Allscripts Population Health Management Investor Summit

Transcription

1 Allscripts Population Health Management Investor Summit Tuesday June 18,

2 Forward-Looking Statements This presentation contains forward-looking statements within the meaning of the federal securities laws. Statements regarding future events or developments, our future performance, as well as management s expectations, beliefs, intentions, plans, estimates or projections relating to the future are forward-looking statements with the meaning of these laws. These forward-looking statements are subject to a number of risks and uncertainties, some of which are outlined below. As a result, no assurances can be given that any of the events anticipated by the forward-looking statements will transpire or occur, or if any of them do so, what impact they will have on our results of operations or financial condition. Such risks, uncertainties and other factors include, among other things: the possibility that our current initiatives focused on product delivery, client experience, streamlining our cost structure, and financial performance may not be successful, which could result in declining demand for our products and services, including attrition among our existing customer base; the impact of the realignment of our sales and services organization; potential difficulties or delays in achieving platform and product integration and the connection and movement of data among hospitals, physicians, patients and others; the risk that we will not achieve the strategic benefits of the merger (the Eclipsys Merger ) with Eclipsys Corporation (Eclipsys), or other companies that we have purchased or that the Allscripts products will not be integrated successfully with these other companies products; competition within the industries in which we operate, including the risk that existing clients will switch to products of competitors; failure to maintain interoperability certification pursuant to the Health Information Technology for Economic and Clinical Health Act (HITECH), with resulting increases in development and other costs for us and possibly putting us at a competitive disadvantage in the marketplace; the volume and timing of systems sales and installations, the length of sales cycles and the installation process and the possibility that our products will not achieve or sustain market acceptance; the timing, cost and success or failure of new product and service introductions, development and product upgrade releases; any costs or customer losses we may incur relating to the standardization of our small office electronic health record and practice management systems that could adversely affect our results of operations; competitive pressures including product offerings, pricing and promotional activities; our ability to establish and maintain strategic relationships; errors or similar problems in our software products or other product quality issues; the outcome of any legal proceeding that has been or may be instituted against us and others; compliance obligations under new and existing laws, regulations and industry initiatives, including new regulations relating to HIPAA/HITECH, increasing enforcement activity in respect of anti-bribery, fraud and abuse, privacy, and similar laws, and future changes in laws or regulations in the healthcare industry, including possible regulation of our software by the U.S. Food and Drug Administration; the possibility of product-related liabilities; our ability to attract and retain qualified personnel; the continued implementation and ongoing acceptance of the electronic record provisions of the American Recovery and Reinvestment Act of 2009, as well as elements of the Patient Protection and Affordable Care Act (aka health reform) which pertain to healthcare IT adoption, including uncertainly related to changes in reimbursement methodology and the shift to pay-for-outcomes; maintaining our intellectual property rights and litigation involving intellectual property rights; legislative, regulatory and economic developments; risks related to third-party suppliers and our ability to obtain, use or successfully integrate third-party licensed technology; and breach of data security by third parties and unauthorized access to patient health information by third parties resulting in enforcement actions, fines and other litigation. See our Annual Report on Form 10-K/10KA for 2012 and other public filings with the Securities and Exchange Commission (the SEC ) for a further discussion of these and other risks and uncertainties applicable to our business. The statements herein speak only as of their date and we undertake no duty to update any forwardlooking statement whether as a result of new information, future events or changes in expectations. 2

3 Agenda 10:00 am Welcome Seth Frank, Vice President, Investor Relations, Allscripts Allscripts Population Health Management Strategy Paul Black, Chief Executive Officer and President, Allscripts 10:15 am Tour of the Center for Connected Medicine Rasu Shrestha, MD, MBA Vice President, Medical Information Technology, UPMC Medical Director, Interoperability and Imaging Informatics 10:45 am Transactional to Transformational Connectivity Strategies to Manage Populations Peter McClennen, President, dbmotion 11:30 am Population Health at Unity Health System John Glynn, MBA Senior Vice President and Chief Information Officer Unity Health System 12:00 pm UPMC Population Health Overview Rasu Shrestha, MD, MBA Vice President, Medical Information Technology, UPMC Medical Director, Interoperability and Imaging Informatics 12:30 pm Lunch Panel Discussion and Q&A Paul Black Peter McClennen Joel Diamond, MD, Chief Medical Officer, dbmotion Partner, Handelsman Family Practice Adjunct Professor, Department of Biomedical Informatics, University of Pittsburgh Rasu Shrestha, MD Joel Diamond, MD John Glynn 1:30 pm Adjourn and depart for airport Please note the audio and/or slides from the 10:15 and 10:45 presentations are not available for replay. 3

