trust is medicine€¦ · the nuka model of care . who makes the decisions? doctor. patient....

© Accolade, Inc. 2014 Proprietary & Confidential

June 5, 2014

Trust is Medicine

Influencing More Care Decisions through Relationships and Empowerment

© Accolade, Inc. 2014 Proprietary & Confidential

It’s About Our Employees

The last thing we want our

employees to have to focus on

is healthcare.

How do we enable them, empower them, help them and keep them focused on their job and the people they love

©Accolade Inc. 2014 Proprietary & Confidential

The Healthcare Dilemma

Employers & Consumers struggle to balance demands of lowering healthcare

costs while increasing program and member value

THE RESULT:

30% Annual health care spend

results in

unnecessary or unproductive care

What’s working to lower costs:

Improvements to provider networks

Negotiated administrative costs

Shifting costs to employees & families

Risk mitigation due to exchange options

What has resulted:

X Consumers are frustrated and confused

X Low engagement and satisfaction results

X Benefit leaders are overwhelmed

X Costly care mistakes

X ROI from existing programs are minimal

X Partners are not accountable

3

©Accolade Inc. 2014 Proprietary & Confidential 4

Effective Population Health Management requires proactively engaging &

influencing care decisions of the entire population

Decision making effecting outcomes

The NUKA Model of Care

Who Makes the

Decisions?

Doctor Patient

Staying Healthy No Yes

Deciding to Seek

Medical Help

No Yes

Diagnosing Yes Yes

Treating an Illness Yes Yes

Complying with

Therapy No Yes


Staying healthy Reacting

to symptoms

Diagnosing symptoms

Choosing a treatment

Complying with

treatment

Families need help navigating their care

Errors Errors Errors Errors Errors

• Not current with screenings

• Unhealthy lifestyle choices

• Inappropriate ER use

• Unnecessary doctor visit

• Specialist visit instead of PCP

• Wrong specialty

• Unproductive MD visits

• Wrong diagnostic option

• Incorrect staging of visits or tests

• Duplicate tests

• Incorrect treatment option

• Inappropriate inpatient or outpatient setting

• Wrong drug therapy

• Lack of care plan • Care plan not

followed • Uncoordinated

inpatient stay • Poorly planned

discharge

Incentives aligned: Providers, employers & employees want the right care the first time

Poor consumer decisions drive

unnecessary and unproductive

care

5


The Usual Industry Approach to “Managing Care”

The Conventional Medical Model Industry Standard for Care Management

Adjust for severity and risk

Assess for gaps in

care

Identify from data

Leverages standard data algorithm

Unproven results

> Reaches small fraction of > population; sickest 6-10%

> Transactional & > fragmented; adds to > frustration

> No relationship or trust; > lost opportunity for impact

Marginal reach = lost impact opportunity


Trust-based Relationship Approach Influences Care Accolade’s psycho-social model starts with the entire population

Po

pu

lati

on

healt

h d

ata

Enable

s p

ers

onalized c

are

pla

n

Leverages natural human behavior

Entire population = more impact

Person/family at center; individual assessment

Data for assessing care gaps & severity

Proprietary stage-of-care medical management model

Validated assessment

tools

Proven savings & satisfaction

> Recognizes that everything takes time

> Addresses care transitions

> Based on influence and trust


Trust in Healing Relationships

WHAT FOSTERS TRUST?

OPEN, FULL ENGAGEMENT

Judgment-free conversation

Boundaries respected

Discussion between equals

No hidden agendas



WHAT IS GAINED WITH TRUST?

A SAFE PLACE

FOR TAKING

PERSONAL RISKS

MAKING IMPORTANT DECISIONS

SOMETIMES CHANGING COURSE



• Research on “contextual errors” and “contextualization of care”

• Asking “fearless” questions to explore context:

– Shows caring

– Builds trust

– Improves health care outcomes

– Reduces errors – and costs


One Place For Families To Go

A Personal Health Assistant who knows families, knows their benefits and supports them at all stages

Any Question,

Big or Small

Health & Benefit Answers

CONTACT ACCOLADE

Engage Earlier & More Often

Build Relationships, Earn Trust

Influence & Enhance Care

© Accolade, Inc. 2014 Proprietary & Confidential 12

Engaging families at the right time

60+% of all families engaged 85+% of high cost families engaged 67% engagement before a care event

Contacts & paid data from 4/12 – 3/13


Reduced program fragmentation = greater engagement

More Engagement vs. Other Programs**

ENGAGEMENT WITH ACCOLADE*

*Accolade engages 60% of families annually, **Time Warner Cable experience


Consistently driving the right care

$0

$20

$40

$60

$80

$100

$120

HospitalInpatient

HospitalOutpatient

PhysicianSurgical

PhysicianMedical

Behaviorial X-Ray/Lab Rx Other

Avg PMPM Accolade Effect

Increases in outpatient MHSA utilization and drug compliance (including preventive visits)

-23%

-8%

Core Accolade customer savings areas

-16%

-3%

-7%

+75%

+10%

UTILIZATION

IMPROVEMENTS

underlying the

savings are also

consistent across

the populations we

serve


Driving Better Health Outcomes

15

1. Slowing the natural migration of poorly managed chronic conditions

High cost

2. Accelerating regression to the mean as condition is brought under control

A significant savings opportunity exists with lower cost members by addressing the depression, anxiety and uncertainty that accompany the condition or episode of care

Only 20% of chronic client’s spend is on their chronic disease. Accolade accelerates the regression to the mean of high cost members by assisting with all health issues.

Low cost

Mean costs

1

2

Chronic conditions include: Asthma, Coronary Artery Disease, CHF, and Diabetes

Chronic Cost

Chronic Population


Accolade’s impact - significant & immediate

$240

$260

$280

$300

$320

$340

$360

$380

$400

Oct2008

Dec2008

Feb2009

Apr2009

Jun2009

Aug2009

Oct2009

Dec2009

Feb2010

Apr2010

Jun2010

Aug2010

Oct2010

Dec2010

Feb2011

Apr2011

Jun2011

Aug2011

Oct2011

Dec2011

Trai

ling

12

mo

nth

s p

mp

m c

ost

Accolade launch

Control Population

*Third Party Validation: Dr. Clyde Schechter, Einstein Medical Center

>8% real savings 3rd party validated savings*

Roll out to additional

regions

Accolade population had consistently been ~$8 pmpm

higher than control for previous few years


Accolade’s impact – most recent results

Positive impacts are consistent with other customer results

$10 PMPM less expensive after 18 months

17

$50B Retailer

$245

$255

$265

$275

$285

$295

$305

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$325

$335

$345

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Trailing 12 Month PMPM

Pilot TTM PMPM Control TTM PMPM

Pilot TTM Pre-Accolade Control TTM Pre-Accolade

Linear (Pilot TTM PMPM) Linear (Control TTM PMPM)

Linear (Pilot TTM Pre-Accolade) Linear (Control TTM Pre-Accolade)

Pilot population nearly $14 PMPM more expensive than the control group

Accolade launch


The Accolade effect is consistent in all populations

• Launch date for each is end of blue line • Charts show all Accolade populations w/year or more of results

40K lives 45K lives 25K lives

75K lives 60K lives 50K lives


Deep relationships = meaningful influence

-5

70

Health Plan Industry Average

Accolade's Net Promoter Score vs. Health Plans & Other Brands

56

74

Delighted Employees

98%+ Employee satisfaction

World-class

70+ Net Promoter Score

71

trust is medicine€¦ · the nuka model of care . who makes the decisions? doctor. patient....

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