Actionable segmentation model findings - by Raphael Louis Vitón & Dream team of industry experts, physicians and leaders from Blue Cross, GEHealthCare, RingLeaderVentures, Maddock Douglas, Dr.Daniel Friedland, etc working on improving health outcomes by Personalizing the Care Management business model for Better Outcomes & Better Economics (through patient empowerment)

1. Personalizing Care Management for
Through Patient Empowerment
BETTER OUTCOMES
BETTER ECONOMICS
&
Focusing investment and action

3. 2014 Summary Brief: Opportunity Assessment,
Consumer Segmentation Study and Strategic
Implementation Guide for Patient Empowerment
Done in partnership by Maddock Douglas (innovation consulting firm)
and Ringleader Ventures with participation from a number of
leaders from HCSC, Blue Cross Blue Shield of Michigan, Highmark,
General Electric and Daniel Friedland, MD and president-elect at
American Board of Integrative Holistic Medicine
WHY
The health care landscape is complex, uncertain and competitive.
It requires each player in the ecosystem to be evermore accountable to
healthy outcomes. Each stakeholder must move from awareness to
action with implementable programs that meaningfully empower patients.
WHAT
This document includes an actionable segmentation study and a
strategic implementation guide. It is the missing link that will help you
focus on getting in front of the trends and becoming a leader in this
space by delivering tangible improvements for the patient experience.
HOW
Use this content to inform near-term investments in patient empower-
ment, care management, ACOs and benefits departments. These innovation
assets will help you identify the patients who can be helped the most
and therefore guide the design and development of new ways to improve
personalized care.
Work with Maddock Douglas and Ringleader Ventures to execute a
definitive road map for action.

4. 2
THE
PURPOSE

5. 3
Why focus on patient empowerment?
To help stakeholders deliver better health
outcomes (through patient empowerment)
PRO
VIDER CONSU
MER
PAYER
Maddock Douglas has worked many years in the health care category,
supporting leaders who are helping their companies, community and industry
through significant inflection points to get to what’s next (shifting from B2B
to B2C and to B2Me). This inspired Maddock Douglas to rally an independent
“coalition of investors” around a simplified and actionable purpose:
Applying the Maddock Douglas consumer insight-driven innovation process,
we have been generating assets that help lead to focused investment in actionable
solutions that drive better health outcomes for patients first and foremost.
Essential to delivering on this in the near term is the intent to find ways of
integrating these assets and ideas with existing patient empowerment and care
management programs while working toward unlocking the “holy grail(s)” of
outcome-based strategic priorities that revolutionary executives in ACOs, care
management and benefits management are searching for:
»» How to help me understand the uniqueness of individual members
within my conditions database as a foundation for improving personalized
care initiatives?
»» How to help me find the patients we can help the most because they want
to be helped?
»» How to help me get newly diagnosed patients oriented appropriately in
order to increase the likelihood of the best outcome for each patient?
Our research investigated if consumers (patients) had different attitudes and
behaviors that could materially affect the impact of programs designed to help
them navigate the interconnected triad of key stakeholders — the patient (and
caregivers), the payer (insurance company) and provider (doctor, hospital system).
Since the level of involvement people have with this triad will affect their experience,
we spent extra effort to make sure we heard from patients who were diagnosed as at
risk for or having a health condition and/or in need of a medical intervention.

6. 4
THREE TRENDS
AFFECTING
THE TRIAD OF
RELATIONSHIPS
PRO
VIDER CONSU
MER
PAYER

7. 5
1The Rise of the Prosumer, Superconsumer and
e-Empowered Patients is “Just Rounding First Base”
Patient
Values &
Expectations
Relevant
Scientific
Evidence
Individual
Clinical
Expertise
EBM
The 21st century patient will have access to the
results of evidence-based medicine (EBM) research
just now being funded and curated for provider use.
“Consumer centricity” is not new to the health care industry; many
institutions (e.g., government, public and private) have devoted effort
to help their organizations consider the impact of their policy and
programs from a consumers’s point of view. This intentional
involvement of the consumer is slow moving and in some
institutions treats all consumers equally, or as the disease/
illness they are engaged in managing. A common belief is
that we have only begun to see the impact it will have on
quickly transforming the entire health care system right before
our eyes, not unlike recent transformations in other equally
complicated industries. As part of the Affordable Care Act signed
into law in 2010, a private, nonprofit entity called the Patient-
Centered Outcomes Research Institute (PCORI) was established.
PCORI is a center focused on helping people make informed health
care decisions and improve health care delivery and outcomes by producing
and promoting high integrity, evidence-based information that comes from
research guided by patients, caregivers and the broader health care community.
A spotlight on care management, evidence-based medicine (EBM) and a paradigm
shift toward a patient empowerment approach to health care has led to several
policies and government-funded initiatives to support this. The American Recovery
and Reinvestment Act (ARRA) of 2009 authorized funding for comparative
effectiveness research — a key enabler of EBM.

8. 6
THE FUTURE DECISION-MAKING PROCESS
H2 best align provider EBM training, language and FFEA framework with patient training,
language and FFEA empowerment tools?
Consumer
> Lifestyle
> Symptoms
Consumer seeks medical help Treatment plan
decided
Consumer is
billed
Aggregate data
(macro) is collected
and distributed (micro)
Find24
1
3
Evaluate
Frame
Apply
2Changing the Conversation (by Shifting to a
Shared Language) Will Change Everything
As the Affordable Care Act continues to fund, promote and reimburse stakeholders
based on EBM practices, our hypothesis is that EBM or a more everyday language proxy
will become integrated into regular conversations. EBM’s four decision-making process
steps (i.e., Frame, Find, Evaluate, Apply [FFEA]) mirror the decision cycle of patients
while engaging with the health care system. At the center of this relationship paradigm
shift, all stakeholders in the system (especially the frontline stakeholders such as payers
and providers) will continue to adapt the way they operate to reflect a new, deeper
understanding of and commitment to unique consumer segment needs, attitudes and
behaviors in order to achieve significant cost savings and, more important, better
health care outcomes for more people (with less waste in the system).

9. 7
3New Players (e.g., Google, CVS, Apple) and
Technology Start-ups are Increasingly Attractive
Alternatives for Patients and Corporations
The flood of related technology start-
ups (e.g., Oscar) and consumer-based
patient empowerment apps are daunting
indicators of solutions flooding the
market and equally daunting for corporate
leaders to discern between which ones will
create value and are worthy of investing
in. More than 40,000 downloadable apps
on U.S. Apple iTunes, to be exact, were
studied in the October 2013 report on
Patient Apps for Improved Healthcare (from
Novelty to Mainstream) from the IMS
Institute for Healthcare Informatics.

10. 8
FOUR UNIQUE
AND ACTIONABLE
CONSUMER
SEGMENTS

11. 9
Four consumer segments emerged from our research — each with distinct attitudes, behaviors and unmet
needs. These segments are not driven by differences in health status or demographics such as age, region,
income, family structure, etc. These segments are differentiated by their approach to health care treatments and
decisions — how they frame questions, find information and resources, evaluate choices and apply learning.
Population studied: Age 18 – 64, have private health insurance; have and/or are at risk for
a health condition and/or intervention; decision-maker for own health care treatment
Overview of Segments*
Wait-and-See
(18.5 million in the U.S.)
»» Passive — have a higher hurdle to take action
»» Least motivated to research and apply information
Passive Passengers
(19.3 million in the U.S.)
»» Rely on others to make recommendations for them
»» Driven by personal trust and experiences
Self-Confident Skeptics
(17.8 million the U.S.)
»» Comfortable with research, data and logic-driven decisions
»» Make an effort to verify information whenever possible because
they are concerned about bias/motives in the system
* In-depth segmentation detail only provided under NDA
Proactive Optimizers
(15.7 million in the U.S.)
»» Tirelessly investigate options and alternatives
»» Value being part of the solution for their own care

