2014 The Advisory Board Company advisory.

com
1
Do we REALLY want Patient
Centered Care?
When Putting the Patient FIRST, Makes the Provider LAST
Global Campus
Talent Development
2014 The Advisory Board Company advisory.com
4
Are we willing (and ready) to

Abate Our Profits?



Global Campus
Talent Development

2
0
1
2

T
H
E

A
D
V
I
S
O
R
Y

B
O
A
R
D

C
O
M
P
A
N
Y
-

2
6
0
8
6
A

We Love Technologywith a PRICE
Innovations to Come Will Take Very Different Form
Source: Hotz RL, Printing Evolves: An Inkjet for Living Tissue, Wall Street Journal,
September 18, 2012; Pollack A, Mice as Stan-Ins in the Fight Against Disease, New
York Times, September 25, 2012; Advisory Board interview and analysis.
Technology in Brief: Mouse Avatar
Researchers are implanting mice "avatars" with a patient's
tumour or part of the patients anatomy
Different treatments are then tested for effectiveness on mouse
In one test, 12 out of 14 test patients successfully shrank their
cancerous tumours with fewer side effects using drug tested
first on mouse avatar
Technology in Brief: Bioprinting
Building on 3D printing technologies, researchers in multiple
locations working on ways to print living human tissue
Replacing ink with living cells, scientists printing tailored tissues
suitable for surgery and organ transplant
Simplest experimental prototypes ready for clinical testing in
five years
I M
A
G
E

C
R
E
D
I T
:

A
U
D
R
E
Y
_
S
E
L
.

I M
A
G
E

C
R
E
D
I T
:
M
A
Y
B
E
M
E
M
E

2
0
1
2

T
H
E

A
D
V
I
S
O
R
Y

B
O
A
R
D

C
O
M
P
A
N
Y
-

2
6
0
8
6
A

What if Better is CHEAPER?
6
Is There Anything Duct Tape Cant Do?
Source: Focht, D.R., Spicer, C., Fairchok, M.P., The Efficacy of Duct Tape vs Cryotherapy in the Treatment
of Verruca Vulgaris, Archives of Pediatrics & Adolescent Medicine 2002; 156 (10):971-974; Cost Helper
available at http://health.costhelper.com/wart-removal.html; Advisory Board interviews and analysis. 1) Cryotherapy: Liquid nitrogen applied by doctor over 3-6 visits
Cost Comparison of Wart Treatments
Study in Brief: Duct Tape
Treatment of the Common Wart
2002 study assessed effectiveness
of duct tape occlusion versus
cryotherapy
1
for treating common
warts
Results found duct tape at least as
effective a treatment as more
expensive cryotherapy


I
M
A
G
E

C
R
E
D
I
T
:

S
Y
I
B
U
S
2
0
0
3
.

4
488
Duct tape Cryotherapy
Efficacy Comparison of Wart Treatments
85%
60%
Duct tape Cryotherapy
1

2
0
1
2

T
H
E

A
D
V
I
S
O
R
Y

B
O
A
R
D

C
O
M
P
A
N
Y
-

2
6
0
8
6
A

New Model for Patient Services
7
Innovators Unrestricted by Current Delivery, Payment Models
Iora Health Contracts Directly With
Employers to Deliver Primary Care
1) Per member per month.
2) 2009; relative to control group created using propensity
matching; gross spending dropped 18%.
Source: Iora Health, available at: www.iorahealth.com;
Advisory Board interviews and analysis.
Case in Brief: Iora Health
Operating the Dartmouth Health Connect clinic for Dartmouth College in Hanover, New
Hampshire, and the Culinary Extra Clinic for the Culinary Health Fund in Las Vegas, NV
Manage top 10 percent of sickest patients using comprehensive, team-based approach
Achieved 12.3 percent decrease in total spending for patients enrolled in 2009
2

Iora Health Local Employer
GPs, contracted specialists
provide care to employee population
Employer pays fixed PMPM
1
fee, clinic
reports outcomes at monthly meetings
Iora doctors coordinate care with
hospitalists; hospital provides data back
Weve been worrying about the impact of
our decisions on physicians and hospitals,
but its time to worry about the impact on
the patient. The hospital perspective is not
our problem, its creative destruction.
Rushika Fernandopulle, MD
Iora Health

Putting the Patient First

2
0
1
2

T
H
E

A
D
V
I
S
O
R
Y

B
O
A
R
D

C
O
M
P
A
N
Y
-

2
6
0
8
6
A

Are we willing (and ready) to

Abate Our Profits?
Abandon Our Comforts?



Global Campus
Talent Development

2
0
1
3

T
h
e

A
d
v
i
s
o
r
y

B
o
a
r
d

C
o
m
p
a
n
y

2
7
8
5
2

Not Just One Service, But Many
9
Health Care Advisory Board CONCLUSION



High-
Risk
Patients
Rising-Risk Patients
Low-Risk Patients
60-80% of patients;
any minor conditions
are easily managed
15-35% of patients;
may have conditions
not under control
5% of patients;
usually with complex
disease(s), comorbidities
Managing Three Distinct Patient Populations
HIGH SERVICE
and LOW COST
HIGH EFFORT
9

2
0
1
2

T
H
E

A
D
V
I
S
O
R
Y

B
O
A
R
D

C
O
M
P
A
N
Y
-

2
6
0
8
6
A

1440 Minutes Per Day
24 Hours a Day / 365 Days Per Year
On Demand Technical Help
Initial Help FREE of Charge
Online / On Phone / In Store

2014 The Advisory Board Company advisory.com 28600A
11
11
Source: PINGMD, available at: www.PINGMD.com, accessed
October 1, 2013; Health Care Advisory Board interviews and analysis.

