Personal iz ing Care Management for

Through Patient Empowerment

BETTER OUTCOMES

BETTER ECONOMICS&

Focusing investment and action

2014 Summary Brief: Opportunity Assessment, Consumer Segmentation Study and Strategic Implementation Guide for Patient Empowerment

Done in partnership by Maddock Douglas (innovation consulting firm) and Ringleader Ventures with participation from a number of

leaders from HCSC, Blue Cross Blue Shield of Michigan, Highmark, General Electric and Daniel Friedland, MD and president-elect at

American Board of Integrative Holistic Medicine

WHYThe health care landscape is complex, uncertain and competitive. It requires each player in the ecosystem to be evermore accountable to healthy outcomes. Each stakeholder must move from awareness to action with implementable programs that meaningfully empower patients.

WHATThis document includes an actionable segmentation study and a strategic implementation guide. It is the missing link that will help you focus on getting in front of the trends and becoming a leader in this space by delivering tangible improvements for the patient experience.

HOWUse this content to inform near-term investments in patient empower- ment, care management, ACOs and benefits departments. These innovation assets will help you identify the patients who can be helped the most and therefore guide the design and development of new ways to improve personalized care.

Work with Maddock Douglas and Ringleader Ventures to execute a definitive road map for action.

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THE PURPOSE

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Why focus on patient empowerment?

To help stakeholders deliver better health outcomes (through patient empowerment)

PROV

IDER CONSUMER

PAYER

Maddock Douglas has worked many years in the health care category, supporting leaders who are helping their companies, community and industry through significant inflection points to get to what’s next (shifting from B2B to B2C and to B2Me). This inspired Maddock Douglas to rally an independent “coalition of investors” around a simplified and actionable purpose:

Applying the Maddock Douglas consumer insight-driven innovation process, we have been generating assets that help lead to focused investment in actionable solutions that drive better health outcomes for patients first and foremost.

Essential to delivering on this in the near term is the intent to find ways of integrating these assets and ideas with existing patient empowerment and care management programs while working toward unlocking the “holy grail(s)” of outcome-based strategic priorities that revolutionary executives in ACOs, care management and benefits management are searching for:

» How to help me understand the uniqueness of individual members within my conditions database as a foundation for improving personalized care initiatives?

» How to help me find the patients we can help the most because they want to be helped?

» How to help me get newly diagnosed patients oriented appropriately in order to increase the likelihood of the best outcome for each patient?

Our research investigated if consumers (patients) had different attitudes and behaviors that could materially affect the impact of programs designed to help them navigate the interconnected triad of key stakeholders — the patient (and caregivers), the payer (insurance company) and provider (doctor, hospital system).

Since the level of involvement people have with this triad will affect their experience, we spent extra effort to make sure we heard from patients who were diagnosed as at risk for or having a health condition and/or in need of a medical intervention.

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THREE TRENDS AFFECTING THE TRIAD OF RELATIONSHIPS

PROV

IDER CONSUMER

PAYER

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1The Rise of the Prosumer, Superconsumer and e-Empowered Patients is “Just Rounding First Base”

Patient Values &

Expectations

Relevant Scientific Evidence

Individual Clinical

Expertise

EBM

The 21st century patient will have access to the results of evidence-based medicine (EBM) research just now being funded and curated for provider use.

“Consumer centricity” is not new to the health care industry; many institutions (e.g., government, public and private) have devoted effort

to help their organizations consider the impact of their policy and programs from a consumers’s point of view. This intentional

involvement of the consumer is slow moving and in some institutions treats all consumers equally, or as the disease/illness they are engaged in managing. A common belief is that we have only begun to see the impact it will have on quickly transforming the entire health care system right before

our eyes, not unlike recent transformations in other equally complicated industries. As part of the Affordable Care Act signed

into law in 2010, a private, nonprofit entity called the Patient-Centered Outcomes Research Institute (PCORI) was established.

PCORI is a center focused on helping people make informed health care decisions and improve health care delivery and outcomes by producing and promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the broader health care community.

A spotlight on care management, evidence-based medicine (EBM) and a paradigm shift toward a patient empowerment approach to health care has led to several policies and government-funded initiatives to support this. The American Recovery and Reinvestment Act (ARRA) of 2009 authorized funding for comparative effectiveness research — a key enabler of EBM.

