Once We Understand, Change Results.

Patient (Persona) Analytics

A Catalyst to Driving Engagement and Compliance
for Risk based Outcomes Contracting

October 5, 2016

©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |1
AGENDA
1 COMPANY OVERVIEW

2
MARKET DRIVERS & CHALLENGES

3
360° ANALYSIS- PATIENT PERSONAS

4 LIFE SCIENCES USE CASES

Q&A
5

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SCIO COMPANY HIGHLIGHTS

OUR MISSION

Drive positive change in life sciences and healthcare by

delivering actionable insights to solve complicated problems
simply and efficiently.

2007 West Hartford, CT 6 Global Delivery Centers 900+

Founded Headquarters Across 3 continents Employees worldwide

Cross Segment Valuable Recognition

Focus Partnerships • Inc.5000 five years in a row (2012-2016)

Life Sciences, Payers, • Microsoft Innovation Award, Life

Oracle Gold Level Partner
Providers & Health Services Sciences
Microsoft Gold Partner
• Chillmark and IDC research recognition

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GLOBAL REACH - OUR CLIENT BASE

400 Million+ Medical claims Across 30 Countries 2X winner of the Microsoft

1.3 Billion+ Pharmacy claims Pharmaceutical and Life Sciences
Innovation Award
analyzed annually

30 Data Warehouses, Integrating
Over 400 Data Sources Each
Refreshed Daily / Weekly / Monthly
Analytics and Insights to Over 60,000 Personalized Life
5,000 Users Across Our Client Sciences Dashboards Each Day /
Base Week / Month

80+
healthcare organizations being PROVIDERS HEALTH SERVICE
LIFE SCIENCES PAYERS
served in these key markets COMPANIES

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WHAT WE DO
Turn data into actionable insights and insights into
proven outcomes for our clients across the continuum
INSIGHT DOMAINS

CARE AND RISK OUTCOMES

OPTIMIZATION

DATA • Patient Risk and Behavioral Analytics

APPLICATIONS OUTCOMES
INTEGRATION AND • Prospective Risk scoring
AND TOOLS & INSIGHTS
MANAGEMENT
• Impactability ranking
• Readmission metrics
• Patient Persona Analytics
• Clinical Indicators
• Socio-economic contribution
• Financial spending patterns

ANALYTICAL
COMMERCIAL EFFECTIVENESS
DATA DELIVERY AND
METHODS & • Business Intelligence
INTAKE CONSUMPTION
MODELS
• Sales Force & Commercial Analytics
• Real-world Evidence
• Cloud Based Data Management

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AGENDA
1 COMPANY OVERVIEW

2
MARKET DRIVERS & CHALLENGES

3
360° ANALYSIS & PATIENT PERSONAS

4 LIFE SCIENCES USE CASES

5 Q&A

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Poll Question 1

Q: How is your organization engaging with payers around risk- based contracting?

A Not currently considering

B Early consideration and planning

C Contracting and collaboration in progress

D Deployment of outcomes/risk-based contract

E N/A I am not sure

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MARKET DRIVERS

MARKET DRIVERS MARKET STRATEGIES

NEW BUSINESS MODELS

DRUG PRICING PRESSURE
PAYVIDERS
OUTCOMES BASED CONTRACTING

COLLABORATION
RISK & DATA SHARING FOR BETTER
VALUE-BASED CARE PATIENT OUTCOMES

PATIENT ENGAGEMENT &

CONSUMERISM

COMPLEXITY OF HEALTHCARE INSIGHTS & TECHNOLOGY AS

A KEY ENABLER

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Potential Headwinds For Life Sciences

PATIENT BEHAVIOR IS CHANGING- CONSUMER AS THE NEW MONEY MANAGER

PAYERS ARE REQUIRING MORE RISK ON DRUG IMPACT AND EVIDENCE OF “PATIENT SUCCESS”

SPECIALTY DRUG COST IMPACT ON OVERALL HEALTH CARE SPEND

IMPACT ON THE GROWTH OF MANAGED MEDICARE AND MEDICAID

IMPACT OF MEDICATION COMPLIANCE ON TOTAL COST OF CARE

HEALTH PLANS WILL REQUIRE OUTCOMES BASED RISK STRATEGY

DISPARATE AND SILOED DATA

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AGENDA
1 COMPANY OVERVIEW

2
MARKET DRIVERS & CHALLENGES

3
360° ANALYSIS & PATIENT PERSONAS

4 LIFE SCIENCES USE CASES

Q&A
5

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360o ANALYSIS MATTERS
SCIO believes in bringing insights to light through a comprehensive lens

IMPACT FOCUS
SCIO Measure and predict areas for
Comprehensive view greatest impact and
identification of untreated
Singular View patients.

