Our Patient’s Perspective Kitty Powell Regional Director, Strategic Planning & Innovation April 1, 2011

1. Our Patient’s Perspective Kitty PowellRegional Director, Strategic Planning & InnovationApril 1, 2011

2. Topics to Explore • Person Centered Models of Care • Consumer Wish List • Our Industries Changing Economics • Companies that Get It • Closing Thoughts

3. Vision In Oregon As people of Providence, we will provide a connected experience of care built on a foundation of clinical excellence.

4. Connected Experience Pilot Navigator PCP PCP Survivor’sClinic Example: Breast Cancer Pilot Surgeon Physical Therapy Pallative Care Oncologist Radiologist Pathologist Integrative Medicine Radiation Oncologist Support Groups Genetics Counselor OB GYN Plastic Surgeon

5. Talk to the customer! • “That weekend – those were the longest days of my life.” • “I felt like the general contractor for my treatment - with no information about how to build the house.” • “I’m so scared about how I’m going to pay for this.”

6. Quantitative Customer Research

7. 2 business days!! And what the heck is diagnostic imaging?

11. Childhood Cancer – Example of Transformational Power

12. Power to the People

13. Topics to Explore • PersonCentered Models of Care • Consumer Wish List • Our Industries Changing Economics • Companies that Get It • Closing Thoughts

15. Emily and I are experts • Emily - • 910 days of chemotherapy • 30 nights in the hospital • Kitty - • Used virtually all the imaging machines (MRI ick!) • 3 surgeries • 8 rounds of chemotherapy • 25 sessions of radiation • 15 IV infusion treatments over 1 year • Clinical trial – numerous lab/imaging tests • Four babies!

16. My Top 10 Wish List • Help me pick my clinical team based on things I care about through a great website and/or mobile app • Measurable outcomes – who is the best • Cost • Access (hours, eVisits, one stop shop) • Personality (eHarmony/Angies’ List)

17. My Top 10 Wish List 2. Offer me a “Care Package” that has all the pieces of my possible treatment packaged together - Have the specialist work together to figure out a treatment plan or present clearly the tradeoffs

18. My Top 10 Wish List 3. Get to know my preferences • “Activation” • Communication style and method • What is my goal of care (Kori – speed)

19. My Top 10 Wish List 4. Give me information – using words I can understand – at the time I need it • Shared decisions tools • Information Rx (not Dr. Google) • Write down info that is repeated for every patient (e.g. what to expect, maps) – Don’t make me ask • Proactively send me information that is relevant to ME

20. My Top 10 Wish List 5. Ask me if I want to know what something will cost in advance – and then tell me 6. Let me schedule, register & pay online - Use PDAs in the clinic if I prefer over paper

21. My Top 10 Wish List 7. Let my sister come to my appointments by Skype or something like it 8. Give me complete access to all of my medical record – including lab results, pathology reports, images – across all my specialist whether they are employed by you or not

22. My Top 10 Wish List 9. Help me figure out a way to stay on top of my medications 10. Stop making me take time off from work to come to your office – I’m busy!

23. Invest more in user experience Inexperienced with healthcare “Just a grandma” ESL, keep things simple Health issues, moderate computer use ESL, alternative care Web developer Medicare, savvy researcher Focused, high expectations Intellectual, minimal computer use Young, Savvy Mom

24. Topics to Explore • PersonCentered Models of Care • Consumer Wish List • Our Industries Changing Economics • Companies that Get It • Closing Thoughts

25. Competition will be based on measurable performance against the triple aim of value If you prove it,they will come. If you buy it,they will come. If you build it they will come. • Compete based on data • Optimize use on what you have • Increase connectivity • Purchase technology • Focus on process, service, facility design • Compete for contracts • Reduce investments • Reduce ALOS • Build capacity Managed Care1990s Technology Market2000s Performance Market2010 ALOS = Average Length of Stay Source: SG2

26. Condition Breast cancer Heart attack & coronary artery disease Immunizations High blood pressure Osteoarthritis Asthma Diabetes Urinary tract infection Sexually transmitted diseases Gastrointestinal disorders Counseling and behavior change % Receiving Recommended Care 76% 68% 66% 65% 57% 53% 45% 41% 37% 29% 18% Best outcomes? QUALITY Percentage of Patients Receiving Evidence Based Medicine Source: McGlynn et al, NEJM 348:2635-2645 2003

27. Best Experience?

28. Affordable? COST Note: $US PPP = purchasing power parity. Source: Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

29. Healthcare costs too much • Emily - $225,000 • Kitty - $180,000 • ANNUAL salary of my start-ups average employee $50,000

30. My observation on costs/quality

31. My observation on costs/quality • Unacceptable and scary variation • Surgeries/infusion/nuclear medicine • Mistakes and rework – and this impacts lives!! • Chemo dosing • Waste • Time, materials, talent (top of license) • Lack of tapping customers willingness to do work for us through self service

32. Topics to Explore • PersonCentered Models of Care • Consumer Wish List • Our Industries Changing Economics • Companies that Get It • Closing Thoughts

33. WellDoc Our mission is to improve the lives of people with chronic diseases.  We fulfill our mission by integrating clinical, behavioral, and motivational applications with everyday technologies, like the internet and cell phone, to engage patients and healthcare providers in ways that dramatically improve outcomes and significantly reduce healthcare costs.

34. WellDoc Our mission is to improve the lives of people with chronic diseases.  WellDoc understands that a successful health care solution goes beyond traditional data collection and sharing.  Translating data into valuable information and actionable knowledge is the answer. Effective solutions must employ advanced analytics, user segmentation, behavioral change and just-in time feedback. Most importantly, solutions must be simple to use and create a desire for users to engage and stay engaged. http://www.welldocinc.com/Products-and-Services/Demonstrations.aspx

35. AmericanWell http://americanwell.com/talk_to_a_doctor_now.html

36. Virtuwell

37. Patients Like Me

39. Who else gets it? • EPIC • Microsoft

40. Topics to Explore • PersonCentered Models of Care • Consumer Wish List • Our Industries Changing Economics • Companies that Get It • Closing Thoughts

41. eHealth Matters TODAY3 Million Visits to Oregon Internet *External visitors only. This does not account for visitors to multiple Web sites or repeat visits.

42. More than 10,000 internet visits a day is more than our other in person touch points COMBINED # of People Served Each Day Source: PHS Finance, June, 2010

43. eHealth – about user experience and engagement

44. The lessons of cancer • Hope • We can beat cancer – and we can transform healthcare • Comfort with uncertainty • Corporate reorg – no problem! • It takes a team • Make a leap of faith and trust your new team • There are angels among us • Don’t forget to exercise and eat well!! • “Good Food, Great Medicine” by Miles Hassell, MD

45. We are the ones we have been waiting for.