SERVICES AGREEMENT
This Agreement is effective this 21 day of June, 1996, (the "Effective Date")
between Disease State Management, Inc., 00 Xxxxxx Xxxxxx, Xxxxxxxxx, Xxx Xxxx
00000 ("Vendor") and EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES. Vendor agrees
to provide services to EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES under the
terms set forth below.
A. SERVICES
Vendor will provide the product(s) or service(s) set forth, and to the
specifications set forth in the proposal incorporated herein as Attachment
A.
The product and all elements as set forth on Attachment A are subject to
prior approval by EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES, such approval
not to be unreasonably withheld.
B. COMPENSATION
EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES will pay Vendor according to the
terms or payment schedule set forth in Attachment A hereto.
In the event that EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES shall request
any changes in the concept, specifications or scope of the product(s) or
service(s) described on Attachment A hereto, Vendor will notify EQUIFAX
HEALTHCARE ADMINISTRATIVE SERVICES of the cost of such revisions and will
not proceed without prior written approval.
If the compensation provision on Attachment A hereto is other than a flat
fee amount per element or for the entire project, Vendor will provide such
documentation in support of all xxxxxxxx as EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES may reasonably require.
C. CONFIDENTIALITY
1. EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES and Vendor acknowledge that
certain confidential and proprietary information may be disclosed by one of
them to the other in the course of this Agreement. For purposes of this
Agreement, the term "Confidential Information" includes the following: (a)
All information regarding the patient, EQUIFAX'S Customer, any patient
medical data and/or status, or provider information; and (b) any other
information identified as confidential in writing by the disclosing party
prior to disclosure. Notwithstanding the confidentiality requirements of
this Agreement, the foregoing shall not prevent EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES from retaining information, including any and all
information and data pertaining to any patient which comes to EQUIFAX
HEALTHCARE ADMINISTRATIVE SERVICES or to which EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES is given access during this Agreement.
2. Should EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES receive confidential
information of Vendor for use in performing their Services, EQUIFAX
HEALTHCARE ADMINISTRATIVE SERVICES agrees to take all reasonable steps to
safeguard the confidentiality of said information and to prevent
unauthorized disclosure thereof by EQUIFAX HEALTHCARE ADMINISTRATIVE
SERVICE'S employees, agents and representatives. EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES shall maintain strict security procedures to
protect the confidentiality of any information received, stored, or
delivered on
Disease State Management -SM- and DSMI -SM- are servicemarks of
Disease State Management, Inc.
patients in the EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES or any
affiliated or associated company's database.
3. The data released hereunder to Vendor regarding patients, patient
medical data, EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES Customers, and
provider information, is considered sensitive and confidential information.
Vendor warrants that is shall use any information provided by EQUIFAX
HEALTHCARE ADMINISTRATIVE SERVICES strictly for the performance of this
Agreement. Vendor acknowledges and agrees to take all steps necessary to
safeguard the confidentiality of all information and reports, whether oral
or written, maintain such information as strictly confidential and to
prevent unauthorized disclosure thereof by Vendor's employees, agents,
representatives and other third parties. Vendor warrants that all such
information and reports will not be disclosed to any person, organization
or entity other than EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES.
4. Each party shall hold the other party, its affiliated companies, the
officers, agents, employees, and independent contractors of the other
party, harmless and shall indemnify and defend such party for any claim of
expense or damage, whatsoever, resulting from the publishing or release by
such party, of information contrary to the above conditions.
5. The obligations of the Paragraph shall not apply to any Confidential
Information which the recipient can demonstrate is or becomes available to
the public through no breach of this Agreement.
6. Neither party to this Agreement shall, except as may be required by law
or federal regulation, or except with express written permission of the
other party, disclose the terms and conditions of this Agreement to any
third party or publicly advertise its contents.
7. The parties agree that Vendor's breach of any of its material
obligation under the applicable Confidentiality provisions of this
Agreement, may cause EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES irreparable
injury for which it would have not adequate remedy at law, and that EQUIFAX
HEALTHCARE ADMINISTRATIVE SERVICES shall be entitled to specific
performance or preliminary or other injunctive relief in addition to any
and all remedies it may otherwise be entitled to at law or in equity.
8. This Paragraph shall survive the termination of this Agreement.
Vendor shall not duplicate any material containing EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES Confidential Information, except in the direct
performance of its services under this Agreement. Vendor shall return all
copies of materials containing EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES
Confidential Information upon Vendor's completion of services under this
Agreement or upon any earlier termination of this Agreement for any reason
whatsoever.
D. INDEMNIFICATION
D1. Each party shall indemnify and hold the other party harmless from and
against all liability, damages, penalties, losses, costs or expenses,
including reasonable attorneys' fees, arising from or in any way related to
its willful or negligent actions or omissions in performing the
responsibilities as described in this Agreement.
D2. "Limitation of Liability"
Neither EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES nor vendor shall in any
way be liable for any special, indirect, exemplary, incidental or
consequential damages, whether based on contract, tort, or any other legal
theory, even if EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES or vendor has
been previously advised of the possibility of such damages. This paragraph
shall survive the termination of this agreement.
E. PROFESSIONAL STANDARDS
Vendor represents that it has facilities, personnel, experience and
expertise sufficient in quality and quality to perform all such assignments
and projects given it by EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES
hereunder and agrees that it will perform all such assignments and projects
in a manner commensurate with professional standards generally applicable
to its industry.
F. OWNERSHIP OF MATERIALS
The parties acknowledge that any modifications to the printed materials
produced by its asthma program for EQUIFAX HEALTHCARE ADMINISTRATIVE
SERVICES are being created at the insistence of EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES and shall be deemed "work made for hire" under the
United States copyright law.
EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES shall have the right to use the
whole work, any part of parts thereof, or none of the work, as it sees fit.
EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES may alter the work, add to it,
or combine it with any other works, at it sole discretion. Notwithstanding
the foregoing, all original material submitted by Vendor as part of the
work or as part of the process creating the work, including but not limited
to listings, printouts, documentation, notes, reports, shall be the
property of EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES whether or not
EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES uses such material. No rights
are reserved by Vendor.
All surveys, reports, data, documentation and all other information
prepared by Vendor in connection with the performance of its services
hereunder will become and remain EQUIFAX'S sole property. Title to all
material and documentation, including data furnished by EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES to Vendor or delivered by EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES into the Vendor's possession shall remain with
EQUIFAX. Vendor shall immediately return all such material or
documentation within seven (7) days of any request by EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES or upon the termination or conclusion of this
Agreement, whichever shall occur first.
EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES hereby grants Vendor a worldwide
perpetual royalty free license to the data and information created by
Vendor in connection with this agreement for purposes of making marketing
presentations to other potential customers and for the development and
sales of additional products based upon this data. Vendor's use of this
data is limited to instances where data will not be identified by patient
or by client of EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES.
Vendor agrees it will not disclose to any third party, without the prior
written consent of EQUIFAX, any proprietary or confidential information
acquired from EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES under this
Agreement, including trade secrets, business plans and confidential or
other information which may be proprietary to EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES.
Vendor warrants and represents that is has or will have the right, through
written agreements with its employees, to secure for EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES the rights called for in this Section. Further, in
the event Vendor uses any subcontractor, even though subcontracting is not
permitted by this Agreement, or other third party to perform any of the
services contracted for under this Agreement, Vendor agrees to enter into
such written agreements with such third party, and to take such other steps
as are or may be required to secure for EQUIFAX HEALTHCARE ADMINISTRATIVE
SERVICES the rights called for in this Section.