12. 10
THE
OPPORTUNITY

13. 11
There are plenty of studies out there stating the inevitability, potential savings and overall value of EBM practices
as well as the shift toward a patient empowerment approach to health care. Many say the same thing in different,
complex ways — that this is important and it is the future of health care. Many organizations struggle with
the ambiguity and uncertainty of what it all means and how to take action. So that’s what our work intends to
answer but from the perspective of the stakeholder who will soon have more of the power: the patient.
Good news.
There is a sizeable U.S. consumer population — over 71 million! — that could be a target for patient
empowerment-related innovation efforts.
»» Even more good news, decision-makers for child or senior with a health condition are an incremental
opportunity (above and beyond the 71 million)
1 Most consumers aren’t familiar with EBM, but many patients have attitudes that are highly supportive of its
objectives and approaches.
»» After being given an explanation of EBM, 94 percent say that EBM has positive benefits; most frequently believe
that EBM weeds out ineffective treatments and/or helps support the creation of more effective treatments
»» 56 percent want their health treatment data aggregated in a way that is useful for others
»» 52 percent understand that the health decisions they make have an impact on the cost of care for everyone
2 Most consumers (patients) acknowledge that there is a clear gap between what they “should” do versus “actually”
do, suggesting an opportunity to alleviate some of the stated emotional, intellectual, logistical and coverage barriers
»» Nearly two-thirds don’t always comply with their doctor’s recommendations
»» Lack of coverage for specific treatments is a key barrier to following doctor’s orders
»» Formulating questions, developing plans and making decisions (even simple ones) is often a process fraught
with stress and uncertainty — and it’s even harder for consumers who are making health care decisions on behalf
of a loved one (Hypothesis: These high-stress, emotional experiences are likely to decrease the likelihood that
patients will end up following EBM practices)
3 There are some consumer behaviors already in place that suggest an opportunity to get consumers more effectively
engaged with their own health care treatment plans and decisions.
»» Nearly half conduct their own research prior to seeing a doctor, and even more look up additional
information afterward
»» More than 60 percent report keeping track of health information or data over time
Where is the opportunity space and
how big is it, really?

14. 12
MOVING FROM
AWARENESS TO
ACTION

15. 13
Health insurance companies:
»» Our data suggests that consumers believe health insurance companies can
and should help connect consumers and providers to information that
supports EBM.
»» According to consumers, there are win-win opportunities for both patients
and health insurance companies. Consumers “give you permission” to get
involved in a positive way.
Providers, health insurance companies, care/conditions/disease
management professionals:
»» We hypothesize that providers and health insurance companies will be
able to offer up information that could help patients (via segment-specific
strategies) trust their provider’s EBM recommendations and provide
resources that could help their patients follow them better (becoming better
patients) — all leading to better outcomes for patients and the incentives
for providers that come along with that.
›› Rather than treat all patients the same way based on their condition,
help your delivery of care investments shift toward more effective
and efficient personalized service based on the segment’s specific
attitudes and behaviors.
Who should care and why?
Our data suggests that according
to consumers, there are win-win
opportunities for both patients
and health insurance companies.
Consumers “give you permission”
to get involved in a positive way.

16. 14
STRATEGIC
IMPLEMENTATION
GUIDE

17. 15
What should you be doing about it?
Stakeholders should identify (classify/tag) your database
of consumers by the patient empowerment segments they
belong to. This is the first step in taking action.
Then you can begin reinventing the way you interact/engage with them
to reflect the new understanding of their behaviors and decision-making
process to give them the best customer experience possible that improves
their health outcome and will propel you forward in leading the eventuality
of EBM and patient empowerment as the future of health care.
While some consumer innovation segments “overindex” in certain patient
empowerment segments, there is no clean alignment. Patient empowerment
attitudes and behaviors are not driven by or even necessarily aligned with consumer
unmet needs related to health insurance. Knowing which patient empowerment
segment you are interacting with can help create a more complete picture of the
consumer and help you provide a better patient experience and improve outcomes.
»» Example: Participants in a condition management program could be tagged
in your database as being part of one of the four consumer segments.
»» This will help develop targeted strategies toward different patients in many
ways — customer experience efforts that initially introduce people to the
program, incentives to keep them engaged, support touch points to help
reduce barriers and improve compliance, etc.
»» Through associated data related to compliance, health outcomes and patient
satisfaction scores, and PAM®
(patient activation measures), you will learn
which strategies are most effective and why.

