NextGen® Population Health “The Game Changer” May 14, 2014

Industry dynamics driving population health management Presented by Elise Freedman, MBA Senior Market Manager, Business Development

Population Health is hot! Everyone says they have a population health solution….Really? If it was that easy…. And population health is defined differently depending on who is using the term NextGen Population Health Helps providers to deliver the most appropriate preventative care and intervention based on the patient’s condition, risk and severity of illness …. across the entire patient panel. An automated and targeted patient outreach and engagement solution (“Set it and Forget it!”) Fully integrated with NextGen EHR, PM, Patient Portal and Dashboard Helps healthcare providers improve: Patients health Quality of care Practice productivity/efficiency Financial outcomes

Population Health is very “Popular”

Core objectives of population health management Deliver better care in lower cost settings Reduce avoidable ER visits and hospitalizations Reduce hospital readmissions Significantly improve patient health outcomes Financial Benefits Maximize financial return for value-based care Reimbursement preventative care Payment for “non‐visit” contact Negotiate better risk sharing terms with payers

Dynamics driving need for population health management US healthcare system ― fragmented care, unsustainable costs Increasing chronic disease and comorbid conditions, obesity, heart disease and diabetes Baby boomers (born between 1946 and 1964) extremely high utilizers especially end of life care Approximately 10,000 Americans turn 65 every day 40.3 million people age 65 or older in 2010; by 2050 projected 88.5 million; 8 in 10 seniors suffer from at least one chronic condition About 25 percent of seniors are obese 20 percent have diabetes 70 percent have heart disease Projected physician shortage Patient non-compliance with treatment Transition to coordinated, collaborative, integrated, value-based New diagnostic/treatment available to improve chronic conditions The A challenging national economy, chronic disease, and an aging population combine to place a tremendous strain on the system. As the new diagnostic and treatment options have been introduced at an accelerated rate. In response to this convergence of economic stress, chronic disease, comorbidity, an aging population, and medical innovation, the population health management (PHM) model is evolving to effectively manage patients across the continuum of health and care by delivering appropriate intervention according to patient risk and disease severity. PHM has grown in prominence and practice, particularly as recent federal healthcare reform efforts stimulate the public and private sectors to adopt models of reimbursement and care delivery that rely upon PHM to bend down the cost curve and improve care. Today, the healthcare system is transitioning from an inefficient, volume based, fee-for-service model to a coordinated, integrated, and value based paradigm for which PHM is ideally suited.

How providers get paid is changing Payer trends Started with CMS quality incentive programs, now commercial payers on board with performance-based payment models (because Medicare is going broke, had to do something) „Patient Centered Medical Home (PCMH) and practices implementing Accountable Care (ACO) programs Paying per member/per month (pm/pm) care management fees and gain sharing revenue for lowering healthcare costs Payers are buying physician groups and launching physician group practices, IPAs CMS American medical association practice management center Chapter 14: Evolving compensation methodologies for employed physicians in an era of changing clinical practice, reimbursement and health reform Elias N. Matsakis, Esq., Rod St. Clair, M.D., John L. Bender, M.D.

“Your patient  your responsibility” But the clincher is: Responsibility for patients’ health is shifting to providers The onus for managing, improving and reporting the health of patients is shifting to providers, particularly primary care physicians Reporting on these outcomes will impact how and how much they get paid Regardless of whether or not your patients are: Compliant Non-compliant Chronically ill Sick  short term My Patients’ Health “Your patient  your responsibility” Along with that the onus for managing the health of all patients, compliant and non-compliant, chronic, sick or well is shifting to the providers across the care continuum…. That is what MU , PCMH and Accountable Care is all about!

The impact of patient noncompliance Non-compliance accounts for: 11% of all hospital admissions 40% of nursing home admissions 20% prescriptions never filled 30% prescriptions never refilled Contact with doctors and hospitals is sporadic/infrequent Problems are not addressed until patient is in crisis 2020, 25% of the American population will have multiple chronic conditions We all are aware Patient non-compliance to follow-up visits and medication adherence impacts the bottom line as well as patient care. Some quick facts: Non-compliance accounts for 11% of all hospital admissions and 40% of nursing home admissions; Up to 20% of all prescriptions written by physicians are never filled; 30% of prescriptions are never refilled. Patient non-compliance is costly to everyone. Patient non-compliance to follow-up visits and medication adherence negatively impacts patient health and health care costs across the health care continuum. Source: Wu, S., & Green, A. Projection of Chronic Illness Prevalence and Cost Inflation. In RAND Corporation.

