House Calls in the 21st Century

Transcription

Cynthia J (CJ) Marks
Vice President & Market Leader, ASO
Health Plan Strategy
“House Calls in the 21st Century”
HCCHMA Annual Meeting
April 7, 2016
© 2002-2016 Teladoc, Inc. All rights reserved.
1
MegaTrends
2
Mega Trends & Convergence
Driving a revolution in healthcare delivery
I
©2015 Teladoc, Inc. All rights reserved.
3
2014 Pew Research Center Survey
90% of US adult population owned some kind
of cell phone
2015 PRCS
64% of all American
adults now own a
smartphone
4
10% of Americans own a
smartphone but do not have any
other form of high-speed internet
access at home beyond their
phone’s data plan.
5
Americans are accessing services
and communicating through their
cellphones “on demand” & are
connected 24/7 through mobile
devices
6
Telehealth Market
WHAT’S HAPPENING TODAY
7
Large and Under Penetrated Markets
Ambulatory Care market
Behavioral Health market
1.25 billion ambulatory care visits1
168 million annual addressable visits
33%
78%
estimated treatable through telehealth2
estimated treatable through telehealth
417 million visits
Up to $40 cost per telehealth visit3
$17bn TAM
131 million visits
Current
Telehealth
Penetration
~$89 per telehealth visit3
$12bn TAM4
Contribution from Behavioral Health market increases TAM to $29bn
1
According to a 2010 report from the Centers for Disease Control and Prevention (CDC); includes visits in the United States per year, including those at primary care offices, hospital emergency rooms,
outpatient clinics and other settings
based on Teladoc's internal estimates / assessment of conditions listed in the CDC report. According to a Deloitte report “eVisits: The 21st Century Housecall,” of the 600 million annual visits to general
practitioner offices in the US and Canada, about 50% are treatable through telehealth; 3 Based on Teladoc estimates for average cost of a telehealth visit (does not include PMPM fees or premium pricing for
new products)
4 Total Addressable visits from AHRQ, 2012 report including only outpatient provider offices; Addressable via Telehealth and $89 Weighted average price based on CDC report and methodology described in
I Copyright 2015footnote
Teladoc1Inc.
and Oliver Wyman report
2 33%
8
Primary Care Problem:
Supply and Demand
Shortage in primary care
physicians due to high demand
is currently 16,000 and that is
projected to increase to 31,000
physicians by 2025
Of the US physician workforce,
35% are PCP's and 65% are
specialists, yet nearly 60% of
patient visits to physicians are
for primary care
Dall TM, Gallo PD, Chakrabarti R, West T, Semilla AP, Storm, MV. An
Aging Population and Growing Disease Burden Will Require A Large and
Specialized Health Care Workforce By 2025. Health Affairs. 2013;
32:2013-2020
Weida NA, Phillips RL Jr.., Bazemore AW
. Does graduate medical education also follow green? Arch Intern
Med.2010;170(4):389–90
Only 30% of Americans can
easily contact their physician
after hours
C. Schoen, R. Osborn, M. M. Doty, D. Squires, J. Peugh, and S.
Applebaum, "A Survey of Primary Care Physicians in 11 Countries, 2009:
Perspectives on Care, Costs, and Experiences,"Health Affairs Web
Exclusive, Nov. 5, 2009, w1171–w1183
Having a PCP versus a
specialist as a primary care
physician reduces healthcare
spending by 33% as well as
lowers mortality by 20%
P. Franks and K. Fiscella, “Primary Care Physicians and Specialists as
Personal Physicians: Health Care Expenditures and Mortality
Experience,” Journal of Family Practice 47, no. 2 (1998): 105–109
62 million people
have no or inadequate
access to primary care due to
shortages of primary care
physicians
National Association of Community Health Centers (NACHC).“The
Medically Disenfranchised and Shortage of Primary Care.” (March
2014).www. nachc.com/research
An increase in primary care
physicians of 1 per 10,000
people would reduce
emergency room visits by 11%
Stephen J. Kravet, Andrew D. Shore, Redonda Miller, Gary B. Green, Ken
Kolodner, Scott M. Wright, “Health Care Utilization and the Proportion of
Primary Care Physicians,” American Journal of Medicine, 2008
In 2015, only 48% of Teladoc users identify as having a PCP
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Average appointment wait times
(in days)
45.4 Boston
Seattle 16
16.8 New York
Portland 19.4
20.6 Philadelphia
Minneapolis 19.2
Detroit 17.8
17.8 Washington D.C.
Denver 26.6
14 Atlanta
10 Dallas
Los Angeles 12.2
14 Houston
San Diego 16.2
13.6 Miami
Family practice wait time is currently 19 days on average
Rural area access can be worse
Psychiatrists, 25 days for first time visit
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Here’s what all that data is really saying:
80%
of adults discharged from ER were there
due to lack of access to other provider.1
40%
Projected increase to yearly PCP
visits by 2025, while also facing a
shortage of PCPs. 2
1. Available from: http://www.cdc.gov.nchs.nhis/releases.htm
2. Available from: www.annfammed.org
11
Industry and Teladoc Maturity
Industry is significantly underpenetrated with opportunity for long-term, sustainable growth
Industry Massively Underpenetrated Today
Teladoc Profitable Before
Industry Reaches Maturity
Market less than 0.5%
penetrated1
417M Addressable Visits2
Continue to Grow Membership
Drive Utilization
Leverage Operating Expenses
(1)
(2)
Based on projection for 2015 virtual visits provided by the American Telemedicine Association. ATA’s projection divided by Teladoc’s calculation of 417M addressable visits.
Ambulatory visits only.
12 I Copyright 2015 Teladoc Inc.
Telehealth 101
HOW DOES A TYPICAL VISIT WORK?
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Care delivered conveniently and securely
however consumers choose
Play Video - “What-is-Teladoc?”
https://vimeo.com/29853062?mkt_tok=3RkMMJWWfF9wsRomrfCcI63Em2iQPJWpsrB0B%2FDC18kX
3RUsK76efkz6htBZF5s8TM3DWFZEXrNC9kEOT7Q%3D
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What we do
