self-Insured & Special Markets
[email protected]
Doug Wilcox
Healthx
Director of Marketing
[email protected]
Journey from Consumer….to Member …..to Patient
Touch Points and Medical Spend
Low to High
CONSUMER
HEALTH &
WELLNESS
PATIENT
CONDITION
MANAGEMENT
Wellness – Alere/OPTUM, WebMD
Telemedicine – Teladoc
Better Portals. The Journey Begins Here.
DISEASE
MANAGEMENT
The Member Journey and Population Health
All members are not created equal:
20% of members = 80% of costs
40-60%
20-25%
5-15%
2-3%
RISK
STRATIFICATION
Healthy / Low
Risk
At Risk
Chronic
Active
Disease
RELATIVE COST
5-10%
15-20%
30-40%
40-50%
ENGAGEMENT
No or very low
touch
Low touch
Medium to
high touch
High touch
POPULATION
The value of engagement increases as members
become patients
Better Portals. The Journey Begins Here.
5
Integrating the Healthcare Ecosystem
Enrollment
Document
& Private
Management
Exchanges
Tax
Advantaged ID Card
Account
Imaging
Management
Current
Integrations
Payments
Processing
Planned
Integrations
Cost &
Provider/
Population
Physician
Quality
Patient
Health
Appointments
Transparency
Management Collaboration
Core Admin/
Claims
Pharmacy
Benefit
EOB Imaging
Management
Wellness
Analytics
Health
Education
Personal
Telemedicine Health
Records
On-line Chat
Healthx integrates and unifies the user
experience across the consumer
engagement ecosystem.
150 + integrations to third party vendors
Provider
Services
Member
Services
Verify
Referrals and
Eligibility and
AuthorBenefits
izations
View and
Manage
Benefits
View and
Manage
Claims
View
View Claims
View payer
remittance Payer Reports
and Claim
Documents
advice
Status Inquiry
Provider
Health
Electronic
Search and
Management Documents
Selection
Financial
Transactions
Alerts
Update
Demographics
Mobile
IVR
Fax
Care Plans Gaps
in Care
Multiple
Language
Capability
Payer
Communications
Cloud-based, Consumer Engagement Platform
• Software as a Service (SaaS) solution connecting payers to members, providers, brokers and employers
• Adopted by more than 180 payers representing 20 million lives and 700,000 providers
• Creates integrated holistic view of healthcare and benefit information
• Secure, easy-to-use, scalable, HIPAA compliant, flexible
• Platform includes: Security and Provisioning | User Profile Management | Design & Branding | Content Management System |
Workflow Tools | Multi-channel Communication | Administrator Portal
Integrates Disparate Data Sources Into Single Unified Database
Claim Data
(medical, lab Eligibility
pharmacy)
Enrollment
Auths /
Referrals
Co-pay,
Deductible)
Biometric
FSA/
HRA/
HSA
Better Portals. The Journey Begins Here.
EMR/
EHR
Provider
Data
Care Plans
Gaps in Care
Built-in
functionality
drives
administrative
efficiency and
enhanced
member
satisfaction.
Ingests
14,000+ files
each month.
6
Integrating the Healthcare Ecosystem
Enrollment
Document
& Private
Management
Exchanges
Tax
Advantaged ID Card
Account
Imaging
Management
Current
Integrations
Payments
Processing
Planned
Integrations
Cost &
Provider/
Population
Physician
Quality
Patient
Health
Appointments
Transparency
Management Collaboration
Core Admin/
Claims
Pharmacy
Wellness
Benefit
EOB Imaging
Management
Analytics
Health
Education
Personal
Telemedicine Health
Records
On-line Chat
Healthx integrates and unifies the user
experience across the consumer
engagement ecosystem.
150 + integrations to third party vendors
Provider
Services
Member
Services
Verify
Referrals and
Eligibility and
AuthorBenefits
izations
View and
Manage
Benefits
View and
Manage
Claims
View
View Claims
View payer
remittance Payer Reports
and Claim
Documents
advice
Status Inquiry
Provider
Health
Electronic
Search and
Management Documents
Selection
Financial
Transactions
Alerts
Update
Demographics
Mobile
IVR
Fax
Care Plans Gaps
in Care
Multiple
Language
Capability
Payer
Communications
Cloud-based, Consumer Engagement Platform
• Software as a Service (SaaS) solution connecting payers to members, providers, brokers and employers
• Adopted by more than 180 payers representing 20 million lives and 700,000 providers
• Creates integrated holistic view of healthcare and benefit information
• Secure, easy-to-use, scalable, HIPAA compliant, flexible
• Platform includes: Security and Provisioning | User Profile Management | Design & Branding | Content Management System |
Workflow Tools | Multi-channel Communication | Administrator Portal
Integrates Disparate Data Sources Into Single Unified Database
Claim Data
(medical, lab Eligibility
pharmacy)
Enrollment
Auths /
Referrals
Co-pay,
Deductible)
Biometric
FSA/
HRA/
HSA
Better Portals. The Journey Begins Here.
