4. Explorys Member Systems
Network enabling platform of 300 hospitals
17 integrated delivery networks
200,000 providers
135 billion data points
Delivering over $52 billion in care annually
Across 35 million patients
Projected as 45 million as newly signed
systems go live in coming months
page 4 | CONFIDENTIAL
8. Growing trend towards mass consolidation to compete
effectively and remain financially secure.
Number of M&A transactions, 2000-2011
page 8 | CONFIDENTIAL
Source: The Health Care M&A Report, Irving Levin Associates, Inc., 2000-2011 and AHA Hospital Statistics
9. Growing trend towards mass consolidation to compete
effectively and remain financially secure.
"It's a numbers
game," he said. "To
effectively take on
the financial risk
providers are being
told to assume, they
need a certain
amount of critical
mass. The bigger
you are, the more the
numbers work to
your advantage.â -
Healthcare remains
highly fragmented
relative to other
industries
Ben Rooks, founder of San
Francisco-based ST
Advisors
Sources:
Kauffman Hall - Strategic Options in a Consolidating Market
Modern Healthcareâs 2011 Hospital Systems Survey
2011 AHA Hospital Statistics, iSuppli Corporation 2010 Semiconductor Suppliers
Air Transport Association 2010 Economic Report. Statistics are prior to the United-Continental merger. Proforma for that transaction, the top 5 and top 15
would have made up 70.0% and 89.5%, Drug Store News Top 50 Rx Power Players, April 2012. Market size is defined as the revenues of the top 50
players
page 9 | CONFIDENTIAL
Top 5 Players
Top 15 Players
10. Growing
Demand for
Value
Payers, patients, and
employers and demanding
accountability in care and
outcomes.
Unsustainable trajectory of
costs coupled with few quality
improvement in the last
decade.
Source: The Commonwealth Fund: The National Scorecard on U.S. Health System Performance, 2011,
page 10 | CONFIDENTIAL
12. Share of Chart
In Network
Out of Network
Is an imperative for growing revenue and managing risk
Proactively manage your patient / customer or someone else will
page 12 | CONFIDENTIAL
13. Pick Your
Initiatives Wisely
How timing, share of
chart, shared savings rate, and
cash flow impact both valuebased-care and fee for service
financials.
page 13 | CONFIDENTIAL
14. The Connected World
Rapidly Forming
A New Healthcare Economy
Clinically Integrated
Networks
IDN 1
Employers
Patients /
Members
Risk Models
PHO
Finance
IDN 2
Health
System
Contact Center
Contracting
Guidelines
TPA
Apps & IT Tools
Regulators
Underwriters
Payers
IDN 3
page 14 | CONFIDENTIAL
16. âThere is concern surrounding
how reimbursement will be distributed
mong the multitude of providers involved in a particular episode. This may
pose considerable challenges to urologists in community practice and
may further incentivize alignment with hospital systems.â
Matthew J. Resnick, MD, assistant professor of urologic surgery at Vanderbilt University Medical Center
page 16 | CONFIDENTIAL
18. BIG DATA is Volume, Velocity, and VarietyâŠ
Volume
150
exabytes
of stored healthcare
data across disparate
care settingsâŠ
Velocity
1,000
Variety
/sec
vital-signs capture by
bedside, home, and
mobile devicesâŠ
80
coding variability
among diagnoses and
test resultsâŠ
Source: âHow big is 'big data' in healthcare?â, by Graham Hughes, MD
âBig Data Use In Healthcare Needs Governance, Educationâ â Information Week, by Neil Versel
âWhy 'Big Data' Is a Big Dealâ, Wall Street Journal, By L. GORDON CROVITZ
page 18 | CONFIDENTIAL
%
19. Applying Big Data effectively could yield $300400 billion in healthcare costs
page 19 | CONFIDENTIAL
20. In a Gartner 2012 survey, 68% of health systems
intend to make new investments in
business intelligence and analytics
in the next 2 years.
Even at the height of the U.S. EHR adoption,
that percentage never reach this level.
page 20 | CONFIDENTIAL
21. However, EMRs are not well positioned to leverage
Big Data for population healthâŠ.
âEarly EHRs were not designed first and foremost to
facilitate and improve the delivery of care; they were
designed to facilitate billing.
