Telemedicine

For more information contact:

Lee Shoemake

Lee@FlexCare.com

(404) 846-4100

Managing Healthcare Costs

Corporate America—The Challenge

Employers have been, are currently, and will continue to seek creative solutions to reduce absenteeism, increase productivity and decrease overall healthcare costs.

They have been forced to restructure their benefit plans.

With more people entering the system, a shortage of physicians and increased waiting times, innovative solutions are needed.

Managing Healthcare Costs

We Have a Solution: FlexCare offers an innovative, timely

and sensible solution. This program offers convenient,

accessible and affordable healthcare.

These benefits offer the

employee and his/her entire family thousands of dollars in savings.

At the same time, it offers the employer those creative solutions they seek.

Health Care Reform and Telemedicine

We are about to have a severe shortage of primary care physicians

What Will Happen?

Individuals will ignore symptoms and delay treatment which can lead to more serious medical complications

Individuals will leave work for minor issues which results in absenteeism, loss of productivity and unnecessary costs

Individuals will continue to overuse Urgent Care and Emergency Rooms

The supply-demand gap The demand in the number of yearly PCP consults

due to population increase and expanded coverage will drive the need for more PCPs.

POPULATION BASELINE AGING ACA EFFECT (health reform)

280,000

240,000

200,000

160,000

2010 2025

"Projecting US Primary Care Physician Workforce Needs:

2010-2025"; Stephen M. Petterson, PhD, Winston R. Liaw,

MD, MPH, Robert L. Phillips Jr, MD, MSPH, David L. Rabin,

MD, MPH, David S. Meyers and Andrew W. Bazemore, MD,

MPH; November/December 2012

ADDITIONAL PCPs NEEDED

52,000 Additional PCPs

needed by 2025

Average appointment wait times (in days) for five medical

specialties included in the Merritt Hawkins Survey (2010).

Family Practice wait time was 20.3 days on average

Average appointment wait times (in days)

Seattle 14.2

Portland 14.4

Minneapolis 19.8

Detroit 12.0

Denver 15.4

Los Angeles 24.2

San Diego 20.2

49.6 Boston

19.2 New York

27.0 Philadelphia

22.6 Washington D.C.

11.2 Atlanta

19.2 Dallas

23.4 Houston

15.4 Miami

Employer adoption of telemedicine Workplace telemedicine is a growing trend, and one that is

gaining increasing attention. • “Health care delivery and treatment

settings continue to evolve, leading to the acceleration of alternate network strategies, including high-performance networks, third-party providers and telemedicine.

• For example, 17% plan to offer telemedicine by 2013, and another 27% are considering it for 2014 and 2015.”

• The Challenge: Most telemedicine services have had low utilization rates due to two significant barriers.

• FlexCare has eliminated these barriers.

1 Health Care Changes Ahead Survey Report, Towers Watson, October, 2012. Link:

http://www.towerswatson.com/assets/pdf/8139/TW-HealthCare-Trends-Survey-NA-2012.pdf

Source: Towers Watson, Health Care Changes Ahead Survey Report, October 2012 http://www.towerswatson.com/en/Insights/IC-Types/Survey-Research-Results/2012/10/health-care-changes-ahead-survey-report

Healthcare Trends

Access Points for Healthcare 1. Medical Offices will be

overcrowded

2. Walk-in Clinics–-Groceries and Pharmacies

3. Overuse of Urgent Care and ER Clinics

4. Telemedicine—Doctors by phone or online video will be the solution– telemedicine will represent the navigators of the future

“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.”

National Center for Policy Analysis

Convenient Care and Telemedicine White Paper, November 2007

“Telemedicine will play an increasingly central role in getting the right care at the right time to individuals…particularly

effective for acute, routine, episodic, self-limited and minor illnesses.”

Telephonic Medical Consults Answer the Call for Accessible, Affordable and Convenient Healthcare. Position Paper. Center for Health Transformation.

The Challenge: Most telemedicine services have had low utilization rates due to two significant barriers—communication and cost. FlexCare has eliminated these barriers.

Introducing Teladoc Teladoc is quality healthcare made simple, on your terms,

when and where you need it.

• An affordable alternative that allows members to resolve many of their medical issues 24/7/365 through the convenience of phone or online video consultations. Anytime. Anywhere.

• Provides members with access to a national network of physicians who can diagnose, treat, and prescribe medication, when appropriate, for many medical issues. All physicians are U.S. board-certified and licensed to practice medicine in your state.

An Innovative Solution

Providing solutions for three of the biggest issues in healthcare:

• Timely access

• Lower cost

• Quality care

Employee / Member satisfaction is one of the

many benefits of addressing these issues

What can it be used for? Top 10 Diagnoses • Sinus Problems

• Urinary Tract Infection

• Pink Eye

• Bronchitis

• Upper Respiratory Infection

• Nasal Congestion

• Allergies

• Flu

• Cough

• Ear Infection

• Headaches and Migraines

• Stomach aches

• Prescription refills

• Electronic prescribing

(SureScripts) or by phone if needed

• Frequency of prescribing similar to provider

practice (about 75%)

• Use of antibiotics limited to short durations No

prescribing of DEA-controlled substances,

medication for psychiatric illness, or lifestyle

drugs (i.e. erectile dysfunction, diet, etc.).

• Generic drugs are automatically recommended

Prescription Management

Prescribing of Medications

Teladoc's prescribing patterns are similar to those found in face-to-face consultations.

PRESCRIPTION RATE GENERIC PRESCRIPTION RATE

80% TELADOC

83% PCP/ER

98% TELADOC

Teladoc prescriptions are for durations of

30 days or less

Teladoc provides non-emergency medical assistance when a doctor is not available.

• When the physician is unavailable and cannot be seen on a timely basis

• Schedule doesn’t permit traveling to see your physician (work, etc.)

• On vacation or a business trip

• For refill of recurring prescription (short term only)

• Geographical barriers (distances to a providers office)

• Pediatric care for any age

When can it be used?

Where can it be used?

Teladoc is compliant with current state regulations in order to operate in 50 states.

How does Teladoc work?

An employee has cold-like symptoms but doesn’t have the time to sit in an urgent care waiting room. Instead they call Teladoc:

Step 2.

Request consult Step 3.

Talk with a physician

Step 4.

Resolve the issue Step 6.

Results

They simply log on to their account or

call Teladoc, 24/7/365, to request either

a telephone or video consultation.

There is NO CONSULT FEE with

FlexCare.

A board-certified physician licensed in

their state reviews their medical history

and provides a consultation over the

phone or through video, just like an in-

person visit.

The physician recommends the

right treatment for their medical

issue. If a prescription is necessary,

it is electronically sent to the

member’s pharmacy of choice.

Your member’s medical issue gets

resolved saving time and money.

Step 1.

Medical history

Member receives fulfillment kit with

instructions. Member is required to

complete their medical history

online, by phone, or by faxing a

paper form prior to requesting a

consultation.

Step 5.

Continuity of care

The physician documents the results of

the consultation in the member’s medical

history. Consultation information can be

sent to the member’s primary care

physician.

The highest quality care

By directly managing their own network, all doctors are:

97% Teladoc physician satisfaction rate

Board-certified Board-certified and state-licensed in internal medicine, family practice, emergency medicine or pediatrics.

Experienced Experienced, with an average of 15 years of practice.

Primary Source Verified

Verified through the National Practitioner Data Bank (NPDB) and the American Medical Association (AMA) Board certification, work history, peer reference, State licenses, monthly state sanction reports, DEA license, criminal and civil background.

U.S. residents U.S. residents, living and working in the United States.

Connected Message Center enables our physicians to follow up with members inside the secure member portal. Easy-to-understand educational articles are available to provide to the member to help them understand their specific diagnosis.

Supporting the patient – physician relationship

Teladoc reinforces that telehealth is not a replacement for the patient’s PCP

• Member communications reinforce importance of PCP relationship

• Every patient is asked before every consult if they would like a copy sent to their PCP

• Patient does not select their Teladoc physician or develop an on-going relationship

• Overutilization of Teladoc services closely monitored.

Teladoc supports the Patient / Physician

Medical Home

Teladoc refers patients to their PCP for any

follow up care

100% Consults by new docs are reviewed

for the first 3 months or after 10 consults

15% Consults reviewed if physician

conducts more than 10 consults in a month

1,500 Charts reviewed on average per

month in 2013.

Teladoc physicians are constantly reviewed to ensure a high level of quality care.

WHAT WE DO THE RESULT

91% Patient medical issues resolved

9% unresolved: 4% referred, 2% out of scope for telehealth, 2%

seeking meds only, 1% sent to the ER

Teladoc quality management

Processes and systems in place to ensure quality consultations.

Teladoc pursues excellence through

quality assurance and improvement.

• Before each doctor performs a consultation, all sections of the medical report must be reviewed and noted as performed

• Evidence Based Medicine and clinical guidelines embedded with hyperlinked references for each consultation

• Rigorous network management to deliver highest quality medical care

• Prescriptions are sent electronically to the patient’s pharmacy

• Patients are educated that antibiotics are not beneficial for colds or flu using the CDC “Get Smart” program and physicians are reminded the appropriateness using the CMA Foundation AWARE

• The patient's medical record is updated following a consultation, sent to the health plan and can also be sent to the patient's PCP

Video

http://youtu.be/rCZYjvUjkoQ http://youtu.be/pYededbGbeM

Making access easy

Teladoc’s mobile application allows members to set up and manage their account, as well as conduct video consults

from their mobile device.

Teladoc Facts -- 2013

Telehealth’s time has come.

Based on Teladoc reporting and member surveys

97% Member Satisfaction

125,000 Consultations in 2013

99%+ Client Retention

0 Malpractice Claims

1hour Guaranteed Response Time

91% Patient Issues Resolved

Teladoc is the first and largest provider of telehealth medical consultations in the United States. Not only do they have the most experience, they have the results to prove it:

What the Employer Can Save

A benefit of telehealth is appropriate redirection of utilization to an affordable alternative.

• Base on Teladoc reporting. Actual savings may vary based on geography.

IF THEY DIDN’T HAVE TELEMEDICINE, WHERE WOULD THEY HAVE GONE?*

HOW MUCH WILL YOU SAVE WHEN MEMBERS USE

TELEMEDICINE CONSULTATION?

33% Urgent care

1% Specialist

43% PCP

15% Nothing

ER

Urgent care

Specialist

PCP

Avg savings per consult

Productivity savings**

Total savings per consult

$155.40

$86.96

$242.36

** Approx 4 hrs lost @ avg wage of 21.74/hr

based on US Dept of labor data

$752

$122

$152

8% ER

$102

Communications We help you drive utilization by providing targeted marketing materials

FlexCare communications include:

• Fulfillment Kit to each household

• Can all be co-branded for client

• A variety of marketing pieces Welcome Letter

Getting Started

Monthly Campaign

General Reminders

The following have been found to drive utilization:

• Send Member Kits and Cards

• Include Teladoc information in benefit summary next to PCP co-pay

• Highlight Teladoc during open enrollment

• Highlight NO MEDICAL CONSULT FEE feature

• Market to members several times a year – especially during cold/flu and allergy seasons

• No two clients are alike: understand what messages and communication vehicles resonate

best with population.

• Use of emailand text messaging as a communication vehicles

• Leverage employer’s logo/brand

• Develop and agree to year long marketing strategy and plan in advance; review every 6

months, based on results

Drivers of low utilization include:

• Not communicating

• Burying Teladoc information in the benefits package

• One size fits all marketing

• Not personalizing (co-branding, using company name)

Build awareness and drive utilization

The value proposition

Telemedicine addresses the biggest healthcare issues and FlexCare eliminates the barriers to utilization.

FlexCare has eliminated all barriers affecting utilization by offering this benefit with NO MEDICAL CONSULT FEES COMPREHENSIVE COMMUNICATION PLAN.

Provides comprehensive 24x7 access to appropriate care for all employees regardless of work location or travel

Significant impact on inappropriate ER and UC utilization; lowers self-insured healthcare costs

Reduced absenteeism and increased productivity

Highest clinical standards found in the industry

Valued benefit offsetting perception that benefits are being reduced as employee contribution is increased

Access

Satisfaction

Quality

Cost

Productivity

Other Features

List-bill capabilities

Fulfillment Kit and Membership Cards

Website Access to benefits and provider locators

Onsite member services call center staffed with English and Spanish speaking representatives who can help with enrollment, verify discounts and assist with customer service issues.

Compliance Department monitoring state legislative

requirements

All benefits are good for the immediate family

Other Benefits

Emergency Travel Assistance

Members have access to a global network of practicing physicians, travel assistance personnel and emergency evacuation benefits when traveling 100 miles from home and suffering a serious injury or illness. Knowing help is merely a phone call away provides members with peace of mind.

*Travel Assistance not available to Florida, Oregon and Washington residents

Fitness Club Discounts International Fitness Club Network Guaranteed lowest rates at over 8,500 quality fitness centers nationwide. Introductory Free Week Trial to all clubs. All meet ACSM guidelines.

How to Sign Up—Pricing based on group size

GROUPS List Bill Agreement Eligibility File