Implementing Direct-to-ConsumerDebbie Voyles, MBA HOM

Corporate Director, Virtual Health

Ballad Health

Agenda

A bit of healthcare history

Changing Landscape

What is Direct-to-Consumer Telehealth?

Demographics of Virtual Visit Users

Key Drivers/Key Concerns

Primary approaches

Keys to Success

Q&A

Healthcare delivery through the years

1940s > 40% of U.S. doctor’s visits were in the home

1960s ↓ sharp decline

2010s < 1%

2019s ↑ Virtual visits - House Calls

A Few Notable Trends

Healthcare spending increased approx. 6%

Global growth rate of telehealth estimated at 26%

Mean Cost of Consumer Visits

• Virtual Health Visit $40• Retail Clinic $66• Doctor’s office $106• Urgent Care $103• Emergency Room $358

35 states and the District of Columbia have some form of telemedicine “parity law"

In the Blink of an Eye….

Pope Benedict XVIBenedict XVI Pope Francis

Change is relentless• We reach for our smart phones 80

times/day

• Moore’s law

• Our phones are yesterday’s supercomputers

• 1:5 Americans use some kind of fitness tracker

Direct-to-Consumer DTC telemedicine is when a patient goes

online, picks up a telephone, or goes to their smartphone and directly contacts a healthcare provider

Video, audio only or questionnaire

Treatment of low-acuity conditions

Direct to consumer telemedicine is a subset of virtual health that shows promise in increasing access to and engagement in medical care

Extend care beyond walls to fill gaps in care

Headlines –DTC development

New York-Presbyterian starts offering virtual ER visits

7-27-16

York Hospital recently launched its first direct-to-consumer

telehealth service

5-8-17

Spectrum Health Tackles the Flu With Direct-to-Consumer Telehealth with MD Live

1-31-18

Providence Targets Patient Demand with Store-and-Forward

Telehealth

4-2-18

Partners, Teledoc Launch Direct-to-consumer Telehealth

Service

8-29-18

South Florida-based Memorial Healthcare is building new

business for its two-year-old direct-to-consumer telehealth service by forging partnerships

with local resorts 10-226-18

Cincinnati Children’s Jumps Onto Teladoc’s DTC Telehealth

Platform

4-12-19

Cleveland Hospital Extends DTC Telehealth Services to College

Students

7-3-19

Cambia Health Solutions is partnering with Lemonaid

Health to pilot a store-and-forward telehealth platform for

employees 2-20-18

Retailers enter the DTC Market

CVS

Teladoc partnership established August 2018

• Minute Clinic Video Visits available through CVS Pharmacy App

• Initial test of program saw 95% satisfaction among patients who opted for a video visit

Rite Aid

InTouch partnershipestablished July 2018

• The two companies signed a letter of intent to partner on a telehealth project

• Kiosks located in RiteAid pharmacies

• Rite Aid owns kiosks, InTouch provides software

Walgreens

Online marketplace established July 2018

“Find care now” marketplace helps Walgreens pharmacy members locate convenient care through a mobile app

Service includes access to MDLive for telemental health urgent care, and a dermatologist on call

Source: CVS Health’s MinuteClinic Introduces New Virtual Care Offering CVS Press Release (2018); InTouch Health & Rite Aid Collaboration, InTouch Health Press Release (2018); Wicklund, E, Walgreens Launches an Online Marketplace for Telehealth, mHealth Intelligence (2018); Service Line Strategy Advisor research and analysis.

Demographics of who uses Virtual Visits

Age

Physical Location

SexIncome Level

Insurance Type

Female vs Male Young vs Old

Female 67%

Male 33%

Age Percent

18-29 24.6%

30-49 34.3%

50-64 3.7%

65+ 2.6%

Advisory Board, What Do Consumers Want from Virtual Visits? Advisory.com

Urban vs Rural

Location …..Once …Multiple ….For Children

Urban 16.2% 22.6% 63.0%

Suburban 5.6% 3.0% 16.8%

Small Town 3.4% 2.5% 6.1%

Rural 3.0% 3.4% 7.6%

Advisory Board, What Do Consumers Want from Virtual Visits? Advisory.com

Income Level Insurance Type

>$71,000 52.1%

<$24,000 12.1%

Privately Insured 13.8% -17.7%

Medicaid 3.3%

Medicare 3.8%

Uninsured 1.8%

Advisory Board, What Do Consumers Want from Virtual Visits? Advisory.com

Patient preference for DTC Services

Survey of 4345 respondents demographically balanced in U.S.