4 Allscripts Population Health Management Strategy Paul Black Chief Executive Officer and President, Allscripts 4

5 Our Vision An Open, Connected Community of Health We provide clinical, financial, connectivity and information SOLUTIONS and related professional services to physicians, health systems, hospitals and post-acute organizations. We deliver insights that healthcare providers require to generate world-class outcomes and transform healthcare by improving the quality and efficiency of patient care. 5

6 Who We Are and What We Do OUR Solutions OUR CLIENTS OUR COMPANY Electronic Health Record Technology 180,000 Physicians ~$1.45BB 2012 Revenue Revenue Cycle Management 50,000 Physician Practices Professional Services 1,500 Hospitals Clinical & Financial Transaction Management 10,000 Post-acute Facilities Hosting 27,000 Individual Postacute Providers Connectivity Population Health Management ~7,100 Employees Grow 2013 R&D1 double-digits Breadth and depth of solutions across the continuum of care Global presence IT Outsourcing 1Total research and development costs before software capitalization. 6

7 Industry Demand Drivers Meaningful Use ICD-10 ~$20BB federal program to drive meaningful adoption of electronic health records Technology and regulatory bar increases over time Yields opportunity for market share gains and competitor replacement/additions Overhaul of healthcare coding system for procedures, diagnosis and billing Opportunities to upgrade revenue cycle management systems Professional and related services opportunity HIPAA Recent updates to HIPAA Rules drive additional HIPAA compliance requirements Technology platform enables and facilitates sharing of information Critical criteria for success in next generation technology systems Shift away from volume to value Population Health Management Requires infrastructure above and beyond the electronic health record Connect, analyze and coordinate care across a community Patient and consumer engagement The PHM technology market could grow to exceed $60BB by Allscripts well positioned to capitalize on evolving market 1 Source: Equity research reports 7

8 Population Health Management Platform 8

9 Unsustainable Trend Requiring Change VOLUME VALUE Fragmented providers and payments Collaboration, connectivity No uniform quality Clinical, financial data, analysis Fees for volume Demand increasing Optimize outcomes Accountable care Source: HFMA Value in Healthcare: Current State & Future Directions, June

10 Leading Footprint Across the Market Used By: 1 of 3 MDs 1 of 3 Hospitals 10,000 Post-acute Care Providers 10

11 Tour of the Center for Connected Medicine Rasu Shrestha, MD, MBA Vice President, Medical Information Technology, UPMC Medical Director, Interoperability and Imaging Informatics 11

12 Transactional to Transformational: Connectivity Strategies to Manage Populations Peter McClennen President, dbmotion 12

13 Transactional to Transformational: A Demonstration of dbmotion Joel Diamond, MD Partner, Handelsman Family Practice Adjunct Professor, Department of Biomedical Informatics, University of Pittsburgh Chief Medical Officer, dbmotion 13

14 Population Health at Unity Health System John Glynn, MBA Senior Vice President and Chief Information Officer Unity Health System 14

15 Unity Health System, Rochester, NY $560 Million revenue 5,500 employees One hospital 346 beds 70+ ambulatory sites Three nursing homes Home Health Agency ACM Laboratory Centers of Excellence Orthopedics Neuroscience Behavioral Health Women s Health Diabetes 15

16 Unity Situation Smallest of three health systems serving a community known for innovation, low cost and collaboration in health care All three systems had plans to add inpatient capacity moderate competition Strong physician relationships (employed and affiliated) Leaders in Patient-Centered Medical Home (PCMH); achieved Level 2 accreditation without the plumbing ; resource intensive Early adopters of EMR technology 16

