Presenter. Rebecca Susic Director Account Management MEDai

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2 Presenter Rebecca Susic Director Account Management MEDai

3 Agenda The Chronic Care Problem Market Needs Risk Navigator Guidelines ROI Company Overview Summary and Discussion

4 The Chronic Care Dilemma Seventy-five cents of every health care dollar we spend is on treatment of chronic disease, most of which is preventable. Source: Almanac of Chronic Disease 2008

5 Other Costs Driven by Chronic Care Patients with Chronic Medical Conditions Account for: 76% of inpatient admissions 88% of prescription drug use 96% of home care visits 72% of physician visits Source: Chronic Conditions: Making the Case for Ongoing Care; December 2002; Partnership for Solutions, Johns Hopkins University, for The Robert Wood Johnson Foundation

6 Using Preventative Care Makes a Difference Source: Partnership for Prevention. Preventive Care: A National Profile on Use, Disparities, and Health Benefits. August Accessed at:

7 So What Are the Market Needs? Engage Physicians Physicians Need Current Data Around Compliance for Their Patients Empower Consumers Consumers Need Accurate and Timely Data to Better Manage Their Care Facilitate Quality Improvement Payors Require the Ability to: Identify compliance with evidenced-based guidelines Customize evidence-based medicine guidelines to address specific quality initiatives

8 Elements for Success Identify Opportunities to Enhance Patient Care Identify members with gaps in care Provide near real-time data updates Provide Timely Feedback to Providers Did the patient follow-thru with testing? Is the patient filling/refilling medications? Offer a Comprehensive Patient History Does the patient see other physicians? Are there poly pharmacy issues?

9 Elements for Success Integrate with Existing Systems Deliver to the Point of Care or In a Members Personal Health Record Support two-way Information Exchange On-line data entry Update compliance Enter exemptions Provide the Flexibility to Add/Edit Rules

10 Targeted Conditions Asthma CAD COPD CVA Depression Diabetes Drug Management Heart Failure Hemophilia Hepatitis C HIV Hyperlipidemia Hypertension Immunizations - Children Low Back Pain Migraine Headache Multiple Sclerosis Osteoporosis Renal Failure Rheumatoid Arthritis Schizophrenia Preventive Care

11 Specific Guideline Example Diabetes Guidelines Eye exam Influenza immunization HbA1c Microalbuminuria Nephropathy screening LDL-C screening Lipid profile Plus nephropathy: ACE-I or ARB Plus CAD: Statin therapy LDL-C < 100 mg/dl Triglycerides < 150 mg/dl HDL > 40 mg/dl HbA1c < 7% HbA1c <= 9% LDL-C < 130 mg/dl

12 Supported Initiatives Medication Therapy Management (MTM) CMS mandated Modify/Create guidelines to identify members for program participation Create custom criteria for enrollment Built-in drug related algorithms Pay for Performance Empower physicians with patient compliance data

13 Value-Add Elements Chronic Impact Score-Identifies Chronic Members Who Have the Highest Need for Intervention Includes: Appropriate medication dosing Drug/Drug interactions

14 Value-Add Elements Ability to Accept Pharmacy Only Data Impute Responsible Physician Pass data to responsible physicians for prompt intervention Near Real-Time Data Updates w/ Robust Data Cleanup

15 MEDai s s Clinical Solutions Data Repository

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17 Real-time Information=Real Impact

18 Overview of Guidelines

19 Snapshot of Physician s s Population

20 Physician s s View of Patient Guideline Compliance Patient Registry

21 Guideline Building Powerful Guideline Generation Security Rights Limit Access to Modify or Disable Guidelines Create/Modify Denominator or Numerator Parameters Set a desired number of events Create new conditions

22 Guideline Customization Enables Customization of Standard Guidelines Customize Guidelines at Different Levels: MEDai product line Conditions/Diseases Sub client codes Individual guideline level

23 Guideline Updating Manual Compliance Overrides Mark exempt or compliant Record reasons, effective dates and duration Custom filters to identify members with overrides

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25 Results of Medical Management Using Guideline Measure HgbA1c: Diabetes 6 months into re-alignment One day per week CDE in MD office IM practice 61 identified Diabetics $100K annual savings in single MD office Population results 15% reduction in HgbA1C in 6 months 40% decrease inpatient/26% decrease ED 50% cost reduction Repeat Years Client Example For every one dollar cost, saved $2.50

26 Avoidable Hospital Costs If Proactively Managed MEASURE Controlling High Blood Pressure Diabetes Care HbA1c Control Persistent Beta Blocker Treatment AVOIDABLE HOSPITAL COSTS $425 million $1.1 billion $550 million $1.3 billion $2.4 million $14.6 million TOTAL $977 million $2.4 billion Source: NCQA 2008

27 About MEDai Subsidiary of Reed Elsevier One of the world s largest providers of business, professional, scientific/health information Two Key Software Solutions Payor decision support Hospital outcomes profiling/reporting Unique Core Competencies MITCH data mining and prediction engine Intelligent data clean-up logic Healthcare expertise

28 MEDai An Industry Leader Superior Predictive Analytics 2007 Society of Actuaries Health Risk Assessment Study - Highest R 2 and Lowest Mean Absolute Predictive Error SOA Results 2007 SOA Results BlueCross BlueShield Association - Preferred Vendor for Predictive Modeling R-Squared R-Squared Clinical Risk Groups Clinical Risk Groups ACG w/out Prior Cost ACG w/out Prior Cost CDPS CDPS ACG w/ Prior Cost ACG w/ Prior Cost MedicaidRx MedicaidRx Vendor/Model Vendor/Model Ingenix ERG Ingenix ERG DxCG DCG DxCG DCG DxCG RxGroups DxCG RxGroups Ingenix PRG Ingenix PRG Impact Pro Impact Pro DxCG UW Model DxCG UW Model MEDai MEDai 100K 250K 100K None Truncation Level 250K None Truncation Level Sophisticated Data Mining Knowledge Discovery & Data Mining (KDD) Cup International or National First Place for an Unprecedented Four Years Running University of California Data Mining Competition 2005 Winner Predicting Credit Risk German Classification Society 2005 Winner Predicting Liquidity Crisis

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30 Questions? Lizzy Feliciano, MBA MEDai, Inc