18. 16
»» Communicate the positive benefits of patient empowerment and
your role in it
»» Demystify the goals and benefits of EBM
»» Make it easier for consumer segments to:
›› Identify, track and access relevant health information
›› Consult and align with EBM-trained doctors
›› Verify whether treatment recommendations are likely to
contribute to a better health outcome
»» Payers, providers and hospital systems (especially integrated systems)
›› Use this segmentation data to help shift accelerated adoption
of outcomes-based incentives: where tiered networks with better
doctors with better outcomes become the standard — drive
member behavior to go to those better-performing doctors with
better outcomes
›› Use this segmentation data as a start-up technology opportunity
filter for understanding which digital tools are addressing
which patient empowerment segment, during which part of
the decision-making process, and for which specific need to
help focus investment decisions (see adjacent image). Maddock
Douglas’ venture capital arm, Ringleader Ventures, conducted
an opportunity assessment to identify the existing businesses
and start-ups in the market that address each segment and the
unmet consumer needs their products and services can solve.
Blue
Jam
Product
Segments
Product
or
Service
Realizing
Treatment
is
Needed
Deciding
Between
Treatments
Tracking
Treatment
Adjust
or
Changing
Treatment
HealthTap
X
Fitbit
X
Basis
X
Jawbone
UP
X
Scanadu
Scout
X
Tinké
X
Integrated
Bionics
X
GymPact
and
Other
Pact
Products
X
Matchup
X
WebMD
X
X
Health
App
X
X
ClickMedix
X
X
X
Decisive
Health
X
X
Expert
Medical
Navigation
X
X
ViMedicus
X
UpToDate
X
Essential
Evidence
Plus
X
University
Research
Online
Documentation
X
Medscape
X
Government
Databases
X
Epocrates
CME
(Web
and
Mobile)
X
DynaMed
X
My
Medications
X
iHealth
X
X
QwikLife
X
RxVault.in
X
CureTogether
X
X
PatientsLikeMe
X
X
TapCloud
X
Blue
Jam
Patient
Empowerment
Segments
Product
or
Service
Wait-­‐and-­‐
See
Passive
Passengers
Self-­‐
Confident
Skeptics
Proactive
Optimizers
HealthTap
X
X
X
Fitbit
X
X
Basis
X
X
Jawbone
UP
X
X
Scanadu
Scout
X
X
Tinké
X
X
Integrated
Bionics
X
X
X
GymPact
and
Other
Pact
Products
X
X
X
X
Matchup
X
X
X
X
WebMD
X
X
Health
App
X
X
ClickMedix
X
X
Decisive
Health
X
X
Expert
Medical
Navigation
X
ViMedicus
X
UpToDate
X
Essential
Evidence
Plus
X
University
Research
Online
Documentation
X
X
Medscape
X
X
Government
Databases
X
Epocrates
CME
(Web
and
Mobile)
X
DynaMed
X
My
Medications
X
X
X
iHealth
X
X
X
QwikLife
X
RxVault.in
X
X
X
CureTogether
X
X
X
PatientsLikeMe
X
X
X
TapCloud
X
X
Opportunity Assessments by P.E. Segments
Focused investment for all
industry stakeholders

19. 17
Because each segment thinks and acts differently from one another, the patient
empowerment solution is definitely not one-size-fits-all. For each segment,
there are unique opportunities related to education, communication, incentives,
tools, apps and other resources that can help patients engage more confidently
and effectively with the health care system in order to bring about better
health outcomes. Following are directional investment ideas by segment:
Wait-and-See
»» Develop automated, noninvasive ways to track and use information that
won’t interfere with day-to-day life
»» Focus only on “the big stuff” with obviously essential benefits
Passive Passengers
»» Encourage alignment with EBM/outcome-focused doctors
»» Create easy connections with experts who highlight credible, valuable
information sources
Self-Confident Skeptics
»» Provide unbiased ways to verify information/doctor recommendations
»» Create visibility into how EBM information is gathered/applied
Proactive Optimizers
»» Demonstrate the impact of concurrent treatment paths
»» Signal when patient is on a treatment path that is likely to be ineffective
or have diminishing returns
Focused investment and
action by segment

20. 18
HOW MADDOCK
DOUGLAS
CAN HELP

21. 19
SO WHAT NOW?
If your organization would like to partner with us to leverage these existing
innovation assets and/or participate in the development of future assets,
Maddock Douglas will collaborate with you to build a road map for action
that includes concrete, incremental steps, actionable strategies, and help you
socialize the plan internally to key leadership stakeholders to get full buy-
in from the organization to successfully activate and sustain this effort.
»» Identify potential short-term actions/wins with access to detailed patient
empowerment segmentation data and action-planning workshops for
related specific “holy grail” strategic priorities referenced on page 3
»» Identify future innovation opportunity spaces related to your business
by continuing patient empowerment work through the Insights phase of
the mind-to-market innovation process
»» Identify ways to engage the third stakeholder in the triad (i.e., providers)
by understanding their attitudes, behaviors and needs related to EBM and
patient empowerment — and identifying the provider segment(s) that will
make the most promising allies and supporters of future strategic initiatives
Meanwhile, Maddock Douglas, Ringleader Ventures and the investment
partners will continue the innovation process, creating more innovation assets
for industry participants to leverage toward the shared purpose:
Ways we collaborate with you:
To help stakeholders deliver better health
outcomes (through patient empowerment)
Raphael Louis Vitón, Maddock Douglas
raff.v@maddockdouglas.com
630-563-6412
For partnership opportunities, contact:
Mike Bechtel, Ringleader Ventures
mike.b@ringleaderventures.com
312-715-7405
For investment inquiries, contact: