The New Philadelphia Casebook. Studies in Health Care INNOVATION

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1 The New Philadelphia Casebook Studies in Health Care INNOVATION Volume 8 July 2018

2 TRANSFORMING THE HEALTH CARE EXPERIENCE WITH TECHNOLOGY Independence Health Group and Comcast join forces to build the digital ecosystem patients need By M. Diane McCormick

Technology is transforming health care, scaling mountains that were once beyond conquest. Diagnoses are delivered. Diseases are cured. Lives are lengthened.

Somehow, amid these rapid changes, technology hasn t landed on that juncture of health care delivery and health care consumer.

Now, in Philadelphia, where shaking up the status quo is a tradition dating to 1776, two corporations infused with startup spirit are harnessing technology for the toughest health care climb of all

Independence Health Group, parent of Independence Blue Cross, and Comcast are collaborating to form a new company devoted to creating a digital platform that has the potential to deliver personalized

3 Technology is transforming health care, scaling mountains that were once beyond conquest. Diagnoses are delivered. Diseases are cured. Lives are lengthened. Technology also is transforming everyday moments, from recommending a book you re sure to love to the reminder that it s time to buy dog food. Somehow, amid these rapid changes, technology hasn t landed on that juncture of health care delivery and health care consumer. The patient plunged into the health care system often feels overwhelmed, unsure what to do next. Now, in Philadelphia, where shaking up the status quo is a tradition dating to 1776, two corporations infused with startup spirit are harnessing technology for the toughest health care climb of all consumer engagement. Independence Health Group, parent of Independence Blue Cross, and Comcast are collaborating to form a new company devoted to creating a digital platform that has the potential to deliver personalized health care management and education. Consumers today expect to get their favorite goods and services at the touch of their fingertips and the sounds of their voices, said Daniel J. Hilferty, Independence president and CEO. It s time for health care to meet these expectations. This collaboration links technology to health care, enhancing the experience and minimizing the barriers that, we know, can make for a frustrating journey. The first joint venture between the two companies blends the health care knowledge of Independence with the technology and production know-how of Comcast. We have the opportunity to connect Comcast s leadership in media and technology with Independence s leadership in care coordination and health innovation, Hilferty said. We are setting out to improve the efficiency and experience of care delivery, centered around one person the patient. At a Glance Opportunity Consumers today acquire a large majority of goods and services digitally, except when it comes to health care. Patients are often thrust into the system, unsure of what steps to take next and how to manage the process. Action Independence Health Group and Comcast are forming a new company devoted to creating a digital platform delivering personalized health care management and education. Result Combining Independence s health care expertise with the technology reach of Comcast should result in a new solution to engage consumers in their health care. The expectations of improved patient experiences and health outcomes should be an attractive tool to physicians and health care facilities in the move to value-based care. HEALTH CARE INNOVATION COLLABORATIVE AN INITIATIVE OF THE CEO COUNCIL FOR GROWTH 3

Deconstructing the health care consumer logjam Ask a smart speaker to play Jason Mraz s I m Yours, and the tune fills the kitchen. Snap a photo of a check, and it s deposited.

Ten or 20 years ago, none of this seemed possible, but technology elves have been hard at work, dreaming up the next big thing that enriches lives and forges connections.

At every point in the health care experience, whether they re caring for themselves, caring for an elderly parent, or caring for a sick child, the big hassle point is the concept of What do I do next?

4 Deconstructing the health care consumer logjam Ask a smart speaker to play Jason Mraz s I m Yours, and the tune fills the kitchen. Snap a photo of a check, and it s deposited. Place a call to Brazil, and the kids get to video chat with Grandma. Ten or 20 years ago, none of this seemed possible, but technology elves have been hard at work, dreaming up the next big thing that enriches lives and forges connections. Somehow, though, the elves didn t keep pace with seismic upheavals in health care. At every point in the health care experience, whether they re caring for themselves, caring for an elderly parent, or caring for a sick child, the big hassle point is the concept of What do I do next? said Brian Lobley, president, commercial and consumer markets, with Independence. Comcast s efforts to provide best-in-class benefits for employees also revealed a broad sense of confusion and friction in the individual health care process, said Don Mathis, Comcast general manager of growth initiatives. Health care consumers have lost control of the process in a world where we expect to have increasing control over these elements. A lot of it is provided by technology that influences our lives, but the medical category is an area where we really don t have control. Comcast has learned to provide information to employees in a way that is very engaging and much more informative around the conditions patients have and the next, best action for going through a personal recovery or care process, Mathis added. The more that people can take health care with them into their homes, onto a device and out of the provider s office, the more comfortable they ll be adhering to the recovery process. We are setting out to improve the efficiency and experience of care delivery, centered around one person the patient. Daniel J. Hilferty Independence President and CEO 4 THE NEW PHILADELPHIA CASEBOOK STUDIES IN HEALTH CARE INNOVATION

