Care providers face growing pressure to maintain margins amidst significant market disruption. New tech-enabled models of care delivery are emerging to address inefficiencies in areas such as obesity management. This slideshare outlines ProjectVision's research into the core methods for implementing a scalable, cost-effective framework for weight management that focuses on managing non-adherence risk.

1. Creating a world without health disparities

2. Utilization Is Shifting to the Outpatient Setting...
2
Growing revenue for outpatient setting, but hospitals are still struggling with
tight margins due to cost inefficiencies in outpatient care
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Inpatient vs Outpatient Revenue
Gross Outpatiet Revenue Gross Inpatient Revenue

3. ...But Total Utilization and Margins are Declining
3
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
30,000,000
31,000,000
32,000,000
33,000,000
34,000,000
35,000,000
36,000,000
37,000,000
38,000,000
39,000,000
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
%ofhospitals
#ofdischarges
Utilization vs Hospitals with Negative Margins
Total number of discharges % of Hospitals with Negative Operating Margins
Much of the decline in % of hospitals with negative margins from 2003-2011 is
due to cannibalization, rather than systemic corrections

4. Obesity-related care costs are one source of margin erosion
4
-2%
0%
2%
4%
6%
8%
10%
12%
14%
16%
2009 2010 2011 2012 2013 2014
PMPM Cost Growth Rate
Overweight/Obese Medicare Overall Private Insurance Overall
related care

5. Impact of Physician Shortage on Labor Costs is Another
5

6. Obesity Drives a Myriad of Other Chronic Conditions...
6

7. ...And Is a Major Problem Across All Income Groups
7

8. Growth in costs is being passed on to patients...
7

9. ...And results in the most vulnerable patients avoiding preventive care
8

10. How did we get here?
Payer Provider Patient
 Lack of granular behavioral
risk data for accurate cost
modeling
 Lack of financial incentives
to providers for preventive
care (this is starting to
change)
 High deductible premium
plans
 High operational cost of
longitudinal management
and preventive care
 Poor patient engagement
 Shortage of physicians
means greater reliance on
mid-level clinicians
 Lack of scalable or
transferable clinical
protocols for managing
behavioral risk
 Rising cost of private
insurance incentivizing
deferral of preventive care
 Barriers to behavior change
not fully addressed by
condition management
plans
9

11. Shift In Mindset Needed To Address the Problem
The financial burden of weight-related
chronic conditions is not a medical
problem.
It’s a behavior risk management
problem
10

12. Elements of Successful Behavioral Risk Management Models
12
Care providers lack the
infrastructure to effectively
engage the patients most
at-risk for non-compliance
Real-time collaboration between providers and patients
Remote patient monitoring
Quantify the barriers to healthy behavior change

13. How To Ensure Scalability?
13
Care providers lack the
infrastructure to effectively
engage the patients most
at-risk for non-compliance
• Consistent quantification of behavioral risk factors, ideally
through passive remote data gathering from patients
• Behavioral risk data analysis that can support the
development of flexible protocols, rather than a model
built around the needs of specific demographics
• Standardized back-end analytical models across provider
groups or service areas

14. Quantifying Behavioral Risk of Non-Adherence
14
SocialData
(patient activity
on the app)
Psychological
Data (patient
assessments)
Environmental
Data (GPS
tracking via
smartphone)
Algorithms analyze
behavioral data
Calculated non-
adherencerisk,
magnitude of
risk factors
Clinician designs
tailored intervention

15. Infrastructure For Enhancing Successful Models of Engagement
15
Care providers lack the
infrastructure to effectively
engage the patients most
at-risk for non-compliance
Behavior Risk Management
Platform
Mid-level clinician staffing for
more cost effective patient
engagement
Implemented at health
system/MCO/ACO
Provided to qualified
patients with weight-
related Dx
MD for program
supervision

16. Goal is to Reduce the Cost Burden of Obesity-Related Care
16
Success and Return on Investment measured across three
areas:
1. Cost savings associated with reduced Emergency
Department and follow-on inpatient admissions for
complaints associated with target diagnosis
2. Cost savings associated with reduced 90-day readmission
rates for complaints associated with target diagnosis
3. Improvement on HEDIS quality measures related to chronic
condition management, patient education, and admission

17. Want to learn
more?
Download the full
white paper
Contact us:
srs@projectvisionhealth.com
415-547-0735
Click here to access the full report