EMR/
EHR
Provider
Data
Care Plans
Gaps in Care
Built-in
functionality
drives
administrative
efficiency and
enhanced
member
satisfaction.
Ingests
14,000+ files
each month.
7
Integrating the Healthcare Ecosystem
Enrollment
Document
& Private
Management
Exchanges
Tax
Advantaged ID Card
Account
Imaging
Management
Current
Integrations
Payments
Processing
Planned
Integrations
Cost &
Provider/
Population
Physician
Quality
Patient
Health
Appointments
Transparency
Management Collaboration
Core Admin/
Claims
Pharmacy
Wellness
Benefit
EOB Imaging
Management
Analytics
Health
Education
Personal
Telemedicine
Health
On-line Chat
Records
Healthx integrates and unifies the user
experience across the consumer
engagement ecosystem.
150 + integrations to third party vendors
Provider
Services
Member
Services
Verify
Referrals and
Eligibility and
AuthorBenefits
izations
View and
Manage
Benefits
View and
Manage
Claims
View
View Claims
View payer
remittance Payer Reports
and Claim
Documents
advice
Status Inquiry
Provider
Health
Electronic
Search and
Management Documents
Selection
Financial
Transactions
Alerts
Update
Demographics
Mobile
IVR
Fax
Care Plans Gaps
in Care
Multiple
Language
Capability
Payer
Communications
Cloud-based, Consumer Engagement Platform
• Software as a Service (SaaS) solution connecting payers to members, providers, brokers and employers
• Adopted by more than 180 payers representing 20 million lives and 700,000 providers
• Creates integrated holistic view of healthcare and benefit information
• Secure, easy-to-use, scalable, HIPAA compliant, flexible
• Platform includes: Security and Provisioning | User Profile Management | Design & Branding | Content Management System |
Workflow Tools | Multi-channel Communication | Administrator Portal
Integrates Disparate Data Sources Into Single Unified Database
Claim Data
(medical, lab Eligibility
pharmacy)
Enrollment
Auths /
Referrals
Co-pay,
Deductible)
Biometric
FSA/
HRA/
HSA
Better Portals. The Journey Begins Here.
EMR/
EHR
Provider
Data
Care Plans
Gaps in Care
Built-in
functionality
drives
administrative
efficiency and
enhanced
member
satisfaction.
Ingests
14,000+ files
each month.
We must be connected to our Members
ENGAGED MEMBERS
OUTPERFORM
the Non-Engaged
by up to 202%*
*Source: Gallop
Better Portals. The Journey Begins Here.
Using technology for interaction makes sense
Over 50% of adults daily
internet use is mobile*
332% usage
increase in
custom apps last
year*
* Source: www.smartinsights.com
Better Portals. The Journey Begins Here.
Improving the Member Healthcare Journey:
Wellness and Telemedicine Strategy
Andrew Lockerbie
Healthx
Vice President, Self-Insured & Special Markets
[email protected]
Doug Wilcox
Healthx
Director of Marketing
[email protected]
Connecting through Wellness
WELLNESS
Better Portals. The Journey Begins Here.
Prevention & Wellness (Pop health) Matter
69%
of Americans are trying to lose
or maintain their weight.1
70%
of Americans who smoke want
to quit.2
47%
of Americans want to be an inspiration
for healthy living for their children.3
80%
1.
2.
3.
4.
I N C R EA S E
in combined medical expense savings
and long-term avoided costs4
2011 Food & Health Survey, International Food Information Council Foundation, Sept 2011
CDC Morbidity and Mortality Weekly Report, USA Today, November 2011
APHA, April 2010
*Based on 2012 BIC ROI analytics, retail industry client
Better Portals. The Journey Begins Here.
12
Mobile-Web Experience: Enabling Engagement for Population
Supports participant engagement in behavior change through key tools and resources:
• Weight
• Stress
Health Focus Areas
• Nutrition
• Tobacco
• Physical Activity
• Health Assessment
Health & Program Tools
• Virtual Coaching
• Goal Setting & Action Plans
• Progress, Activity Tracking & CareAlerts
• Incentive Tracking
• Message Center
Motivational Resources
• Health Challenges
• Health Content
• Community Support
Better Portals. The Journey Begins Here.
13
Health Assessment
Comprehensive health
assessment that educates
about health status
Actionable
recommendations
Encourage participation to
change behavior
Identify modifiable risks
Paper versions available
Better Portals. The Journey Begins Here.
