Creating the digital patient home

©inVentiv Medical Management 2013 Proprietary & Confidential
C r e a t i n g T h e
D i g i t a l
P a t i e n t H o m e :
A R e t a i l
P h a r m a c y
O p p o r t u n i t y
September 2013

©inVentiv Medical Management 2013 Proprietary & Confidential 2
Who Is inVentiv Medical Management?
Claims
Surveillance
High Cost
Services
Stratify Risk
Duplicate
Services
Personalization
of Clinical and
Financial
Strategies
Cost Savings
Care Outcomes
Length of Stay
Readmissions
Reporting
Ongoing Care
Coordination
Identify
Opportunities
Engage
Consumers &
Providers
Measure
Outcomes
Provide
Insights
Claims

Our mission focuses on the long view of population
health by improving care, lowering cost and
delivering outcomes that matter.
CostAnd Care Management Services Including:
Cost Management
Deploying multiple administrative & clinical
strategies to reduce the price paid for healthcare
Accountable Care Solutions
Meeting the need for care coordination, consumer
engagement and cost containment to support the triple
aim in complex conditions
Utilization Management
Evidence based medicine supporting predictable, cost-
effective outcomes
Case Management
Facilitating the relationship between the provider and
patient to enhance care
Wellness Promoting behavioral change through
prevention education & biometric screening
Disease Management
Motivational Coaching of the individual to reduce the
burden of disease through lasting change
Predictive Analytics
Looking back at utilization while looking forward at risk.
Actionable health informatics realized from structured
and unstructured data
Integrated Cost and Care Reporting
Results of combined cost and care interventions at the
client, group and individual level
Claims Surveillance and Mining
Diving into the longitudinal care utilization history of an
individual to uncover what others miss. Gaining a real
world view of practice patterns of providers; which
drug, which patient, when, why?
Gaps in Care
Alerts to deviations from standard of care and
intervening to close the gap
Single Sourcing Synergy
The only medical management provider delivering the
full spectrum of cost and care management solutions
in a single population health offering, maximizing the
impact on outcomes

1 + 1 + 1 = 4?
Trust
Access
12 Rxs PMPY
CX
Integration
Data
Golden Moments
Prochaska
Motivation

©inVentiv Medical Management 2013 Proprietary & Confidential
Among Firms Offering Health Benefits
Percentage That Offer an HDHP/SO, 2005-2012
4%
7%
10%
13%
11%
15%
23%
31%
0%
10%
20%
30%
40%
50%
2005 2006 2007 2008 2009 2010 2011 2012
NOTE: Tests found no statistical difference from the previous year shown (p<.05). The 2012 estimate includes 0.6% of all firms offering health benefits that offer both an
HDHP/HRA and an HSA-qualified HDHP. The comparable percentages for previous years are: 2005 [0.3%], 2006 [0.4%], 2007 [0.2%], 2008 [0.3%], 2009 [<0.1%], 2010
[0.3%], and 2011[1.8%].
SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2005-2012.
Here’s some information and
some money to manage.
There’s no reliable data and
huge variance. Good luck!

OurActions Impact Costs
Source: AON 2012 Healthcare Survey

Adherent Patients Cost Less
• Adherence has been shown to drive lower medical costs1:
– CHF savings $8,881 / year
– Hypertension $4,337 / year
– Diabetes $4,413 / year
– Dyslipidemia $1,860 / year
• Adherence has also been shown to reduce absenteeism by 7 days
per year per patient with chronic diseases (~$1,700 in savings)2
• Additionally, there is a significant gap between perceived
adherence (which is high) and actual adherence (which is low)
signaling a need for increased intervention3
1 – Health affairs article - http://www.cimit.org/images/events/ciw/Adherence-Health-Affairs.pdf
2 - http://www.drugstorenews.com/article/cvs-caremark-research-finds-link-between-medication-adherence-employee-productivity
3 – Gap in perceived versus actual adherence identified in 2011 Express Scripts Drug Trend Report

Overwhelmed With Opinions
PBM
MCO
Retail Pharmacy
Physician
Hospital
Disease Management
Pharma
Employer

Access Trust

Source: Silverlink Communications: 13 Common Pitfalls In Consumer Health Engagement