Comcast s health care partnerships include production of videos on healthy aging for the University of California, Davis, and development of Kaiser Permanente s My Pregnancy app on its Xfinity X1

5 Designing innovative initiatives Comcast, with about 160,000 employees, is Independence s biggest customer. Together and separately, each company has delved into solving health care challenges through innovation and digital technology. Comcast s health care partnerships include production of videos on healthy aging for the University of California, Davis, and development of Kaiser Permanente s My Pregnancy app on its Xfinity X1 platform. Independence s partnerships and investments for scalable, high-impact solutions include its Achieve Well-being consumer empowerment solutions, which apply behavioral science to let members create customized plans to improve nutrition, physical activity, stress levels, sleep, and other lifestyle factors. It is also innovating value-based care models and public-private collaborations to improve care quality, lower costs, and promote innovation throughout Greater Philadelphia. Around 2015, the conversation between the two started shifting past the traditional clientvendor talks. Could they team up for exponential impact, well beyond Comcast employees and Independence members? What followed was a journey of innovation, Hilferty said. Consumers trust Independence to help them and their families live healthy lives. They welcome Comcast into their homes and feel comfortable navigating technology. It made sense to bring comfort and trust together, connecting consumers with credible wellness education and the health care system in ways that feel familiar and inspire confidence to take that next step, whatever it may be. Initially, the two companies considered co-investing in existing technologies, whether new approaches that disrupt health care or traditional routes focused on improving quality and lowering costs, Lobley said. In time, talks encompassed the strengths of each player Independence s knowledge of the health care landscape, product design, cost drivers, and consumer roadblocks, and Comcast s grasp of technology s impact on daily life. HEALTH CARE INNOVATION COLLABORATIVE AN INITIATIVE OF THE CEO COUNCIL FOR GROWTH 5

Comcast saw an opportunity to put control in the hands of the health care consumer as they go through the process, as much as that s possible, Mathis said.

Whether providing services for hospitals or creating the UC Davis videos, Comcast wanted to better understand the intersection of health care, technology, and entertainment, Mathis said.

6 Comcast saw an opportunity to put control in the hands of the health care consumer as they go through the process, as much as that s possible, Mathis said. Health care is a category that is going to evolve over time, and so is the opportunity to play a role in it. Whether providing services for hospitals or creating the UC Davis videos, Comcast wanted to better understand the intersection of health care, technology, and entertainment, Mathis said. After agreement on the idea of a new company, the effort s rallying cry became the health care consumer s question of what to do next, Lobley said. That became our thesis statement of what would become this company that was digitizing the health care itinerary. The effort blends the doctor s visit, follow-up, prescriptions, procedures, and all the stops along the way, putting tools in the hands of the insurer, the employer, the patients, and the provider, and having this ecosystem connect. Businesses forge the future of health care Here s a funny thing about many health care stories in the news lately: The names leading the headlines are technology companies. Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. announced formation of an independent company to improve health care for their 750,000 employees and lower costs. Google expects to use structured data and artificial intelligence for disease detection, new data infrastructure, and possibly insurance. Hilferty said the Amazon venture is fascinating given Amazon s understanding of the consumer and its ability to speak to consumers in ways that are focused on their needs, and ultimately delivering a product. It is also an opportunity. In this environment, the Independence-Comcast venture combines the best of all worlds, leveraging the health care expertise of Independence with the technology reach and media savvy of Comcast. Independence has an 80-year history of delivering innovative health care solutions, and Comcast has these incredible digital distribution channels, Hilferty said. The reach of both entities makes the new venture a national solution. What a combination! We bring both of our skill sets together to deliver a new array of products, services, and education to our membership and their customers, Hilferty said. Corporate America s deep dive into health care helped spur the initiative, Mathis said. With health care up to 18 percent of U.S. GDP a $3.3 trillion enterprise, according to the Centers for Medicare & Medicaid Services it really affects all of us. The question isn t whether you should be in health care, he said. It s a question of when, not if, you ll be involved. 6 THE NEW PHILADELPHIA CASEBOOK STUDIES IN HEALTH CARE INNOVATION

You don t solve health care by coming in as the bull in the china shop, Mathis said.

