I once put instant coffee in my microwave and almost went back in time.

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I once put instant coffee in my microwave and
almost went back in time.
Steven Wright
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Principles and Opportunities in eHealthThe
Aetna Contribution
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What Will We Accomplish Today?

• Understand the Driving Principles of eHealth
• Justify Resource Allocation to eHealth
• Identify Health Care Delivery Constituents
• Present the Value Proposition for payers,
  providers, and plan sponsors
• Cruise the Internet for examples of programming I
  am involved with at Aetna
• Appreciate the need to integrate forms of health
  content
• Illustrate the internet space and levels of
  health content
• Capture the opportunities that abound in this
  space
• What will Aetnas role be in this exciting
  transformation?

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Understand the Driving Principles of eHealth
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Hi-Ethics, Inc., or Health Internet Ethics,
unites the most widely used health Internet sites
supporting the highest ethical standards. Member
companies are committed to earning the trust and
confidence of consumers who choose to use
Internet health services for improving their
health and healthcare. Our common goal is to
establish and comply with the highest standards
for privacy, security, credibility and
reliability so that consumers can realize the
fullest benefits of the Internet. Hi-Ethics,
Inc., has signed an agreement with TRUSTe, the
leading online privacy seal program, to jointly
develop a rigorous E-Health Seal for health Web
sites. The agreement represents a significant
milestone in consumer protection among health
oriented Web sites, and it demonstrates the
industry commitment to a tough self-regulatory
process to earn the public's trust. The new
E-Health Seal will certify that a Web site is in
compliance with the 14 Hi-Ethics principles. The
Hi-Ethics principles offer ethical guidelines on
privacy and confidentiality, quality of health
information, advertising and commercial
relationships, consumer relations, and best
practices for professionals on the Internet.
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• Adam.com
• allHealth.com/iVillage
• America Online
• Americas Doctor
• Discoveryhealth.com
• drkoop.com
• HealthCentral.com
• HealthGate
• HEALTHvision

• Healthwise
• InteliHealth
• LaurusHealth.com
• Mediconsult/Physicians Online
• Medscape
• PersonalMD
• PlanetRx
• WebMD
• WellMed

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Sample Ethical Questions that Generated the 14
Principles for Offering Internet Health Services
to Consumers

• What is internet privacy? How can you assure it?
  Are there layers of privacy?
• What is internet confidentiality? How is it
  different than privacy?
• What is the definition of quality health
  internet content? How do you audit this?
• Can you professionally advertise and market
  products around health information? What are the
  limitations and parameters?

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14 Ethical Principles for Offering Internet
Health Services to Consumers

• Privacy Policies
• Enhanced Privacy Protection for Health-Related
  Personal Information
• Safeguarding Consumer Privacy in Relationships
  with Third Parties
• Disclosure of Ownership and Financial Sponsorship
• Identifying Advertising and Health Information
  Content Sponsored by Third Parties
• Promotional Offers, Rebates, and Free Items or
  Services

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14 Ethical Principles for Offering Internet
Health Services to Consumers

• Quality of Health Information Content
• Authorship and Accountability
• Disclosure of Source and Validation for
  Self-Assessment Tools
• Professionalism
• Qualifications
• Transparency of Interactions, Candor and
  Trustworthiness
• Disclosure of Limitations
• Mechanism for Consumer Feedback

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14 Ethical Principles for Offering Internet
Health Services to Consumers

• Privacy Policies
• Enhanced Privacy Protection for Health-Related
  Personal Information
• Safeguarding Consumer Privacy in Relationships
  with Third Parties
• Disclosure of Ownership and Financial Sponsorship
• Identifying Advertising and Health Information
  Content Sponsored by Third Parties
• Promotional Offers, Rebates, and Free Items or
  Services

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Justify Resource Allocation to eHealth
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Why eHealth Now?

• Spiraling health care costs -- the imperative to
  find operating efficiencies
• Administrative cost are 28 of 1.3 Trillion
• Shocking medical care error rates
• 98,000 deaths annually
• 8th leading cause of death
• Marked mal-distribution of medical services
• awareness, access, availability, compliance
• Pervasiveness of the Web
• Growth of health care consumerism and
  self-education

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Spiraling Health Care Costs
Health care costs are predicted to rise
dramatically in the next several years.
Health Care Expenditures in U.S.
Trillion
2.0
Administrative Expenses
1.5
1.0
Expenses for Medical Care
.5
0
Source PriceWaterhouseCoopers 1Q 2000
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Pervasiveness of the Internet

• At the close of 1999, 72.0 million U.S. adults
  were current and active Internet users,
  representing 36 of the U.S. adult population
• During the course of a lifetime, the typical,
  current online adult will spend nearly two years
  of his or her life online.
• Source Cyber Dialogue 2Q 2000