17 Early Adopters Used electronic health records early in the game Ambulatory 2004 Hospital 2006 Best-of-breed approach Ambulatory: NextGen Inpatient: Cerner Home Care: Allscripts Long-Term Care: AOD Tremendous benefits of each, however limited ability to collaborate and share data 17

18 New York State HIT Situation 2010 New York State funded 11 RHIOs, a shared infrastructure and best practice education Rochester RHIO well established by 2010 with connectivity to 15 hospitals, over 800 physicians and 2,500 users 18

19 Unity IT Strategic Needs 2010 Enable clinical integration within Unity and the community Improve clinical adoption and optimization Further analytic capabilities across the continuum of care Function as a cohesive care delivery organization Develop a patient-centric, not location-centric chart Develop infrastructure and tools to facilitate resource-intensive PCMH model for Care/Disease Management 19

20 NY State Grant Provided $6.5M Community Diabetes Collaborative Access Improved access to information by implementing and connecting EMRs Share Create unified patient view for Unity Community interoperability, leveraging RHIO Care Management Tools to support PCMH model for transitions of care and management of chronic diseases Analyze A longitudinal patient record to support data analysis and decision support Engage Engagement via patient portal and outreach 20

21 Program Participants Unity Participants Community Participants Hamilton Manor and Latta Road Nursing Homes Lifetime Care Home Health University Cardiovascular Associates Westside Podiatry Metro Footcare Nephrology associates Borg and Ide Imaging Several Opthalmology Practices Rochester RHIO Payers: Excellus and MVP Six Primary Care Practices Wound Care Center Diabetes and Endocrinology Services Dialysis Centers Vascular Surgery Diagnostic Imaging Unity Hospital Behavioral Health Long-Term Care Facilities ACM Laboratory 21

22 HIE is Foundation for Coordinated Care u.net Connect HIE powered by dbmotion to help diagnose and treat patients Special focus on information needs to support transitions of care for Unity patients All providers, nurses, and staff access relevant clinical information and images, regardless of where they were generated Improved efficiency, provided a more complete picture of the patient s situation, and helped the patient become an active participant in his/her care 22

23 Unity HIE U.Net Connect RIS-PACS 23

24 HIE Aligned with Key Initiatives Meaningful Use (MU) Patient-Centered Medical Home (PCMH)Care Management Quality Improvement Effort to reduce readmissions Initiative to enhance physician relationships Physician recruitment, retention and satisfaction Increase/improve referrals from affiliated practices Establish or reinforce Centers of Excellence Enable Payment Reform Bundled Payment Pay 4 Performance/Exploring Accountable Care Organizations (ACO) Other 24

25 Foundation for Population Health Patient Registries Identify Gaps in Care Patient Engagement Outcomes & Impact 25

26 Population Health In Practice Community Diabetes Collaborative Diabetes Registries Practice Dashboards Care Opportunity Reports Nurse Care Managers Hospital Discharge Reports Physician "Worry List" Daily Care Opportunity Report Work the Disease Registries Close Open Referrals Diabetes-Specific Results: Reduced patients with uncontrolled A1c levels by 14% (A1C > 9%) Decreased time to bring patients in control of their diabetes Heavily dependent on interoperable EHRs and CDW 26

27 Benefits to Unity Significantly moved the needle on Unity IT Strategy Rapid adoption throughout Unity Enhanced physician collaboration and satisfaction Shift from Office-Centric to Patient-Centric Attained Level 3 status of the Patient-Centered Medical Home (PCMH) accreditation for all primary care practices Attained Stage 6 HIMSS designation for Acute and Ambulatory It is viewed as a tool that is more powerful than anticipated 27

28 Benefits to Patient Care Survey Results ED follow-up is significantly easier info readily accessible Can quickly review other provider's notes, test results, procedure notes, etc. Ability to confirm prior work ups, medications list, and data review Much easier to get lab results and helpful with ED visits Helps avoid repeating labs or tests Helps find background information on confused patients when no family is available to provide medical history, looking for prior labs Ability to see recent changes to outpatient meds not documented elsewhere Understanding nature, treatment plan for chronic illness with acute exacerbations Ability to follow-up care even if you are not physically present at the bedside 28

29 Future Plans Organized for Accountable Care Analytics that enable the organization to develop best clinical practices and enhance population health Addressing other Chronic Diseases Diabetes experience will help define programs for CHF and others Deploy Collaborate to Affiliated Providers Clinical Data Warehouse (CDW) Data fed into the Clinical Data Repository (CDR) through the dbmotion Solution used for reporting and analysis Accelerate value from potential merger with Rochester General Health System Eliminate need to replace EMRs Reduce time to collaboration between providers 29

30 Population Health Overview at UPMC Rasu Shrestha, MD, MBA Vice President, Medical Information Technology, UPMC Medical Director, Interoperability and Imaging Informatics 30

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32 What s wrong with this picture? The U.S. spends more on health care per capita than other OECD* countries U.S. ranks in the bottom 25% of those countries on life expectancy Source: Harvard Business Review, April Organization for Economic Co-operation and Development 32

33 7 of 10 1 of 2 1 of 3 Just 5% 7 out of 10 deaths among Americans each year are from chronic diseases 133 million Americans almost 1 out of every 2 adults has at least one chronic illness 1 in every 3 adults is obese and almost 1 in 5 youth between the ages of 6 and 19 is obese Just 5% of Americans accounted for half of all US health care costs 33

34 Quality not as good as it could be (McGlynn, 2003; NCQA, 2009; Schoen, 2009) Safety IOM errors report found up to 98,000 deaths per year (Kohn, 2000) Cost rising costs not sustainable; US spends more but gets less (Angrisano, 2007) Inaccessible Information missing information frequent in primary care (Smith, 2005) 34 34

35 3 Key Trends Interoperability goes mainstream March towards intelligent healthcare Consumer empowerment 35

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38 UPMC Today: Snapshot $10 billion integrated global health enterprise 55,000 employees 22 academic, community, and regional hospitals with more than 4,200 licensed beds More than 187,000 inpatient admissions and 165,000 surgeries performed annually Each year, more than 4.5 million outpatient visits and 480,000 emergency visits More than 40 UPMC Cancer Centers with 180 affiliated oncologists UPMC Health Plan: 1.7 million total members, a network of more than 125 hospitals and other facilities and more than 11,500 physicians 38

39 Look at UPMC 39

40 Data Liquidity 40

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45 Mapping Out the Patient Story PCP Trainer Endocrinologist Diabetes Educator Social Worker Pharmacist Dietician 45

46 Why Connected Healthcare Matters to UPMC 39, Petabytes of data Users 5,069,255 Patient records 100% 48 Most frequently used medications semantically grouped Clinical source systems integrated Change is coming health delivery redesign Patient centered record versus episodic record Building strong analytics for accountability Tighter integration between payor and provider Filtering the noise - smarter information 46

47 Data Available in dbmotion 47 47

48 Three Node Deployment PA SIIS (State Immunizations) Quest Labcorp Altoona Regional Hospital Armstrong County Hospital Butler Hospital Excela Health System Westmoreland Hospital Excela Health-Frick Hospital Heritage Valley Health System Heritage Valley Sewickley Heritage Valley Beaver Jefferson Regional Hospital St. Clair Hospital The Washington Hospital Children s Hospital of Pittsburgh of UPMC UPMC Health Plan Magee-Womens Hospital of UPMC UPMC Bedford Memorial UPMC East UPMC Hamot UPMC Horizon UPMC McKeesport UPMC Mercy UPMC Montefiore UPMC Northwest UPMC Passavant UPMC Presbyterian UPMC Shadyside UPMC St. Margaret Western Psychiatric Institute and Clinic of UPMC 48

49 Clinical Connect - Western Pennsylvania HIE National Health Information Network (NHIN) State of PA Immunizations PA SIIS Quest/Labcorp Altoona Regional Hospital The Washington Hospital* UPMC* dbmotion WPA HIE dbmotion Armstrong County Hospital Butler Hospital* Siemens EHR St. Clair Hospital* Excela Health System Heritage Valley Health System** Jefferson Regional Hospital McKesson EHR Meditech EHR GE Centricity eclinical Works emd Epic EHR Allscripts My Way EpicCare Mobile MD Eclipsys EHR Allscripts Enterprise Medent CCD Publish CCD Consume Actionable Data or HIE **In EHR Vendor *HIE Copyright 2013Capable Allscripts Healthcare Solutions, Inc. Database Sync Selection Clinical Viewer 49

