1. DBRA Introduction to Telemedicine 101, 201

2. What is Telemedicine? Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Telemedicine is not a separate medical specialty. Telemedicine includes consultation, diagnosis and treatment Improves patient care Increases patient access Reduces medical costs for payers and patients * As defined by the American Telemedicine Association (ASA)

3. Telemedicine Market “ Telemedicine has the potential for restructuring medical care in ways that can solve many of the problems, while reducing costs and improving quality of care” “Revolutionizing the delivery of healthcare telemedicine is one of the most important modern innovations in health care, and will benefit from rapid adoption and growth over the coming years, settling as a $24B industry by 2016” “Telemedicine essential to health care reform” 1-National Center for Policy Analysis-Fathers of HSA-Convenient Care and Telemedicine Study 2-Research and Markets 3-White paper Study-e-health Magazine

4.  Telemedicine market expected to be $24 billion by 2016  28 percent of all pediatric ER visits could have been handled through a telemedicine consultation Privately held  Employers spend $63 billion in over/in appropriate use of ER, Urgent Care and Office visits

5. Telemedicine Encompasses all aspects of care PCP Specialist Remote location Mental health Surgery and specialty care

6. Acute care Telemedicine Not a replacement for PCP Lower risk High frequency of claim volume Direct impact Impacts –Preventative care –Chronic care –Care compliance – Wellness

7. Acute care-Stats 70% of doctors office appointments could have been treated through telehealth 66% of ER visits are Non- Emergencies 1/3 of patients report difficulty in timely doctor appointments ¼ of patients report they cannot take time from work to see a doctor 28% of Pediatric ER visits could have been handled with telehealth 42% of the 354M annual acute care visits are treated by personal physicians the rest are made to:  28% Emergency Room  20% Specialists  7% Outpatient clinics * American Wellness Council -2008 Study ** Health Affairs 2010 *** National Center for Policy Analysis-Fathers of HSA-Convenient Care and Telemedicine Study

8. Telemedicine impacts Patient Employer Broker/Consultant Payer Provider

9. Patient-current Shortage of Primary care doctors 48M more people entering the health care system Overuse of Emergency Room Average face time with a doctor is less than 7 minutes Expensive Wait times

10. Patient-Telemedicine Easy Access Low cost Convenient Readily available Physician care advocacy –Home or away –24/7/365 –Continuity of care

11. Employer-current 30% plus of insured EE’s do not have primary care doctor-and growing Overuse of ER Time off of work Rising health care premiums Drop in younger (good risk) plan participants Dissatisfied employees

12. Employer -Telemedicine Reduce claim costs Increase employee satisfaction Low cost employee benefit Increase in network compliance Help employees navigate health care system Reduce absenteeism

13. Broker-current Limited plan flexibility Limited number of markets Reduced benefits Increased cost Plan instability Reduced commissions Lack of differentiation

14. Broker-Telemedicine Health care reform Plan flexibility Added benefit Reduces cost Assist with member retention Commissionable Differentiation

15. Payer -current Shortage of primary care doctors Employees using more costly care options Employers dropping coverage Shrinking plan enrolment Conditions going untreated Paralyzed with PPACA

16. Payer-Telemedicine Access to care Reduces claim cost Earlier intervention Outside of MLR

17. PCP Provider-current 32 patients per day Reimbursement has been cut Average PCP income $127k Yr 150k PHP shortage by Year 2020 Less than 2% of medical school enrollees elect PCP Deliver model is outdated

18. Provider-Telemedicine Deliver quality care Quality of life No overhead Leverage strengths Set scheduled Increase revenue Leverage current technology

19. For today's discussion Telehealth as it relates to  Acute Care  Wellness  Savings

20. Common Conditions Treated Conditions TreatedMedications Prescribed AllergiesRespiratory infectionsAllegraKeflex Arthritic PainSinus infectionsAlbuterolLevaquin Bronchitis Stomach Ache/Diarrhea AmoxicillinLipitor Certain rashesStrep throatAugmentinLisinopril Cold/FluUrinary tract infectionAzithromycinMacrobid GastroenteritisGeneral information BactrimMetformin Headaches/Migraines Many other illnessesBiaxinNasonex Insect bites Minor joint trauma (sprains & strains) Ciproprednisone DiflucanPyridium FlonaseTamiflu HCTZTassalon Ibuprofren 800Zithromax Z-Pak

21. ¼ of patients report they cannot take time off from work to see a doctor. Less than 25% of doctors communicate via email and less via phone Providers only get paid when they see a patient in the office.

22. Cost of Physician Access

24.  Medical information exchanged from one site to another by the use of electronic communication for the health or education of the patient or health care provider  Includes consultation, diagnosis and treatment  Improves patient care  Increases patient access  Reduces medical costs for payers and patients About Telemedicine * As defined by the American Telemedicine Association (ATA)

25.  Patients overuse emergency rooms  Shortage of Primary care doctors  Difficult to schedule Ad hoc physician appointment  National network of board certified, licensed physicians  Patients rushed and not enough information during office visits  70% of all doctors office visits could have been treated though telemedicine.  66% of all ER visits are non-emergencies  inefficient use of higher cost settings cost employers over $63 billion  1/3 of patients report difficulty with scheduling timely appointments

26. How It Works 1. Patient Member completes PMH Patient contacts 1-800MD 2.Customer Care Center Intakes presenting complaint Routes the PMH to on-call Pages appropriate on call physician in the appropriate state 3.Physician Reviews PMH Contacts patient Provides information, diagnosis, treatment and medications if appropriate Directs care as needed Completes encounter form and updates EMR 4.Patient Medical records available in EHR via password protected member portal Medications electronically sent to pharmacy of choice

27. Common Conditions Treated Allergies Arthritic Pain Bronchitis Certain rashes Cold/Flu Gastroenteritis Headaches/Migraines Insect bites Minor joint trauma (sprains & strains) Respiratory infections Sinus infections Stomach Ache/Diarrhea Strep throat Urinary tract infection General information Many other illnesses

28. Physician Network  Board certified  Fully credentialed  Licensed in their respective states  Provide service in accordance with state regulation  Trained in the delivery of telemedicine  Coverage in 50 states

29. Cost Containment Voluntary Pre-Certification Least expensive Most Convenient Readily accessible Point of service tracking Diagnose when appropriate Direct care as needed In network steerage Physician care advocate

30. Integration Direct EDI claims submission Improved quality care through –Imbedded care guidelines –Disease management –Pre-loaded medical history –Patient alerts –Drug interactions Formulary Management Preloaded Provider list Member Access to patient portals

31. My1-800MD Patient Portal  Members have access to:  Secure portal  Medical consultations  Medical decision tools  Wellness tools  Symptom checker  Drug interaction checker  EHR- Electronic Health Records https://www.1800md.com

35. Claims Savings Analysis

36. Reports

38. Next Steps: