Narus PPT Brochure 10.2.15

Narus PPT Brochure 10.2.15

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  EVERY MOMENT COUNTS
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  WHEN FACING A LIFE-LIMITINGMEDICAL CONDITION EVERYONE deserves an experienced advocate who seeks to understand what is most important to you, who works to ensure that every decision you make will be an informed decision, and who recognizes that every moment we have counts.
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  In the midstof so much new information and specialty physician appointments, patients may lose connectivity to their primary care physician and care coordination becomes a challenge. Pain and symptoms related to treatment increase the frequency of emergency room visits and hospitalizations (many of which may be completely unnecessary). PROBLEM: Existing Care Support Models are Failing the Sickest Individuals The healthcare system is challenged to meet the needs of patients with life-limiting conditions. Providers often become pre-occupied with medical facts and treatment options, losing sight of individual patient goals. Pain and symptom management Understand the costs of various treatment options and manage unecessary costs To relieve any burden for their families and family caregivers A sense of control for the decisions about their treatment and care Avoid inappropriately prolonging the dying process Narus Health Advantage: 2
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  The top 5%make up 50% of the cost 25% 25% 47% 3% Predominantly end-of-life and highly complex cases – involving multiple providers working with patients The 50% of members with the least annual spending make up only 3% of cost = Total cost of private insurance spending by members = 1% of members The top 1% of members make up 25% of total cost 3 Private Insurance Spending is Disproportionately Concentrated
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  NARUS HEALTH’S SOLUTION ATechnology Enabled, Community-Based Care Partner Technology Enabled. Using technology, the Narus Health triage process ensures that the patients who are most in need of palliative and care support are identified and engaged. Community-Based. An in-home comprehensive assessment identifies the qualitative issues (called Care Domains) that impact the patient’s overall course of care. These issues, coupled with a clear understanding of the patient’s individual goals and the physician’s overall care plan, form the basis of the day-to-day interaction between the Narus Health field team and the patient. Care Partner. Our interactions support the patient’s physician(s) – and complement the physician’s office visits with day-to-day patient interaction and insight, helping avoid complications, unwarranted emergency room visits and unnecessary hospitalizations. The Narus Health team also provides support to the family and the patient’s care giver (often a family member), so that the patient’s support system is both informed and engaged in the care process. There are 5 elements of Narus Health’s services that deliver significant value to the patient, the physician and to our payer partners: 1. Group Stratification and Program Triage 2. Patient Engagement and Program Enrollment 3. Patient Assessment using Care Domains 4. Sharing Findings with Physicians & Supporting the Physician's Treatment Plan 5. Ongoing Care Support 4
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  Medical Claims Daily Hospitalizations PreauthorizationFile Eligibility & Benefits Pharmacy & Lab Data Biometric & Consumer Provider EMR Data Sources Vendor Program Status Updates DAILY PROCESS NEW ENROLLMENT AND/OR DAILY PROGRAM UPDATES MONTHLYCLAIMS Triage & Case Enrollment in Narus Health Program TriageLogic Daily&Monthly • Knowledge Based Pathways • Dynamic Care Plan • Care ManagementWorkflow CA | Stage 4 CA | Stage 3 CA | Stage 1 & 2 Neuro | ALS, MS Neuro | Other Kidney | Liver Failure CHF | COPD | CAD Outsourced & Partner Programs Dynamic & Adaptive Care Management HEALTHPLAN& PROVIDERDATASOURCES PHASE 1. Group Stratification and Program Triage Using pre-authorization data, emergency department visit data, hospital admissions and medical claims data, Narus Health uses a proprietary set of case selection “rules” (that are vetted with the health plan) to ensure that the most appropriate cases are identified for enrollment. This process may also be used by our health plan partners to identify and select cases for enrollment in other care support or disease specific programs. 5