- Rob Tholemeier and John Moore, Chilmark Research, June 2013.
page 21 | CONFIDENTIAL
23. Payer Claims
Charges, payments, Rx fills,
3rd party providers
Provider Billings
Part
of the Picture
EDI billing and payment
adjudication (EDI)
Healthcare System Operations
Allocated costs, actual costs,
labor, and materials
Provider Info
Physicians, nursing staff,
specialists, and care coordinators
page 23 | CONFIDENTIAL
24. Payer Claims
Ambulatory EMR (employed & affiliates)
Charges, payments, Rx fills,
3rd party providers
Diagnoses, findings, labs, procedures, encounters,
appointments
Provider Billings
ED & In-Patient EMR
EDI billing and payment
adjudication (EDI)
Diagnoses, findings, labs, procedures,
encounters, appointments
Patient
Demographics, behaviors,
and attitudes
Healthcare System Operations
Allocated costs, actual costs,
labor, and materials
Provider Info
Physicians, nursing staff,
specialists, and care coordinators
Administrative
page 24 | CONFIDENTIAL
Long Term Care
Diagnoses, findings, labs, procedures,
encounters, appointments
Homecare & Telemedicine
Readings, patient reported outcomes,
nursing visits, and mobile
Clinical
25. Big Data in the Real World
Use Cases
page 25 | CONFIDENTIAL
26. Driving Knowledge from BIG DATAâŠ
Whatâs the best that can happen?
Optimize
Competitive Advantage
What will happen next?
Predict
&
Model
What if these trends continue?
Why is this happening?
Forecast
Analyze
Alert
DrillDown
Query
Report
What actions are needed?
Future-oriented and
source of competitive
advantage
Descriptive Analytics
(the âwhatâ)
What exactly is the problem?
How many, how often, when?
What happened?
Degree of Intelligence
page 26 | CONFIDENTIAL
Predictive Analytics
(the âso whatâŠ.
And the ânow whatâ)
âRearview mirrorâ â
Provides foundation and
insight
27. Patients and Providers
Creating Win-Win Opportunities
Maximize Quality
Identify the highest impact opportunities relative
to risk-adjusted benchmarks and track progress.
Maximize Margin
Risk stratify populations, profile providers, predict
outcomes, and direct action towards reducing
unnecessary cost and optimizing reimbursement.
Maximize Market Share
Drive top-line revenue through provider alignment
and virtually integrated networks.
page 27 | CONFIDENTIAL
28. Patients and Providers
Creating Win-Win Opportunities
Maximize Quality
Identify the highest impact opportunities relative
to risk-adjusted benchmarks and track progress.
Maximize Margin
30% quality improvement within
value-based care disease
management programs
Risk stratify populations, profile providers, predict
outcomes, and direct action towards reducing
unnecessary cost and optimizing reimbursement.
Maximize Market Share
Drive top-line revenue through provider alignment
and virtually integrated networks.
page 28 | CONFIDENTIAL
29. âWe saw a 51% reduction in hospital admissions, a
35% reduction in readmissions and a 37% reduction in
emergency department visitsâ
Teaera Roland, Nurse Care Coordinator, Mercy Health
page 29 | CONFIDENTIAL
30. âWe have had improvements across all of our
measures throughout the course of the year.â
âOur pneumococcal vaccine rate rose from 52 percent in 2011 to 60
percent at the end of 2012; our colonoscopy rate went from 34 percent
to 40 percent during that time. And our tobacco cessation counseling
rate rose from 56 percent to 77 percent.â
Dr. Amy Frankowski, MD, Catholic Health Partners
page 30 | CONFIDENTIAL
31. Patients and Providers
Creating Win-Win Opportunities
Maximize Quality
Identify the highest impact opportunities relative
to risk-adjusted benchmarks and track progress.
Maximize Margin
Accurately price care bundles
for direct-to-employer
risk-based contracts.
Risk stratify populations, profile providers, predict
outcomes, and direct action towards reducing
unnecessary cost and optimizing reimbursement.
Maximize Market Share
Drive top-line revenue through provider alignment
and virtually integrated networks.
page 31 | CONFIDENTIAL
32. Patients and Providers
Creating Win-Win Opportunities
Maximize Quality
Identify the highest impact opportunities relative
to risk-adjusted benchmarks and track progress.
Maximize Margin
Empowering Colorado Health
Neighborhoodsâ physician-led
clinically integrated network
across more than 2,000 providers.
Risk stratify populations, profile providers, predict
outcomes, and direct action towards reducing
unnecessary cost and optimizing reimbursement.
Maximize Market Share
Drive top-line revenue through provider alignment
and virtually integrated networks.
page 32 | CONFIDENTIAL