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THE FUTURE DECISION-MAKING PROCESS

H2 best align provider EBM training, language and FFEA framework with patient training, language and FFEA empowerment tools?

Consumer > Lifestyle > Symptoms

Consumer seeks medical help Treatment plan decided

Consumer is billed

Aggregate data (macro) is collected and distributed (micro)

Find 24

1

3Evaluate

Frame

Apply

2Changing the Conversation (by Shifting to a Shared Language) Will Change Everything

As the Affordable Care Act continues to fund, promote and reimburse stakeholders based on EBM practices, our hypothesis is that EBM or a more everyday language proxy will become integrated into regular conversations. EBM’s four decision-making process steps (i.e., Frame, Find, Evaluate, Apply [FFEA]) mirror the decision cycle of patients while engaging with the health care system. At the center of this relationship paradigm shift, all stakeholders in the system (especially the frontline stakeholders such as payers and providers) will continue to adapt the way they operate to reflect a new, deeper understanding of and commitment to unique consumer segment needs, attitudes and behaviors in order to achieve significant cost savings and, more important, better health care outcomes for more people (with less waste in the system).

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3New Players (e.g., Google, CVS, Apple) and Technology Start-ups are Increasingly Attractive Alternatives for Patients and Corporations

The flood of related technology start-ups (e.g., Oscar) and consumer-based patient empowerment apps are daunting indicators of solutions flooding the market and equally daunting for corporate leaders to discern between which ones will create value and are worthy of investing in. More than 40,000 downloadable apps on U.S. Apple iTunes, to be exact, were studied in the October 2013 report on Patient Apps for Improved Healthcare (from Novelty to Mainstream) from the IMS Institute for Healthcare Informatics.

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FOUR UNIQUE AND ACTIONABLE CONSUMERSEGMENTS

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Four consumer segments emerged from our research — each with distinct attitudes, behaviors and unmet needs. These segments are not driven by differences in health status or demographics such as age, region, income, family structure, etc. These segments are differentiated by their approach to health care treatments and decisions — how they frame questions, find information and resources, evaluate choices and apply learning.

Population studied: Age 18 – 64, have private health insurance; have and/or are at risk for a health condition and/or intervention; decision-maker for own health care treatment

Overview of Segments*

Wait-and-See (18.5 million in the U.S.)

» Passive — have a higher hurdle to take action

» Least motivated to research and apply information

Passive Passengers (19.3 million in the U.S.)

» Rely on others to make recommendations for them

» Driven by personal trust and experiences

Self-Confident Skeptics(17.8 million the U.S.)

» Comfortable with research, data and logic-driven decisions

» Make an effort to verify information whenever possible because they are concerned about bias/motives in the system

* In-depth segmentation detail only provided under NDA

Proactive Optimizers(15.7 million in the U.S.)

» Tirelessly investigate options and alternatives

» Value being part of the solution for their own care

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THEOPPORTUNITY

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There are plenty of studies out there stating the inevitability, potential savings and overall value of EBM practices as well as the shift toward a patient empowerment approach to health care. Many say the same thing in different, complex ways — that this is important and it is the future of health care. Many organizations struggle with the ambiguity and uncertainty of what it all means and how to take action. So that’s what our work intends to answer but from the perspective of the stakeholder who will soon have more of the power: the patient.

Good news.There is a sizeable U.S. consumer population — over 71 million! — that could be a target for patient empowerment-related innovation efforts.

» Even more good news, decision-makers for child or senior with a health condition are an incremental opportunity (above and beyond the 71 million)

1 Most consumers aren’t familiar with EBM, but many patients have attitudes that are highly supportive of its

objectives and approaches.

» After being given an explanation of EBM, 94 percent say that EBM has positive benefits; most frequently believe that EBM weeds out ineffective treatments and/or helps support the creation of more effective treatments

» 56 percent want their health treatment data aggregated in a way that is useful for others

» 52 percent understand that the health decisions they make have an impact on the cost of care for everyone

2 Most consumers (patients) acknowledge that there is a clear gap between what they “should” do versus “actually” do, suggesting an opportunity to alleviate some of the stated emotional, intellectual, logistical and coverage barriers

» Nearly two-thirds don’t always comply with their doctor’s recommendations

» Lack of coverage for specific treatments is a key barrier to following doctor’s orders

» Formulating questions, developing plans and making decisions (even simple ones) is often a process fraught with stress and uncertainty — and it’s even harder for consumers who are making health care decisions on behalf of a loved one (Hypothesis: These high-stress, emotional experiences are likely to decrease the likelihood that patients will end up following EBM practices)

3 There are some consumer behaviors already in place that suggest an opportunity to get consumers more effectively

engaged with their own health care treatment plans and decisions.

