1. Population Health Management: Paradigm Shift from ‘Providing Care’ to ‘Managing Health’ November 2014

2. Confidential property of Optum and Amref Health Africa Optum & Amref have joined hands to bring globally proven & market relevant healthcare solutions to Africa 2 One of the Largest Healthcare Services Company in the World Committed to making the health care system work better for everyone Africa’s Largest International Healthcare Organization Dedicated to making a lasting healthcare change in Africa

3. Confidential property of Optum and Amref Health Africa Optum is part of UnitedHealth Group, the largest & most respected Healthcare companies in the world Largest Health & Well-being company globally Fortune #14 Amongst the 500 largest US companies in 2014 125 countries Operations in all 50 US states & 125 countries $120+ Billion UnitedHealth Group Revenues in FY 2013 85 million + Consumers of Health Benefits & Services 6000 + Direct Hospital Relationships 3 Health Services Consulting, Technology and BPO business solutions for healthcare organizations  Information and technology enabled health services platform  Intelligence and decision support tools  Health Management and interventions  Operational optimization and performance management Africa Office in Nairobi, Kenya

4. Confidential property of Optum and Amref Health Africa Maternal Health Making pregnancy safer and expanding reproductive health Maternal Health Making pregnancy safer and expanding reproductive health Amref is a leading healthcare organization in Africa with rich experience in delivering health services 57 Years of serving Africa 35+ Countries where Amref reaches 110M Annual Budget in USD 1000+ Healthcare Staff 7 Regional offices in Africa Child Health Reducing morbidity and mortality among children Child Health Reducing morbidity and mortality among children Fighting Diseases Scaling up responses to HIV, TB, Malaria Fighting Diseases Scaling up responses to HIV, TB, Malaria Water and Sanitation Preventing and controlling diseases related to water, hygiene and sanitation Water and Sanitation Preventing and controlling diseases related to water, hygiene and sanitation Clinical and Diagnostic Services Increasing access of quality medical, surgical and diagnostic services to communities Clinical and Diagnostic Services Increasing access of quality medical, surgical and diagnostic services to communities Strategic Priorities Research and Innovation Developing a strong research & innovation base to drive health improvement in Africa Research and Innovation Developing a strong research & innovation base to drive health improvement in Africa 4

5. Confidential property of Optum and Amref Health Africa 5 Increasing disease burden and rising healthcare costs present huge challenges across the Sub- Saharan Africa. These challenges are significant but not insurmountable Population Health Programs, which enable the shift from “Providing Care” to “Managing Health”, can address the issues of Affordability, Accessibility and Adequacy of healthcare across the African region

6. Confidential property of Optum and Amref Health Africa 6 The Healthcare Needs in Africa 66% of global HIV burden NCDs expected to overtake CDs and become the biggest challenge by 2030 $12 bn costs every year in lost wages due to malaria across Sub-Saharan Africa Dual Disease Burden Accessibility Adequacy Affordability Sub-Saharan Africa: 11% of World Population; 24% of Global Disease Burden 85% of diabetes cases go undiagnosed

7. Confidential property of Optum and Amref Health Africa Navigating from ‘Providing Care’ to ‘Managing Health’ 7 Providing Care Quality Patient Satisfaction Cost Managing Health Point of Care Self-Health Management Referrals Health Education Aligned Incentives Care Coordination Preventive Care & Wellness Population Health Management New Care Delivery Models The focus of healthcare in Africa must be to proactively engage with the population to keep them healthy and manage health risks of chronic disease patients leading to better quality of life Providing Care when sick is not enough….

