Marketing and Planning Leadership Council - Becker's Hospital Review · PDF fileMarket Drivers...

Marketing and Planning

Leadership Council

Transforming with Telehealth Prepared for Becker’s Hospital Association,

American Well

©2014 The Advisory Board Company • advisory.com

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Road Map

Market Drivers of Telehealth

The Real ROI of Telehealth

Transforming with Telehealth


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A Growing Need for On Demand Care

Sources: “Retail medical clinics: Friend or foe?,” Accenture, available at http://www.accenture.com; “Delivery reform and coverage expansion: Health care cheat sheets for IT,” Advisory Board Company, available at http://www.advisory.com; Petterson SM, et al., “Projecting US primary care physician workforce needs: 2010-2025,” Annals of Family Medicine, 10, no. 6 (2012): 503-509; “Physician Shortages to Worsen Without Increases in Residency Training,” AAMC, available at https://www.aamc.org/download/286592/data; Health Care IT Advisor research and analysis.

1) Primary care physicians.

Influx of newly insured

needing PCPs1

40% Newly insured lack

formal source of care

PCP

shortage

45,000 Estimated PCP shortage

by 2020: Need to expand

primary care capacity

Market forces driving telehealth

http://www.accenture.com/



http://www.advisory.com/

https://www.aamc.org/download/286592/data

https://www.aamc.org/download/286592/data


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High-Deductible Plan Enrollment Continues to Grow

Purchasers Encouraging Patient Price Sensitivity

Source: Aon Hewitt et al, "The Consumer Health Mindset," 2013; Pickens G et al, "Thomson Reuters Healthcare Indexes: Consumer Confidence," Thomson Reuters 2009; Health Care Advisory Board interviews and analysis. 1) Consumer Directed Health Plan.

High-Deductible Health Plan Enrollment

7%

10%

18%

25%

2003 2005 2010 2012

Individuals with Deductible of $1,000 or More

23% Consumers report they are

postponing care after enrolling in a CDHP1

17% Consumers report they are

sacrificing care after enrolling in a CDHP1

Price Sensitivity in Action


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Patients Directing More of Their Own Care….

Source: Kahn S, "Emergency & Other Outpatient Care Centers in the US," IBISWorld, October 2013; Lerman S, "Primary Care Doctors in the US," IBISWorld, September 2013; MarketData Enterprises, "Retail Health Clinics & Urgent Care Centers Poised For Strong Growth – Market Worth $10 billion," available at: www.prweb.com, accessed October 1, 2013; Son A, "Diagnostic & Medical Laboratories in the US," IBISWorld, August 2013; Son A, “Urgent Care Centers in the US,” IBISWorld, February 2013; Health Care Advisory Board interviews and analysis.

1) Retail: $0.78B, PCP: $128B, UCC: $14.5B, Freestanding diagnostic imaging: $21B, HOPD: $57B, Non-urgent ER: $14B.

Least Consumer

Involvement Most Consumer

Involvement

Trauma

Care

Preventive

Care

Low-Acuity

Illness Care

Specialty

Care

Non-elective

Complex Care

Elective

Surgery

Moderate-Acuity

Illness Care

Imaging

Diagnostics

Physician input, guidance significantly

influences care and access decisions

Patients comfortable directing own

care based on personal judgment

Patient Involvement in Accessing Care

$235B Estimated market size

for consumer-directed services1


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“On-Demand” Increasingly Means Online

Source: 2014 Primary Care Consumer Choice Survey, Marketing and Planning Leadership Council interviews and analysis.

1) Based on proportions of respondents interested in teleheatlh.

Survey Finds Email Visits Preferred to Clinic Near Errands or Work

Increasing Consumer Preference

Emailing provider with symptoms

Preference for Location of Services

Clinic location near work

Clinic located near errands

Clinic located near the home

Young, Wealthy, Busy—Strongest Potential Telehealth Targets1

Of 18-29 yrs olds

54% Of those making

>$71K per year

49% Of those working

>35 hours per week

53%


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Barriers to Telehealth Being Removed

Source: Health Care IT Advisor research and analysis.

Changing Regulatory Environment

Federal

Expanding telehealth services

and geographic areas eligible

for reimbursement

State

Enacting telehealth parity laws

to ensure certain virtual

services are being reimbursed

on par with in-person consults

Professional Bodies

Setting guidelines for safe,

evidence-based telemedicine

Commercial Insurers

Partnering directly with

telehealth vendors to provide

virtual care to beneficiaries

Why should systems meet consumer demands today, and in the future?


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Case in Brief: Medical

Associates Clinic

Early Adopters Now Recruiting Early Majority

Following Trial, Overwhelming Preference for Virtual

Source: 2014 Primary Care Consumer Choice Survey; Teledoc, available at http://www.teladoc.com/healthplans/how-it-works-for-your-members/, accessed July 2014; “The Virtual Primary Healthcare Revolution,” Becker’s Hospital Review , available at http://www.beckershospitalreview.com/strategic-planning/the-virtual-primary-healthcare-revolution-what-health-systems-need-to-know.html, accessed July 2014; “Just how far in usage and savings can telemedicine take US healthcare?” mHealthNews, available at http://www.mhealthnews.com/news/just-how-far-usage-and-savings-can-telemedicine-take-us-healthcare, accessed August 2014; Marketing and Planning Leadership Council interviews and analysis.

71%

Of midsized to large U.S. employers anticipate offering employees

telehealth services within three years

92%

Of a virtual visit provider’s patients said they would use the

service again

91%

Of Zipnosis users would recommend the service to at least three friends

• Four-physician practice in

Kentucky

• Piloted the Me-Visit mobile app

to offer online care for primary

care and chronic condition

follow up needs

• In 30-month pilot, 20% of

patients used the app, and 97%

of users preferred the service to

in-person care

http://www.teladoc.com/healthplans/how-it-works-for-your-members/












http://www.beckershospitalreview.com/strategic-planning/the-virtual-primary-healthcare-revolution-what-health-systems-need-to-know.html
























http://www.mhealthnews.com/news/just-how-far-usage-and-savings-can-telemedicine-take-us-healthcare























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Competitors Stepping in to Meet New Demand

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1) 2013-2015 numbers projected; 1,437 clinics as of June 1, 2013. 2) Walgreens announced double-digit clinic growth, but no specific goals.

Source: Accenture, "Retail medical clinics: From Foe to Friend?," 2013; Ritchie J, "After a stall, Kroger could add clinics," Cincinnati Business Courier, July 5, 2013; Robeznieks A, "Retail clinics at tipping point," Modern Healthcare, May 4, 2013; Health Care Advisory Board interviews and analysis.

2000-20151

Estimated Total Number of Retail Clinics in the

US

100

Pages of research

that Walgreens

prepares before

constructing a new

pharmacy site

2.5 PB

Consumers Already at the Core

202

868

1135 1172 1220 1355 1418

1743

2243

2868

2000 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Growth trajectory depends on preferred payer relations, PCP

capacity, and health system partnerships

Retailer

Retail clinics

planned in 2013 150 10+2 30 0 15

Petabytes (1015)

of consumer data

that Walmart has

banked


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Innovators Positioned to Siphon Off Business

Systems Lose Visits as the Ambulatory Network Fragments

Source: CDC/NCHS, "National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey," 2009-2010; “Primary Care Physician Shortages Could be Eliminated Through Use of Teams, Nonphysicians, and Electronic Communication,” Health Affairs 32:1. Jan 2013. Health Care Advisory Board interviews and analysis.

Annual Visits to PCPs

Annual ED Visits

Visits Eligib le for NP-Led Care

103M

47M

132M

Non-urgent ED Visits Shifted

to Other Care Sites

573M 18% of PCP visits could be handled by NPs

at convenient care sites

Non-urgent ED visits could be treated at urgent

care, retail or primary care

Visits At Risk of Shifting to Other Sites of Care


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Road Map

Market Drivers of Telehealth

The Real ROI of Telehealth

Transforming with Telehealth


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Limited New Capacity in Existing Clinical Model

Traditional Levers Not Sufficient to Improve Service Standard

Role #1: Capacity Expansion

• Costly to keep

clinics open beyond

normal business hours

• Physicians are already

overworked with

daytime schedule

Extend

Hours

• Physician supply

becoming increasingly

restricted

• High labor cost to

employ additional

physicians

Expand

Physician Supply

• Scheduled visits

already truncated

to 10-15 minutes

• Patient dissatisfied

with degree of

medical attention

Increase

Patients per Hour

Source: Altschuler J, et al., "Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation," Annals of Family Medicine, September/October 2012; Merritt Hawkins, “2009 Survey of Physician Appointment Wait Times,” available at: www.merritthawkins.com; The Physicians Foundation, "A Survey of America's Physicians: Practice Patterns and Perspectives," available at: www.physiciansfoundation.org; Health Care Advisory Board interviews and analysis.