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  PHASE 2. Patient Engagementand Program Enrollment Once the right group of eligible patients are identified (using the program triage filters) the Narus Health Enrollment Team engages each patient to explain our service (a benefit offered by their health plan or employer) and schedules an in-home (or on-site) visit with a highly trained Narus Health Nurse Care Partner. This engagement process ensures that the right patients are enrolled in the program, and the value of the service is properly described. Most recently diagnosed patients have a myriad of questions; they are looking for support; and they are seeking clarification about "next steps." The individuals we select for care coordination services have at least two of the following characteristics: • High annual claims cost (average > $50,000 per annum) • Significant primary diagnosis: CA, ALS, CHF, CAD, COPD, Kidney or Liver Failure • Multiple, severe co-morbidities • Prognosis of progressive and eventually fatal disease • Multiple providers of care • Significant pain and symptom management issues 6
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  The Narus HealthTeam will complete an in-home, personal assessment of the patient, structured around Care Domains. These Domains are qualitative drivers of the patient’s overall engagement and are highly predictive of future costs and complications. These 7 areas of assessment include: Knowledge & Choice We confirm the patient's current knowledge about their diagnosis and treatment choices. If issues are identified, we collaborate with their physician(s) to address the issues, so the patient's anxiety is reduced, and they have both knowledge and insight. Pain & Symptom Management We identify any discomfort, pain or other symptoms. We ensure the symptoms are carefully monitored and addressed immediately. Pain, nausea, shortness of breath and anxiety are the top reasons patients visit emergency departments, most of those visits are unnecessary with careful daily monitoring and support. Family & Community Support We evaluate each patient's social and family support system. Is there a caregiver present? Are there transportation needs? Issues within these support structures, if not addressed, may disrupt treatment and can lead to unnecessary complications. PHASE 3: Patient Assessment using Care Domains 7
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  Treatment Plan Support Anew, significant diagnosis can often disrupt the continuity of care for patients with underlying chronic diseases. Our team provides a consistent, day-to-day support system for the patient, ensuring that all of the various providers (primary care physician and specialists) are kept informed and have full visibility of the patient's situation and treatment plan. If the patient does not have a primary care physician, we work with the attending specialist and the health plan to address non-specialty related issues that arise. Delivery System Access Depending on where the patient lives, having access to expert providers, urgent care, hospitals, medical technology, experimental therapies and support organizations may be limited. We identify these barriers and work with the physician and health plan to address them. Patient Goals and Terminal Care Planning The Narus Health Team encourages each patient to define their personal goals. Goal setting empowers patients, guides advanced directives and offers insights for making informed terminal care decisions. Benefit Coverage We help each patient have insight into levels of coverage available through their plan, options provided and alternative choices within their benefits plan. Also, Narus Health helps patients think about funding and support when specific services or selected experimental options are not covered in their benefit plan. 8
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  A complement tothe clinical evaluations provided by various physicians for the individual patient, Narus Health’s evaluation of the patient’s Care Domains delivers valuable insight to the practitioner. As each of the individual’s Care Domains are evaluated, a list of open issues is created within the Narus Health engagement plan. Each issue requires a specific goal and a set of actions that will mitigate the issue and achieve the goal. Issues, Goals and Actions are all set with specific target dates, and a measurable outcome is recorded. This methodology of documenting the patient’s Issues and Goals, identifying planned Actions, and desired Outcomes is a powerful way to communicate meaningful information to the attending physician, specialty physicians, and the health plan leadership. The Narus Health Nurse Care Partners are trained in systematic care processes and receive specific training in palliative care. The company further invests in these individuals by helping each become fully CCM (Complex Care Management) certified. PHASE 4: Sharing Findings with Physicians & IGAO Development 9
