Phoning It In Eric Johnson freshbenies 2.0 – CE Class Slides – Telehealth & Advocacy: Next-Gen Consumerism Tools. Revised 6/27/15.

What’s Going to Happen? Single Payer! The ACA will remain the law of the land (with fixes) The President will let the ACA “explode” The ACA will be repealed and replaced Nothing

We’ll Know Soon Enough The details of the replacement plan aren’t that important. What is important is the current trends in the industry and the impact the changes will have on those trends. With this information, you can start planning to help your clients as the changes are implemented. REVERSE STAY THE SAME ACCELERATE

Trends – the 4 Ps The 4 Ps Premiums Plan Design Prescriptions Provider Networks

Premiums Why? Essential Benefits Guaranteed Issue Healthcare Inflation The Trend Why? Essential Benefits Guaranteed Issue Healthcare Inflation

Premiums Why? Essential Benefits Guaranteed Issue Healthcare Inflation Won’t Change The Trend Why? Essential Benefits Guaranteed Issue Healthcare Inflation

Premiums Long-term, the emphasis on consumerism and transparency could actually bend the trend line downward. It will take time, though. Consumerism The Trend Why? Essential Benefits Guaranteed Issue Healthcare Inflation

Plan Design This isn’t going to change! What we’ve seen: Higher Out of Pockets No up-front copayments More focus on HSAs This isn’t going to change! Instead of a reduction in out-of-pockets, we’ll see a focus on ways to cope with the rising out-of-pockets.

No up-front copayments Prescriptions The Trend: The Proposal: Smaller formularies Preferred pharmacies Higher costs No up-front copayments Speed drugs to market

Provider Networks ACA Replacement Ideas Getting smaller Provider shortage Longer wait times ACA Replacement Ideas More power to the states in regulating provider networks Selling insurance across state lines

More power to the states Source: Patient Protection and Affordable Care Act; Market Stabilization Proposed Rules

Insurance Across State Lines Difficult to accomplish with provider networks May require reference based pricing Possible Result: more balance billing

The 4 Ps Premiums Repeal could set back the premium clock a couple years Trend line won’t change without lower health care costs Plan Design President Trump promises much better coverage at a much lower price Replacement plans focus on expanding HSAs Prescriptions ACA replacement focuses on increasing competition by approving new drugs more quickly Won’t be an instant fix Provider Networks Networks have been shrinking No sign that this will change with ACA replacement

PRESCRIPTION INFLATION

$ $ $ $ $ $

$ Docs $ Rx’s $ Deds OOPs $ Copays $ $

Holes = Cost Strategies Increasing deductibles and out of pockets, increasing or dropping copays, moving drugs to higher Rx tiers, and shrinking provider networks are all strategies put in place to keep premiums under control. Premiums are still going up, just not as quickly…

Employees Don’t Understand

Brokers are lifeboat salespeople But we can’t sell whole lifeboats – they’re not in our clients’ budgets. We have to sell lifeboats with holes. For the past six years, we’ve been strategically placing those holes in the boat. In 2016, we need to fill those holes. We need to do that in 2017 too…

Health Savings Accounts Continued to grow during President Obama’s terms in office Are a big part of President Trump’s proposal Are part of every Republican replacement plan for the Affordable Care Act Are what I’m talking about at 2pm…

Worksite insurance products can fill some of the gaps in coverage Accident plans Critical illness plans Hospital indemnity plans Medical bridge plans

Unfortunately… While these other insurance products can help soften the effect of increasing deductibles and out-of-pocket limits, they do little to offset the access issues created by smaller networks, missing copayments, and less generous drug formularies.

Discount / Savings Networks Can provide alternatives to the insurance discounts offered through the health plan. Pair well with an HSA for dental and vision services.

Telehealth / Telemedicine Can help restore access to health care providers at a time when costs and wait times are increasing. Disclosure: Telehealth is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act. Some state restrictions may apply.

Different Levels of Medical Need Urgent/Emergent, Physicals, Significant Specialty, Surgery IN-PERSON DR. Primary Care, Acute, Short Term, Rx, Triage TELEHEALTH Advice, Triage, No Rx, Primary & Specialists DOCTORS ONLINE

Some charge a consult fee. solved over phone/video. What is Telehealth? Call anytime, consult with a U.S. doc & get a prescription written, if needed. Some charge a consult fee. Some don’t. Up to 70% of medical issues can be solved over phone/video. Telehealth services are available to you at home, work, or wherever you may be. From Teladoc – the industry leader. You can connect via telephone or online video, free of charge, with our network of physicians for informational or diagnostic consultation. This service is a convenient and inexpensive alternative to non emergent Emergency Room, Urgent Care or Physician office visits. Telehealth provides the least expensive and most convenient care. Telehealth offers 24/7 access to its proprietary nationwide network of U.S. licensed physicians for telephone and online video consultations. Physicians provide specific answers to medical questions and advice regarding non-emergency, routine medical conditions. Physicians discuss symptoms, recommend treatment options, diagnose many common conditions, and prescribe medication when appropriate. Telehealth can provide medical diagnosis and treatment for common ailments such as: Cold and flu symptoms Bronchitis Allergies Poison ivy Pink eye Urinary tract infection Respiratory infection Sinus problems Ear infection Many other non emergency acute medical conditions. * On-demand healthcare– wherever and whenever you need, as often as you need * Access to a physician from anywhere via telephone or online, 24/7 * Physicians discuss symptoms, recommend treatment options, diagnose many common conditions, and prescribe medication when appropriate. Never wait for a doctor again! * Save money by avoiding unnecessary doctor’s office or ER visits * Our network of physicians is U.S.-based, licensed, board-certified, rigorously credentialed and experienced * Instant, affordable treatment for all ages - from children to senior citizens * Powerful online health tools that empower members to lead healthier, more productive lives * Prescriptions phoned into your local pharmacy for pickup * HIPAA compliant and confidential * Free Electronic Health Record (EHR) – Store, manage, and share your medical records from one central location Disclosures Telehealth operates subject to state regulation and may not be available in certain states. Telehealth physicians do not prescribe controlled medications. Telehealth is not insurance. Telehealth does not replace your primary care physician. This is NOT Insurance. Some state restrictions apply.

Telehealth Experience Complete medical history Request a consult Talk with a physician Resolve the issue Continuity of care How does the member experience work with Teladoc? Simple 5 steps. This is NOT Insurance. Some state restrictions apply.

Telehealth Value hhhhhhhhhh SHORT- TERM SAVINGS: SHORT & LONG-TERM If they didn’t use telehealth, where would these people have gone? What would these visits have cost? hhhhhhhhhh 8% ER Visit ……………..…… $1,477/visit 42% Urgent Care ……………..…… $163/visit 39% Office Visit ……….……….… $131/visit 11% Do Nothing ………..………… $? Unknown future cost of neglected issues *Per Teladoc member reporting. Individual results may vary. SHORT- TERM SAVINGS: Average medical savings per call: $237 Cost of 4 hours lost productivity: $ 88 …………………………………..……………………..………………….………………… Immediate savings/consult: $325 Multiple studies show the unnecessary visits that are treated in expensive locations. Costs shown here are national averages per E.R. and Dr. visit. A year’s family membership in the freshbenies Health package ($10/family/month) is depicted here. It is a very low cost – compared to the unnecessary visits. The short term, hard-dollar savings are $325/consult. When you consider the ongoing and broader costs, as was analyzed during the Veracity Study, the savings are double this amount. Even just considering the Short-Term savings, with the level of usage freshbenies members have, companies more than pay for the program with these savings. SHORT & LONG-TERM SAVINGS: VERACITY study found cost of higher ER use, readmit rates & neglected issues: ……………………………………………..……………………..………………….………………… Actual savings/consult: $717 This is NOT Insurance. Some state restrictions apply.

with all state regulations Telehealth compliant with all state regulations This new map with restrictions is as of June 2015. This is NOT Insurance. Revised July 2015

Texas Medical Board drops appeal against Teladoc lawsuit By Dave Barkholz and Erica Teichert | October 22, 2016 The Texas Medical Board last week withdrew its appeal against Teladoc's lawsuit that alleges the state's telemedicine rules violate federal antitrust laws, sending the dispute back to a federal trial court. The board's proposed rule requires physicians to meet with patients in person before they can treat them remotely, or another provider must be physically present during the first telemedicine appointment to establish a doctor-patient relationship. Lewisville, Texas-based Teladoc maintains that the board violated the law because federal antitrust laws require the board to be supervised by the state in order to create the rules, which the company maintains will affect access to care. According to the board, the restrictions are to ensure quality of care, not to stifle competition. But the U.S. Justice Department and the Federal Trade Commission recently took Teladoc's side in the dispute, telling the 5th U.S. Circuit Court of Appeals that the state's rules were anticompetitive and lacked appropriate review. The agencies encouraged the appeals court to reject the medical board's appeal and maintained the underlying rule should be eliminated.

21st Century Cures Act

Currently being reconsidered in TX A bill is working its way through the Texas legislature that would confirm that telehealth is in fact legal in the state of Texas. Will also allow for video consults. Good chance of passing.

What is Doctors Online? Get fast answers at no cost from specialists via email or app: physicians,  psychologists, dentists, dietitians, fitness trainers. Doctors Online provides 24/7 access to web-based answers to medical questions from an expert team of board-certified physicians, psychologists, pharmacists, dentists, dietitians, and fitness trainers. (Other services include physician-written weekly Health Tips, two Health Risk Assessments, a 3D Video Library with access to 250+ medical topics.) Email access to the eDocAmerica medical team. Smartphone App (iPhone/Droid) access to the medical team. * Ask any medical or health questions and always get personal, direct answers. * 3D Video Library with more than 250 videos. * Weekly Health Tips emails from doctors. * Healthy Lifestyle Assessment to help you monitor your current health status. * Personal Health Record provides secure storage for your health information. * All services are unlimited, confidential, and include the entire immediate family. No hidden fees of any kind. This is NOT Insurance. Some state restrictions apply.

Doctors Online I have kidney cancer. My doctor suggests surgery. What questions should I consider first? I was bit by a dog while jogging. Owner says his shots are up to date. Should I be concerned? This is a picture of an odd-shaped growth on my arm. Is it bad? Any ideas? My recent blood test is attached. My white cells are low. What does this mean, & what do I do? My knee hurts when jogging. Can I rehab it myself? I lost my mom (& best friend) last year. I have no energy & gained 25lbs. I’m so depressed. Can you help? Sample Doctors Online questions – of the various specialists! This is NOT Insurance. Some state restrictions apply.

$156 Doctors Online Value Every 4th session saves a doctor visit: The average user has 4 sessions / year. The Doctors Online service save members a tremendous amount of time and money & frustration! Much more than the cost of freshbenies bundles. This is NOT Insurance. Some state restrictions apply.

CASE studies

Soften the Move to Higher OOP$ Encon Systems Saved Visits, Saved $ “We Teladoc’d Teladoc to death! The experience is BETTER than we expected!”

240 employees: cost: $26,000 144 telehealth consults. Self Funded Case: Save Claims & Time Masergy Communications 240 employees: cost: $26,000 144 telehealth consults. savings: $46,000-$110,000

Shrinking Network / Growing Wait Time North State Grocery 300 employees retail hours

Redirect Unnecessary Claims Ed Martin Auto Group 272 employees: cost: $28,000 100 telehealth consults. savings: $33,000-$76,000

ROI Compounds Annually The Delta Companies: 2.5 years 324 employees: cost: $73,000 631 telehealth consults. savings: $205,000-$452,000 78%: NET: $375,000 $4: 20% (162: $116,000) $77,000   $0: 3% (24): NET: $17,500

Testimonials Compound Annually “Every week someone stops by with great feedback: ‘Telehealth is easy to use,’ ‘it’s convenient,’ ‘it saved me from having to make an ER visit on a late night.’ Advocacy also saves me a lot of time – I no longer have employees bring me a stack of EOBs to look over and tell them what to pay! We get to give our employees their time & sanity back, and we save many times more than what this costs us!” - Calli Corley, VP HR

Done right, it’s no myth! You can’t phone it in. Telehealth cost savings: Done right, it’s no myth! But it does take some work. You can’t phone it in. freshbenies 2.0 – CE Class Slides – Telehealth & Advocacy: Next-Gen Consumerism Tools. Revised 6/27/15.