Duane Steward, DVM, MSIE, PhD SOLOMON Putting the Patient Back Into Personalized Health Care

Duane Steward, DVM, MSIE, PhD Problem: Patient’s Role is Diminishing in Medical Decisions Treatment is incomplete, misdirected or inappropriate because the patient is not interested, misrepresented or does not value the outcome adequately. Patients are sometimes dissatisfied because they are surprised by outcomes they did not expect, treatment outcomes are misfit to life goals and they do not feel well understood. Care givers want to give patients the best of care and more to improve quality of life, but they are ill equipped with no systematic and reliable way to determine what the individual patient thinks or wants. Meanwhile they are constrained by the boundaries of managed healthcare. Employers are struggling to manage human resources with health care plans that minimize cost while maximizing quality of life and thereby productivity.

Duane Steward, DVM, MSIE, PhD Role of SOLOMON * in Healthcare SOLOMON Personal Health Preference Model Personal Health Preference Model Depersonalized Health Preference Model Healthcare Policy and Research Insurance, HMO, Employer Health Plan Internet Web TV Home Software Waiting Room Software Medical Care Delivery *Systematic Obtainer of Language Overtly Multidimensional and Operational in Nature

Duane Steward, DVM, MSIE, PhD SOLOMON Interview (conducted independently anytime prior to need for specific decision support) Patient Identify Personal Examples to draw from Identify Life Features that define Health Determine Numerical Scales for Life Features Identified Determine Relative Importance Between Features Health Preference Model SOLOMON Determines What The Patient Prefers for Health Solomon

Duane Steward, DVM, MSIE, PhD SOLOMON’s Result in Use Patient SOLOMON Interview Health Preference Model State of Health w/ Personalized Score State of Health Physician with Diagnosis and Treatment Options Physician consultation Treatment Decision State of Health w/ Personalized Score State of Health w/ Personalized Score SOLOMON Puts the Patient Back Into Personalized Health Care

Duane Steward, DVM, MSIE, PhD Solution: SOLOMON [repeat of past 2 slides] Patient Health Preference Model State of Health w/ Personalized Score State of Health Physician (with Diagnosis) provides multiple outcomes for multiple Treatment Options Physician consultation Treatment Decision State of Health w/ Personalized Score SOLOMON Puts The Patient Back Into Personalized Health Care State of Health w/ Personalized Score Solomon Determine Relative Importance Between Features Determine Numerical Scales for Life Features Identified Identify Life Features that define Health Identify Personal Examples to draw from

Duane Steward, DVM, MSIE, PhD Personal Health Preference Models in Use Physicians choose outcomes for scoring Patients score the states in their terms Physicians score the states in patient terms Patient and Physician score in collaboration

Duane Steward, DVM, MSIE, PhD Results of SOLOMON Treatment is more complete and on target Patient is more satisfied with treatment selection Provider is more confident in care delivered Employer and Third-party Payer sees less expense for unwanted care Populations are more active and productive SOLOMON Puts The Patient Back Into Personalized Health Care

Duane Steward, DVM, MSIE, PhD Will Patients Use SOLOMON? Meta-analysis Conclusions [regarding chronic conditions]: The effect size comparisons in the use of Web-based interventions compared to non-Web- based interventions showed an improvement in outcomes for individuals using Web-based interventions to achieve the specified knowledge and/or behavior change for the studied outcome variables. These outcomes included increased exercise time, increased knowledge of nutritional status, increased knowledge of asthma treatment, increased participation in healthcare, slower health decline, improved body shape perception, and 18- month weight loss maintenance. The Effectiveness of Web-Based vs. Non-Web-Based Interventions: A Meta-Analysis of Behavioral Change Outcomes, Wantland, et al. Journal of Medical Internet Research, Vol 6, Issue 4, Article e40.

Duane Steward, DVM, MSIE, PhD Benefits of SOLOMON Patients Better understand their health care and options Better achieve their goals for health Feel better about their health and about their care Potential for measurably better quality of life Physicians Patient-informed and confident in providing care Potential for decreased liability Decreased stress in delivery of care Potential to improve patient compliance Deliver more fitting care Potential for decreased frequency of malpractice claims HMOs and Health Insurers Potential for reduced cost of health care Employers Potential for reduced cost of health care Increase productivity of staff with better health and mental attitude

Duane Steward, DVM, MSIE, PhD Potholes to be Addressed or Avoided Patients 2-4 hours time required to solicit models 10-25% of patients find questions abstract and too hard to understand Physicians Need to spend time providing outcomes to score and a score consultation Need to substantiate claims of health benefit, change in malpractice claims and impact on health status or quality of life HMOs and Health Insurers Need to educate the Third-Party Payers (3PP) why Physicians will use it Need to educate the 3-PPs why Patients will use it Need to recruit the 3-PPs as partners Employers Need to substantiate claims of health benefit and cost reduction Need to substantiate and educate how the ROI is cost-effective? Who will pay for it? What revenue model will support it? We will develop a Business Plan that answers these questions well We will include the research to meet needs cited above