Telehealth Alliance of Oregon

February 2015

Michelle Wernert

Health eXpress ExperienceTelehealth in Practice

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

House calls circa 1930

Beginnings of Telehealth

The future…?

6

Pope Benedict XVI

Pope Francis

7

8

Coming full circle

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

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

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

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

Health eXpress Clinical Scope

Cough, cold & allergyFluRashOral lesionsDiarrheaBladder infection

Smoking cessationPinkeyeEar painAcneJoint painLow back pain

HeadacheBurnsSunburnsWellness servicesChildren’s servicesRx scripts

28% of IC and ED visits

National Institute of Health 2010

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

KioskWeb Mobile

Current Hours Mon to Fri: 8am to 8pmWeekends: 9am to 5pm

18

Health eXpress Kiosk

8 Workstation Kiosks across Oregon

19

Meet the Provider Team

Kim TullThanh Nguyen

Our licensed, board-certified Providence Family Nurse Practitioners can provide diagnosis and treatment recommendations, which may include prescriptions or labs.

Larlene Dunsmuir Kimberly Rodda Kristen Harris Melissa Sanchez

Rated at 4.8 Stars by Health eXpress Patients

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

Health eXpress – Web Visitwww.healthexpress.com

22

23

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

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

Community Partnerships - Promotores2014• 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

Promotores Health eXpress

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

Community Partnerships

31

32

2014 in ReviewLessons Learned

33

Health eXpress Visits TrendsVolume increased 3X Year over Year

Utilization vs. Satisfaction

2012

2013

2014

81%

81%

96%

96%

98%

98%

210

515

1591

# of Patients seen % Patient satisfaction rate % Patients believe service is same or better than a traditional visit

35

Where Would Patients Have Gone

Location Average Cost PCP $ 159 Urgent $ 193 Immediate Care $ 193 ER $ 1,557

45.96%

33.13%

16.98%

3.93%

If you had not used Health eXpress, where would you have gone instead?Done Nothing

Emergency Department

Primary Care Physician

Urgent/Immediate Caren = 483

36

2014 Top Medical Conditions

Primary Diagnosis (Top 10)

0 20 40 60 80 100 120 140 160 180

Number of Records

Sinusitis

Upper respiratory infection

Sore throat

Bronchitis

Dysuria

Conjunctivitis

Dermatitis

Rash

Stye, eye irritation, pink eye

Urinary tract infection

Total Prescriptions: 1,070% of Visits that Resulted in a Prescription: 67.3%

37

Top 10 Medications Prescribed

Medication Description 2014

0% 5% 10% 15% 20% 25%

% of Total Distinct count of Px Encounter CSN ID

Decongestants

Cough/Cold

Penicillins

Macrolide Antibiotics

Antiasthmatic

Dermatological

Ophthalmmic

Corticosteroids

Fluoroquinolones

Misc. Antiinfectives

Top 10 Medications

Percent of patients whose medical concern was addressed: 98.7%

38

Addressing Patients’ Concerns

CPT Code Primary Dx (grouped)

0 1 2 3 4

Number of Records

99999 Joint / Leg / Back painBronchitisDysuriaElevated blood pressureFeverMedication refillAbdominal painConjunctivitisIll feelingLump on neckScreening for HIVSnoringURI (upper respiratory infection)

Patients Evaluated and Referred Elsewhere

• 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 DemographicsAge & Gender

AGE RANGE

Age0-17

Age18-30

Age31-50

Age51-65

Age66-80

Age81-100

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

% of Total Number of Records

12.23%

36.74%

18.15%

14.80%

2.45%

0.06%2.25%4.44%

7.53%

% o

f Vis

its

40

Web vs. Mobile Utilization

FEMALE MALE

0%

10%

20%

30%

40%

50%

60%

% of Total Number of Records

35.43%

21.36%

23.12%20.10%

Connection Type (web or mobile) (group)MOBILE WEB

% o

f Vis

its

Connection Type (web or mobile) (group)MOBILE WEB

• Female mobile users are the largest demographic

• Mobile is comparatively more popular with women than men

69% of selfpay visits are patients in the

Portland/Vancouver Metro area

41

Client Account PATIENT ZIP (Grouped by County)

0% 5% 10% 15% 20% 25%

% of Total Count of Number of Records

Self-Pay OR - Washington

OR - Multnomah

OR - Clackamas

WA - Clark

OR - Deschutes

OR - Yamhill

OR - Lane

OR - Jackson

25.65%

25.65%

9.42%

7.85%

3.14%

2.62%

2.62%

2.09%

Self-Pay Web/Mobile Visits DTC Patients by County

PDX Metro

Health eXpress DemographicsLocation

Average Wait Time: 3:40 minutesWait Time Target: < 4:00 minutes

42

Health eXpress Wait Time

Mar Apr May Jun Jul Aug Sep Oct Nov Dec0:00

1:12

2:24

3:36

4:48

6:00

Average Wait Times Over the Year

Average Visit Length: 10:46Key Factors in Longer Visits:• More complicated health issue• Technical IssuesProviders 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

:00 :02 :04 :06 :08 :10 :12 :14 :16 :18 :20 :22 :24 :260

10

20

30

40

50

60

Conversation Duration

Minutes

# of

Vis

its

wit

h D

urati

on

Mar Apr May Jun Jul Aug Sep Oct Nov Dec0:080:100:110:120:140:150:170:18

Average Duration of Visits Over Time

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

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

Questions?

47

Retail Staffed Kiosk Model

Health eXpress Service Models# Patient Technology Scheduled? Customers Notes

1 Web (Unstaffed)

American Well Website Platform

On-Demand Oregon: Selfpay, PEBB, Evergreen, PHP Insurance, Intel

The web application can include a Single Sign On

2 Mobile (Unstaffed)

American Well App (iOS or Android)

On-Demand Oregon: Selfpay, PEBB, Evergreen, PHP Insurance, Intel

The app does not include all features of the website

3 Employer Kiosk (Unstaffed)

Jabber / Cisco Scheduled 8 Kiosks: PEBB & PGE

Free to employees

4 Retail Kiosk (Staffed)

Jabber / Cisco Scheduled 2 Kiosks: Safeway, Jackson Care Connect, All Care Health Plan

Available in Medford (OR) as alternative to ER

5 Employee Clinic Kiosk (Staffed)

Jabber / Cisco Scheduled 2 Kiosks: PSVMC, PPMC

An extension of Employee Health