3.5% had an online video visit with their care provider

52% were willing to have a visit vs. 25% not willing

35% less willing to see a different provider from same healthcare organization and 19% were least willing to see a different provider from a different organization

56% felt was important to have an established relationship with a provider

60% felt is was important for a telemedicine provider to have access to their health records

Source: BMC Health Serv Res. 2017; 17: 784 Brandon M. Welch, Jillian Harvey, Nathaniel S. O’Connell, and James T. McElligott

Key adoption drivers for Virtual Visits

Cost sensitivity• Same co-pay

if billing insurance

• flat rate for Self-pay option

• No travel costs

• No salary loss due to time away from work

Convenience• Timely

access to services

• Patient requested time, particularly during traditional business hours

Quality guarantee

• No charge if diagnosis can not be made and patient is referred to in-person care

Physician trust• Endorsement

from regular primary care provider for virtual visit option

• Part of current healthcare system

Word of mouth• Experience

of family, friends and co-workers who have used the service

Source: Virtual Visit Consumer Choice Survey, Market Innovation Center (2016); Advisory Board research and analysis.

Top Concerns in using Virtual Visits

Quality of the care received

Possibility that the provider

cannot diagnose or treat

Lack of personal connection with

provider

Security of health

information

Cost of visit too high

Lack of technology

needed

Unreliable or faulty

technology

Possibility of being seen by a

NP or PA

Lack of private space

Poor or no internet

connection

Three Primary Approaches to DTC

1) provider to patient by their own care

provider

2) entails patients seeing a different care

provider from same organization as the

primary care provider

3) care provider is from an organization outside the patient’s medical

home

Provider to patient by their own care provider

Pros

Patient-provider relationship already established

Complements the in-person visits

Provides continuity of care

Provider already in network for insurance plan

Cons

Hard to get PCP to agree to always be available to patients

May have limited time option

Patients sees a provider from same organization

Pros

Provider has access to medical records

Allows for continuity of care

Does not require PCP to maintain 24/7/365 coverage

Provider should be in network

Ability to bill insurance or charge flat fee

Cons

Must have multiple providers available for on-call services

If multiple states – providers must be licensed in all patient states

Extra pay to cover

Patients see providers from an organization outside the patients’ medical home

Pros

Multiple providers to cover services

Outside organization responsible for ensuring providers licensed in state patient located

Cons

No doctor-patient relationship developed

Little or no coordination of care with PCP

Many use questionnaires only

May or may not be willing to bill insurance

Providers may not be part of insurance plans

Maybe more costly

Expectations

Studies show that a health care system can expect to retain a quarter of the consumers it sees as patients

RAND Study…We estimated that 12 percent of direct-to-consumer telehealth visits replaced visits to other providers, and 88 percent represented new utilization.

Enhance patient access and convenience

Attract and retain new patients

Reduce costs by shifting patients to lower cost settings

Cut patient/provider travel time

Keys to Success

Know your why –

Assess your needs and environment

Define the program model

Develop the business case – is

it part of your strategic plan?

Leadership Support

Support at all levels –

administrative and clinical

Dedicated Staff

Virtual Health Team

Virtual Health Steer

Operational Committees

HIT Team

Choose the right provider

Well-established

Local is better

Dedicated champion

Legal and regulatory

LicensureFederal and state

regulations

Billing and reimbursement

options

Informed consent

Keys to Success

Choose the right Technology

Modality optionsEasy to use for both providers and patients?Help desk support

Determine success metrics

up frontNumber of encounters, miles saved, ED visits reducedQuality and outcomes

Establish a referral process

List of providers/specialists to refer to if needed

Over-educate

Training of staff on proper etiquetteInsurance patients know how to access and what to expect

Market

FlyersWebsite

Establish regular check-in’s

Know what patients thinkKnow what providers think

Conclusions

Focus needs to be on the customer and meeting their needs

Value is the end game – not cost reduction alone

DTC is best used as part of a continuum of services

Services that encourage engagement and care coordination might do a better job of turning consumers into patients

Though DTC is about convenience and immediacy, it’s crucial to slow down and give patients proper, thoughtful attention.

Q&A