50 Building a Foundation for Accountable Care 50

51 Semantics Harmonizes Data from Diverse Systems Data gathered from diverse sources needs to be stored and reviewed in one consistent form Data needs to be normalized/standardized The data s content needs to be preserved: its context in time, space and in relationship with other data allowing EMRs to remain viable data sources UMLS LOINC NDC RxNorm ICD-9-CM Mapping data from different source systems to national standards ICD-10-CM ICD-10-PCS DRG APC APDRG Harmonization between UPMC systems CPT HCFA HCPCS CDT SNOMED CT HL7 Creation of ontologies to support clinical use cases around Data Exchange, meaningful use and disease management OMB Commercial Provider Revenue Race/Ethnicity Interface HL7 CVX Taxonomy Codes Standards Terminologies 51

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54 Clinicians Exchanging Clinical Information Electronically Accelerating Electronic Information Sharing to Improve Quality and Reduce Costs in HealthCare Bipartisan Policy Center, October

55 Closing the Loop Relevant Data at the Point of Care Direct delivery Relevant data exchange back to the EMR EHR Agent Peripheral applications 55

56 Distinct Users Monthly 01/01/ /30/2013 5,000 4,595 4,452 4,299 4,395 3,819 4,509 3,910 3,912 3,982 3,736 4,500 4,000 3,498 3,221 3,282 3,144 3,275 3,350 3,094 3,037 3,115 2,938 3,046 2,685 2,790 3,500 3,000 2,500 2,000 2,142 2,384 2,611 2,367 2,758 2,106 2,100 2,005 1,979 2,103 1,866 2,036 1,803 1,589 1,355 1,595 1,500 1,364 1,

57 Total Number of Charts Opened Monthly 01/01/ /30/ ,000 45,993 46,569 42,807 45,000 42,153 39,647 37,916 40,000 36,072 35,468 33,695 35,000 30,000 30,879 29,290 30,222 28,594 32,314 28,012 25,654 25,000 20,000 15,000 10,000 5,

58 Number of Charts Opened per Year 472,991 06/01/ /30/ , , , , , , , , , , ,000 60,604 50, ,

59 Getting to a Unified Clinical Workspace Today: dbmotion aggregates data from 48 systems across UPMC into a VPO (virtual patient object) + Clinicians operate from multiple EMRs Challenge: Need to flow data into the clinical workspace without having to navigate through multiple applications and tabs Guidelines: Limited real estate, minimum clicks Level of trust: A cultural shift towards more information around the patient and questions as to trust and what data will actually have to be exchanged 59

60 Solution: dbmotion EHR Agent Enabling the Shift from episodic care record to the longitudinal patient record Seamless presentation of data that is actionable, distilled and meaningful Vendor agnostic in terms of EMR being utilized by clinician Aware of physician, patient and application context Patient centric clinical delta of meds, allergies, problems, documents etc. Single delivery vehicle for search, quality measures, alerts, notifications, clinical data adjudication 60

61 Some Key Findings rd 2/3 87 % Said that the data they saw on the Agent directly impacted their clinical decision and determined their plan of care Said they found the EHR Agent easy to use 61

62 Is the Data Sufficient? Is the information shown within the EHR Agent clinical categories pertinent and sufficient? Yes No N/A Encounters 71.1% 17.8% 11.1% Problems 84.4% 6.7% 8.9% Allergies 95.6% 0.0% 4.4% Medications 91.1% 6.7% 2.2% Labs 68.9% 13.3% 17.8% Immunizations 75.6% 13.3% 11.1% Documents 71.1% 15.6% 13.3% 62

63 Is the Data Helpful? If you could actively move specific types of patient information from the EHR Agent into your native EMR, which types of data would be most useful to move? 63

64 Clinical Context Analytics at the point of care EHR Agent Transformation Intelligent Healthcare Rolebased alerts Harmonization Evidence Based Logic Collaborate Aggregation Ontology, Logic Semantic Interoperability Syntactic Interoperability Customizability, Design Vocabulary Identification 64

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66 Allscripts Population Health Management Investor Summit Tuesday June 18,