Health Transformations: The future of the physician-patient relationship Bill Marsh, Vice President and Chief of Staff, Colorado Permanente Medical Group

2April 26, 2015 Health Care is Unfrozen: Why now? What does this mean? Rapid Response Rapid Learning

A Growing Network of Immediate Access Choices Markets Responding to Unmet Needs 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. Traditional Access Points Consumer- Oriented Access Points Retail Clinic Urgent Care CenterVirtual Visit Primary Care Office Low AcuityHigh Acuity Emergency Department Consumer-Oriented Service Delivery Sites Filling the Gap Driving Provider Questions: Should we partner to establish retail clinics ? Should we build or expand our urgent care footprint? Is virtual care something that we should provide? When should we enter into partnerships to meet patient demands? 3

4April 26, 2015 Rapid Response Rapid Learning A Fast-Emerging Market Segment $13.7B Estimated revenue from virtual visits in 2018, up from $100M in % Projected increase in households using virtual care between Source: Wang H, “Virtual Health Care Will Revolutionize The Industry, If We Let It.,” Forbes, 3 April 2014; available at: accessed May 9, 2014; Health Care Advisory Board interviews and analysis. From Administrative Transactions to Real-Time Care Delivery Providers Expanding the Applications of Virtual Care Virtualize Care Delivery Asynchronous, message- based visits Live, video-based visits Streamline Clinical Transactions Prescribe new medications Receive lab results Deliver online education, shared decision-making tools Automate Administrative Functions View medical records Schedule in-person appointments Refill existing prescriptions Pay bill Impact on Access

5April 26, 2015 Market Forces Turning Patients into Consumers Rapid Response Rapid Learning Catalyzing a Shift in Network Demands Source: Health Care Advisory Board interviews and analysis.

6April 26, 2015 Paradigm shifts happening: Encounter based (visit) To information based Physician centered Patient-centered Population-based care Personalized care Reactive care Proactive care Episodic care Continuous care Mass production Mass customization Physician deliveredTeam delivered (with patient) Rear-view analytics Predictive analytics (“Big Data”) Silo care Integrated care

Paradigm shifts continued: 7April 26, 2015 QualityValue = (Q/$) ME Managing DiseaseMaintaining health Unwarranted variationWarranted variation Medical Team has infoEveryone has access to info

“ Spread health to all………………… we meet people where they are.” 8April 26, 2015

Where is Kaiser Permanente Colorado today? 9April 26, 2015 Received 1M patient s in 2013 Received 2M telephone calls for clinical care in 2013 Completed 200,000 “scheduled” telephone visits. Advice referral with photo

Where are we going tomorrow? 10April 26, 2015 Video visits to home Web chat and text Self triage with intelligent routing Member-generated data: questionnaires and remote monitoring Social networking Proactive outreach with personalized, individual care plans Predictive analytics Personalized genomics

Self-triage with Intelligent Routing 11April 26, Acute Conditions Call centerRNMDMy Team MD, RN, NP/PA, PharmD

Member Generated Data 12April 26, 2015 Questionnaires Patient self-monitoring

40% of your health is driven by what? 13April 26, 2015

Personalized Genomics 14April 26, 2015

What patients really want from health care = care personalized to me! 15April 26, 2015 Restore health Timely care Kindness, empathy, and respect Hope and certainty Continuity, choice, and coordination None or little out of pocket expense Best medicine: testimonials vs. statistics Source: JAMA; Detsky

“It is not necessary to change, survival is not mandatory.” W. Edwards Deming American Engineer & Statistician