Are There More McDonalds In The US Than
Retail Pharmacies In The US?
>10 within 4 miles of my house

Pharmacy 2020: Ubiquitous Integration
• Your pill bottle can tell based on weight that you’re getting low on pills and texts you, orders a refill, and
puts a reminder in your phone.
• As you drive by the pharmacy, you get an alert that the Rx is ready early with a coupon to come in.
• Upon entering the pharmacy, the facial recognition software identifies you bringing up your profile for the
pharmacist and pulls in your recent shopping list to see you’re not eating the right foods.
• As you walk into the store, the network picks up your latest data from your devices and integrates that
into your profile.
• The shopping cart app routes you to the right diabetic foods and provides an augmented reality view of
how to use them with the foods at home.
• As you come to the counter, the pharmacist instantly recognizes you and has your Rx ready. Based on
the alerts, they steer you away from the kiosk to counsel you about a new program they’re offering.
• As you stand at the counter, the scale in the floor captures your latest weight.
• As you’re paying, the POS system gets a gaps-in-care alert from your managed care company which has
the pharmacist talk to you about needed screenings.

Facedeals:ASample Of What’s To Come
Source: http://redpepperland.com/lab/details/check-in-with-your-face

Can You Sell CigarettesAnd Be A Health Destination?
Source: http://www.cnn.com/2011/OPINION/08/14/greene.smoking.labels/index.html

Summarizing The Landscape
• Technology will continue to get more predictive
• Your smart phone will become your virtual assistant
• Integration has to happen (Rx, Medical, Lab, Devices)
• Healthcare will continue to be a local business driven by windshield decisions
• Healthcare exchanges will eventually allow consumers to vote with their feet
• Consolidation will accelerate with large companies jumping in
• Pharmacists will one day stop counting pills
• Pharma will eventually care more about adherence then acquisition
• Targeted drug therapy will be the norm (and not just for specialty drugs)
• People will need an expert to help them as they take on accountability

The Opportunity

√
√
√
Source: Patient Centered Primary Care Collaborative - http://www.pcpcc.org/about/medical-home
What’sAMedical Home?

4.1 5-30
Rxs PMPY
(Barclays Capital)
Provider Visits
(CDC)

Source: http://www.ideo.com/work/community-pharmacy/
Walgreens Worked With IDEO To Innovate

Constantly Changing Messaging
• Regular soda
• Alcohol
• Caffeine
• BMI
• Sitting disease
• Supplements

Consumers HaveALot Of Questions
• Which plan should I choose?
• What foods should I buy?
• Should I use this vitamin?
• Is there a cheaper medication?
• Should I download this app?
• Am I going to die?
• What are the side effects?
• How will this affect my work?
• How do I interpret my lab report?
Picture from http://www.bizjournals.com/triangle/news/2013/08/14/blue-cross-opening-retail-stores-in.html

From advice to device, the pharmacy has always
represented a first line of defense for health
information and wellness. The digital revolution
shouldn’t diminish this much, but further entrench the
pharmacy practice as an essential component of
care–with a human touch and a digital reach.
John Nosta, Forbes
Source: http://www.forbes.com/sites/johnnosta/2013/08/20/digital-health-and-the-pharmacy-a-prescription-for-success/

IxAndApplication Prescribing
•Which App should I use?
–Condition
–Age
–Other apps you like
–Newly diagnosed
–Gender
–Relationship with MD
Only 27% of MDs actively
encourage patients to their
own health through mHealth
app. 13% report they actively
discourage mHealth
participation.
PWC Paths to Growth survey

Expertise Is The Missing Gap In The Quantified Self
Movement

My “Personal” Pharmacist

Patient-To-Patient
Sources: Manhattan Research, PatientsLikeMe, CureTogether, Pew Internet

It’s time for you to
get up and move.
Don’t forget to have
a small lunch since
you have dinner
plans tonight.
You should probably
stop at Panera rather
than going to
McDonalds.
Don’t forget to bring
all your medications
with you to your new
PCP tomorrow.

What Will Be TheAshville 2.0?