53% Percentage of PCPs

at full capacity

21.7 hours Time it would take an MD to

meet all daily clinical needs

for representative panel

68,500 Expected PCP

shortage by 2025


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Virtual Visits Create Space in the Day

E-Visits Offer Potential for Capacity Gains, Especially with High Utilizers

6% of visits

21% of visits

42%

of visits

31%

of visits

35% of panel,

0-1 visits/year

25% of panel,

2 visits/year

25% of panel,

4 visits/year

15% of panel,

5 visits/year

35% of panel,

0-1 visits/year

25% of panel,

2 visits/year

25% of panel,

2 visits/year,

2 e-visits/year

15% of panel,

3 visits/year,

2 e-visits/year

~15 Example increase in panel

size from converting periodic

check-ins to e-visits

571 ~5 Minutes needed to

respond to typical

email query

Average PCP visit

length, in minutes

Typical PCP Workload

Workload with Remote Check-Ins

29% increase in available time, panel

size

1 Square=1% of Physician Time with Patients

Routine check-ins converted to

shorter remote interactions,

but most MDs unpaid for time

Source: Health Care Advisory Board interviews and analysis.


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Increasing Patient Panel Size with E-Chronic Care

Source: Marketing and Planning Leadership Council interviews and analysis.

Of the average panel has

one or more chronic

conditions

40% Number of annual visits

consumed by the average

patient in this group

4+ Increase in available time

and panel size by shifting 2

of these 4 visits online

29%

Treating Chronic Conditions Online at MGH Beacon Hill

Ensure capacity by engaging highest-risk patients

20% of patients

consumed 5-10

OP visits per

person per year

Shifted 85% of

targeted patients

to virtual visits

• 15% of in-person

visits shifted online

in six months

• Patients receive

more visits

Increased

capacity for

panel growth


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Rapidly Pulling Patients in with Virtual Offering

Source: Health Care Advisory Board interviews and analysis.

Role #2: New Patient Recruitment

1) Urgent care centers within 30 miles if physical care center needed. 2) Pseudonym.

15 weeks

Build-to-open time for

virtual care platform

Build-to-open time for

urgent care facility

• Multi-hospital system located in the East

• Entering new markets with virtual strategy to capture

consumer segments preferring site-less care delivery

• Patients can engage providers via webcam, send

secure photos, and submit biometric tests for clinicians

to review in real-time

Case in Brief: Underwood Health2

Tech-Savvy Patients Attracted to Virtual Care

Virtual Market Capture Strategy

Tailoring web banner campaign to targeted consumer demographic (tech-savvy, healthy, busy)

Marketing smart phone accessib ility to mobile users

Virtual co-pays lower than on-site co-pays for ED, urgent care centers; $45 for consumer paying OOP

2 Login to virtual access portal

3 Conduct synchronous virtual visit

1 See virtual care advertisements

15 months

Patients in market areas with no

physical site of care1


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Avoiding Unnecessary Utilization

Telehealth Investment Supports Primary Care Expansion


Role #3: Cost-Management

Case in Brief: American Well

• American Well is a telehealth company that provides telehealth technology and clinical services for Enterprise and SaaS telehealth deployments

• Clients include health systems, health plans and employers

• American Well’s DTC service, Amwell, is available for consumers, employees, members and patients 24/7 live video-based access to doctors

Amwell’s Virtual Visit Model

Patients access doctors 24/7

for co-pay (or $49 without

insurance)

1

Available on mobile (iOS,

Android), web, on-site kiosk and

phone

2

Roughly 85% of visits result in a

patient’s concerns being fully

resolved without urgent care or

ED visit

3


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Hardwiring Virtual Patient-Provider Follow-Up

Focus on Established Patients with Discrete Care Needs

Source: Health Care Advisory Board interviews and analysis .

Mass General Criteria for Patient

Inclusion in Virtual Follow-Up

Established relationship with PCP

Chronic symptoms, care needs

Protocol-driven care plan

Comfortable, amenable to virtual care

Case in Brief: Massachusetts General Virtual Practice Project

• Division of Massachusetts General Hospital in Boston, Massachusetts founded in 2005 to

research and evaluate virtual care options

• In 2011, developed evidence-based platform for performing asynchronous follow-up visits for

chronically ill patients; piloted with 10 conditions and have since expanded to 30

Providers Considering Remote

Management Investments

55%

ACOs deploying and evaluating remote patient management technology


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Source: Health Care IT Advisor research and analysis.

