1. Leveraging Payer Data to Jumpstart RHIOs
David St.Clair
Chairman & CEO
MEDecision, Inc.
March 7, 2005

2. Agenda Our Vantage Point The RHIO Market Leveraging Payer Data
Collaborative Care Management

3. MEDecision’s Vantage Point

4. MEDecision’s Position
We are the software leader in Collaborative Care Management.
Collaborative Care Management enables all members of a Patient’s Care Team to share information about the Patient’s history and status, combined with clinical “best practice”, to improve the quality of care and outcomes.
MEDecision focuses on health care Payers and the emerging Regional Health Information Organizations (RHIOs) as principal customers.
MEDecision’s Integrated Medical Management (IMM) solution set is the most comprehensive, functionally integrated and adaptable suite of products in production today.
We create “Actionable Intelligence” for the health care system.
MEDecision provides authorized stakeholders with access to the new Payer-based Health Record (PBHR) in a flexible and responsive care management environment to accelerate decisions, automate processes and adjudicate clinical requests on the spot.

6. MEDecision’s Position
Today, we have a more than 60 Payer customers nationally, managing care for 42 million people.
15% of top 433 MCOs, 1 out of every 6 insured Americans;
21 of the BlueCross BlueShield Plans;
Significant pockets of managed Medicaid business;
Collaborative Care Management is most likely in markets with progressive Payers that represent a significant portion of each physician’s practice.
We have market-dominant Payers in more than 30 markets.
The bridge from the Payer space has been iEXCHANGE® Web.
In production or being implemented in half of the markets.

7. MEDecision’s Position
iEXCHANGE Markets
iEXCHANGE Penetration

8. The RHIO Market

9. The RHIO Market Hundreds of initiatives springing up nationally.
Predominantly well-intentioned, but under-funded…
Lots of excitement, but having difficulty focusing…
Challenges are daunting for every group.
“Without proven models, how can we raise money?”
“What services and capabilities should the network provide?”
“What technologies should we assemble, and how can we support them?”
“How can we minimize or eliminate first-mover disadvantages?”

10. The RHIO Market High-level Steps to Start a RHIO
Create a Collaborative environment for constituents.
Set Reasonable expectations and schedules.
Plan for the Success of early adopters and investors.
Link the “Investment-Value-Investment-Value-Investment-Value” chain.
Prepare the ground for future growth.
Enroll the regional market leaders as Leaders.
Innovation requires a “leap of faith” mentality, but with very small cliffs!
Be willing to praise commitment publicly – it’s an early ROI for Leaders!
Take Action!
Small trust-building steps today are much more valuable than bigger successes years from now, and early, small mistakes will likely not be fatal!
Remember the concept: “Speed to Value”

11. So, what should be the first step?
The RHIO Market
What is the “First-Mover Disadvantage”?
The Network Effect: the value of a network grows exponentially as the number of nodes increases.
Therefore, the early adopters risk receiving no real value for their connections to a RHIO, as no other user likely has data to share about their patients…
So, what should be the first step?

12. Leveraging Payer Data

13. Patient Data Sources
Today, a tremendous amount of Payer data is available for clinical summarization and analysis.

14. Patient Data Sources
However, other electronic data about Patients are distributed in multiple repositories.

15. Patient Data Sources
Three primary systems are used to integrate and store Patient Data.

16. Electronic Health Record
Patient Data Sources
Electronic Health Record
“EHR”
Our challenge is to intelligently “weave” these primary sources of Patient data together.
EHR = PBHR + EMR + PHR!

17. Uses for Woven Record “EHR” Clinician Decision Support
“RHIO”
Clinician Decision Support
Consumer Decision Support
Care Management Support

18. Uses for Woven Record The EHR becomes the source data for:
Patient-centric Risk Assessment & Predictive Modeling.
Comparison to Evidence-based Medicine treatment plans and identification of “Treatment Opportunities.”
Populating care management systems in Payer, Provider and Disease Management organizations.
Public Health and Surveillance programs.
Clinical research with unidentified records and data.
The PBHR is the first step to the EHR, and it’s moving into production in Provider settings today!
Has years of experience in Disease Management organizations.

19. Collaborative Care Management

20. The Emerging Opportunity
The market for Electronic Health Records (EHR) is exploding, and Payers can become “infomediaries” to help create Regional data exchanges.
2nd generation analytics to create the Payer-Based Health Record through a “data weaving” process;
Evidence-Based Medicine and predictive modeling capabilities to identify Treatment Opportunities (“gaps in care”) in Patient Clinical Summaries;
Multi-Payer connectivity solutions and a Service Oriented Architecture to efficiently deliver Payers’ data to the point of care.
The goal is to fully integrate all care management functions across the entirety of the “Care Team.”
Payers, Disease Management vendors and multiple Providers.

21. Sources of Clinical Data
The Future of the PBHR
Users of Clinical Data
Sources of Clinical Data
xEHR
xEHRs
ASP/RHIO
xEHR
xEHRs
xEHR
iEXCHANGE Web PBHR/PCS
PRAV
MIDR

22. Collaborative Disease Mgmt.
CHF
CHF
Diabetes
Behavioral
Behavioral
Payer Systems
COPD
Asthma
Diabetes
Coaching
DM Services Company
ASP/RHIO

23. Collaborative Care Mgmt.
CHF
CHF
Behavioral
Behavioral
Customer Systems
COPD
Asthma
Diabetes
Coaching
DM Services Company
ASP/RHIO
iEXCHANGE® Web

24. Questions?

25. Thank You!