» Nearly half conduct their own research prior to seeing a doctor, and even more look up additional information afterward

» More than 60 percent report keeping track of health information or data over time

Where is the opportunity space and how big is it, really?

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MOVING FROM AWARENESS TO

ACTION

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Health insurance companies:

» Our data suggests that consumers believe health insurance companies can and should help connect consumers and providers to information that supports EBM.

» According to consumers, there are win-win opportunities for both patients and health insurance companies. Consumers “give you permission” to get involved in a positive way.

Providers, health insurance companies, care/conditions/disease management professionals:

» We hypothesize that providers and health insurance companies will be able to offer up information that could help patients (via segment-specific strategies) trust their provider’s EBM recommendations and provide resources that could help their patients follow them better (becoming better patients) — all leading to better outcomes for patients and the incentives for providers that come along with that.

› Rather than treat all patients the same way based on their condition, help your delivery of care investments shift toward more effective and efficient personalized service based on the segment’s specific attitudes and behaviors.

Who should care and why?

Our data suggests that according to consumers, there are win-win opportunities for both patients and health insurance companies. Consumers “give you permission” to get involved in a positive way.

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STRATEGIC IMPLEMENTATION GUIDE

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What should you be doing about it?

Stakeholders should identify (classify/tag) your database of consumers by the patient empowerment segments they belong to. This is the first step in taking action.

Then you can begin reinventing the way you interact/engage with them to reflect the new understanding of their behaviors and decision-making process to give them the best customer experience possible that improves their health outcome and will propel you forward in leading the eventuality of EBM and patient empowerment as the future of health care.

While some consumer innovation segments “overindex” in certain patient empowerment segments, there is no clean alignment. Patient empowerment attitudes and behaviors are not driven by or even necessarily aligned with consumer unmet needs related to health insurance. Knowing which patient empowerment segment you are interacting with can help create a more complete picture of the consumer and help you provide a better patient experience and improve outcomes.

» Example: Participants in a condition management program could be tagged in your database as being part of one of the four consumer segments.

» This will help develop targeted strategies toward different patients in many ways — customer experience efforts that initially introduce people to the program, incentives to keep them engaged, support touch points to help reduce barriers and improve compliance, etc.

» Through associated data related to compliance, health outcomes and patient satisfaction scores, and PAM® (patient activation measures), you will learn which strategies are most effective and why.

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» Communicate the positive benefits of patient empowerment and your role in it

» Demystify the goals and benefits of EBM

» Make it easier for consumer segments to:

› Identify, track and access relevant health information

› Consult and align with EBM-trained doctors

› Verify whether treatment recommendations are likely to contribute to a better health outcome

» Payers, providers and hospital systems (especially integrated systems)

› Use this segmentation data to help shift accelerated adoption of outcomes-based incentives: where tiered networks with better doctors with better outcomes become the standard — drive member behavior to go to those better-performing doctors with better outcomes

› Use this segmentation data as a start-up technology opportunity filter for understanding which digital tools are addressing which patient empowerment segment, during which part of the decision-making process, and for which specific need to help focus investment decisions (see adjacent image). Maddock Douglas’ venture capital arm, Ringleader Ventures, conducted an opportunity assessment to identify the existing businesses and start-ups in the market that address each segment and the unmet consumer needs their products and services can solve.

