DBRA

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 • Encompasses all aspects of care • PCP • Specialist • Remote location • Mental health • Surgery and specialty care

5. 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

6. 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

7. Telemedicine impacts • Patient • Employer • Broker/Consultant • Payer • Provider

8. 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

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

10. 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

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

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

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

14. 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

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

16. 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

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

18. Common Conditions Treated

19. 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.

20. Cost of Physician Access