1. Telehealth Alliance of Oregon February 2015 Michelle Wernert Health eXpress Experience Telehealth in Practice

2. Agenda Why Telehealth – What’s the big deal? Disruptive Innovation and Telehealth Health eXpress Overview Health eXpress - 2014 in Review Community Partnerships Lessons Learned Crossing the Chasm On the Horizon

3. House calls circa 1930

4. Beginnings of Telehealth

5. The future…?

6. 6 Pope Benedict XVI Pope Francis

7. 7

8. 8

10. Coming full circle

12. 12 A review of Health eXpress A web enabled platform that connects consumers to quality health care providers securely where ever they are and at convenient hours. Health care providers can Discuss symptoms Diagnose conditions Prescribe medications Manage care more efficiently

13. 13 Health eXpress Program Alignment Improve Population Health Improve timely access to care Prevent escalation of symptoms Decrease avoidable high acuity visits Care Experience Improve convenience for patients Increase access to care Connected care (EMR, follow-up) Cost Containment and Affordability Increase appropriate use of healthcare services Support utilization of preventative care services

14. Why online care matters to employers Convenience - patients can access their provider from home and on their schedule High satisfaction scores- 81% rate online care better than in-person care Differentiation in benefit package- offering employees options and innovative solutions Improves employee satisfaction Allows employees flexibility Lower absenteeism: average time savings 2 hours per visit within the work day Increase capacity – Same day, flexible appointments Increases productivity and capacity Direct savings of 45% to 50% per visit average Better utilization of care - higher cost visits avoided (i.e. late night ED visits because nothing else is available) Support employees that are at risk or high needs patients (diabetes management) Reduces cost of care

15. 15 How Health eXpress works Patients access care logging in or walking into Kiosk Electronic medical record is charted in Epic Providers refer when appropriate Patients and primary care providers (if agreed to by patient) receive after visit summary to ensure connected care Patients receive follow-up phone call and care through Health eXpress when appropriate

16. 16 Health eXpress Clinical Scope Cough, cold & allergy Flu Rash Oral lesions Diarrhea Bladder infection Smoking cessation Pinkeye Ear pain Acne Joint pain Low back pain Headache Burns Sunburns Wellness services Children’s services Rx scripts 28% of IC and ED visits National Institute of Health 2010

17. 17 Health eXpress Service Models Kiosk Service On site location in a private space Walk in appointments Clear high-definition video Telepresenter Option Web/Mobile Service On Demand Available to anyone with a internet connection, web cam and microphone Available on Android and iOS Kiosk Web Mobile Current Hours Mon to Fri: 8am to 8pm Weekends: 9am to 5pm Current Hours Mon to Fri: 8am to 8pm Weekends: 9am to 5pm

18. 18 Health eXpress Kiosk 8 Workstation Kiosks across Oregon

19. 19 Meet the Provider Team Kim Tull Thanh Nguyen Our licensed, board-certified Providence Family Nurse Practitioners can provide diagnosis and treatment recommendations, which may include prescriptions or labs. Larlene Dunsmuir Kimberly RoddaKristen Harris Melissa Sanchez Rated at 4.8 Stars by Health eXpress Patients

20. 20 Launched in 2014 Web/Mobile for… Employer Group Subscriptions Selfpay (Direct to Consumer) Insurance Billing Providence Health Plan – Launched 1/2/2015 Kiosks at… PEBB & PGE expansion Promotores Mobile Clinic Safeway Medford Hospital In partnership with CCOs

21. 21 Health eXpress – Web Visit www.healthexpress.com

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23. 23

24. 24 This option means that the user will have to go to MyAccounts, Edit Profile to enter their information later. It acts the same as selecting ‘no’.

25. 25

26. 26 Community Partnerships Health eXpress Mobile Clinic Partnership with the Parish Health Promoter Program – “Promotores” Provide a Nurse Practitioner consult as appropriate via Telehealth Provide health screenings to underinsured population Blood Pressure Cholesterol Lipids Glucose Includes referrals to PCP care as well as financial assistance programs

27. 27 Community Partnerships - Promotores 2014 12 clinics offered Patients Screened = 220 Patients Health eXpress Visit = 79 Patients Referred to additional services = 38 Patient Satisfaction 100% would recommend service 100% patients understood next steps in care or treatment

28. 28 Promotores Health eXpress

29. 29 Community Partnerships Health eXpress Medford Partnership with the Oregon CCOs Staffed kiosk located at the Medford Hospital 50,000 CCO Members ~400 to 500 per month seek care at ED for low acuity conditions that can be treated by Health eXpress CCO Members = $0 Selfpay = $49 Providence Health Plan = depends on plan Launched November 2014

30. 30 Community Partnerships

31. 31

32. 32 2014 in Review Lessons Learned

33. 33 Health eXpress Visits Trends Volume increased 3X Year over Year

34. Utilization vs. Satisfaction

35. 35 Where Would Patients Have Gone n = 483

36. 36 2014 Top Medical Conditions

37. 37 Top 10 Medications Prescribed

38. 38 Addressing Patients’ Concerns

39. Average Age: 41.5 Oldest Patient: 83 Youngest Patient: 1 month Overall Male: 29.1% Overall Female: 70.9% Our Providers can treat children to as young as they feel comfortable, recommended age is > 4 months old 39 Health eXpress Demographics Age & Gender % of Visits

40. 40 Web vs. Mobile Utilization % of Visits Female mobile users are the largest demographic Mobile is comparatively more popular with women than men

41. 41 DTC Patients by County PDX Metro Health eXpress Demographics Location

42. Average Wait Time: 3:40 minutes Wait Time Target: < 4:00 minutes 42 Health eXpress Wait Time

43. Average Visit Length: 10:46 Key Factors in Longer Visits: More complicated health issue Technical Issues Providers becoming more efficient with technology, lowering duration of visits. Average visit duration fell by 3 minutes over the year. 43 Health eXpress Duration of Visit

44. 44 Crossing the Chasm Finding and engaging clinical telehealth champions Medical Liability Provider Compensation Infrastructure Reimbursement Navigating Regulations Licensure Medicare & Medicaid FSMB Guidelines State by State adoption Integration with EMR Adoption

45. 45 On the Horizon Expansion Washington (EPIC) – Q1 2015 Health eXpress Regional Expansion Additional Employer Groups Additional Payers PHP Medicare Advantage Primary Care Specialty Care

46. 46 Questions?

47. 47 Retail Staffed Kiosk Model

48. Health eXpress Service Models #PatientTechnologyScheduled?CustomersNotes 1Web (Unstaffed) American Well Website Platform On-DemandOregon: Selfpay, PEBB, Evergreen, PHP Insurance, Intel The web application can include a Single Sign On 2Mobile (Unstaffed) American Well App (iOS or Android) On-DemandOregon: Selfpay, PEBB, Evergreen, PHP Insurance, Intel The app does not include all features of the website 3Employer Kiosk (Unstaffed) Jabber / CiscoScheduled8 Kiosks: PEBB & PGE Free to employees 4Retail Kiosk (Staffed) Jabber / CiscoScheduled2 Kiosks: Safeway, Jackson Care Connect, All Care Health Plan Available in Medford (OR) as alternative to ER 5Employee Clinic Kiosk (Staffed) Jabber / CiscoScheduled2 Kiosks: PSVMC, PPMC An extension of Employee Health