Telehealth Advisory Council, Florida Blue Experience February 21, 2017

Table of Contents Florida Blue History in Telehealth 3 Florida Blue Approach 4 Current Offerings View 5 Current Offerings & Results 6 Current Offerings & Results – Care Management Pilots 7-10 Former Experience 11 Summary of Results Experienced and Barriers to Entry 12 Reimbursement 13-14 Questions 15 2

Florida Blue History in Telehealth 2009 – Florida Blue was an early adopter of e-visits, using Relay Health vendor to support 2013 – Researching opportunities within remote monitoring 2014 – Florida Blue partnered with provider to support kiosk offering 2014 – Began working with vendors for vendor based telemedicine offering 2015 – Present - Working with providers for telehealth video consultation pilots 3

Florida Blue Approach Listen to customer needs and wants. Evaluate, develop pilots and test opportunities in Telehealth Monitor. Looking for improved quality outcomes which are beneficial for all. Interested in market needs driving offerings. Find solutions that increase quality outcomes for members 4

Current Offerings Telehealth at Florida Blue Remote Monitoring Telehealth pilots with Florida Blue Network Providers In Progress Broader Telehealth pilots with Florida Blue Network Providers Telemedicine pilot (vendor offering network and technology) (Teladoc) Equipment / Kiosks Remote Monitoring Telehealth at Florida Blue 5

Current Offerings & Results Telemedicine offering through Teladoc to self-funded employer groups Two employer groups purchased the benefit for 2016 Utilization was 2.2% and 2.22% 228 total visits from both groups’ employees and dependents Currently, a total of 11 employer groups (8 %) have added the benefit . Telemedicine pilot (vendor offering network and technology) (Teladoc) 6

Current Offerings & Results – Care Management Pilots Pilot with Nicklaus Children’s Hospital and Neuro Network Partners Population of fully insured & Federal Employees epileptic & migraine pediatric patients Access to care for acute episodes Aligned quality metrics No utilization to date 4% have accepted the access offering and registered for potential future events 18% of targeted patients have declined to participate Currently evaluating barriers to participation . Telehealth pilots with Florida Blue Network Providers In Progress 7

Current Offerings & Results – Care Management Pilots Pilot with Nemours Population of fully insured and Federal Employee asthma and diabetes patients Access to care for chronic condition management and acute episodes Aligned to quality metrics No utilization to date We will evaluate barriers to participation Telehealth pilots with Florida Blue Network Providers In Progress 8

Current Offerings & Results – Care Management Pilots Two additional telemedicine virtual visit pilots with implementations expected soon Others in exploratory stage . Broader Telehealth pilots with Florida Blue Network Providers 9

Current Offerings & Results – Care Management Pilots Remote Monitoring Monitoring equipment for COPD and CHF patients Early identification and preventative/quick treatment Population of Medicare Advantage members 540 engaged Quality improvement results are to be determined Remote Monitoring 10

Former Experience Kiosk Offerings Partnered with provider to offer kiosk telehealth access offering in Miami Utilization was low with approximately 100 visits over 12 operational months Kiosk company filed bankruptcy, as such Florida Blue is no longer involved in the pilot . Equipment / Kiosks 11

Summary of Results Experienced and Barriers to Entry Utilization for new offerings is low We are experiencing this trend with our telehealth offerings We are working to better understand the market Of the providers with whom we have collaborated, technology setup is a barrier Approximately half do not prioritize the infrastructure One quarter have and/or are moving forward with a pilot One quarter have the technology, but have other barriers to moving forward at this time (capacity, program design) Mainly large systems have the capabilities . 12

Reimbursement Focus is on gaining knowledge to find appropriate use cases for telehealth Pilots are a successful test vehicle Currently, we do not reimburse for telehealth outside of our pilots As with other services, we need the ability to negotiate rates with all providers for all services on behalf of our members Collaboration with provider partners has enabled pilot implementations without the need for regulation . 13

Reimbursement Florida Blue reimburses for the same services via telehealth within the pilots as we do for face-to-face For example, if our policy is that a prescription refill is not a reimbursable event on its own (without additional monitoring, evaluating, and assessing), this policy would hold true for a telehealth visit as it does for face to face. 14

Questions ??? 15