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Media Adoption Curves
Source Morgan Stanley Technology Research, 1997
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More Consumers Seeking Health Information Online

• In 3Q 2000, 25 million consumers searched for
  health content online
• Online consumers seeking health information will
  increase 30 in 2000 versus 1999
• By 2003, estimates show 68.5 million consumers
  will seek health care information using the
  Internet.
• Source Cyber Dialogue study 3Q 2000

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Growth of Health Care Consumerism

• Empowered health care consumers -- more than
  one-third of all adults online seek health
  information on the Internet.
• Source Cyber Dialogue study 3Q 2000

68.5
40.4
31.1
millions of U.S. adults using the Internet for
health information
17.1
13.4
1997
1998
1999
2000
2001
2002
2003
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Can You Make Money in eHealth?
Licensing
Hosting
Commerce
Subscription
Advertising
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Can You Make Money in eHealth?
Administrative Efficiency
Quality Production Improvement
Commerce
Community/ Branding
Licensing
Hosting
Advertising
Subscription
Sponsorship
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Managed Cares Major Movements

• Reaching the Lowest Unit Cost
• Discounts, Case Rates, All-Inclusive Per diems,
  and Capitation.
• Seeking Appropriate Utilization
• Pre-certification, Utilization Review, Case
  Management, Centers of Excellence, Retrospective
  Review.
• Getting the Right Patient to the Right Service at
  the Right Time for the Right Cost
• Health Risk Appraisals, Wellness Programs,
  Screening Programs, and Disease Management
• Empowering the Health Care Consumer
• Multi-Option Health Care Coverage, Multi-media
  Patient Education and Demand Management
• Changing the System of Health Care Delivery
• Electronic connectivity, internet, intranet, push
  technology, electronic medical record

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Fabius Hierarchy of Health Care Delivery
Prosperity
Productivity
Care Effectiveness
Administrative Efficiencies
Electronic Connectivity
Start from the bottom and work your way up!!!!
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Identify Health Care Delivery Constituents
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The B2E Pentagram of Health Care Delivery
B2B
Payer
Provider
B2C
B2C
B2B

B2B
Consumer
B2C
B2C
Supplier
Purchaser
B2C
B2B
B2B
Consultant
B2B B2C B2E
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Present the Value Proposition for members,
payers, providers, and plan sponsors
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What Are Benefits of e.Health to Constituents?

• e.Health supports clear and distinct value
  propositions to
• Members
• Plan sponsors
• Providers
• Payers
• Suppliers
• Consultants
• Value propositions are predicated on providing
  connectivity, streamlined processes, content,
  commerce opportunities and self-service

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Value to Payer

• Administrative Ease
• Administrative Cost Reductions
• Member Satisfaction and Retention
• Improved Predictive Modeling and Risk Management
• Getting the Right Patient to the Right Service
  at the Right Time for the Right Cost

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MedUnite Inc.

• San Diego-based Industry Sponsored Marketplace
  (ISM) which will develop real-time,
  Internet-based health care transaction systems to
  connect providers and health plans
• Underwritten by a consortium of health plans
  across the country
• Will enable physicians, other health care
  providers and insurers nationwide to use a
  standardized approach to key administrative tasks
• Will result in faster claims reimbursement and
  instant approval on eligibility and service
  authorization
• Will assure confidential, secure transactions
  that will be as easy as using an ATM
• Working with physicians to encourage the health
  care community to utilize this system

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• Founding Investors
• Aetna
• Anthem
• CIGNA
• Health Net, Inc.
• Oxford
• PacifiCare
• WellPoint Health Networks
• Technology partners
• Computer Sciences Corporation
• Deloitte Consulting
• Sun Microsystems
• Xcare.net

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Key Advantages of MedUnite

• Three strong advantages
• Deliberately narrows focus on health care
  business transactions
• Combines expertise in health care administration
  and health care information technology
• Provides physicians with standard, easy-to-use
  method for transacting with the majority of
  insurance plans

The MedUnite solution will be universal -- the
people that physicians need to communicate with
will have access -- and the technology will make
the system simpler, more efficient and more
cost-effective. -Dave Cox, President and CEO,
MedUnite
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e.Health Value to Providers

• Proposition Make it easier for physicians to do
  business with us through electronic connectivity,
  reduced paper and streamlined processes.
• Easier submission of claims and referrals
• Real time member eligibility inquiry
• Faster authorization
• Quicker and more accurate payment
• Electronic funds transfer and remittance
  advices
• Provides instant access to useful information
  and resources

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E-Pay
Electronic Referral and Claims Payment system
that ensures a rapid processing and resolution of
all valid claims.