Pharmacy Needs To Embrace Several Things
• Privacy
• Connected systems
• Data integration
• CRM
• Beyond the pill strategies
• Healthy home
• Motivational Interviewing plus
• Consumer insights
• Continued expansion of services
SMAC
• Social
• Mobile
• Analytics
• Cloud
Source: SMAC from mHealth Trends and Strategies 2013 by netcentric strategies

Logical But NOT Easy

Insight Driven Healthcare

Personalized Communications Is Key
Only
8% of programs use
behavioral economic
theory to drive
behaviors
Only
17% use consumer
marketing techniques
Source: AON, Healthmedia

We Don’t Make It Easy
Source: http://www.wired.com/magazine/2010/11/ff_bloodwork/
Also in Ernst & Young Global Life Sciences report

Lack Of Engagement Leads To Self-DiagnosisAnd
The Creation Of ePatients
The ePatient is a patient who is
empowered by the internet and
digital technology to find education,
support and treatment.
Source: ePatient Definition - http://www.exlpharma.com/e-patient-connections#.UiDweNLFVH0
Skin Scan from http://www.theatlantic.com/health/archive/2012/09/diagnosing-skin-cancer-via-iphone-the-apps-to-know/262325/

Can Retail Re-Imagine Themselves? The Initial Focus
Has To Be On Mature Consumers.

• 54% of adults age 65+ use the internet
• 12% of adults age 65+ own a smartphone
• 30% of adults age 65+ have looked online for
health information in the past year
• 81% of adults age 65+ track their weight, diet,
exercise routine, or other health indicator
• AND this continues to go up
Will Seniors Use Technology?
Source: http://www.pewinternet.org/Commentary/2011/November/Pew-Internet-Health.aspx

But, It Has To Go Beyond That To Thinking HardAbout
Who To EngageAnd How
Americans in poverty are more likely to suffer from a variety
of chronic health problems, both psychological and physical.
(Gallup-Healthways Well Being Index)

The AAFP opposes the
expansion of the scope of
services of retail clinics beyond
minor acute illnesses and, in
particular, opposes the
management of chronic medical
conditions in this setting.
When There Is Money On The Table, There Will BeA
Fight For It
Consumers will use disease
management services offered
through retail pharmacies.
Consumers are comfortable
using primary care services
offered through pharmacy-based
retail clinics.
Source: http://www.aafp.org/about/policies/all/retail-clinics.html
And http://amcp.org/WorkArea/DownloadAsset.aspx?id=11958

Payment Reform Will Be An Issue
“Fee-for-service payments drive up health care costs and potentially
lower the value of care for two main reasons. First, they encourage
wasteful use, especially of high-cost items and services. Second, they
do nothing to align financial incentives between different providers.”
Quote from http://www.americanprogress.org/issues/healthcare/report/2012/09/18/38320/alternatives-to-fee-for-service-payments-
in-health-care/

There’sARoot Cause Issue Here…
16 minutes per encounter
49 seconds explaining new treatments
8.5 seconds talking about administration
4.7 seconds talking about side effects
Source: Tarn and al., “How Much Time Does It Take to Prescribe a New Medication”

Only 12%
of the population has a
proficient health literacy level.
Source: http://nnlm.gov/outreach/consumer/hlthlit.html

The Future Is Bright!
From
(Current)
To
(Successfully Transformed)
Focus • Acute, Reactive, Episodic • Predictive, preventive, chronic care, personalized
Care Delivery • Doctor-centric
• Large variation in care
• Disconnected
• Hospital & Office centric (local)
• Windshield
• Patient-centric teams of caregivers
• Evidence-based & standardized care
• Integrated
• Physician & virtual venues closer to patient
• Matched
Alignment of
Incentives &
Value
• Value based on volume of services • Value based on outcome & quality of services (sharing
of risks & rewards)
Consumer
Engagement
(Responsibility)
• Lacking “value exchange”
• Limited health literacy
• Not consumer centric
• Clear value from healthcare system
• Increased transparency and plain language
• Focus on individual experience
Transparency
(Cost & Clinical
knowledge)
• Paper-based
• Confusing
• Lack of knowledge (cost & quality)
• Opaque
• Personal choice of treatment
• Electronic (EMR/EHR)
• Predictable
• Shared decision making
• Transparent
• Best practices for treatment
Innovation &
Big Data
• One-off solutions (i.e., 16K apps)
• Data silos
• VC / PE based innovation
• Private / public collaboration
• Technology centric (e.g., Google glass)
• Crowdsourcing
Derived from IBM Healthcare 2015 report