Why Telehealth Now?

The time is already right for providers to improve care management via telehealth

for chronic disease patients, and the need for it will only increase over the next

years and decades.

Leaving Fee For Service Behind in the Era of PHM1

Demographics and Health of the US Population as a Driver of Chronic Disease Management using Telehealth

People who hav e a

heart attack each y ear

– f or 500,000, it’s their

f irst (CDC)

720,000 New cancer cases

expected to be

diagnosed in 2014

(American Cancer

Society )

1,665,540

Projected shortage of primary

care doctors by 2020 (AAMC5)

45,000

Although there has always been value in being able to reach patients remotely, fee for service models

and payers have not directly supported it. The ACO2 movement, an increased interest in patient

engagement, and a focus on population health management, are all drivers of telehealth.

Baby -boomers hitting

retirement age ev ery y ear

ov er the next 20 y ears

3M Percentage of adults that

are obese (CDC3) – the

largest percentage are

middle-age adults

1/3 US diabetics (American

Diabetes Assoc.) – 86

million are pre-diabetic

(CDC)

30M

Increased number of home aides

needed by 2020 (Bureau of Labor

Statistics)

70% Percent that liv e in areas with

insuf f icient primary care doctors

(HRSA4).

20% Gaps to Fill

1) Population health management; 2) accountable care organization; 3) Centers for Disease Control; 4) Health Resources and Servi ces Administration; 5) Association of American Medical Colleges.


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Gauging the Urgency of Telehealth Investment

Guiding Indicators

Are you losing patients to more convenient forms of care (e.g. retail

clinics)?

Do you have a long wait for a primary care physician?

Do many of your patients live far from a primary care office?

Are you in a state that has Medicaid coverage for telehealth?

Are you in a state that has private insurance coverage for telehealth?

Is a significant part of your patient population covered by large and/or

self-insured employers?

Have your competitors launched telehealth programs?

Does your market have a high proportion of the aging population?

Does your market have a high proportion of tech-savvy young invincibles?

Patients

Payers

Market

Conditions

20 © 2014 American Well Corporation | Confidential

Transforming with Telehealth How Mobile- and Web-based Healthcare is Changing the Business of Health and Patient Engagement

AMERICAN WELL

Peter Antall, MD | Medical Director, American Well Joseph Briggs, PMP | VP, Professional Services, American Well December 11, 2014

© 2014 American Well Corporation | Confidential 21

Focus on Clinical Applicability How You Can Use Telehealth Across Your System


Telehealth Addresses Key Strategic Challenges

Improving/Simplifying Access to Care

Reaching New Geographic Areas

Managing Medical Expenditure


Telehealth Leapfrogs Retail Clinics

Delivering greater value AND higher satisfaction at lower cost

Retention Satisfaction &

Loyalty Lifetime Value Acquisition

Retail Clinic Specialty

Care Referral Referral

Online Urgent Care

Convenience

Primary Care

Patient


Who Uses Telehealth Urgent Care? And When?

0%

2%

4%

6%

8%

10%

12%

12a 2a 4a 6a 8a 10a12p 2p 4p 6p 8p 10p

Time Distribution of Visits

Female 52%

Male 48%

Gender

9% 12%

28% 25%

20%

5%

1%

0%

5%

10%

15%

20%

25%

30%

0-17 18-24 25-34 35-44 45-54 55-64 65+

0%

5%

10%

15%

20%

Day of Week Distribution of Visits

Age

Source: American Well data, 2014.


Our Experience Meeting Consumer Demand

Consumer-friendly Telehealth Mobile and Web Apps Primary care, behavioral health and registered dietician staff coverage Clinical service consulting and onboarding services available

Source: Advisory Board, “Telemedicine and Concierge Care: Trends in Consumerism and Non-Traditional Primary Care Delivery”, 2014.

Choice of provider

Patient information /to-do list for visit follow up

High satisfaction: 4.7 of 5 stars

3-minute wait time

24/7 coverage

Easy, intuitive

Mobile, web, and phone

Reasonable price

Clear pricing and payment

Claims submission for insurance

Tailored Service On-Demand Access Affordability


Health Systems Bear More Financial Risk

Accountable care is growing fast

134 235

368 124

135

154

Jan 2013 June 2013 Jan 2014

Non-CMS

ACOs

1. Oliver Wyman, ACO Update: Accountable Care at a Tipping Point, 2014.

2. Global Institute for Emerging Healthcare Practices, “Preventing Hospital Readmissions: The First Test Case for Continuity of Care” 2012

Readmissions are costly under accountable care and most are avoidable

84%

78%

76%

5-day 15-day 30-day

Number of ACOs1 Percent of Post-discharge Readmissions that are

Preventable2


Telehealth-centric Care Reduces Readmissions

1. “Care About Your Care: Tips for Patients When They Leave the Hospital”, The Darmouth Atlas Project, 2011.