It s an opportunity to take the capabilities we have as a company and deploy them in a category and a partnership-like format, with the end result being actually improving the lives of consumers.

otherwise a pretty fraught and scary process. If we can help change that outcome, it ll be a great accomplishment, as well as good business.

7 You don t solve health care by coming in as the bull in the china shop, Mathis said. You need to work with the players who are already in the sector and have an understanding of it and work collaboratively toward a solution. These things don t come along every day, Mathis said. It s an opportunity to take the capabilities we have as a company and deploy them in a category and a partnership-like format, with the end result being actually improving the lives of consumers. In this strategy, Comcast is expanding its technology and entertainment services toward a new purpose, using its capabilities and assets to change the outcomes of a patient going through what is otherwise a pretty fraught and scary process. If we can help change that outcome, it ll be a great accomplishment, as well as good business. In a world filled with announcements of businesses trying to rein in health care costs, the Independence-Comcast partnership hits a sweet spot for its pairing of health care leader with media and technology innovator. This is not about Comcast or Independence, Hilferty said. This is about both of us. It s the ultimate circumstance where one plus one doesn t equal two. One plus one equals four. It s considerably more powerful. Fast facts about IoT growth The internet of things (IoT), in simple terms, refers to the connection of devices to the internet everything from cars and refrigerators to heart monitors and electric meters. Virtually every industry and country is embracing technology to move forward for everything from increasing efficiency to improving customer service. Following is a glimpse at where the movement is: By 2020, it s estimated that 20.4 billion IoT devices will be deployed globally, according to analyst firm Gartner. The Americas lead in the area of connected health, with 55 percent of current global projects, while 45 percent of smart city projects are in Europe, according to IoT Analytics. By 2020, discrete manufacturing, transportation and logistics, and utilities industries are projected to spend $40 billion each on IoT platforms, systems and services, according to Statista. The top three IoT projects in progress are smart cities at 23 percent, connected industry at 17 percent, and connected buildings at 12 percent, IoT Analytics reports. In America, 19 percent of companies surveyed on IoT use reported their goal is to cut costs, while 23 percent of enterprises in China are focused on using it to increase competitiveness, a study by analyst firm Ovum found. HEALTH CARE INNOVATION COLLABORATIVE AN INITIATIVE OF THE CEO COUNCIL FOR GROWTH 7

Framing people-focused solutions The term digital health should be obsolete by now, Hilferty said. No one says digital navigation or digital banking.

loved one, he said. Independence members are ready to embrace new technology, Hilferty added.

8 Framing people-focused solutions The term digital health should be obsolete by now, Hilferty said. No one says digital navigation or digital banking. Technology should be foundational to every aspect of health care, and it starts with the devices that each person chooses to use every day, whether it s a 60-inch television in the living room or a six-inch mobile phone in the hand. Imagine if, in those same places, you could access a reminder to take a new medicine, watch a video on the treatment of a wound, or find a post-surgery care plan that is personalized for you or a loved one, he said. Independence members are ready to embrace new technology, Hilferty added. A promotion of its Achieve Well-being tools precipitated major upticks in member usage, new registrations, and time spent interacting with the website. Independence s creation of a mobile communications platform made major inroads in members using health coaches, closing care gaps, and for a significant result around a major driver of costs switching to appropriate generic drugs from brand names 20 percent more often. The linchpin of the new company, undergoing formation but unnamed as of June 2018, is a platform that welcomes contributions from partners equipped with the expertise to make the consumer experience robust, credible, and indispensable. The open architecture allows us to partner with best-in-class third parties, Lobley said. We don t have to solve every condition. If someone is doing diabetes really well, they can be a partner on the platform. If someone is doing well-being really well, we re not going to try to reinvent the wheel. We re going to try to amplify other solutions, so this platform allows that member to experience it and, in some cases, have one-stop shopping. Lobley compared the platform to a highway with different exit points. Consumers can choose interchanges marked for weight loss, knee replacement, cardiology, or any other condition or wellness goal, while feeling compelled to get back on the main highway and make the platform a partner in healthy living. Having the ability to engage a patient and have them really stay engaged is a key differentiator in this venture. 8 THE NEW PHILADELPHIA CASEBOOK STUDIES IN HEALTH CARE INNOVATION

We re going to personalize the journey and make it really important to you, Lobley said. That s probably the thing we ve learned most in all of our business.

