Jeremy Bainbridge Regional Director, MedNow

What is MedNow? Direct to Consumer Specialty Care 24/7 Easy Access Save time & Money Easy Access Specialty Care MedNow is Spectrum Healths tele-medicine program. Like all tele-medicine programs we are able to leverage different types of technology to deliver care to patient throughout the state of Michigan. This technology eliminates the need for the provider to be physically located where the patient it. MedNow is broken up into two very distinct programs-Our direct to consumer program where we can deliver low acuity primary care to anyone in the state of Michigan 24 hours a days-7 days a week and our specialty care which allows our patients to see a specialist from any of our regional locations Opening up access Keeping care local

Why? Transitioning from volume-based to value based care. “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change” - Charles Darwin As healthcare reimbursements continue to change we need to find a way that will allow us to transition from a volume based environment into a value based environment. By leveraging technology to provide care we are able to gain efficiencies with our providers and maximize our resource utilization and better meet our patients needs.

Why? Consumer Demand Technological Advancements Value Based Care The healthcare consumer is also changing. Our patients are becoming more price sensitive as they are covering more and more of their healthcare costs. As more and more people have higher out of pocket costs or high deductible plans they are beginning to shop around for their care and are more willing than ever to change providers due to cost. Our customers are also demanding better access to care when it is convenient for them. Healthcare is one of the only industries that has historically ignored their customers needs when determining hours of operation. Cost Savings

76% of Michigan households have access to the Internet <http://www.census.gov/content/dam/Census/library/publications/2014/acs/acs-28.pdf>.

68% of Americans own a smartphone http://www.pcworld.com/article/2999631/phones/pew-survey-shows-68-percent-of-americans-now-own-a-smartphone.html

80% of patients report being comfortable communicating with physicians via text, email or video This number is continuing to rise as we all get more comfortable doing more things on our computers, cellphone and tablets. More and more people are leveraging technology to do things like online bill pay, shopping, streaming music and movies. In my house we do all of our grocery shopping on line and pick it up when it is convenient for us. Now Meijer is advertising a new program where they will deliver the groceries to your house eliminating the need to go to the grocery store!

90% of the world’s population will have a smartphone by 2020 As smart phones become a part of all of our daily lives we are all beginning to use them to accomplish more and more. From grocery shopping-to buying movie tickets-to ordering food and more and more people are using them to receive health care. http://thenextweb.com/insider/2014/11/18/2020-90-worlds-population-aged-6-will-mobile-phone-report/#gref.

Video Visits are ideal for non-life threatening conditions such as pink eye, allergies, cold and flu, sinus issues and more. MedNow video visits allow the provider to check you out using a webcam anywhere you have an internet connection. Now that we have discussed why we are looking at tele-medicine as a path forward and the way that we are leveraging the internet and smart devices we can talk about our MedNow program. Our direct to consumer program allows patients with low acuity conditions to see a SH provider 24/7/365 using their smart device, laptop, tablet or home computer. They need to have a strong internet connection and a device with a camera.

Traditional Access Points Consumer- Oriented Access Points New Care Model Traditional Access Points Low Acuity High Acuity Primary Care Office Emergency Department Consumer- Oriented Access Points Typically in many of our regional communities there are very few choices for receiving health care-if they can’t get into their PCP office than they are left to either go without care or go to the ED. MedNow is allowing patient to receive care when and where the patient chooses. Patients can not receive care when they are at school, home, work or where it is convenient for them. Source: Mehrota A et al, "Visits To Retail Clinics Grew Fourfold From 2007 To 2009, Although Their Share Of Overall Outpatient Visits Remains Low," Health Affairs, August 2012; Health Care Advisory Board interviews and analysis.

Driving Exceptional Value Excessive test 5-hour Visit 20% need Follow-up 40 min. wait 3 hour visit We know that the average low acuity visit in the ED costs approximately $370 and takes about 5 hours from the time a patient leaves their home, receives care and then returns home. If your community has an urgent care you are able to be seen that day at a cost of approximately $150 and about 3 hours time total time. To be seen in your PCP office for the same low acuity condition it costs around $100 bucks and again total time spent is about 3 hours. The challenge in most PCP offices is that they do not have access. In most PCP offices it takes a few weeks to be seen if you are lucky. When patients are seen for the same low acuity condition via video visit with MedNow the cost is $45 and the visit it done when and where the patient chooses. Patients can often be seen within 30 minutes and can choose a time that works best for them. eVisits are another option that cost $25. We will talk more about eVisits in a couple minutes. 3 hour visit Time to appt 3 weeks Waiting @ home * Numbers are approximate