8. Confidential property of Optum and Amref Health Africa What is Population Health Management? 8 Behavioural and lifestyle changes based on care pathways Include interventions from qualified medical personnel on need basis Behavioural and lifestyle changes based on care pathways Include interventions from qualified medical personnel on need basis Help patients understand the impact of nutrition, activity, hygiene, stress and lifestyle Reinforce self- management skills Help patients understand the impact of nutrition, activity, hygiene, stress and lifestyle Reinforce self- management skills Create tailored care plans based on risk levels Detailed plan includes diet, exercise, medication compliance & lifestyle changes Create tailored care plans based on risk levels Detailed plan includes diet, exercise, medication compliance & lifestyle changes Proactive assessment of health risks to identify target population segments Direct patients to appropriate health management programs Proactive assessment of health risks to identify target population segments Direct patients to appropriate health management programs Care Planning Risk Assessment Education Interventions 1 2 34

9. Confidential property of Optum and Amref Health Africa PHM Program in silos are not Cost Optimal and Less Effective in Outcomes 9 Different programs are supported by different siloed applications Investment in IT systems is not optimally leveraged when program funding expires Applications are not interoperable which inhibits managing comorbidities Investments in healthcare IT must be made in well-planned systematic manner such that all applications have common design principles, same data standards, and are completely interoperable. Modules like registration, medical history etc. must be common for all applications and leveraged across multiple programs Malaria HIV Cancer Tuberculosis Diarrheal Diseases Hypertension Dyslipidemia Diabetes Malnutrition

10. Confidential property of Optum and Amref Health Africa Hypertension PHM programs with common technology blueprint are interoperable, cost effective and scalable 10 Registration Demographics Medical History Health Risks Major Surgeries Known Conditions Allergies Lifestyle Data HIV Cancer Tuberculosis Diarrheal Diseases Dyslipidemia Diabetes Common design principles and data standards across applications Synergies across programs are leveraged for “managing health” due to interoperability Common modules are leveraged across applications Applications are scalable for new programs Technology Blueprint Malaria Malnutrition

11. Confidential property of Optum and Amref Health Africa Roadmap for Africa to enable Population Health Management 11 Stage 0Stage 1Stage 2Stage 3 Data Standards Technology Blueprint Policies and Procedures Disease Surveillance Data Collection Applications Basic Workflows Interoperable & Integrated Systems Completely Automated Workflows Big Data Analytics Evidence Based Medicine Technology Analytics Static Reports Dynamic Reports Integrated Data Warehouse Simple Analytics Advanced Business Intelligence …

12. Confidential property of Optum and Amref Health Africa Population Health Management Ecosystem 12 Population PayerProviderEmployers Schools Telecom Players Government Collaboration across the key stakeholders of the PHM Ecosystem will be the key to make health management more impactful and drive better health outcomes Develop Health Initiatives aimed at improving the health of the population and reducing healthcare costs Promote wellness and disease management program for members to reduce medical costs Sponsor employee health and wellness programs Drive better clinical outcomes and improve patient satisfaction Provide downloadable mobile health/ e-health applications for consumers Initiate the culture of wellness by promoting healthy habits and lifestyle among students

13. Confidential property of Optum and Amref Health Africa Leveraging technology for Population Health Management 13 Screening and monitoring Health Services Physical Education & Recreation Programs Diet & Nutrition Programs Communication & outreach Population Health Programs Training/Counselling

14. Confidential property of Optum and Amref Health Africa Critical Success Factors for Population Health Management 14 Health Outcomes Community & Environment Skilled Capacity Technology Behavioral Modification Communication Communication and socialization of PHM for mass adoption Creating skilled capacity of health manager roles Managing behavioral & lifestyle changes through positive reinforcements Basic infrastructure availability for leveraging technology solutions

15. Confidential property of Optum and Amref Health Africa Representative PHM Model 1 – Payer Driven 15 Claims Data Preventive Care Disease Management Programs Set Targets Care Plan Periodic Follow-Ups Set Targets Care Plan Periodic Follow-Ups Medical Interventions Health Manager Lifestyle Changes Medical Interventions Risk Stratification Program Enrollment Referrals High Risk Members with Chronic Disease

