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�ACCESSING HEALTHCARE IN UNDERSERVED COMMUNITIES��

The time for change is NOW

TAYLLORE WOODS

UNIVERSITY OF HARTFORD

RISK MANAGEMENT AND INSURANCE

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AGENDA

My Background
The importance of health coverage
Challenges in the current healthcare environment
Opportunities for patient-centered care/access
Why innovating the healthcare industry is important

Community efforts
Consumer satisfactions importance
Lack of resources for navigation
Risks involved if innovation does not occur from patient perspective
My innovation – the solution

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BACKGROUND

ABOUT ME

Risk management and insurance
Women's leadership program
Students of color group
First degree Black Belt
Passion to help communities with my understanding of risk and how to manage it

PROJECT

13 weeks of research

Subject matter experts, building innovation prototype, weekly papers, weekly meetings with Professor. Thomson

My project has been created through the lens of risk management, integrating the use of technology to manage/mitigate risks involved

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HEALTH COVERAGE IS IMPORTANT FOR PEOPLE

The National health expenditure in the United States is $3.8T and it has grown 4.5% since 2019 which amounts to $11,582 per person.

54% - private insurance (avg cost: $456 ind., $1,152)
29% - public insurance
16% - uninsured which includes 50 million Americans (including 8 million children)

Health insurance is a plan you buy and in return you receive coverage for different kinds of medical care
Protects people from risk of large financial losses due to medical expenses associated with care
Social programs – Medicare/Medicaid to help groups of citizens pay for medical costs
Private programs – Health maintenance organizations (HMOs), Preferred provider organizations (PPOs), Exclusive provider organizations (EPOs), Point of service plans (POS) and high deductible health plans – maybe linked to HSA

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UNINSURED AMERICANS

Less likely to have preventative care and procedures

Lack resources to access the healthcare industry

Other responsibilities with higher priority in their lives

Lack of convenience to receive care in rural areas

Ineligibility for public insurance plans

Young people believe they don’t need insurance

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HEALTH COVERAGES COMPARED TO UNITED STATES

United Kingdom:

Funding: general taxations and payroll tax

Government roles: controls the healthcare system and set general policies/health legislations

Maintaining quality: care quality commission and nurses improving care for health technology for efficacy and cost effectiveness

Canada:

Funding: publicly funded - country's 13 provinces and territories – each have its own insurance plans and cash assistance from federal Gov. on a per capita basis

Government roles: oversee financing, organizing, delivering health services, supervising providers to provider consistency across all healthcare

Maintaining quality: Canadian Institute for health information reports and monitors system performance + 7 more agency's

Statistics & facts to Think About

United kingdom:

Universal healthcare – believes all residents are entitled to free public health care
Founded by NHS – designed to eliminate illness, poverty, unemployment and improve education
10.5% (21/200) of UK’s population has voluntary supplemental care – 4 million policies
Private health care is for rapid access care, choice of specialists, better amenities and elective hospital procedures

Canada:

Decentralized universal healthcare
Financial relief for citizens with high out of pocket expenses – after 3% of net income (CAD 2,288, USD $1,816) – for eligible medical expenses per year.

(tax credit of 15% for remaining expenses

2/3 of Canadians have private health insurance which covers dental, vision, outpatient drugs, rehabilitation and private hospitals rooms which are paid through unions, employers and other organizations with group contracts

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UNITED STATES HEALTHCARE ISSUES FOR PEOPLE

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COMMUNITY EFFORTS

It will take a community to tackle a massive challenge such as our complex healthcare industry

Current examples of companies disrupting their current industry for opportunities with technology innovations

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CURRENT CHALLENGES IN THE HEALTHCARE INDUSTRY

Lack of access for all people
Focusing on patient centered experience, not only point of care
Convenient and easy access to all parts of the healthcare experience
Lack of technology innovation for the end-to-end patient experience

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PATIENT PERSPECTIVE

WANTS

Patient satisfaction to be a priority

Providers they can connect with and feel comfortable around – find easily

To feel heard and taken into consideration about their concerns about the healthcare industry

NEEDS

End to end patient experience

Lower costs for care

Education about healthcare and coverage

Accessibility and equity

BENEFITS

Patients will feel like a priority in all aspects of the healthcare industry = higher satisfaction rates = positive health turnouts

Less stress for patients when it comes time to accessing and following through all elements of healthcare processes

Healthcare insurance providers and financers will have more understanding for their patients (customers)

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INNOVATION IS IMPORTANT

Innovations create opportunities for companies and consumers to enhance experience and operations from both perspectives

Quality and accessibility are what consumers are looking for, technology is the point of access now and it is time to start utilizing them

