An Electronic Dashboard For Improving the Quality of Health Care and for Decreasing the Cost of health Care Stephen A. Kardos D.O.

Stimulus For Dashboard Development  Rising Health care expenditures  Failure of existing methods to stabilize and reduce medical expense Insurance Government programs Doctors and hospitals Limited access provider networks Disease Management Companies  Lack of available information for precise medical interventions to improve health status improvement History

Challenge Solution  Disparate systems  Outlier management  Business block management  Care determined by benefits  No leveraging of information  Emphasis on process  Emphasis on network discounts  Single relational database  Population management  Individual client management  Need for care is independent of benefits  Leveraged information  Emphasis on outcome  Emphasis on Care Management History

 Logic derived from medical practice standards  Published US standards of care (ADA, AHA, other)  Single flexible software program that allows multiple preventive health and disease states to be managed (“Excel” spreadsheet for Health)  Technology-Driven “Dashboard” Automated Integration of: Claims data Clinical data Pharmacy data Laboratory data Algorithm Evolution

Care Management Definition Stratification of medical risk in each population Clinical guidelines Wellness Preventive Disease management Case management Utilization review Predictive modeling Prescription drug management Plan design  Care Management is the convergence of multiple medical tactics properly applied to specific populations including:

Drug Dose Doctor Date Cost Diagnosis Procedure Date Cost BP Height Weight Hgba1-c Urine Protein Electrolytes Cost PHARMACY CLAIMLABORATORY DATACLINICAL DATAMEDICAL CLAIM TRIVERIS DOCTORS NURSES STATISTICIANS EPIDEMIIOLOGISTS ADVOCATES TRIVERIS DOCTORS NURSES STATISTICIANS EPIDEMIIOLOGISTS ADVOCATES EMPLOYERS / INSURERS PLAN MEMBERS HEALTH CARE PROVIDERS Computer System Integration of Claims Payment & Care Management Computer System Integration of Claims Payment & Care Management

Step 1 Derivation of Wellness Disease Records (WDR) Member Clinical data Claims data Pharmacy data Test results data Wellness WDR 1 Wellness WDR 1 Diabetes Type I WDR 2 Diabetes Type I WDR 2 Care Management Health Improvement Tracking System Other WDR 3 Other WDR 3

Eye Exam MQR Eye Exam MQR HgA1c MQR HgA1c MQR BP MQR BP MQR Lipid Control MQR Lipid Control MQR Step 2 Current medical care management compared to Minimum Quality Requirement (MQR) Diabetes Type I WDR Diabetes Type I WDR Clinical data Claims data Pharmacy data Test results data Care Management Health Improvement Tracking System

Eye Exam MQR Eye Exam MQR HgA1c MQR HgA1c MQR BP MQR BP MQR Control Lipids MQR Control Lipids MQR Doctor Member Care Management Step 3 Sharing information for action Diabetes Type I WDR Diabetes Type I WDR Care Management Staff

Care Management Dashboard Activities  Preventive care  Chronic disease management  Acute and catastrophic case management  Triveris communication to member and doctor

Dashboard Demonstration Slides

Results

Case Study FEHBP Diabetic Patients (01/98-09/2004) Case Study FEHBP Diabetic Patients (01/98-09/2004) 4, % , * 3, % , Claim PMPM 4,9844,5094,5715,1355,594 Bed days per 1000 member yr Hospital admissions per 1000 member yr per 1000 member yr 81.0%65.9%48.2%47.8%30.4%HgbA1c Testing Median Age 2,9793,0783,1553,0902,947Patients * Un-immunized Influenza Epidemic Improved Quality-Less Hospital Use-Lower Expense

Case Study FEHBP Hypertension Patients (01/98-09/2004) ,4267, *2002* ,2907, Bed days per 1000 member yr Bed days per 1000 member yr Hospital admissions per 1000 member yr Hospital admissions per 1000 member yr ER visits per 1000 member yr ER visits per 1000 member yr Office Visits PMPM Median Age 7,4337,4337,8087,8088,2148,2148,0998,0998,0248,024PatientsPatients * Un-immunized Influenza Epidemic Improved Quality-Less Hospital Use-Lower Expense

Case Study Chronic Renal Failure Patients (01/98-09/2004) Case Study Chronic Renal Failure Patients (01/98-09/2004) 15,83015,830 1,9631, *2002* 13,79713,797 1,6261, Claim PMPM ,46114,46114,00414,00419,32919,32922,55922,559 Bed days per 1000 members/yr Bed days per 1000 members/yr 1,5481,5481,5071,5071,7321,7322,0582,0582,0632,063 Hospital admissions per 1000 members/ yr per 1000 members/ yr Hospital admissions per 1000 members/ yr per 1000 members/ yr Median Age PatientsPatients * Un-immunized Influenza Epidemic Improved Quality-Less Hospital Use-Lower Expense

Conclusion  Makes care management possible  Efficient  Bonds doctors and patients and plan sponsors  Improves health status  Lowers plan expense Dashboard