16. Confidential property of Optum and Amref Health Africa See how Jane managed her Disease with a health management program driven by her Insurance firm 16 Mrs. Jane Kimotho has been risk stratified using her claims data and diagnosed with Diabetes & Hypertension She registers in a Disease Management program with her Insurance firm African Health Plan Mr. Antonio, Health representative for her Health Plan develops a detailed care plan for Jane Sets health targets for her to tackle Blood Pressure, Blood sugar and Obesity Prepares a Diet and exercise plan for Jane One day, Mrs. Jane Kimotho complained of anxiety and palpitation. She calls Antonio and discusses her symptoms Mr. Antonio, referred Jane to the right doctor in the network hospital where she was given right medication Thus, Jane could avoid the intensive treatment and in-patient admission to the hospital Now, Jane has maintained her blood pressure and sugar level with medication compliance, diet and exercise; she leads a healthy life

17. Confidential property of Optum and Amref Health Africa Representative PHM Model 2 – Government Initiative 17 Demographics Medical History Health Risk Survey Preventive Care Disease Management Programs Set Targets Care Plan Periodic Follow-Ups Set Targets Care Plan Periodic Follow-Ups Medical Interventions Health Manager Lifestyle Changes Medical Interventions Referrals High Risk Members with Chronic Disease High Surveys Risk Stratification Program Enrollment Bio- Surveillance system Disease Source Identification Health Education Direct Medical Resources Medical Intervention

18. Confidential property of Optum and Amref Health Africa Bio-surveillance helped people of Sandera village to reduce the impact of malaria 18 The Primary health clinic in Sandera village has a patient reporting a case of Malaria. The doctor reports the case to the public health authorities through SMS/Toll free call Healthcare medications, health workers and resources for removing mosquito breeding grounds are directed to the village for controlling Malaria 26 more cases of Malaria are reported from the village over next few days As this number of cases exceed threshold, authorities are alerted through email/SMS about the malaria outbreak The Public health department update their Communicable disease records for Malaria of this individual case Due to prompt action by authorities, Malaria is controlled with just 31 cases Health Education is provided to the community to help them understand the preventive measures

19. Confidential property of Optum and Amref Health Africa The people of the county have improved health outcomes through PHM by the Government 19 The Unit team comprising of doctors and health workers visits the Balgishu County and conduct a community health camp to collect data on: Demographics Historical medical data Health Risk Assessment Through health risk surveys, the Unit team stratifies the population with high cholesterol levels and diagnosed with Dyslipidemia High risk population are enrolled in preventive care program and those diagnosed with dyslipidemia were registered for disease mgmt. The Unit team designs the care plan for this population and advises each individual on: Target HDL,LDL levels Diet and Exercise Plans Lifestyle Changes and Health Education The unit team does periodic face-to-face follow-ups with the enrolled people to discuss their progress Health workers conduct education sessions and do a telephonic conversation with the target population once a week The overall result is lesser medical intervention, lower healthcare costs and better quality of life for the people of county

20. Confidential property of Optum and Amref Health Africa 20 Case Studies

21. Confidential property of Optum and Amref Health Africa Case Study 1: Integration of TB with HIV, Malaria and Maternal and Child Health in Ethiopia 21 Why integration? Maximizing opportunities and minimizing lost opportunities For efficiency, effectiveness Building on existing interventions and community initiatives including volunteers e.g. mother coordinators, kebele health communities etc. and HEWs Reaching out more beneficiaries S. Omo: Integration of TB- Malaria-HIVAIDS and MNCH Programmes Period: June 2012-May 2014 (CA) Improved health service utilization and safer prevention practices among the most marginalized communities Afar: Community Based TB Prevention and Treatment Initiative: An integrated approach to health development initiatives Period: April 2012-March 2015 (BMSF) Increased knowledge and awareness of community members on TB prevention and treatment practices in pastoralist setting Improved capacity of the health system to deliver effective care and treatment for infected people