9 We re going to personalize the journey and make it really important to you, Lobley said. That s probably the thing we ve learned most in all of our business. Take anything you ve interacted on, whether it s Amazon or Zappos or Nordstrom s, and everything s a personalized journey. It s all about what you need. Of course, as Mathis noted, people typically don t look forward to getting involved in health care, but engagement having the ability to engage a patient and have them really stay engaged is a key differentiator in this venture. The real trick is to get something in the hands of consumers at scale, he said. We felt nothing existed like that out there. We felt we could build it better than we could buy into it. Pilot testing focuses initially on the Independence and Comcast populations in the Philadelphia region. Expansion into markets ready to energize the health care experience and lower costs will follow. The pilot test will gauge consumer engagement during a health care episode and beyond. Are patients using the platform to follow and track treatment protocol, taking their prescriptions and pursuing follow-ups? Then, have they found good reason to return and, in Lobley s words, make the platform part of their lives? If you re on an orthopedic journey and we ve shown the platform works for five months or six months, you re now still engaging periodically because you re getting something useful for it, he said. Now, if you have congestive heart failure or diabetes, you re going to come back and say, That s my trusted source. That is my home base. A digital element woven into Independence s unique approach to value-based models in health care is one example of Independence s approach to innovation. Through its Facilitated Health Networks model, providers agree to accept more risks, especially for costly readmissions, in exchange for support from Independence in building deeper digital connections to patients. In this universe of value-based care, where reimbursements are based on outcomes and not an accounting of procedures delivered, the new venture is expected to attract health care providers and physicians incentivized by the idea of thoroughly engaged patients. Whoever s taking the risk of the medical cost is going to be the ultimate sponsor of this platform, Lobley said. There are providers who are taking a lot of risk today. The most visible front of our digital revolution is consumer engagement, Hilferty said. We need to give people knowledge and power to stay healthy, and to make the right choices about the care they need. That still starts with their doctors, the most important relationship in health care, but we can provide tools that reinforce positive behavior and good decisions. HEALTH CARE INNOVATION COLLABORATIVE AN INITIATIVE OF THE CEO COUNCIL FOR GROWTH 9

10 Harnessing the Philadelphia spirit Philadelphia offers a unique skill set that fuels health care innovation, the players say. An abundance of talented people all geared toward aligning their interests and amplifying them through collaboration and innovation. Interconnectivity among eds and meds, the educational and medical institutions in every corner of the city and surrounding regions. An entrepreneurial spirit that s not dog-eat-dog but personalized and supportive. In Philadelphia, there s a real sense of companies working together and lending a helping hand to smaller folks in their sectors. From the entrepreneurial perspective, it s a robust ecosystem that s growing, and I love the fact that Comcast and Independence are doing their part to help foster that, Mathis said. Health care is changing at a dizzying pace, and two iconic Philadelphia companies are taking the lead, Hilferty said. The digital revolution gives us the power to deliver personalized care. It s a transformation that demands new capabilities across every part of the system, improving how we empower consumers and employers, how we pay for care and, ultimately, how we bend both the quality and the cost curves. Today, Philadelphia s revolutionary spirit is imbued in the Health Care Innovation Collaborative. Under the CEO Council for Growth, nine Philly-based corporate giants are banding together in The Power of Nine. Two of the nine are Independence and Comcast, putting into action the collaborative s mission to leverage assets and elevate recognition of Philadelphia as a global leader in health care innovation. The time for a digital health revolution is here, Hilferty said. Amazing things are ready to happen. This is Philadelphia s moment to lead another revolution from this city. 10 THE NEW PHILADELPHIA CASEBOOK STUDIES IN HEALTH CARE INNOVATION

12 The CEO Council for Growth, a Council of the Chamber of Commerce for Greater Philadelphia, leads our region forward by envisioning a stronger, more competitive community, convening decisionmakers, taking action, and advocating for policies and practices that strengthen our regional economy. This team of devoted business, higher education, and civic leaders reaches across our 11-county Greater Philadelphia community. We are engaged advocates who are committed to innovation in business, improving regional mobility, and fostering talent as key opportunities that define our competitive advantage and drive economic growth. The Chamber of Commerce for Greater Philadelphia brings area businesses and civic leaders together to promote growth and create opportunity in our region. CEOCOUNCILFORGROWTH.COM #LEADFORWARD

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