Symptoms treated with On Demand care Allergies Back Pain Bites & stings Cough, cold & flu Diarrhea Ear ache Fever Headache Heart burn Pink eye Rash/hives Sinus infection Sore throat Sprains & Strains Smoking cessation Urinary problems Patients age of 3 years and older can be see for these conditions without leaving the comfort of their home. Patient must be located in the state of Michigan in order to use this service due to current provider licensure laws. We are able to see all patients regardless of insurance status and they do not need to have a Spectrum Health provider. Treating patients 3 years and older

On Demand Demonstration \\data\DATA\SH\MedNow\Compliance\Comm&Marketing\Videos\Final Video Visit 10.11.mp4

eVisits allow you to describe your symptoms in a Myhealth questionnaire the provider will use to diagnose and treat the condition the same day.

eVisits

Differentiators Program Goals Open Up Access Electronic Medical Record Integration Part of Integrated Health System Medical Assistant Support 24/7/365 Video Capability Appointment Time Selection Enhanced Patient Experience Program Goals Open Up Access Keep Care Local and Convenient Lower the Cost of Care

Specialty MedNow allows patients with more serious conditions to have a consultation with a Grand Rapids-based Spectrum Health specialist via a secure video connection from remote Spectrum Health clinics and hospitals.

Specialty MedNow Equipment Jeremy

Specialty MedNow Care Settings ED Inpatient Outpatient Home Oncology Bariatrics Behavioral Health Cardiology Diabetes Infectious Disease Pulmonary Orthopedics Pediatrics Sleep Wound Care Vascular Care Settings ED Inpatient Outpatient Home

$195.03 Current State Patient Costs Total Time: 4.27 Hours Patient Lives in Ludington, MI Patient's Household Income is $40,957 Patient Owns Vehicle That Gets 16 MPG Patient's Appointment is with Specialist in Grand Rapids, MI Patient Must Take Time Off of Work to Attend Appointment 88 Minutes – Patient Travels to Grand Rapids (if traffic, construction, or weather allow) Patient Locates Correct Parking Ramp of Specialist's Facility 10 Minutes – Patient Parks and Locates Building Elevator 10 Minutes – Patient Walks to Specialist's Office 20 Minutes – Patient Waits in Waiting Room 15 Minutes – Patient Waits in Exam Room 15 Minute – Patient Meets with Specialist 10 Minutes – Patient Leaves Office and Returns to Vehicle 88 Minutes – Patient Travels to Ludington (if traffic, construction, or weather allow) Total Time: 4.27 Hours Current State Patient Costs Food Expense: $9.00 Total Gas Expense: $100.47 Wages Lost: $85.65   Total Patient Costs Excluding Any Medical Expenses: $195.03 Lung Mass Patient Story

$15.21 Future State Patient Costs Total Time: 0.7 Hours Patient Lives in Ludington Patient's Household Income is $40,957 Patient Owns Vehicle That Gets 16 MPG Patient's Appointment with Specialist at Spectrum Health Ludington Hospital via Telehealth Patient Must Take Time Off Work to Attend Appointment 5 Minutes – Patient Travels to Spectrum Health Ludington Hospital 5 Minutes – Patient Parks and Locates Specialist's Office 5 Minutes – Patient Waits in Waiting Room 2 Minutes – Patient Waits in Exam Room 15 Minutes – Specialist Meets with Patient via Telehealth 5 Minute – Patient Leaves Office and Returns to Vehicle 5 Minutes – Patient Travels Home Total Time: 0.7 Hours Future State Patient Costs Food Expense: N/A Total Gas Expense: $1.43 Wages Lost: $13.78   Total Patient Costs Excluding Any Medical Expenses: $15.21

Dashboard When we started this program we assumed that we were going to be seeing a lot of 18-35 year old men and we quickly found out we were wrong. The most common patient is a 36-45 year old female. We also assumed that we would see very few patient over 65 which we were wrong about too! Many of our older patients are used to using technology and have had not problems using MedNow. The oldest patient that we have had was over 90 years old!

Prescription/ABX Metrics

Patient Satisfaction We look at many aspects of customer satisfaction- patients feel that the provider spends enough time with them More than half of patients prefer the video visit to a traditional office visit Over 90% of patients say that the appointment times available fit their schedule And over 90% of patient said they are more likley to use SH in the future because of this service

338,000+ Patient Miles Saved If the average patient drives 65 miles per hour we have saved our patients about 5200 hours of driving time This is equal to 217 days or 7.2 months of driving time!

3,500+ Avoided ED and UC visits

69 Avoided Transfers

What’s coming Competition Disruptive Technology

Impact Changing the way care is delivered Provider and Patient Satisfaction Decreasing Cost of Care Decreased ED/UC utilization Avoidable transfers Improved Access to care

Questions? For more information please visit our website www.spectrumhealth.org/MedNow