RESOURCE FOCUS
Focus resources on contracting
Vs. payer collaboration and
commercial operation
resources

3600 FOCUS
Incorporate multiple data
sources to determine
behaviors leading to
compliance, engagement and
risk reduction.

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Poll #2

Q: Is your organization able to integrate disparate sources of data to create a 360° view of
the patient and risk?

A No, it’s a big challenge

B Partial ability

C Yes, we have a robust solution

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Approach to Value: Patient Persona’s

Dynamic Risk Management of

Patient Populations

PROVIDER
Data Flow

OUTCOMES
Predictive Provider Performance
Analytics Management
360° ANALYSIS

Treatment Pathways
Individualized for each Persona
Prescriptive
Analytics

Patient
Patient Migration Towards
Greater Compliance

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Patient Persona example: High Utilizers
Description
Low Risk Median
High-risk adults, mostly non- college level education, blue collar employees with average income. They
0.71 Risk
happen to be high utilizers of healthcare services given that they are higher risk and the average chronic
Prospective conditions is greater than one.
Score
Intervention: High risk with high utilization, so need to education HCP to ensure steerage

Demographic Attributes Gender Education Median Home Value

% Above Poverty Level 68% $146K
% Blue Collar Employed 36%
% Single Family Dwelling 33% Socio-Economic Score
% Married 48%
% Household with children 60%
62
School College 60 100

Age Group Estimated Income HCP

Utilization Attributes Engagement
7% 1% Individuals
IP Utilization 1.45 12% Median Age 4%
with
ER Utilization 0.84
43 $200K+ Income
14%
Level
# Average Chronic Conditions 2.05 $100K - $200K
58% > $50K Spending
65+ 55-64 $50K - $100K
Paid Amount PMPM ER $95
35-54 16-34
Pattern
Less than $50K
Paid Amount PMPM IP $247 72%
Average
23%
Spending
72%

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Example of Personas – Clinical Attributes

Median Risk Prospective

Score
1.13
1.02
0.86 0.82
0.70 0.71
0.54

Healthy & Balanced Chronic older High Cost Baby

High Utilizers Quality Driven Cost Conscious
Affluent Adults Adults Boomers

0.6 0.7 0.8 1.2 1.2 1.3 1.6

No.of chronic
conditions

0.09 0.05 0.10 0.04 0.07 0.08 0.09

IP Utilization

0.25 0.22 0.34 0.23 0.18 0.21 0.23

ER Utilization

$75 $73 $147 $54 $75 $118 $248

IP Paid PMPM

$10 $9 $14 $9 $7 $10 $11

ER Paid PMPM

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Poll #3

Q: What types of data is your organization leveraging to better understand patient risk and
outcomes based contracting? (Select all that apply)

A Medical and pharmacy claims data

B Clinical data

C Socio-economic data

D Behavioral and attitude data

E Utilization and Compliance

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AGENDA
1 COMPANY OVERVIEW

2
MARKET DRIVERS & CHALLENGES

3
360° ANALYSIS & PATIENT PERSONAS

4 LIFE SCIENCES USE CASES

Q&A
5

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THE OPIOID CHALLENGE

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Existing and Untreated Patients by Opioid Dependence
Compliance and Risk

Patients are stratified by compliance and prospective risk

• (10)
Market Potential
Highest is up
prospective risktopatients
6x the(e.g.
current number
decile of patients
10) consume 75% ofon Opioid Dependence
healthcare spend therapy. 80% of
which
Eachare non
year compliant.
prospective risks shifts patients between each decile group (e.g. patients health improves resulting in lower
risk while other patients become more sick)