• Number of enrolled physicians increased over 100
  from end of 1999!
• Received over 16.3 million electronic claims
  (1/1/00-12/31/00)
• 74 of all HMO claims are auto-adjudicated
  resolution averaged 2 days
• 99.5 of all HMO and Non-HMO claims are resolved
  within 15 days

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e.Health Value to Plan Sponsors
Electronic plan administration and reporting
Secure electronic enrollment maintenance options.
Benefit human resourceadministration solution.
e.Plan Sponsor Monitor
Vital financial and utilization information.
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e.Plan Sponsor Monitor From U.S. Quality
Algorithms
A decision support and reporting tool that allows
customers to evaluate and better manage their
health benefits programs

• e.PSM features
• Direct delivery of information through the
  Internet 7 days a week, 24 hours a day
• Ability to download and print report packages
• Types of reporting includes
• Level 1 - standard reports
• Level 2 - preformatted reports
• Level 3 - custom reports

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Illustrate the Internet space and levels of
health content
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The Internet Space
Connectivity
Content
Commerce
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Levels of Content

• Informational
• Interactive
• Interventional
• Actual Therapy

Therapy
Interventional
Interactive
Informational
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InteliHealth Evolution

• Where can I
• find information
• about diabetes?

• How can I
• track my blood
• sugar levels?

• Can we enroll
• you in a diabetes
• disease mgmt
• program?

Healthier Diabetics
Health Care Improvements
Information

• Active
• Solutions
• Answers Questions
• Enhanced doctor-patient relationship

• Proactive
• Fosters healthy lifestyles
• Changes practice of care and its outcomes
• Aligns clinical data, content and health
  solutions

• Passive
• Medical Encyclopedia
• Provides Knowledge
• Latest research and technology

Examples

• Ask A Doc

Signs and Ask A Doc Navigator Symptoms Trackers D
isease Specific Emails Guide Prevention
Screening Pregnancy Planner Drug Interaction
Checkers Online Disease Mgmt, Patient Management
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Formats of KnowledgeThe Microsoft Analogy

• Written Word Word
• Medical Literature
• Databases Access
• Data Warehouses
• Spreadsheets Excel
• Collective Experience

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USQA Data Warehouse
Provider Ratings of Care
Patient Outcome Measures
Patient Ratings of Care
Chart Reviews
USQA Data Warehouse
Membership Demographics
Provider Demographics
Medical Claims and Encounter Data
Hospital Discharge Abstracts
Patient Management Data
Pharmacy Claims Data
Laboratory Results Data
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Approach to Risk Stratification
CHF Risk Categories
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Asthma Disease Management Program
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Medical Mgmt. Matrix
World Literature
Data Warehouse
Content Components
SUBJECT MATTER EXPERT ANALYSIS
Analysis
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3
4
1
Colo- Rectal
Pap
Mamo
Immun.
MHE
DM
Asthma
CHF
LBP
USQA
MHE/ Marketing
InteliHealth
Informed Health
Diabetes
Sub. Abuse
BH
Depr/
Anxiety
ADD
Information
Brst CA
High Risk
WH
Infer.
Maternity
HSM
Report Cards
Patient Lists
New uses
New Tech.
TA
CPBs
Form. Mgmt.
Mail Order
Early Warn.
MCM
e.PSM
Error Reduct.
Rx
Pre- Cert
UM Review
Retro. Review
PM
CM
Trans- plants
Rare cond.
Out of Country
NME
Internal
NAVIGATOR
Gateway
MedUnite
Electronic Data Interface
Plan Sponsor Connectivity
Connectivity Platform
Provider
Consumer
Plan Sponsor
End User
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Capture the opportunities that abound in this
space
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Opportunity - The Matrix
Consumer/ Patients
Physician Hospital
Suppliers Ancillaries
Employers Purchasers
Consultants Brokers
Payors
Coverage Policies/ Members Rights Responsibiliti
es
Standard Benefit Plan Design
Product Magazine or Instructions
Plan Comparisons
Content
Consumer health content
Professional Health content
Durable Medical Supplies Online RX
Plan Billing Banking Transfer
Clinical Office Supplies
Online Health Products
Comparison Quotes Sales
Premium/Fee Collection
Commerce
Accounts Receivable/ Accounts Payable
Plan Enrollment/ Eligibility/ Reporting
Test Results/ Scheduling
RFP Response
Provider Ordering
Provider Payments
Connectivity
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What Did We Accomplish Today?

• Introduced the Driving Principles of eHealth
• Justified Resource Allocation to eHealth
• Identified Health Care Delivery Constituents
• Presented the Value Proposition for all players
• Appreciated the need to integrate forms of health
  content
• Developed an understanding of the levels of
  health content
• Captured the opportunities that abound in this
  space
• Demonstrated Aetnas participation in this
  exciting transformation

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In the middle of difficulty lies opportunity.

• Albert Einstein (1879-1955)