1) Proprietary.
2) Documented exchanges reduce physician liability; patient acknowledges disclaimer describing proper platform use.
3) 100% HIPAA compliant secure communication,100% of the time.
Health care technology startup located in New York, NY
Online platform enables efficient care network communications through secure text,
picture, and video messaging; mobile app notifies user when communications are
sent, received and resolved
Platform reports 100% improvement in customer satisfaction

Real-Time Patient Access to
Physician, Care Providers
Patients submit clinical
questions via mobile wizard
1

or web application
Photo or video attachments
provide detail on ailment
2,3
Physician or care provider
recommends next care step

Case in Brief: PINGMD

Point, Click, and Heal
2014 The Advisory Board Company advisory.com 28600A
12
On the Phone, All the Time,
Source: Creswell J, Start-Up Health Insurer Finds Foothold in New York,
The New York Times, March 28, 2014, available at: www.nytimes.com;
Health Care Advisory Board interviews and analysis.
Fastand FREE
Case in Brief:
Prepaid healthcare
offers free televisits,
free generic drugs, and
a limited number of free
PCP visits per year
S
C
R
E
E
N
S
H
O
T
:

O
S
C
A
R

Average televisit
response time
7 min

Promises response time
of less than one hour
2014 The Advisory Board Company advisory.com 28600A
13
Catering to an Unmet Need
13
Patient Portal Access Increases Engagement with Health System
Source: McCarthy D, et al., Kaiser Permanente: Bridging the Quality Divide with Integrated Practice, Group Accountability, and Health
Information Technology, The Commonwealth Fund, 2009: 1-28; Kaiser Permanente Careers: Hawaii, available at:
http://www.kaiserpermanentejobs.org/hawaii.aspx, accessed April 30, 2013; Health Care Advisory Board interviews and analysis.

Case in Brief: Kaiser Permanente Hawaii
Branch of Kaiser Permanente based in
Honolulu, Hawaii; cares for 229,000 members
across the state
Piloted Kaisers patient portal in 2005
Region experienced a 26% decrease in
doctor visits in the two years following
portal implementation
8%
Despite a 26% drop in doctor visits post-portal
implementation, Kaiser Permanente Hawaii
experienced an 8% increase in total patient contact
2003 2007
Secure messaging
Scheduled telephone visits
Office visit
Distribution of Patient Contacts
at Kaiser Permanente Hawaii
5.21
5.61
Contacts
per
member
26%

2
0
1
3

T
h
e

A
d
v
i
s
o
r
y

B
o
a
r
d

C
o
m
p
a
n
y

2
7
5
0
5
B

Are we willing (and ready) to

Abate Our Profits?
Abandon Our Comforts?
Abdicate Our Positions?



Global Campus
Talent Development

2
0
1
3

T
h
e

A
d
v
i
s
o
r
y

B
o
a
r
d

C
o
m
p
a
n
y

2
7
5
0
5
B

UnpopularEven When Right
No Longer Respected?
Being Guided by Others
No Longer In Control?
Are we willing (and ready) to

Abate Our Profits?
Abandon Our Comforts?
Abdicate Our Positions?



Global Campus
Talent Development
Three Unique Roles for Us To Play

1) Servants to Exceed Expectations


Global Campus
Talent Development
Far Beyond Our Work Alone
Treating the (Obvious) Symptoms
Far Beyond Our Work Alone
Treating the (Obvious) Symptoms
Service Happens in the White Space
Addressing Needs Not Activity
Patient Experience Simulations
Three Unique Roles for Us To Play

1) Servants to Exceed Expectations
2) Gamers to Encourage Behavior



Global Campus
Talent Development
Profuse apologies for the realities of life, making
amends for service slips, and trying to placate
frustrated patients
Encouraging patients to face
reality and accept care plans
via honest conversations
Celebrations and token
gestures to boost spirits
and reward compliance
Convincing patients that
hard choices and trade-
offs are the best course
of action for their care
Counterintuitively, passive
acceptance is not what we want. We
need patients to be activated,
motivated, and involved in their care
The very uncertainty and lack of
control that causes grief is also the
necessary ingredient for triggering
action!
Three Unique Roles for Us To Play

1) Servants to Exceed Expectations
2) Gamers to Encourage Behavior
3) Entrepreneurs to Envision the Future



Global Campus
Talent Development
Are we willing (and ready) to

Abate Our Profits?
Abandon Our Comforts?
Abdicate Our Positions?



Global Campus
Talent Development
Are we willing (and ready)
to become

1) Servants to Exceed
Expectations
2) Gamers to
Encourage
Behavior
3) Entrepreneurs to
Envision the
Future



Global Campus
Talent Development
Are we willing (and ready)
to

Abate Our Profits?
Abandon Our
Comforts?
Abdicate Our
Positions?