Next Generation Home Health Strategies Keith Crawford, SVP

Overview Keith H Crawford, Coram, Senior Vice President, Strategic Initiatives Session Description: Home Health has quickly grown into an integral part of our long-term strategy to reduce the costs of healthcare while improving quality of care. In order to develop and implement a successful Home Health strategy, organizations much focus on a number of factors including patient ownership of their health, technology, communication and collaboration. During this session, attendees will learn some of the ways that Home Health is changing a care providers business model and how to build the correct Home Health strategy for your organization. Learning Objectives: Discuss how to work with various third party organizations and technology providers to develop a successful Home Health strategy for your organization Develop a deeper understanding of the role secure information sharing and interoperability plays in Home Health Keith Crawford, SVP Coram Specialty Infusion

Whether referred to as integrated healthcare or accountable care, the current focus on new healthcare models is a reaction to long-standing concerns around quality, cost, and efficiency. Many of these issues stem from care delivery systems that have been: Directed more at acute, episodic treatment rather than prevention and early intervention Fragmented rather than integrated and coordinated Focused on patient eligibility and billing rather than patient engagement within and outside of the care setting Customized to the idiosyncrasies of individual facilities rather than standardized across care sites Rewarded more for volume than for quality and cost outcomes The resulting inefficiencies have made healthcare less effective, less safe, and more costly than can be tolerated… Healthcare Delivery Keith Crawford, SVP Coram Specialty Infusion

New care models represent an effort to solve deeply embedded healthcare delivery problems experienced by organizations of all sizes. Part of the solution is better quality and cost measurement and broader knowledge sharing… Underneath their often complex regulations, Accountable Care Organizations (ACOs) and Integrated Healthcare Organizations (IHOs) share a similar backbone – the drive to address population health management. Population Health Population health management can be understood as the practice of engaging a clearly defined group of patients and providers across the care continuum. The goal is simply to enable better health outcomes for all at the lowest cost. The pillars of population health are summed up in the Triple Aim of the Institute for Healthcare Improvement: Provide better health outcomes for the population served Enhance each individual’s experience of care Reduce the per capita cost of care New Care Models Keith Crawford, SVP Coram Specialty Infusion

The intent of population health management is to replace fragmented, episodic care delivery with a holistic, coordinated approach that improves the health outcomes and experience of care for the population served, while lowering per capita costs. To be capable of providing true value for population health management - an healthcare information technology platform requires three foundational “layers”: Data Collection Electronic repositories that record patient care from two perspectives–clinical (Electronic Medical Records) and administrative (revenue cycle, claims) System Intelligence Rules-based workflow that enables the leveraging of clinical and operational guidelines and policies throughout the care process – predictive modeling Data Interoperability Standards-based Health Information Exchange (HIE) technology that enables data, workflow and applications to be uniformly accessible across the community of care Population Health Keith Crawford, SVP Coram Specialty Infusion

Epidemiologic Impact / Age Wave In 2011 – The first of the baby boomers turn 65 10,000 Americans celebrate a 65 th birthday daily 80% have three or more chronic conditions (Co-Morbidities) Highest per capita annual healthcare spend (~$15,000) Adults 65 years and older account for: 30% of all doctor’s office visits 58% of all in-hospital days of care 70% of all <30 days hospital readmission 80% of home care visits The Senior Boom 79 million Baby Boomers in the U.S. Boomers are between the ages of 47 and 65 By 2030, 26% of the population will be 65 or older 60% use social networking, 55% have smart phones Every 24 Hrs 10,000 Americans turn 65 One of the most important social phenomena which the U.S. will experience is the coming “Age Wave” which will impact virtually every aspect our society and dramatically impact our healthcare system Boomer generation controls 77% of all U.S. financial assets They control 55% of discretionary spending Keith Crawford, SVP Coram Specialty Infusion

Healthcare Information Technology The limitations of paper-based care documentation have been well-established. Such systems slow the dissemination of vital information, introduce greater likelihood of error, and add cost and inefficiency to patient care. An EMR, in contrast, creates a dynamic electronic record of patient encounters over time, iteratively adding data on patient demographics and problems, clinician notes, treatment recommendations, medications, vital signs, and other information. According to the U.S. Department of Health and Human Services, “Increased adoption of EMRs has the power to cut health care costs, reduce paperwork, improve outcomes, and give patients more control over their health care, while maintaining full protections on the privacy of individual health information.” Industry-wide, total savings could range up to $100 billion over the next 10 RAND Corporation EHR will result in total cost savings of $200 per patient per year. MASTEK Corporation Poor Drug adherence and medical errors, cost reduction could of $50 billion a year MASTEK Corporation $12 billion in Medicare and Medicaid costs over the next 5 years RAND Corporation Keith Crawford, SVP Coram Specialty Infusion

Disparate Electronic Medical Records Fragmented Healthcare Hospital EMR Emergency Doctor EMR Specialist EMR Homecare EMR Allied Health EMR Pharmacy EMR Centroid of Care Currently the hospital acts as the “centroid of care” with providers organizing care activities around that setting. The use of EMR is customized to the idiosyncrasies of individual facilities rather than standardized across care settings - leading to transactional care and elusive longitudinal medical records. The consequences of fragment care and disparate EMRs puts the patient at risk and removes them from proactively managing their health. Patient Keith Crawford, SVP Coram Specialty Infusion

Complete exchange of health-related information that meets interoperability standards and can be created, managed, and consulted by authorized clinicians, staff, and patient across more than one health care organization – the patient becomes the “Centroid of Care” Hospital Allied Health Doctor Pharmacy Specialist Emergency PreventionPre-Acute & AcuteChronic Care Supportive Care Disease Management Remote Monitoring Care Coordination Post-acute Care Pharmacy Care Coordination Disease Management Pharmacy PreventionPre-Acute & AcuteChronic Care Health Information Exchange Homecare Patient Centroid of Care Transforming The Healthcare Continuum Keith Crawford, SVP Coram Specialty Infusion

CMS Pricing Data, MedPac Pricing Analysis, Internal Coram Data, KHC 2012 Emergency Hospital Doctor’s Office Pharmacy Acute-Care Chronic-Care Preventative Care Dentistry & Vision Home Homecare Strategies Discussion Learning Objectives: Discuss how to work with various third party organizations and technology providers to develop a successful Home Health strategy for your organization Develop a deeper understanding of the role secure information sharing and interoperability plays in Home Health Emerging care delivery model – the home becomes the central cost pivot

Next Generation Home Health Strategies Keith Crawford, SVP