Virtual Coaching to Drive Behavior
Change
Helps
participants set behavior change
goals and work through a personalized
action plan to achieve those goals
Focus on reducing health risks and offer
personalized, actionable information,
tools and resources
With or without the support of a coach
Five focus areas:
–
–
–
–
–
Stress
Physical Activity
Nutrition
Tobacco Cessation
Weight Management
Better Portals. The Journey Begins Here.
Incentive Tracking and
Customization Capabilities
Highly configurable points based dashboard
displaying a set of activities available to earn points
towards the incentive program
Unique program designs configurable
Variety of incentive tracking available
–
–
–
Activity-Based
Value-Based
Claims-Based
Program Details page (with link to Program Overview
on client specific content page)
Points History page to track multiple incentive
program cycles
Better Portals. The Journey Begins Here.
Key Results
• Deliver turnkey, configurable member-driven strategy and design
• Develop and execute an integrated, consumer-oriented experience that empowers individuals to
identify and address unhealthy behaviors before they escalate into high-cost chronic conditions.
• Achieve reduced overall health risk and health care savings.
Engagement
• 73% lost weight1
• 45% quit tobacco1
• 42% increased ability
to cope with stress2
• Over 50% increased
exercise & improved
nutrition2
Quality
• NCQA WHP
accredited
• Performance reporting
– ranked in the 90th
percentile in the areas
of risk reduction,
tobacco quit rates and
physical activity level
Savings
• Estimated health care
savings: $162 per
participant3
• 95% Participant
satisfaction2
1 - Data on file. Book of business survey results. Results measured among respondents to a survey at 6 months post program enrollment,.
2 - Data on file: Book of business results.
3 - Data on file: Book of business results. Results reflect a wellness savings cohort study analyzing per member savings by participation rate.
4 - 2014 Client Satisfaction Survey results.
Better Portals. The Journey Begins Here.
Client Satisfaction
• 98% - RN/coach
expertise4
• 94% - Member
experience4
• 94% for Marketing
Resource Center4
• Named ‘Top
Wellness Vendor’ by
Employee Benefit
News in 2014
Member Journey through Wellness Participation
Promoting Personal Health Ownership through Flexible, Member-Foccussed
Technology Access
MEMBER
ENTERS THEIR
WELLNESS
JOURNEY
Programs/Accountability
Better Portals. The Journey Begins Here.
Knowledgable
Connecting through Telemedicine
Tele-Medicine
Better Portals. The Journey Begins Here.
Doug Reminder
Replace with Teladoc slide
Better Portals. The Journey Begins Here.
Telemedicine works for all constituants
Consumers/
Members
Providers/Payers
Employers
Better Portals. The Journey Begins Here.
Provide 24x7, on demand
access via phone, mobile,
and video
Prevent unnecessary
ER/UC visits to more cost
effective mode of care
57% of companies plan to
adopt telemedicine
Telemedicine adoption rate is unprecedented
900,000
900% GROWTH!
575,000
Teladoc has grown from 1,000 consults in
2005 to a projected 900,000 visits in 2016.
We delivered our one millionth visit in
October, 2015
298,000
EST.
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Everyone is embracing telemedicine
Consumers are open to virtual care…
54%
18-29 year olds
49%
$71,000+ income
53%
Work 35+ hours
…and employers are embracing it.
48%
currently offer
telehealth
services
Source: Forbes “ The Future of Health Ecosystem” 2/3/2016
74%
plan to offer
telehealth in
the next year
Benefits of Telemedicine
24/7/365 ACCESS
Provide 24/7, ondemand access to boardcertified providers via
video, phone or mobile
app
TREAT HEALTH ISSUES
Diagnose, treat and
prescribe medications
(if necessary) for
common health issues
PROVEN ROI
Prevent unnecessary
ER/UC visits to more costeffective mode of care
Telemedicine Features/Results Slide
Better Portals. The Journey Begins Here.
Member Journey through use of tele-medicine
Promoting Personal Health Ownership through Flexible, Member-Foccussed
Technology Access
MEMBERS
ACCESS TELESERVICES at
TIME OF NEED
VIRTUAL VISIT/CARE: WORKS FOR ALL MEMBERS
TIME and $$ SAVED OF THEIR HOUSEHOLD
Better Portals. The Journey Begins Here.
EXPERIENCE
IMPROVED
Questions?
Please submit questions through the GoToMeeting sidebar.
How do I get Electronic Healthcare Delivery?
If you would like more information on implementing the Electronic
Healthcare Delivery within your Healthx platform,
reach out to your account manager to request a demo.
Or contact us at
[email protected].
See our blog @ www.healthx.com
We will follow up with a recording of the webinar and answer
additional questions you may have.
Better Portals. The Journey Begins Here.
Improving the Member Heatlhcare Journey:
Wellness and Telemedicine Strategy
Andrew Lockerbie
Healthx
Vice President, Self-Insured & Special Markets
[email protected]
Doug Wilcox
Healthx
Director of Marketing
[email protected]