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

2. 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The ACA will be repealed and replaced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

3. 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

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

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

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

7. 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

8. 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.

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

10. 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

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

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

13. 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

14. PRESCRIPTION INFLATION

16. $ $ $ $ $ $

17. $
Docs $
Rx’s $
Deds
OOPs $
Copays $ $

18. 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…

19. Employees Don’t Understand

20. 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…

21. 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…

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

23. 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.

24. 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.

25. 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.

26. 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

27. 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.

28. 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.

29. 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.

30. 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

31. 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.

32. 21st Century Cures Act

33. 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.

34. What is Doctors Online? Get fast answers at no cost from specialists
via 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.)
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 s 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.

35. 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.

36. $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.

37. CASE studies

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

39. 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

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

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

42. 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

43. 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

44. 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.