1. eVisit Online Consultations: Ready for Prime Time? Marc-François Bradley President, Sophrona Solutions Minnesota MGMA Conference eVisit Breakout August 2, 2007 Paul C. Seel MD Medical Director, Sophrona Solutions

2. What is an eVisit? Gives patients 24/7/365 Convenience Reduces practice phone calls Compensates physicians for non-office patient communication Two-way physician-patient communication of clinical information conducted over a patient portal

3. Structured vs. Unstructured Communication VS Structured eVisit

4. Elements of a Structured eVisit ► Chief complaint ► History of the present illness ► Past medical history ► Surgical history ► Social history ► Family history ► Allergies ► Alcohol, tobacco and caffeine ► Pharmacy information

5. Why Do eVisits? ► Quality  Improved documentation of phone calls  Increased touch points for chronic disease patients  Improved access to care ► Cost  A low cost way to provide low intensity, non-urgent service  Reduced costs for data entry—the patients do it  Level staff work load  Reduced phone traffic ► Revenue Opportunities  Provides reimbursement for phone calls  Allows a shift to higher intensity services

6. Ingredients for Innovation ► Market  Patients want it  Payers have begun to embrace it  Physicians will adopt if it benefits some combination of efficiency, quality and reimbursement ► Product  Internet based platforms for asynchronous communication  Logic driven interviews to generate structured histories ► Salience  Is there sufficient clinical application?  Can it create efficiencies?  Does it make business sense?

7. Patients Want the Convenience of This Type of Access to Their Physicians  In a HarrisInteractive survey, 74% of patients desire the ability to communicate with their physicians via some sort of e-mail; only 8% of patients report such access. 1  University of Minnesota MHA students found similar desires (77.9%) in the Twin Cities patients along with evidence of the patients being web savvy (74% on-line banking). 2  13.5% said they had no interest in any on- line communication. 2 1 http://www.harrisinteractive.com/news/newsletters/wsjhealthnews/WSJOnline_HI_Health-CarePoll2006vol5_iss16.pdf 2 U of MN MHA students; 104 randomly selected Strategic Positioning Analysis 2007

8. The Retail Clinics….. patients are seeking convenient access for simple health care problems  80% of retail clinic users judged the clinics satisfactory on quality, cost and convenience criterion.  64% of the general population was concerned a serious condition might be missed, down from 71% in 2005.  Other concerns such as staff training were also decreasing. HarrisInteractive Health Care Survey March 2007

9. By The NCHS’s Numbers 1 ► Office Visits  910 million total outpatient physician visits/yr  92.4 visits/primary care MD/week  48.3% of all visits were in follow-up for a condition previously seen by the physician ► Phone Calls  26 phone calls/primary care MD/week 1 National Center for Healthcare Statistics http://www.cdc.gov/nchs/data/ad/ad374.pdf

10. Urinary Tract Infections ► 17 million UTIs in patients < 65 yrs of age 1 ► 164,000 physicians involved in active IM, FP and Ob/Gyn practice 2 ► 100 episodes /yr in patients< 65 yrs of age/ physician ► Evidence based medicine supports the treatment of uncomplicated UTIs without a face-to-face encounter 1 Data pooled from UpToDate incidence stats 2 http://www.cdc.gov/nchs/data/ad/ad374.pdfhttp://www.cdc.gov/nchs/data/ad/ad374.pdf

11. Ambulatory Care Points of Pain ► “I spend hours a day on the phone rendering uncompensated care” ► “I have no time to see the patients I need to, let alone new patients” ► “My overhead is killing me” ► “Why in the world are my patients going to the retails clinics”

12. What does it cost to provide a Service? Profitability Analysis of a Phone Call Provider Net Profit – Phone Call Receptionist cost @ $12/hr RN cost @ $30/hr Physician cost @ $200/hr Billing cost @ $15/hr Phone Calls ($ 1.00) ($ 5.00) ($ 33.33) - Total Cost ($ 39.33) Reimbursemen t0 Net ($39.33)

13. Profitability Analysis Provider Net Profit - eVisit Receptionist cost @ $12/hr RN cost @ $30/hr Physician cost @ $200/hr Billing cost @ $15/hr 00T47 eVisit - ($1.50) ($26.00)($3.75) Total Cost($31.25) Reimbursement $ 35.00 Net $ 3.75

14. Comparison: eVisits vs. Phone Medicine? Comparison: eVisits vs. Phone Medicine? ► Financial  Net loss with a phone call -$ 39.33  Net profit from an eVisit +$3.75 eVisit +$3.75  Overall difference $ 43.08 ► Non-Financial  Improved documentation  Save time and avoid phone tag  Asynchronous advantages

15. eVisit Pilot Survey After 250 eVisits by 16 Physicians ► Physician Satisfaction (10 out of 16 respondents)  100% Adequate info to make a clinical judgment  90% Easy to use and will continue to use  50% Saves time ► Patient Satisfaction ( 132 out of 250 respondents)  97% Satisfied with the clinical response and medical content  87% Easy to use and 100% would use again  91% Saves time Clinical Appropriateness -- Patient use and clinical response audit found use to be appropriate in each case upon review of the records.

16. Patient Portal Technology  ASP (application service provider) architecture is common.  Typically no additional hardware needed.  Usually licensed as a service and not sold.

17. Patient Portal Technology ► Ease of use  Seamless connection from website  Single patient login  Simple for office staff ► Secure & HIPAA compliant ► Broad set of communication functions:  Pre-Registration, Bill Payment, Appointment Scheduling

18. What does an eVisit look like? Quick Demonstration

19. Pitfalls & Critical Success Factors Pitfalls ► Over reliance on the software to provide the solution ► Inappropriate clinical application ► Inattention as critical mass volume of eVisits develops ► Lack of recognition for physician work component

20. Pitfalls & Critical Success Factors Critical Success Factors ► Insurance reimbursement ($35 in MN) ► Patient population  Internet savvy patient population that prizes personal time and convenience  For patients on high-deductible plans – eVisits are the lower cost option ► Structured eVisit. ► Easy access to charts.

21. Pitfalls & Critical Success Factors Critical Success Factors ► Clinic Readiness Assessment  Do doctors really understand how expensive phone calls are for them? ► Triage & Flow Planning ► Patient Adoption Marketing Plan ► Internal policies:  Level of service, physician responsibility, and assuring coverage.

22. eVisit FAQs HarrisInteractive * HarrisInteractive, September 2006 QuestionsAnswer Who will use it and are their demographics unique? 74% of patients wish to communicate with their physician*. How to maintain confidentiality? Password protected, HIPAA compliant. How to avoid patient rambling and inappropriate usage? Controlled list of eVisit types, structured question sets for each. What about reimbursement? In MN BCBS, HealthPartners, and some Medica and PreferredOne plans will pay $35. What are the liabilities? Currently malpractice makes no distinction based on whether a physician is doing eVisits.

23. Thank You Copy of today’s presentation: www.sophrona.com/resources.htmwww.sophrona.com/resources.htm