G. DURATION OF AGREEMENT
1. Term
This Agreement is effective as of the Effective Date and shall continue in
full force and effect until the earlier of (i) completion of the project
assigned hereunder, (ii) terminated by at least thirty (30) days written
notice by either party to the other, sent by registered mail to the address
for each party first set forth above, or to such other address which a
party may designate for its receipt of notices hereunder. This Agreement
may be terminated by EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES immediately
in the event EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES is unable to obtain
waivers from its customers regarding Vendor's services.
2. Payment on Termination
Upon termination of this Agreement EQUIFAX HEALTHCARE ADMINISTRATIVE
SERVICES is to pay for all authorized work in process.
3. Transfer Upon Termination
Vendor shall transfer, assign and make available to EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES or EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICE'S
representative all property and materials in Vendor's possession or control
and any copies thereof belonging to and paid for by EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES, and all information regarding EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICE'S project(s) covered by this Agreement, as set forth
in Paragraph C herein.
4. Neither EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES nor Vendor shall be
liable to the other for damages of any kind, including but not limited to
lost profits or Incidental, punitive or consequential damages, relative to
termination of this Agreement in accordance with Section 6.2, even if
advised of the possibility of such damages.
H. INDEPENDENT CONTRACTORS
Vendor shall at all times be an independent contractor and shall so
represent itself to all third parties. Nothing in this Agreement shall be
deemed to constitute either party the agent or legal representative of the
other nor to constitute the parties as partners, agents or joint ventures
of one another.
I. THIRD PARTY OBLIGATIONS
In connection with this Agreement, Vendor shall make no commitments or
disbursements, incur no obligations nor place any advertising, public
relations or promotional material for itself EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICE'S its parent, subsidiaries or affiliate companies,
nor disseminate any material of any kind using the name of EQUIFAX
HEALTHCARE ADMINISTRATIVE SERVICES and/or EQUIFAX HEALTHCARE ADMINISTRATIVE
SERVICE'S such parent, subsidiary or affiliate companies or using their
trademarks, without the prior written approval of EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES.
J. GOVERNING LAW
This Agreement is entered into in the State of Texas and shall be
constructed and governed under and in accordance with the laws of that
State.
K. MISCELLANEOUS
1) The terms of this Agreement shall be binding upon EQUIFAX HEALTHCARE
ADMINISTRATIVE SERVICES and Vendor and their respective successors and
permitted assigns. Notwithstanding the foregoing, this Agreement is not
assignable in whole or in part by Vendor without the prior written consent
of EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES. Factoring of accounts
receivable is not permitted.
2) The failure of either party to take action as a result of a breach of
this Agreement by the other party shall constitute neither a waiver of the
particular breach involved nor a waiver of either party's right to enforce
any or all provisions of this Agreement through any remedy granted by law
or this Agreement.
3) EQUIFAX HEALTHCARE ADMINISTRATIVE SERVICES is an Equal Opportunity
Employer and does not discriminate against any person because of race,
color, creed, age, sex, or national origin. Vendor represents that it has
the same policy of Equal Opportunity Employment.
4) This Agreement contains the entire understanding of the parties with
respect to the subject matter contained herein, supersedes any prior
written or oral communications and may be modified in writing subject to
mutual agreement of the parties hereto.
5) The headings of each paragraph are for reference only and shall not be
construed as part of this Agreement.
6) Except for the obligation to pay money property due and owing, either
party shall be excused from any delay or failure in performance hereunder
caused by reason of any occurrence or contingency beyond its reasonable
control, including. but not limited to, failure of performance by the other
party, earthquake, labor disputes, riots, governmental requirements,
inability to secure materials on a timely basis, failure of computer
equipment, failures or delays of sources from which information or data is
obtained and transportation difficulties.
IN WITNESS WHEREOF, the parties hereto, each by a duly authorized officer, have
entered in to this Agreement this 21 day of June, 1996
EQUIFAX HEALTHCARE Disease State Management, Inc.
ADMINISTRATIVE SERVICES, INC. 00 Xxxxxx Xxxxxx
0000 Xxxxxx Xxxxxx Xxxx Xxxxxxxxx, Xxx Xxxx 00000
Xxxxx 0000X
Xxxxxx, XX 00000
By: /s/ M.E. Xxxxxx By: /s/ Xxxxxx X. Xxxxxxxx
--------------------------- ---------------------------
Title: Vice President & C.O.O. Title: President & C.E.O.
----------------------- ---------------------------
Portions of this Exhibit have been omitted pursuant to a request for
confidential treatment. The omitted portions, marked by [****], have been
separately filed with the Commission.
--------------------------------------------------------------------------------
ATTACHMENT A
ASTHMA
DISEASE MANAGEMENT
PROPOSAL
____________________________________________
FOR
EQUIFAX HEALTHCARE ADMINISTRATION
SERVICES
PRESENTED BY
Disease State Management,-SM- Inc.
00 Xxxxxx Xxxxxx
Xxxxxxxxx, Xxx Xxxx 00000
000-000-0000
Disease State Management and DSMI are registered service
marks of Disease State Management, Inc.
--------------------------------------------------------------------------------
Asthma places a tremendous burden on patients and health care providers and
demands a significant portion of our nations health care dollars. Disease State
Management, Inc.-SM- is committed to improving health outcomes through the
application of state of the art technologies. Our proprietary interactive voice
recognition systems, enhanced database modeling techniques and on-demand
publishing combine to provide the powerful educational intervention necessary to
enhance patient adherence to treatment recommendations, empower patients to
self-manage their disease and provide immediate referrals when specific "high
risk" triggers are met.
DSMI's-SM- staff of systems engineers, clinical experts and physician
consultants perform a comprehensive review of the targeted disease state to
insure that "best practices" and nationally recognized guidelines form the
program's foundation. Recognized leaders in outcomes management provide
guidance throughout the project development process.
Once the baseline parameters have been established, our staff begins the process
of building the intervention protocols. DSMI's-SM- asthma intervention program
consists of six interactive voice response based telephone interventions. Each
contact generates on-demand published educational materials targeting individual
concerns. Additionally, physicians and other health care providers receive an
at-a-glance formatted report for inclusion in the patient's medical records.
These reports highlight specific areas of concern for the patient and
demonstrate areas where an individual's adherence to the prescribed therapy is
lacking.
As an extra feature, DSMI's-SM- clinical staff establishes specific "at risk"
triggers that are continually monitored. Patients meeting specific criteria
demonstrating an increased risk of hospitalization, emergency services or other
costly intervention will have their providers notified immediately for follow
up. This critical notification and tracking of key indicators has been
demonstrated to reduce the global cost of managing chronically ill patients.
Each intervention is uniquely structured and targets specific behaviors such as:
diet, exercise, smoking cessation, self-management, key triggers and
compliance with pharmacological therapy. By providing unique, individually
tailored intervention strategies, DSMI-SM- not only highlights areas where
noncompliance and poor self management are impacting the plan's expenditures but
also provides an active intervention to modify "at risk" behavior before an
emergency room visit or hospitalization occurs.
In addition to providing ongoing support for patients, DSMI's-SM- fully
integrated systems approach allows for immediate on-line data collection and
evaluation. Interactive Voice Recognition systems allow administration of
HEDIS, Health Quality, patient satisfaction, and Quality of Life surveys without
operator induced bias. The process streamlines data collection and provides a
cost effective method to query patients.
TRENDS IN ASTHMA
Chronic lung diseases such as asthma, bronchitis and emphysema pose serious
challenges to both patients and health care providers. Despite an increased
understanding of these disorders, improved pharmacological therapies and a
greater awareness among potential sufferers, the incidence rates continue to
soar. In fact, between 1982 and 1993 the number of people reporting chronic
bronchitis increased seventy-nine percent, while those having emphysema and
asthma increased twenty-five and forty-eight percent respectively.(1)
Currently, over twelve million people suffer from asthma in the United States,
making it not only one of the nation's most common diseases but one of the most
costly as well.
INCREASE IN INCIDENCE RATES: 1982 - 1992
[GRAPH]
DEATH RATE FOR ASTHMA: 1982 - 1992 (PER MILLION)
[GRAPH]
While the reason for the rapid growth in the number of chronic suffers remains
uncertain, one thing is certain: these diseases pose a serious threat to
patients' well being. Despite tremendous advances in both diagnostic and
pharmacological therapies in recent years asthma continues to exact a tremendous
financial toll in terms of both direct and indirect costs.
___________________________
(1) American Lung Association, Adapted form information published by the
Division of Epidemiology, National Heart, Lung and Blood Institute
IMPACT OF INCREASED PATIENT EDUCATION EFFORTS
The economic impact of asthma is staggering. In asthma patients diagnosed as
moderate to severe the annual cost of treatment often exceeds $ 100,000. In
fact, Xxxx Xxxxxxx Mutual Life Insurance Company in Boston has identified 1,300
patients whose care resulted in $28 million dollars in expenditures. Among the
most common reasons for exacerbation of symptoms are: an inability of the
patients to self-manage their disease, poor pharmacological compliance, low
adherence to provider recommendations, a lack of patient knowledge concerning
their disease and failure of the provider to adhere to established treatment
guidelines; all areas that DSMI's-SM- asthma intervention program will impact.
* Study of severe asthmatics found 1,300 patients generated $ 28 million
in claims
* Highest individual level of asthma-specific costs was $ 126,343
* Highest expense for all care were for a 2 year old female - $ 584,211
* 235 members had claims exceeding $ 100,000 annually for treatment
Targeted educational intervention programs for asthma patients have proven
effective. A recent study, conducted at the National Jewish Center for
Immunology and Respiratory Medicine and the Xxxx Xxxxxxx Managed Care Group,
demonstrated significant improvements in patient outcomes for severe asthmatics
following a comprehensive initiative to educate patients.
PATIENTS ADMITTED WITHIN THE PAST 6 MONTHS
[GRAPH]
ADMISSIONS WITHIN THE PAST 6 MONTHS WERE LOWER IN PATIENTS RECEIVING TARGETED
SUPPORT.
Additionally, personalized asthma self management, which tailors program
materials to the individual, has demonstrated positive results in moderate to
severe asthmatics (2)(3). In a recent investigation incorporating targeted
support, the extension of face-to-face treatment via follow-up telephone calls
to the patient's home was rated more convenient and more acceptable to patients
than traditional group sessions (X.X. Xxxxx, personal communication, July 12,
1994). Finally, in a cost-benefit analysis of a self-management program for 47
adult asthmatics effectively reduced hospitalization cost from $18,488 to $1,538
and lost income from $11,593 to $4,589.(4)
_________________________
(2) Kotses H., Xxxxx X., Environmental control of asthma self-management.
Journal of Asthma. 1990; 27:373
(3) Kotses H., Xxxxx C., Xxxxx X.X., Individualized asthma self-management: A
beginning. Journal of Asthma. 1991; 288:287-289.
(4) Taitel M.S., A self-management program for adult asthma. Part II: Cost-
benefit analysis. Journal of Allergy and Clinical Immunology.
1995;95(3):672-6.
FINANCIAL IMPACT OF ASTHMA
The following analysis reflects admission costs data for patients having severe
asthma. It reflects incident and admission rates for severe asthma as indicated
by the American Lung Association.
# of Covered Lives 500,000 500,000 500,000
------------------------------------------------
Asthma Incidence Rate 0.05 0.05 0.05
------------------------------------------------
# Asthma Patients 25,000 25,000 25,000
------------------------------------------------
# Patients with Severe asthma 1250 1250 1250
------------------------------------------------
Cost per Day as Inpatient $1,000.00 $1,000.00 $1,000.00
------------------------------------------------
Average Length of Stay ( days ) 4 4 4
------------------------------------------------
# Hospitalizations/year 3 2 1
------------------------------------------------
Annual Hospitalization Cost/Patient $12,000.00 $8,000.00 $4,000.00
------------------------------------------------
------------------------------------------------
Total Hospitalization Cost to Plan $15,000,000.00 $10,000,000.00 $5,000,000.00
------------------------------------------------
------------------------------------------------
IMPACT OF DISEASE MANAGEMENT PROGRAM
------------------------------------------------
# Patients Enrolled in DM Program 1250 1250 1250
------------------------------------------------
Estimated Operational Costs/Patient $70.00 $70.00 $70.00
------------------------------------------------
Total Operational Costs $87,500.00 $87,500.00 $87,500.00
------------------------------------------------
------------------------------------------------
------------------------------------------------
PROJECTED REDUCTION IN ADMISSIONS
------------------------------------------------
5% Reduction 5.00% 5.00% 5.00%
------------------------------------------------
Annual Savings $750,000.00 $500,000.00 $250,000.00
------------------------------------------------
7.5 % Reduction in Admissions 7.50% 7.50% 7.50%
------------------------------------------------
Annual Savings $1,125,000.00 $750,000.00 $375,000.00
------------------------------------------------
10 % Reduction in Admissions 10.00% 10.00% 10.00%
------------------------------------------------
Annual Savings $1,500,000.00 $1,000,000.00 $500,000.00
------------------------------------------------
------------------------------------------------
------------------------------------------------
% Success Rate Required to Break Even 0.58% 0.88% 1.75%
------------------------------------------------
# Pts. Avoiding Admission to Break Even 7 11 22
------------------------------------------------
PROGRAM OVERVIEW
See the "Program Intervention Description" section for details about each of the
interventions. The selected intervention schedule will be delivered to patients
who are enrolled in the program. Note that the term "provider" is used to
denote a case manager or another health care provider designated to receive
communications regarding the patient.
I. COMPONENTS
* Business reply mailer
* Patient diary
* Program description/overview
* Custom designed educational materials
* Demand published patient reports
* Demand published provider reports
* Crisis flags
* Voice demonstration line
* Logo integration
II. INTERVENTION PROTOCOL:
MONTH 1:
* Patient enrollment via business reply mailer
* Initial telephone intervention within seven days of business reply mailer
receipt
* Patients receive demand published report following IVR intervention
* Appropriate preprinted educational materials sent to patients
MONTHS 2 - 4
* Patients receive interactive voice response based telephone interventions
monthly
* Patients receive demand published report following each IVR intervention
* Appropriate preprinted educational materials sent to patients
* Physician receives demand published, patient specific report for inclusion
in patient record following IVR intervention at month 2 and 4
* Additionally physician receives immediate notification via phone/fax for
any patient reporting status indicating a critical "at risk" trigger has
been met
MONTHS 6 AND 8
* Patients receive interactive voice response based telephone interventions
* Patients receive demand published report following each IVR intervention
* Appropriate preprinted educational materials sent to patients
* Physician receives demand published, patient specific report for inclusion
in patient record following IVR intervention at month 8
* Additionally physician receives immediate notification via phone/fax for
any patient reporting status indicating a critical "at risk" trigger has
been met
Month 1 2 3 4 6 8
--------------------------
IVR Intervention * * * * * *
--------------------------
Patient Report * * * * * *
--------------------------
Physician Report * * *
--------------------------
Preprinted Materials * * * * * *
--------------------------
"At risk" Reporting
(as needed) * * * * * *
--------------------------
PROGRAM INTERVENTION DESCRIPTION
See the "Program Schedule" section for an outline of the protocol for
delivering these program components. Note that the term "provider" is used
to refer to a physician, case manager or other health care provider
designated to receive communications regarding the patient.
BUSINESS REPLY MAIL (BRM)/PROGRAM DESCRIPTION
* Two (2) page pre-printed mailer designed for distribution by providers to
patients and return via postage paid mail
* Provides brief assessment for identifying patient data (e.g., name,
phone number, best time to contact) necessary for DSMI-SM- to initiate a
telephone call to patient
* Program description includes a brief program overview
INTERACTIVE VOICE RECOGNITION BASED TELEPHONE INTERVENTIONS
* Six (5) minute interactive voice recognition base telephone interventions
initiated by live operators to patients at preferred contact times
* Cost-efficient interface: operator-initiated contact to identify patient
and transfer to automated, voice response system
* High appeal voice response system using a recorded human voice versus
computer synthesized speech
* Patient responds in normal speaking voice versus pushing touch tone
buttons
* Self-report follow-up assessment of relevant medical and behavioral
factors: update on disease status, prescribed treatment including diet,
exercise, and medications, patient motivation, treatment barriers, patient
knowledge indicators regarding symptom identification and disease self-
management
* Patient receives personalized questions and clinically appropriate
feedback driven by expert system to promote patients' awareness of their
condition and adherence to their treatment regimen
* Allows identification of patient concerns
* Adds vital progress information to the longitudinal patient database
PATIENT REPORTS
* Laser printed, on-demand published report including personalized text
and graphics
* Mailed to patient within a week after each telephone intervention
* Personalized and pre-printed materials reinforce patient awareness and
knowledge regarding their condition and promote treatment adherence
PHYSICIAN REPORTS
* One page laser printed, on-demand published report integrating
patient's follow-up and enrollment data
* Mailed to patient's provider within a week after each patient
interactive voice response intervention
* "At-a-glance" format provides efficient documentation of critical
patient data, ready for insertion into the medical record
Portions of this Exhibit have been omitted pursuant to a request for
confidential treatment. The omitted portions, marked by [****], have been
separately filed with the Commission.
* Facilitates identification of patient education needs and hard-to-
manage patients, appropriate allocation of health care resources,
and timely modification of treatment regimens
* Enhances patient-provider communication
"AT RISK" REPORTING:
* Physicians/providers will be notified via fax when patients report
symptoms, noncompliance or other critical factors indicating an increased
risk for an acute event, hospitalization or emergency procedure
OPERATIONAL REPORTING:
DSMI-SM- will provide operational and outcome reports quarterly.
PROGRAM FEES:
[*****] In lieu of such payment Equifax Healthcare Administration Services
agrees:
Program operational fees shall be are based upon a minimum enrollment of 2000
patients within 36 months of the effective date of this agreement. The
operational fee for the first 2000 enrollees shall be $[*****] per enrollee.
Fees for all subsequent enrollees shall be $[*****] per enrollee. In the event
that Equifax Healthcare Administration services fails to achieve a minimum of
2000 enrollees within 36 months of the effective date of this document, equifax
healthcare administration services agrees to a one time liscensing fee equal to
( 2000 minus the number of enrollees achieved times $[*****]. Such payment is
due 36 months from the effective date of this contract.
Program operational fees shall be billed upon patient enrollment and are payable
within 30 days of receipt. Payments exceeding 30 days past due will accrue a
service charge of 1% per month of the outstanding balance. In the event of a
patient withdrawal from the intervention program, DSMI-SM- will prorate the
remaining expenses.
Printing fees for all pre-printed materials (e.g., marketing brochure, BRM,
program description) will be the responsibility of Equifax Healthcare
Administration services. DSMI-SM- will furnish estimates for printing costs
upon determination of volumes and final specifications.
CUSTOMIZATION
Any customization will constitute a revision to the intervention protocol (i.e.,
additional patient and/or physician reports and/or variations in on-demand or IV
content). Any logo design used on the demand published reporting is limited to
black and white/grayscale. DSMI-SM- shall furnish estimates for development and
delivery to Equifax Healthcare Administration Services prior to undertaking any
revision.