24/7/365 ACCESS
Provide 24/7, on-demand
access to board-certified
Washington and Alaska
providers via video, phone
or mobile app
PROVEN SAFE, EFFECTIVE
AND AFFORDABLE
Prevent unnecessary ER/UC
visits to more convenience, costeffective mode of care
ENHANCED PRODUCTS
Behavioral Health,
Dermatology and Tobacco
Cessation available
TREAT HEALTH ISSUES
Diagnose, treat and
prescribe medications
(if necessary) for common
health issues
15
Simple, Convenient and Intuitive
1 REGISTER
2 3 REQUEST & CONNECT
4 5 VISIT & RESOLVE
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Who are the players?
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Telehealth Landscape
# of
Visits
Share1
Mode of Visit
Monetization
575k+
~70%
Choice of Video
or Phone
Access Fee
(“PEPM”)
~15%
Choice of Video
or Phone
Access Fee
(“PEPM”) or
License Fee
MD, BH
professionals
~10%
Video Only
License or
Other Fee
MD, BH
and dieticians
~5%
Video Only
Visit Fee
Only
1,500
125k –
150k
60k –
80k
<50k
1 Share
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Doc
Network
2,900
MD, BH, Derm
professionals
2,300
MD, Psych,
and other
based on total telehealth 2015E visits. Depicts share only among top four players. Calculated by dividing Teladoc 2015 total visits of 575K by the sum of all combined visits for Teladoc,
MDLive, American Well and Doctor on Demand for calendar year 2015. Visit counts for competitors represent management estimates.
I Copyright 2015 Teladoc Inc.
Rapid adoption and
growth by and sectors
900,000
575,000
Growth demonstrated by year over
year consult volume.
Reached one million virtual visits in
October, 2015
Projecting 900,000 visits in 2016.
298,000
EST.
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
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Regulatory Roadmap
POSITIVE TRENDS
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National
coverage
•
•
•
•
Video or phone
Video only
Phone only
Unavailable
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Quality & Outcomes
PROVIDER NETWORK CONFIGURATIONS
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The highest
quality of care
• Rigorous Quality Assurance program
•
•
•
•
and oversight
Maintenance of evidence-based protocols
Ongoing development and adherence to
evidence-based protocols
100+ proprietary telehealth guidelines
Zero malpractice claims. (over 1 million
consultations to date)
THE RESULT: Teladoc is the first telehealth company to receive NCQA
certification, achieving a perfect score for two consecutive certifications.
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CONTINUOUS
MONITORING TO
ENSURE QUALITY
QA team regularly reviews
visit charts to:
Ensure patient safety;
Appropriate and advice and
prescribing practices.
Monitor medication frequency
Regularly compare against
quality guidelines
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Maintain a high
quality of care even
during peak hours,
days, seasons.
SCALE DELIVERS:
RESULTING IN:
Seamless experience
Physician coverage
Clinical quality
Industry knowledge
Easy
Timely
Consistent
92% resolution
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Reduces Cost
DELIVERING VALUE
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Studies finds these episode-of-care
savings
$191
$2,661
$600+
Teladoc savings
vs. office visit and UC
Teladoc savings
vs. ER visit
Teladoc savings
vs. weighted average
(office visit, UC & ER)
*Episode of care: Includes initial encounter and any subsequent utilization of follow up office visits, hospitalization, or ER utilization, resulting from initial
encounter within a 30 day window for same and related diagnoses
**Weighted Average is based on redirection rates determined using member utilization of bricks and mortar services: 75% OV; 20% ER; 5% Do Nothing
27
An independent study revealed
34% visits occurred on weekends & holidays
21% patients did not seek care in the past year
6% required a follow-up visit
52% represent top 3 diagnoses
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Reviews from the
members
“My family physician spends a lot of time
and covers my questions thoroughly, so it
would be hard for a “Teladoc” to improve on
that. Really, this service has exceeded my
expectations, by far and I am grateful it. It is
the next best thing to my family physician.”
“First time user and was completely
satisfied with the service. I would definitely
use it again in the future.”
“I can't say enough positive comments
regarding this service!”
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What should be considered when
selecting a telehealth platform?
CUSTOMIZABLE
Custom branded pages
HIGHLY SCALABLE
Over 3,000 visits/day
12.9M members
PURPOSE BUILT
Easy-to-use member
experience. Multimodality.
SECURE & RELIABLE
3rd party tested and
validated
FULLY INTEGRATED
Real-time eligibility
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Key goals in obtaining organizational
buy in
• Maintain year-over-year health care cost increase to one-half of the national
•
•
•
•
•
market trend
Extend success of several previously implemented programs designed to improve
member engagement and manage utilization and costs
Reduce emergency room abuse by increasing engagement with health care provider
community
Enhanced health care offering by providing convenient access to medical care at no
cost to our associates
Favorable perception from covered union work force
Win-win for organization and associates
31
Telehealth can tackle the big
issues in healthcare
OUR SOLUTION:
ISSUES:
More patients (30M uninsured)
Over 800K visits in 2015
Fewer PCP’s
24/7 access to providers
Longer wait times (avg. 19 days)
10 min median response time
Misuse of ER (no access to PCP)
92% patient resolution
$673 average savings/claim
Increasing costs
32
Thank You.
33
Q&A
34

House Calls in the 21st Century

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