22. Confidential property of Optum and Amref Health Africa Case Study 2: Our Clinical and Diagnostics Program to enable better care delivery (1/2) 22 Diagnostic systems strengthening at national or sub-national levels Quality assurance system Evaluating new equipment and techniques appropriate for peripheral laboratories Evaluations and assessments of diagnostic services Laboratory Policy, Policy Guidelines and Strategic Plan development Quality management systems, equipment management etc. Development and review of pre-service and in-service training curricula in all areas of medical laboratory technology Training of clinical and laboratory staff in various courses including improved diagnostic practices; Investigations of outbreaks Providing mobile laboratory services to remote and rural health facilities to support on-site training and disease outbreak investigations Quality Assessment & Improvement Programs Capacity Building & Laboratory System Delivery Policy Development

23. Confidential property of Optum and Amref Health Africa Case Study 2: Our Clinical and Diagnostics Program to enable better care delivery (2/2) 23 Medical and surgical specialists providing consultations and operations to address hospital health care gaps to help meet local community needs Medical and surgical specialists to support emergency and refugee situations Medical engineering specialist support for equipment maintenance and training Hospital-based drug supply management and introduction of electronic packages Mobilization of women for fistula surgery Hands-on training in surgery, medical and technical practice Specialized training in vesico-vaginal fistula, cleft lip and palate, burns and hand surgery Medical Services Delivery Capacity Building

24. Confidential property of Optum and Amref Health Africa Case Study3: Drive health awareness & improve community care with E-Learning & M-Learning Programs 24 eLearning programme for Uganda midwives and for Tanzania nurses and midwives. Content development and eContent development Assisted the Nursing Councils in Malawi and Lesotho. An eLearning readiness assessment for Lesotho done in March 2012 Supporting the pilot implementation of eLearning for Nurses and midwives in Lesotho Development of an eLearning strategy for Senegal E-Learning & M-Learning Initiatives

25. Confidential property of Optum and Amref Health Africa 25 Case Study 4: Leadership Management and Governance (LMG) Training Management Development Institute (MDI) Health Systems Strengthening (HSS) programmes, over 700 health sector managers, from 31 African countries benefited. Anecdotal reports from these beneficiaries show: improved accountability, operations management and improved services to their respective clients. 2000 & beyond - Introduction of technology supported learning including telemedicine, eLearning and mLearning 1980s -1990s - Introduction of Print- based distance education 1970s -1980s - Introduction of Radio programmes on National Radio for health workers 1950’s – 60’s AMREF is founded using the flying doctors service to deliver healthcare and training to remote areas in Africa Development of training in Amref Developed a critical mass of health professionals skilled in Leadership, Management and Governance (LMG).

26. Confidential property of Optum and Amref Health Africa Case Study 5:Proactive Identification of Health Risks 26 State Road Transport Corporation was facing issues related to large healthcare costs of its employees The Healthcare costs for the Client were constantly increasing due to –Increase in the number of adverse healthcare incidents on the job (drivers) –Chronic diseases of the employee and dependent population –Late detection / Symptomatic detection of diseases Optum conducted Health Risk Assessments for the employee population Collected data for ~600 employs with HRA Questionnaire including Basic Demographics Vitals Capture Alcohol/Smoking habits Existing Ailments Sleeping habits Musculoskeletal issues Based on the inputs, key disease conditions were identified, a risk score was calculated and employees were classified as Low Risk, Moderate Risk and High Risk

27. Confidential property of Optum and Amref Health Africa 27 Case Study 6: Health standards to improve Healthcare Developed health domain data standards and interoperability architecture Aimed at improving the delivery and monitoring of population health programs Uniform data across health systems & programs Standard data elements Meta data defined for uniform interpretation of data Facilitate uniform and accurate reporting/tracking Ministry of Health of an emerging market wanted to standardize health models across the country as there were: Technology Applications in siloes Interoperability among IT architecture Lack of adequate standards for clinical data

28. Confidential property of Optum and Amref Health Africa 28 Thank You