Lives are depending on the innovation of the end-to-end patient experience

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END-TO-END PATIENT EXPERIENCE

The healthcare industry is a customer service industry
Currently there are key touch points in care facilities that provides support for the patient

Scheduling, service and delivery

There is always potential for innovation at all current and new touch points

There is a disconnect for patients in the healthcare experience
Billing and insurance claims are the most traumatic part for most people

Miscommunications happen most here

There is no relationship between payer/financing service and patient
Obvious need for accessing financial services and insurance companies

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INEQUITIES IN UNDERSERVED COMMUNITIES

Inability to access care easily if at all

Includes: travel distance, cost, entering the healthcare industry, ineligibility for social programs, time spent on more important priorities

Lack of support through financial struggles, no understanding of experiences an individual and their families go through

Gender/racial biases in the healthcare industry

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ACEQ SOLUTIONS

Mission statement:

To provide substantial services all in one place for underserved communities to educate, manage, access, and rely on for everything related to healthcare.

Value:

To communities that lack the resources to access healthcare and are facing life/death decisions resulting from lack of resources.

Goals:

To provide an easy use application for patients to easily access the end-to-end experience for people.

*All in one platform to access all features of your healthcare experience*

Access – Cost – Equity – Quality

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PERSONAL RISK PROFILE

CHALLENGE

Not everyone receives preventative services or knows how to manage their own health conditions

SOLUTION (FEATURE)

Personal risk profile (AI)

Personal health information
Financial information – insurance plan
Suitable coverage based on personal risk profile
Recommendations based on PHI from risk profile
Appointment reminder
Risk behavior information – technology to promote proactive measure based on risk profile

BENEFIT

Preventative and proactive care is important to maintaining health.

connectivity amongst devices for easy access for patients

patients can access, manage and maintain features of their own health

providers can utilize this information, that can be updated at any time by patient

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CARE CONNECTOR

CHALLENGE

In underserved communities and rural areas, it is hard to find a doctor/specialist/provider that fits your financial and personal needs

Patients want doctors they can relate with and be comfortable with.

SOLUTION (FEATURE)

care connector - customizable (telematics)

View information on doctor with reviews from patients (current/past)
Write reviews on your doctor right under their profile
Find a care provider in your area – specific to your need

BENEFIT

Helps patients find providers with their specific wants/needs

In rural and underserved communities, it is hard enough to access healthcare. Patients in these areas want people that understand their experiences and near them

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EDUCATION

CHALLENGE

In underserved communities and rural regions, there is a lack of education about healthcare access

SOLUTION (FEATURE)

Education feature (AI)

Terminology used in healthcare and insurance
Financial terminology used in insurance
Common questions asked

BENEFIT

Patients will be able to advocate for themselves having common terminology defined

Patients can ask informed questions about care, finances etc.

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END-TO-END PATIENT EXPERIENCE

CHALLENGE

Key touch points are not all innovated for patient centered experience

Patients are not engaged throughout the entire process and desperately need help

SOLUTION (FEATURE)

Billing and claims process access (AI)

Current insurance plan connected to app
Account information with full functionality to contact provider and ask questions
Uninsured patients: assistance on how to access, help with financial coverage and suitable plans/options for the patient
Financial recommendations customized for patient to help them navigate and manage their finances

BENEFIT

Importance on the patient and the way they are accessing and managing paying for medical expenses

Begins a relationship between the payer and patient

Collecting data on patient to make informed decisions

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PATIENT SOCIAL NETWORK PLATFORM

CHALLENGE

Patients don’t have a safe space to converse about recommendations and ideas from other patients with similar health conditions/disease/financing troubles etc.

SOLUTION (FEATURE)

Patient social network platform

Chat groups specific/related to patient to share ideas and recommendations
Ideas and recommendations can be sent to company to help patients have a say in their healthcare experience
Data (common themes) from chat groups will be logged to improve and enhance patient experience on a constant basis providing new features

BENEFIT

Patients will feel connected to one another and won’t feel like they are the only ones going through troubles

Provides a platform for ideas from the patient perspective come to life

Provides data and information for companies utilize

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SWOT ANALYSIS OF ACEQ

Strengths: innovative technology, THE patient experience, trusted relationship with patients, accessible to anyone, patient social networking platform

Weaknesses: many different features and providers involved, personal information all in one spot, disrupt current industries that are focused on generating revenue

Opportunities: Trusted partnerships with well-known companies, relationships with hospitals and care facilities, consumers are looking for a voice in healthcare industry

Threats: cybersecurity threats affect personal identifiable information (PII), third party vendor risks, regulations in place that could put hold on certain features

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