The prevalence of chronic diseases has created a national health care crisis Six "unhealthy truths" about chronic disease in the United States: 1 Chronic diseases are the No. 1 cause of death and disability in the U.S. 2 Treating patients with chronic diseases accounts for 75 percent of the nation's health care spending (75% of $2.8 trillion!) 3 Two-thirds of the increase in health care spending is due to increased prevalence of treated chronic disease 4 The doubling of obesity between 1987 and today accounts for 20 to 30 percent of the rise in health care spending 5 The vast majority of cases of chronic disease could be better prevented or managed 6 Many Americans are unaware of the extent chronic diseases could be better prevented or managed

Many chronic diseases can be prevented with lifestyle and behavioral changes Modifiable behaviors that cause illness, suffering, and early death related to chronic diseases lack of physical activity poor nutrition tobacco use excessive alcohol consumption Page last reviewed: August 13, 2012 Page last updated: August 13, 2012 Content source: National Center for Chronic Disease Prevention and Health Promotion

Blame is not a factor  possible reasons for patient non-compliance Language barriers (including regional semantics) Example: (Diabetes vs Sugar) Socio-economic conditions Unwillingness to follow treatment Lack of understanding treatment instructions Insufficient provider follow-up What else is going on with my patients? Patient's personal life and circumstances could be contributing to their poor health and non-compliance

What percent of your patient population looks like this? Very Healthy

What percent of your patient population looks like this? Mostly Healthy

What percent of your patient population looks like this? Not so good Where does this guy go when he goes into cardiac arrest? When do you think he last saw a doctor for a check-up?

Then, there’s everyone else… When’s the last time you had a preventative screening on time? How many doctor’s appointments did you cancel this year because you were too busy? Do you always take your medications as prescribed? Do you stop taking medication when you start feeling better? Do you eat properly? Exercise regularly? Get enough sleep? Even relatively healthy people need to follow directions. Population health management applies to all patients. www.shamedog.com

Population Health as it relates to NextGen Care Coordination

You can’t measure what you don’t track P4P programs (PCMH/ACO) earn incentive payments for programs such PQRS, Bridge to Excellence (BTE) and MU Practices must track and monitor the health status of their entire patient population Providers are responsible for documenting and reporting outreach efforts Bottom line: You can’t get paid on what you don’t report

NextGen Population Health generates reports that track and analyze performance Physicians and practice administrators can produce analytical reports on CQM performance as well as detailed patient reports identifying treatment opportunities within the patient population Outreach communication reports that can be scheduled for delivery Graphical reports to measure performance of outreach program

NextGen Health Quality Measures (HQM) collects EHR data organized by patient encounter Produces summary and detail outcomes results per program rules Performs automated calculation, tracking and reporting Extracts new clinical data Provides useable reports to provide insight and performance metrics at a practice, provider and patient level Enables clients to receive incentive for performance Automatically submits CQM reports for MU Compliance HQM is NextGen for reporting CQM’s and Objectives for Primarily for Meaningful Use but used for other reporting Data Warehouse collects and stores non-PHI clinical data to produce summary and detail reports using specific program rules Automated calculations are performed in an aggregate format which can be used for attestation/reporting depending on year HQM reporting eliminates the need for Claims reporting and G-Codes Benchmarking against other NG clients

Integrated NextGen solutions in a single platform  bringing it all together CCO Phase1 integrates and optimizes NextGen products in our Ambulatory EHR and EPM Patient Registry (new!) Population Health Patient Portal NextGen Share Dashboard KBM

Tools for comprehensive provider-driven population health management CCO Phase 2 provides a complete, vendor-agnostic solution leveraging Mirth products by providing: Comprehensive care management and collaborative chronic disease management Central Data Repository and Data exchange Population health activation Advanced “cohort” analytics and risk modeling Need graphic from creative

Advanced data analytics identify treatment opportunities and report those outcomes Ultimately, providers will need to predict which patients are likely to get sick to minimize future costs Data driven workflows manage care plans, track events, and schedule appointments and reminders. Patient engagement tools that enable patient participating in their healthcare goals Population Health Analytics

NextGen care coordination goals Improve care quality and patient safety for decreased hospitalizations and re-admittance Increase staff efficiency by reducing time required to develop care plan Greater focus on patient goals and expected outcomes Establishes clear, organized and specific interventions to improve patient care Improved patient compliance with their prescribed care plans through automated communications and clinical decision support Our goals for the care coordination series Are to provide improve quality & patient safety to avoid re-admissions or unnessary hospitalization To increase staff efficiency by providing a central location where care planning & documentation can occur To provide greater focus on patient’s goals & expected outcomes by establishing clear and organization steps and interventions for them to follow By providing the ability to fully document the patients care plans, it will improve patient compliance and provide for improved communication.

Care coordination workflow Identify care team members and define roles Enter, review and modify referral information Identify barriers to care: patient disabilities and limitations other issues impacting patients ability to comply with care plan Review and modify current care plan and track progress Log and review all patient-related communications, including: phone calls emails text messages Patient communications documented by various categories and filtered to show all or selected data

Manage the shared care plan Standardized care plan accessible to and modifiable by designated providers, case managers and caregivers Customized to patient needs: Health maintenance Chronic care management Complex cases Advanced directives Includes patient directed goals Patient preferences and directives Planned provider and patient interventions Barriers to care

Templates that advance PCMH & Collaborative Care Enhanced care coordination templates provide efficient and reliable care coordination among multiple providers to provide safer and more effective healthcare

Proactive Patient Engagement Before I move on the demo, I would like to show few screen shots to give you flavor of our application and point out how we address the 3 challenges that we discussed in the beginning.

Proactive instead of Reactive Today you see patients when they are sick or due for an appointment They call you to make an appointment As we shift from volume-based to value-based care, providers need to focus on: Proactive patient engagement for preventative care Keeping patients from falling through the cracks Quality reporting for an ever-increasing volume of measures and mandates

Really important NextGen Population Health differentiators Fully integrated with NextGen EHR EPM Patient Portal Dashboard No interfaces required! But wait…there’s more! With other PH vendors… Patient receives an alert to schedule appointment for a mammogram When patient calls to schedule the appointment, reception pulls up the patient chart but there is no info in the patient record regarding the alert and why the patient is calling But…NextGen is fully integrated so all patient info is integrated within the workflow, The receptionist will have all information about the alert sent for each patient contacted

NextGen integration  no interfaces required NextGen Practice Management and NextGen Ambulatory EHR streamline workflow Display outcomes performance in NextGen Dashboard Creates alerts on patient chart with triggering event Alert cleared when appointment is kept Chart notes added in Practice Management with reasons for outreach Follow-up documentation goes directly into EHR Evidence-based quality measures leveraged using NextGen Health Quality Measures (HQM) Data mining capability within PM and EHR Within a single system, NextGen ambulatory solutions to streamline client workflow, capturing and documenting all activity and communication for future reporting requirements. Were able to do this by including chart notes to the practice management system to include reasons for out reach We provide follow- up documentation directly into the EHR We leverage evidenced based quality measures by using HQM And of course we are able to data mine across the practice management and EHR products

Pre-programed notifications are automatically sent to your patients “Set it and Forget it” While you are away on vacation… 2,500 automated flu shot reminders have just been sent from your NextGen® Ambulatory EHR to a targeted group of patients During the week, 50 patients schedule their flu shots Pre-programed notifications are automatically sent to your patients Back at the office… 2500 flu shot reminders are send from your NextGen EHR in a week and 50 patients are administered flu shots

Target patients for follow-up and preventative care Hypertensive patients for blood pressure control Diabetic patients with A1C levels greater than seven Women age 55, who require pap smears and mammograms in May Men, age 60 who require prostate exams in September To begin with you can zero in patient for follow-up visits or preventive care e.g. Hypertensive patients for blood pressure control Diabetic patients with A1C greater than 7 Women age 55, who require pap smear and mammograms in May

Patient engagement outreach channels Phone & Interactive Voice Response (IVR) Text Message Email Patient Portal Mobile & Remote Monitoring Integration

Program alerts using a stratified approach These alerts have been automatically programmed in your NextGen EHR As these patients schedule appointments, all encounters are documented and tracked in your EHR You can generate reports as you need them Congratulations…!!! You have just met an important Meaningful Use 2 requirement Leveraging technology Meeting with high-risk patients is not the only way Reid Hospital approaches population health management. The hospital also uses an electronic population health tool from NextGen Healthcare to query which clinic patients have not had an annual wellness checkup and contact those patients to schedule visits. This allows the organization to reach out to low-risk and high-risk patients alike and transition them into proactive care. Additionally, Reid Hospital plans to use the tool to identify populations with chronic conditions for which regular interventions are known to improve quality and reduce the likelihood of patients becoming high-risk. For example, the technology will help the hospital track hemoglobin A1C measurements for diabetic patients and proactively alert patients when any anomalies are detected. Reminders: “Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care” Secure Messaging: “Use secure electronic messaging to communicate with patients on relevant health information for 5% “

The patient profiler for simple stratification Diabetic patients with A1C greater than 7 Women age 50, require pap smear and mammograms in May

The patient profiler for more complex stratification Identify male patients age 40 who have: Diabetes with history of high A1C High blood pressure and Hyperlipidemia with high total cholesterol and LDL No foot or eye exam for last 6 months and No booking for next 2 months

ROI, NextGen client  Infinity Primary Care Expected Revenue Projection Reminders sent: 10,000 per month (calculated on full provider participation) Roughly three patients contacted for each provider per day % Patient of patients responded: Between 20 – 45%; average of 33% Approximate revenue per visit: $95 Generating one additional visit per day for each provider Additional Annual Revenue: $3,420,000 To summarize the benefits of our first release here are few quotes from our clients who are using NextGen’s Population Health solution..

Infinity Primary Care success story “NextGen Population Health fills an important gap between patient communication and patient health management. In the past, we would dedicate hours of staff time attempting to contact a small percentage of patients. Now, we use a stratified approach to engage our at-risk patients with a single click. NextGen Population Health has improved the way we care for our patients.” 30% Average response rate 3 Patients contacted daily per provider 10,000 patient reminders monthly Patrick Stevenson Director of IT https://www.youtube.com/watch?v=YnO8_QYSzug Pop health, anticipate increasing our revenue by several million dollars, Maybe we will have a diabetes clinic, AC1 that hasn’t been checked in the last month Infinity Primary Care were one of the first clients to get mass adoption of the Patient Portal. Today they are doing the same with Population Health, using it in conjunction with EHR and Portal to proactively reach out to their patients. They say that it takes the randomness out of care management. In addition to improving care they anticipate greatly enhanced revenue for doing the right thing. Amlitore network in SE michagan 13 location 55 dr and 80 residents Involved with several quality initiatives including BCBS & NCQA’s PCMH & MU Show AR, Dashboards outreach compliance dashboards Need a way to manage quality care more efficiently CEO allows us to target patients that have chronic disease hypertension CHF diabetes list goes on and on allowing us to change our approach to prevent and chronic care proactive instead of reactive Starts with PP text message and email notification to come into the office and laically to come into the office and takes the randomness and guess work out of follow up Standardization is big to, documenting how many patient we contacted why, how much time we spend wich is nearly ZERO because everything is automated Set it and forget it. With a a click of a few buttons you can contact 10,000 or more patients per month. Maybe we will have a diabetes clinic, AC1 that hasn’t been checked in the last month etc We anticipate increasing our revenue by several million dollars. Pop health helping us provide more timely and quality care

ROI roughly ½ million $ additional annual revenue Activity and Variables Annual Projections Number of providers 32 Number of patients reached at 200/month/provider 76,800 Response Rate 33% Potential Appointments 25,344 Number of additional appointments (from previous year) Capacity for 3 additional patients per week 4,992 Average profit (stated as income) per visit $95. Average profit for all new visits $474,240

Data Integration & Analytics Coming soon…. Data Integration & Analytics Integration with Payer data (CCLF) Integration with third-party Risk Stratification (Statictical and Predictive modeling) tools Dashboards: Chronic Condition Payer Analysis Care Coordination Enhance care coordination workflows in NextGen EHR with population health data (outreach & gaps in care) Actionable Patient Registry with Referral Management Patient Engagement Enhance patient communication methods Gather survey and remote monitoring data from patients In the end we would like to share with you our plans to take the solution to next level…. We will be focusing on 3 key areas of population health management – Data Integration , Care Management & Patient Engagement Under data integration : We will be extending the population profiler across continuum of care by integrating with payers data and HIE in the community for collaborative care. Once the data is available across the continuum we will be incorporating risk scoring and implementing care management workflow to manage high risk patients for better care and decrease cost. Along with this we will be integrating with the latest Dashboard from NextGen and BI reporting tools. In parallel we are working on latest technologies to enhance patient engagement and reduce non-compliance e.g. mobile app for follow-up visit reminders and medication adherence. We are also looking into integrating with remote health monitoring devices to gather clinical data for alerts to providers and patients. A B C

Ready to take a deeper dive? We will now demonstrate how easy NextGen Population Health is to use Kim Root will now show you various features and functionality Its up to you to just dip your toe or take a deeper dive with fully automated outreach across your entire patient population.

Let’s see NextGen Population Health in Action Live Demo presented by Kim Root NextGen Application Specialist

NextGen Population Health results  Healthier clinical and financial outcomes Outreach communications is the first step in managing chronic conditions Increase revenue from additional patient encounters and treatment opportunities Improves patients engagement which is essential to meet health reform requirements Augments EHR to meet ACO, PCMH, and MU2 criteria

Questions? Before I move on the demo, I would like to show few screen shots to give you flavor of our application and point out how we address the 3 challenges that we discussed in the beginning.

NextGen Population Health Resources Population Health web page Watch for future monthly population health webinars demos White paper Demo Video Brochure Contact your sales representative Request a live demo efreedman@nextgen.com swilliamson@nextgen.com

Thank You !