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  • Managing anyoverflow inbound patient calls during the day, when their nurse is busy • Triaging and addressing all overnight and weekend patient calls to the nurse care partner so that seamless support occurs • Facilitating care coordination needs identified by the field team • Providing social services expertise for psychosocial and resource needs Narus Health Medical Director Chief Clinical Officer & VP of Quality Complex Care Managers NP Clinical Team Leader Complex Care Managers NP Clinical Team Leader NP Call Center Leader Complex Care Managers Social Workers Care Coordinators Chapliancy Call Center Local Market 1 Local Market 2 Local market team support CLINICAL TEAM STRUCTURE The local market teams (nurse care partners delivering services) are supported by a 24/7 Narus Health Patient Support Center. The Support Center enhances the patient experience by: 10
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  • Delivers arobust patient management and palliation program focused on pain and symptom management and supporting coordination of care among numerous providers • Supports the patient in understanding their options for treatment and the patient’s decisions regarding their care • Counsels the patient in setting life goals and, when appropriate, advanced directives • Transitions individuals to survivorship or end-of-life care when appropriate • Captures patient reported data throughout the course of care (ESAS) • Supports the caregiver and the family throughout the process PHASE 5: Ongoing Narus Health Support Throughout our engagement with the patient, the Narus Health team: Narus Health Scientific Advisory Board Narus Health is partnering with thought leaders in our space who will provide insight of industry best practices. This group of advisors also evaluates Narus Health on our overall performance and program outcomes to ensure exceptional support for patients and their families. 11 Automated & Ongoing • Data Integration • Analysis • Reporting • Communications Measure Outcomes Population Surveillance Identify Care Gaps Stratify Risks Engage Patients Manage Care
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  NARUS HEALTH’S OPERATINGMODELHEALTHPLAN& PROVIDERDATASETS Data Assimilation andAnalytics Data Sources Daily Hospitalization Direct Referrals Medical Claims Pharmacy & Lab Data Member Eligibility Provider EMR Data Biometric & Consumer Population Surveillance Dynamic Care Plans Knowledge Based Pathways Patient Triage & Work Flow Enterprise Rules Engine Access to Clinical Expertise Engagement & Interaction Symptom & Care Support Patients and families have access to a care management expert 24|7 to aid with questions, address symptoms, and reduce worry. Interactions include identification and support for the patient’s personal goals, pain and symptom management, appointment scheduling, medication refills. and changes. The care management process supports both the patient and the family care giver. We ensure that each individual is treated with dignity and that care and treatment wishes are followed. PATIENT Care Insights Knowledge & Choice Pain & Symptom Management Family & Community Support Treatment Plan Support Delivery System Access Patient Goals & TCP Benefit Coverage Primary Care Physician Treating Specialists Ancillary Providers Narus Health Team Patient and Family Scientific Advisory Board Consulting Specialists Medical Researchers Palliative Experts 1. TECHNOLOGY ADVANTAGE Through our stratification process, we are able to ensure the right individuals are enrolled in our programs 2. SERVICE ADVANTAGE The structured assessment and management of Care Domains using an IGAO framework affords us the opportunity to share meaningful, new information for the physicians overseeing the patient’s care. 3. CONSUMER ADVANTAGE Our mobile framework encourages patient and family interaction and ensures that the Narus Health care manager is always immediately accessible. 13
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  PATIENT ACUITY ANDPAYER BILLING PROCESS Using mutually agreed upon diagnostic categories, severity ranking, and IGAO assessment, a patient acuity is assigned that defines both the level of support required and the fee charged to provide that month’s support. Using this methodology, the health plan and Narus Health are afforded the opportunity to define consistently the resource need of the individual patient through a transparent and verifiable process. The Narus Health algorithm is dynamic, adjusting as needed each time new data is captured, either from the health plan or from a Narus Health care partner. The patient’s acuity, for purposes of both support and billing, are then periodically adjusted as their need for support changes. The health plan and/or employer is billed each month for Narus Health’s services based on the level of service received by the patient. 5 4 3 2 1 Primary and Secondary Diagnoses Comorbidities Narus Assessment IGAO Specific Chemotherapy Regimens Social Support ESAS Hospitalization or ER Visit High Low Service Levels: 14