Getting Started
Understand – Engage - Innovate

Location; Location; Location Will Become
Data; Data; Data
Pictures of the Express Scripts Consumerology Lab - http://www.express-scripts.com/research/consumerology/lab/

It Could BeAs
SimpleAs…
80% of heart disease &
stroke and Type II
diabetes and 40% of
cancer
Could be prevented if
Americans were to do
three things:
1. Stop smoking
2. Start eating
healthy
3. Get in shape
The Power 9 ™ from The Blue Zones: Lessons for
Living Longer From the People Who’ve Lived the
Longest:
1. Keep moving
Find ways to move naturally, such as walking and
gardening, using fewer laborsaving devices.
2. Find purpose
And pursue it with passion.
3. Slow down
Work less, rest, and take vacations.
4. Stop eating …
… when you're 80 percent full.
5. Dine on plants
Eat more veggies and less meat and processed foods.
6. Drink red wine
Do it consistently but in moderation.
7. Join a group
Create a healthy social network.
8. Feed your soul
Engage in spiritual activities.
9. Love your tribe
Make family a high priority.
Source: CDC; The Blue Zones

Think Differently – E.g., WellDoc: DeviceAs Rx

Data – E.g., Proteus Digital Health: The Smart Pill

Source: http://nnlm.gov/outreach/consumer/hlthlit.html

MobileApps: Build It …But Will They Come (and Stay)?
$10B spent on mobile apps in the past 3 years with 70% of all those apps
thrown in the electronic trashcan. (Mobiquity)
Source: http://powerfulinfographic.com/wp-content/uploads/2012/05/infographic.jpg
Only 26% of consumers used an app more than 10 times!

"As health care becomes more consumer-driven, we — as a company and, in
particular, our pharmacists — coupled with technology, innovation and expanded
clinical training — will play an even greater role in helping our customers live
healthier, happier lives. Today's customers want to be empowered as they make
choices for themselves and their families. And as a partner on their health care team,
we at Rite Aid must adapt and change, too, to ensure we're providing customers with
the best service and support to help them reach their wellness goals. Our pharmacy
team has been hard at work, developing new and exciting ways for our pharmacists
to engage with and help our customers achieve their personal health and wellness
goals."
John Standley, chairman and CEO, Rite Aid
Source: http://www.chaindrugreview.com/inside-this-issue/news/01-07-2013/2013-outlook-retail-pharmacy-embraces-change

My Ashville 2.0 Example
•Group counseling
•Nutritionist
•Telemedicine
•Prescriptions
•Immunizations
•Screenings
•Supplies
•Food
•Connected devices

A Chronic Disease Changes Your Shopping Experience

1 + 1 + 1 = 4?
Trust
Access
12 Rxs
PMPY
Consumer
Experience
Integration
Data
Golden
Moments
Prochaska
Motivation

Is ThereAn ROI???
Alain Labrique, Ph.D., the founding director of the Johns Hopkins University
Global mHealth Initiative, and his team recently conducted a survey of the
mHealth studies that were registered in the government’s clinicaltrials.gov
database as of November 2012. Labrique writes: ”We identified 215 unique
mHealth studies that were registered in the clinicaltrials.gov database, of
which 8.4 percent (n=18) were observational in nature while the remaining
91.6 percent (n=197) were interventional. Of the 215 studies, 81.8% (n=176)
studies used a classical randomized trial design and 40 new studies were
added to the database between May and November 2012 alone. Based on
these results, we posit that the field is entering a new ‘era’ where a body
of rigorous evaluation of mHealth strategies is rapidly accumulating.”
Labrique concludes: “The transition into an era of evidence-based mHealth
supports our position that innovation in this domain can be evaluated with
the same rigor as other public health strategies, attenuating some of the
hype previously associated with mHealth.”

Creating the digital patient home

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