 

     

     

Blue  Jam  Product  Segments    

Product  or  Service  Realizing  Treatment  is  Needed  

Deciding  Between  

Treatments  

Tracking  Treatment  

Adjust  or  Changing  Treatment  

HealthTap   X              

Fitbit   X              Basis   X              

Jawbone  UP   X              Scanadu  Scout   X              

Tinké   X              Integrated  Bionics   X              

GymPact  and  Other  Pact  Products   X              

Matchup   X              WebMD   X   X          

Health  App   X       X      ClickMedix       X   X   X  

Decisive  Health       X       X  

Expert  Medical  Navigation       X       X  ViMedicus       X          

UpToDate       X          Essential  Evidence  Plus       X          University  Research  Online  Documentation  

    X          

Medscape       X          Government  Databases       X          

Epocrates  CME  (Web  and  Mobile)       X          DynaMed       X          

My  Medications           X      

iHealth   X       X      QwikLife           X      

RxVault.in           X      CureTogether       X       X  

PatientsLikeMe       X       X  

TapCloud               X  

       

 

     

     

Blue  Jam  Patient  Empowerment  Segments    

Product  or  Service   Wait-­‐and-­‐See  

Passive  Passengers  

Self-­‐Confident  Skeptics  

Proactive  Optimizers  

HealthTap        X   X   X  

Fitbit         X   X  Basis           X   X  

Jawbone  UP           X   X  Scanadu  Scout           X   X  

Tinké           X   X  Integrated  Bionics       X   X   X  

GymPact  and  Other  Pact  Products   X   X   X   X  

Matchup   X   X   X   X  WebMD           X   X  

Health  App           X   X  ClickMedix           X   X  

Decisive  Health           X   X  

Expert  Medical  Navigation               X  ViMedicus               X  

UpToDate               X  Essential  Evidence  Plus               X  University  Research  Online  Documentation  

        X   X  

Medscape           X   X  Government  Databases               X  

Epocrates  CME  (Web  and  Mobile)               X  DynaMed               X  

My  Medications       X   X   X  

iHealth       X   X   X  QwikLife               X  

RxVault.in       X   X   X  CureTogether       X   X   X  

PatientsLikeMe       X   X   X  

TapCloud           X   X  

     

Opportunity Assessments by P.E. Segments

Focused investment for all industry stakeholders

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Because each segment thinks and acts differently from one another, the patient empowerment solution is definitely not one-size-fits-all. For each segment, there are unique opportunities related to education, communication, incentives, tools, apps and other resources that can help patients engage more confidently and effectively with the health care system in order to bring about better health outcomes. Following are directional investment ideas by segment:

Wait-and-See » Develop automated, noninvasive ways to track and use information that

won’t interfere with day-to-day life

» Focus only on “the big stuff ” with obviously essential benefits

Passive Passengers » Encourage alignment with EBM/outcome-focused doctors

» Create easy connections with experts who highlight credible, valuable information sources

Self-Confident Skeptics » Provide unbiased ways to verify information/doctor recommendations

» Create visibility into how EBM information is gathered/applied

Proactive Optimizers » Demonstrate the impact of concurrent treatment paths

» Signal when patient is on a treatment path that is likely to be ineffective or have diminishing returns

Focused investment and action by segment

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HOW MADDOCK DOUGLAS CAN HELP

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SO WHAT NOW?If your organization would like to partner with us to leverage these existing innovation assets and/or participate in the development of future assets, Maddock Douglas will collaborate with you to build a road map for action that includes concrete, incremental steps, actionable strategies, and help you socialize the plan internally to key leadership stakeholders to get full buy-in from the organization to successfully activate and sustain this effort.

» Identify potential short-term actions/wins with access to detailed patient empowerment segmentation data and action-planning workshops for related specific “holy grail” strategic priorities referenced on page 3

» Identify future innovation opportunity spaces related to your business by continuing patient empowerment work through the Insights phase of the mind-to-market innovation process

» Identify ways to engage the third stakeholder in the triad (i.e., providers) by understanding their attitudes, behaviors and needs related to EBM and patient empowerment — and identifying the provider segment(s) that will make the most promising allies and supporters of future strategic initiatives

Meanwhile, Maddock Douglas, Ringleader Ventures and the investment partners will continue the innovation process, creating more innovation assets for industry participants to leverage toward the shared purpose:

Ways we collaborate with you:

To help stakeholders deliver better health outcomes (through patient empowerment)

Raphael Louis Vitón, Maddock Douglasraff.v@maddockdouglas.com 630-563-6412

For partnership opportunities, contact:

Mike Bechtel, Ringleader Venturesmike.b@ringleaderventures.com 312-715-7405

For investment inquiries, contact: