Chief Medical Officer, Teladoc The Shift to Digital Care: how did we get here? Regulatory Lessons Learned Henry DePhillips, M.D. FAAFP Chief Medical Officer, Teladoc https://www.technologyreview.com/s/601062/apple-hopes-youll-talk-to-your-iphone-and-call-your-doctor-in-the-morning/#/set/id/601078/ Start with humor as the lead into the age of “consumer driven EVERYTHING.” Tech innovation has changed society’s relationship to their health care in the same way it changed how we access travel, banking, retail, entertainment, media and even socializing. In the context of 21st century medicine, telemedicine/telehealth is an inevitable evolution. Trends signify that 3 out of 4 patients want to be able to use online services to be communicate with their provider, view lab results and request appointments and nearly half would consider switching doctors to a practice that offers the ability to complete these important tasks online. http://www.informationweek.com/news/healthcare/patient/229300352

Consumer expectations are in conflict with healthcare trends CONSUMERS ARE MORE ACCESSIBLE & CONNECTED LACK OF ACCESS IS DRIVING COSTLY CHOICES 80%+ of adults <50 yrs old have smartphones & are connected1 Avg wait time for a first visit with a psychiatrist: 25 days3 65MM people live in primary care desert4 1/3 of consumers have a health, fitness or medical app, 2x vs 20132 71% of employer sponsored ER visits are unnecessary5 Two trends very much in conflict: trend 1: the time it takes to get a family practice – or even worse a behavior health – appointment is getting worse (anyone see the Marktetwatch article from 4/1 about the shortage of doctors?) Trend 2: consumers are increasingly accessible & connected… an open to telemedicine This move toward handheld medicine is occurring thanks to advances that have made the tools and their wireless links ubiquitous, reliable and affordable. About half of all Americans have smartphones.26 Eighty percent of the time, the average American is in range of 4G LTE, making it nearly as easy to conduct a video visit with a doctor as it is to call a cab with a smartphone. 1. Pew Research Center, November 2016. 2. PwC, 2016. 3. HealthDay, October 2014. 4. MarketWatch, March 2016. 5. Truven Health Analytics, April 2013.

Telemedicine is well equipped to close these gaps Treatable through telehealth 1.25B Total Ambulatory Care Visits 168M Total Behavioral Health Visits 412M (33%) 131M (78%) CDC, AHRQ.

What is Telemedicine? Telemedicine is the transfer of medical knowledge from where it is to where it is needed, using technology appropriate for the situation. Like Baskin Robbins ice cream, there are 32 flavors. Teladoc offers one of those. Frequently. (540)

Regulatory Lesson #1 The medical standard of care must be met. Period. Stethoscope MRI Telecommunications (Internet Pharmacies)

Regulatory Lesson #2 Technology Neutral. Video High Definition Photos/Interactive Audio Sharing EMR/Interactive Audio A comment about “phone only”

Regulatory Lesson #3 “It is bad policy to regulate out of existence something for which there is no demonstrable harm to the citizenry.” Paramedics in the field Teleradiology Physician cross coverage Telemedicine

Real World Example The Opioid Epidemic. Or, what I learned during a lunch break motorcycle ride in the country. Addiction Counseling supply and demand.

Healthcare has been Provider Centric Telemedicine represents the first true foray into the world of consumer centric care.

How the average American sees healthcare I can get the care I need on my terms, control my health information and provide care for my family. How the average American sees healthcare My Teladoc Care Team Teladoc physician, behavioral health, nutritionist, pharmacist, specialists My Health Information EHR exchange, device data integration, my doctors, health alerts, screeners & tools Member Member Support & Guidance Referrals, caregiver & family care, community, incentives

“You can’t list your iPhone as your primary-care physician” https://www.technologyreview.com/s/601062/apple-hopes-youll-talk-to-your-iphone-and-call-your-doctor-in-the-morning/#/set/id/601078/ Start with humor as the lead into the age of “consumer driven EVERYTHING.” Tech innovation has changed society’s relationship to their health care in the same way it changed how we access travel, banking, retail, entertainment, media and even socializing. In the context of 21st century medicine, telemedicine/telehealth is an inevitable evolution. Trends signify that 3 out of 4 patients want to be able to use online services to be communicate with their provider, view lab results and request appointments and nearly half would consider switching doctors to a practice that offers the ability to complete these important tasks online. http://www.informationweek.com/news/healthcare/patient/229300352