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Example of Prospective Risk by CBSA (Core Based Statistical Area)

Top 5 % of US Opioid
CBSAs Dependence Rx
High=top 20% Middle=middle 30% Bottom=bottom 50% New York 4.7%
Philadelphia 3.7%
Pittsburgh 3.6%
Boston 2.6%
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Detroit 2.3%
UNDIAGNOSED DIABETES PATIENT CHALLENGE

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Patients by Diabetes Groups, Compliance and Risk

Patients are stratified by compliance and prospective risk

(10) Highest prospective risk patients (e.g. decile 10) consume 75% of healthcare spend
Each year prospective risks shifts patients between each decile group (e.g. patients health improves resulting in lower
risk while other patients become more sick)

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Undiagnosed Diabetic Patients
Patients at Risk for Diabetes by Risk Category

Hospitalizations per 1000 ER Visits per 1000

140 200 Rank across all Counties
180
120
160
Hospitalizations per 1000

100 140
Prospective Risk: 9
ER Visits per 1000

120
80

60
100

80
ER/1000: 15
40 60

40
IP/1000: 24
20

-
20

-
Impactability: 7
10 9 8 7 6 5 4 3 2 1 10 9 8 7 6 5 4 3 2 1
Risk Decile Risk Decile
Avg. #CC: 2.67
10 – High Risk…..1 – Low Risk

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Identify Gap Prioritization at the Patient Level

In Last 12 Months Cost Incurred in Last 12 Months Predicted

Probability
Probability of ER Impactability
Patient # # ER InPatient ER OutPatient Professional Pharmacy of ER Difference
Admit IF all the Score
Hospitalization Visits (PMPM) (PMPM) (PMPM) (PMPM) (PMPM) Admission
gaps are closed
000000010506 1 1 $2,999 $302 $209 $201 $130 93% 22% 71% 1.68

000000010331 0 0 $237 $158 $147 90% 27% 64% 1.51

000000010043 0 2 $287 $231 $225 $133 91% 22% 69% 1.64

000000010154 0 0 $231 $178 $103 74% 16% 58% 1.39

000000010539 0 0 $340 $181 $96 70% 27% 44% 1.04

000000010507 0 0 $333 $208 $134 73% 24% 49% 1.15

Patient Risk Score Impactability Score Gap1 Gap2 Gap3

000000010506 0.89 1.68 Diabetes - Consider Foot Exam HbA1c Less Than 7 Target

000000010331 0.83 1.51 Lipid Panel Spirometry

000000010043 0.81 1.64 Consider Pulmonary Rehabilitation AST Test Physical Therapy

000000010154 0.73 1.39 Lipid Panel Spirometry Alpha-Glucosidase

Diabetes and Macroalbuminuria - Consider Diabetics 50 years and Older - Consider

000000010539 0.73 1.04
Adding an ACE Inhibitor or ARB Screening for Peripheral Arterial Disease

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Summary: Persona Analytics Enabled Response to Headwinds

Utilize Benchmarking to Identify Patterns of Drill into High Risk Patients to

Potential Utilization and Waste Uncover Impactability Score

Measure Impact of Non Compliance on HEDIS Armed With A “Single Sheet of Music” Partner
Star Ratings for Managed Medicare and with Payers on Risk Based Outcomes
Medicaid Plans Using Specific Products

Identify Geographies at Highest Risk Across

Commercial, Managed Medicare and Medicaid

Track Utilization of Medication on Impact

to Other High Cost Chronic Conditions

Identify the Geographic “Hot Spots” and Draft Care Which Comorbidity Increases
Plan Messages for HCPS and Associated Health Plans Patient Prospective Risk

Understand the Compliant / Build Capabilities to Measure

Non-compliant Patient Persona Outcomes and Pay for Value

Track Results with Providers and

Evaluate Impact on Hospital Readmissions
Health Plan Care Managers
and Bundled Payments

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AGENDA
1 COMPANY OVERVIEW

2
MARKET DRIVERS & CHALLENGES

3
360° ANALYSIS & PATIENT PERSONAS

4 LIFE SCIENCES USE CASES

Q&A
5

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Q&A

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