Healthcare in the Age of the Consumer University Hospitals Medicine Quality Summit November 22, 2014 Thomas F. Zenty III Chief Executive Officer

Agenda How we got here Importance of social media Increasing demands on physicians Opportunity in a consumer directed market Dialogue 6/9/20152

Healthcare Spending 6/9/20153

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Enrollment in High-Deductible Plans has Tripled since /9/20155

Growth in High Deductible Health Plans Total Enrollment in High 2014 Data by StateDeductible Health Plans 1.Illinois 1,055,000 2.Texas 1,043,000 3.Ohio 803,000 4.Pennsylvania 692,000 5.Michigan 691,000 6/9/20156

Consumer Paradigm: 6/9/20157 “Doctor, the patient will see you now”

Change Imperatives Increased competition Increased cost-sharing Consumerism and retail markets Public and private exchanges Social media and UH’s reputation Medicare growth 6/9/20158

Change Imperatives Give me choice and control Keep it simple and personalized Make it convenient, accessible and available High quality is assumed 6/9/20159

Change Imperatives Support sustainable growth Improve efficiency and consistency Increase affordability Leverage technology investments to improve speed to market and member experience 6/9/201510

New Entrants Into Healthcare 6/9/201511

Importance of Social Media Global penetration of cellular coverage is 92% as of 2013; –25% of US smartphones have healthcare apps 70% trust medical information shared by others on social media 40% likely to share information about their health on social media 50% use social media for health care decisions More than 50% of health care reporters look to social media for information and medical experts 6/9/201512

6/9/ – Pope Benedict Inauguration

2013 – Pope Francis Inauguration 6/9/201514

Importance of Social Media Consumers feel social media was built by consumers and trust the medium more than others 6/9/201515

ZocDoc – One example 6/9/201516

Increased Transparency – Univ. of Utah Internal website shows all patient comments – both negative and positive – when patients search for a doctor 6/9/201517

UH Access Department Central scheduling and physician referral services handle ~ 900,000 calls / year –50% of calls lead to scheduled appointments –30% of calls related to what it will cost the patient Copay, deductible, facility fee, etc. Physician A vs Physician B Facility A vs Facility B 6/9/201518

UH Access Department New system (Clear Quote) predicts what patients out of pocket costs will be –Expected go live Q –Takes into account physician behavior 6/9/201519

UH Access Department Community standard is same day appointment 6/9/201520

Emergence of Virtual Health Virtual doctor-patient video consultations to grow 65% by 2018 Expected revenue from video consultations: – $100 Million – $13.7 Billion Mayo Clinic goal - serve 200 million people Kaiser of Northern California predicts by 2016 they will have more virtual visits than in-person visits 6/9/201521

Emergence of Big Data As an industry we are now beginning to use data to anticipate what consumers want and expect Big data leads to: –New research and treatments based on clinical intelligence –Identification of best practices –Reduction in inconsistencies among providers –Predictive models to forecast patient behavior and provide preventive care –Better patient experience by targeting what patients want and when they want it –Cost savings from more efficient use of information 6/9/201522

Early Results of Reform Higher Quality Can Coincide with Lower Cost National results since 2010: –Early elective deliveries down by two-thirds –Ventilator-associated pneumonia down by > than half –Pressure ulcers down by 26% –Patient falls down by 15% –Medicare 30-day readmissions down by 8% –Prevented 560,000 hospital-acquired conditions –Saved 15,000 lives 6/9/201523

Early Results of Reform Higher Quality Can Coincide with Lower Cost UH results since 2010: –Early elective deliveries down by 72% –Ventilator-associated pneumonia down by 50% –Pressure ulcers down by 49% –Patient falls down by 52% –Medicare 30-day readmissions down by 19% –Prevented 149 hospital-acquired conditions 6/9/201524

Increasing Demands on Physicians Improve quality Manage costs Coordinate care Improve productivity Shift from volume to value Respond to regulatory change Adopt culture of shared authority Engage patient as partner EMR Social media interactions with patients Stay current 6/9/201525

The Challenge of Change for Physicians 6/9/201526

From Challenge to Opportunity in Consumer Directed Healthcare Investing in / improving EMR How long people are willing to wait How do patients want to communicate Use of apps 6/9/201527

Taxi/Car Booking a Flight Online Booking a Flight via Phone Opening a Bank Account Opening a Credit Card Online Shipping Accessing a Doctor MINUTES HOURS DAYS WEEKS MONTHS 28 What Will You Wait For?

Patients Prefer Near-Term Appointments 6/9/201529

How Do Patients Want to Communicate 62% want to communicate via with physician 65% want appointment reminders via 25% want to schedule appointments online 76% are willing to go online to view test results 10% want interactions solely through an app on their phone Health systems who don’t adapt will continue to struggle to build a strong consumer experience 6/9/201530

Clinical Integration Higher quality Continuity of care Bi-directional information flow More efficient processes Cost reduction for all stakeholders Positioned for lower risk management Customer facing “Doctor, the patient will see you now” 6/9/201531

Primary Care Institute Four main goals: 1.Help physicians deliver excellent outcomes and patient experience 2.Increase physician engagement and satisfaction with UH 3.Encourage innovation in developing new care models 4.Improve value 6/9/201532

Primary Care Institute Deliverables Discover new models of patient management and clinical care Improve communication Adopt care models that enhance experience and outcomes Foster growth in care services that MDs want to deliver Create opportunities for MDs to partner with community 6/9/201533

What PCP’s Can do to Help Be open to learning, discovery and innovation Participate and share insights Trust that future incentives will lead to better health outcomes 6/9/201534

2/08/2010University Hospitals6/9/2015University Hospitals35