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  OPPORTUNITY FOR MARKETIMPACT AND MARKET ENTRY 0.68% Cancer patients as a percentage of total commercially insured population 10% Cancer costs as a percentage of total commercially insured population ANNUAL RATE OF COST GROWTH For Commercial Patient Population 9% 20% Overall Cancer Cancer Opportunity is Significant $100+ Billion Marketplace —7.5% CAGR 1.7 Million People in the U.S. Were Diagnosed With Cancer in 2014 By 2020, Cancer will surpass Heart Disease as the Leading Cause of Death The Narus Health program covers patients who are defined in the “Top 1%” for the health plan in terms of total costs. Most of these patients have more than $50,000 in annual costs with either a significant primary diagnosis (CA, ALS, MS, CHF, CAD, COPD, Organ Failure, Trauma) or they have multiple, severe co-morbidities with significant pain and symptom management issues. A high-opportunity starting point for many health plans are the patients with late stage Cancers – due to the significant costs of complications, frequent emergency department visits and hospital admissions. 15
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  X-Ray CT Scan PET Scan Bronchoscopy Mediastinoscopy EBUS CTScan Needle | FNA Surgery | Staging Stain Tissue Diagnosis Staging Localized | 7.2% Regional | 22% Distant | 53.1% Unstaged | 7.7% Adjuvant Therapy Secondary CA Prevention Screenings LT Side Effects Surgery Chemotherapy Radiation Clinical Trial Palliative Care ALK EGFR Pathologist | Laboratory Clinical Trials Clinical Treatment Pathways Molecular Testing Targeted Therapy Pulmonologist PCP Screening | Nodule Pulmonologist Intervental RAD Thoracic Surgeon Pulmonologist Intervental RAD Thoracic Surgeon Thoracic Surgeon Medical Oncology RAD Oncology PCP Medical Oncology Pulmonologist Symptom Presentation Tissue Collection Histologic Diagnosis Clinical Diagnosis Treatment Decision Follow Up Care Care Management & Coordination | Pain and Symptom Management ▲▲▲ ▲▲▲ SAMPLE PATIENT JOURNEY: Patient with lung cancer Within each of the treatment phases, the patient will encounter multiple providers. Should they elect to participate in a clinical trial, the number of specialty providers only increases. This journey can feel overwhelming to a patient. Simply trying to navigate the appointment schedule is challenging. The Narus Health Care Team provides a consistent, day-to-day support system for the patient, ensuring that all of the various providers (primary care physician and specialists) are kept informed and have full visibility of the patient's situation. 16
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  High Utilization ofEmergency Department and Hospitalization for Cancer Patients ED visits for every 1,000 chemotherapy patients Hospitalizations for every 1,000 chemotherapy patients Average cost per ED visit Average cost per inpatient admission Pain Respiratory GI Malaise Neurologic Bleeding Fever Injury Chief Complaint of Cancer Patients Presenting at Emergency Departments n = 37,760 Through our prior work, we were able to demonstrate a 40% drop in ER visits within the population we managed and a 25% drop in Inpatient Admissions. Source: Mayer DK, et al., “Why Do Patients with Cancer Visit Emergency Departments? Results of a 2008 Population Study in North Carolina,” Journal of Clinical Oncology, 2011, 29: 2683-2688; “Cancer Patients receiving Chemotherapy: Opportunities for Better Management.” Milliman Client Report,available at: http://publications.milliman.com/research/health- rr/pdfs/cancer-patients-receiving-chemotherapy.pdf, accessed May 3, 2013; Oncology Roundtable interviews and analysis. NARUS HEALTH A Sample Opportunity Our founder has been a pioneer in the care management and support space for over 20 years. Using a combination of technology and expert services, we can make a significant positive impact on the lives of patients and families dealing with life- limiting illnesses. Through a thoughtful assessment of the patient’s Care Domains, we deliver valuable insight to the patient’s physician and overall care team. These insights directly impact the patient’s total cost of care while ensuring an exceptional care experience. The opportunity to reduce unwarranted ER visits and admissions is significant. Most of these are a result of pain, nausea, shortness of breath or anxiety that occur either after hours or when there is no one available to support the patient and immediately respond to their concerns. 16
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  618 Church Street,Suite 130, Nashville, Tennessee 37219 615.933.8265 www.narushealth.com