2. Snell, “The Role of Remote Care Management in Population Health”, Health Affairs Blog, April 4, 2014

Better communication is central to avoiding readmissions1

Better patient/caregiver education

Addressing medication confusion

Hospital staff/PCP communication

PCP and specialist follow-up visits

Sharing test results with patient/PCP

Telehealth can help reduce avoidable readmissions up to 70%2

. . . by engaging patients wherever they are

Discharge Planner

PCP

Behavioral Health

Provider PharmD

Patient

and through better care team co-ordination


Online Urgent Care Offer a convenient and more cost-conscious alternative to ED, urgent care and retail clinics Tactics: Work with a dedicated telehealth medical group to provide full -time or augmented coverage Offer telehealth triage at point-of-service

Chronic Disease Management and Care Coordination Improve access and enhance interactions with high-risk patients Tactics: Augment capabilities of existing disease management personnel with patient- and/or provider-initiated

telehealth visits Ongoing consultation without the burden of in-office or in-home visits Enable care providers to collaborate virtually

Post-procedure and Post-discharge Follow-up Improved oversight for patients at risk for readmission Tactics: Substitute telehealth for pre- and post-op consultations that would typically occur in-office Enable patients to request on-demand consultation for concerns or complications Enable bed-side specialty consultations for patients at home or in rehab/LTC facil ity

Telehealth Integration Best Practices

© 2014 American Well Corporation | Confidential 31

Telehealth Implementation What to Expect from a Shared Implementation


Telehealth Implementation: Four Areas of Focus

Telehealth Technology

Clinical Workflow

Clinical Services

Patient Engagement


▪ HIPAA and DoD-grade security

▪ Flexible use cases and workflow

▪ Patient entry: mobile, web, kiosk

▪ Documentation integration options

▪ Off-the-shelf integration: • Real-time eligibility • Payment processing • ePrescriptions and med. history • Automated claims processing

Telehealth Technology: Platform Requirements & Best Practices

Platform Requirements Best Practices

▪ Identify a Technical Lead

▪ Perform Hosting and Security due diligence

▪ Determine clinical documentation strategy

▪ Identify key health plans to integrate for eligibility and reimbursement


Clinical Workflow: Partner Experience & Best Practices

▪ Regulatory and reimbursement landscape expertise

▪ Understanding of clinical workflows and documentation

▪ Experience collaborating with clinical departments

▪ Development of telehealth-specific guidelines & protocols

Partner Experience Best Practices

▪ Consider existing brick-and-mortar clinical & administrative workflows

▪ Engage all participants involved in visits & patient communication

▪ Develop early wins by focusing initial efforts on select use cases


Clinical Services: Expertise & Best Practices

▪ Expertise running a telehealth medical practice

▪ Explicit process for knowledge transfer

▪ Operations support (scheduling, demand forecasting, performance)

▪ Onboarding resources (training, licensing, credentialing)

Expertise Best Practices

▪ Determine staffing approach to online urgent care offering

▪ Start coverage with telehealth medical practice staff clinicians

▪ Augment coverage with existing clinical resources


Patient Engagement: Communications Tools & Best Practices

▪ Demonstrated success messaging telehealth services to patients

▪ Expertise across service types (patient-initiated, provider-directed)

▪ Dedicated marketing support to liaise with your comms. team

▪ Customizable communication materials

Communications Tools Best Practices

▪ Understand patient value proposition for each use case

▪ Use existing resources (website, patient portal) to drive awareness

▪ Utilize web marketing best practices to engage existing and new patients


Beyond the Basics: What To Look for in A Telehealth Partner

Patient and

Provider

Usability

Available

Across Key

Access Points

Provider

Coverage and

Expertise

Understanding

of Clinical

Workflows

Thoughtful

Product

Roadmap

Marketing

Expertise and

Resources


Transforming with Telehealth How Mobile- and Web-based Healthcare is Changing the Business of Health and Patient Engagement

AMERICAN WELL

Peter Antall, MD | Medical Director, American Well Joseph Briggs, PMP | VP, Professional Services, American Well December 11, 2014

Marketing and Planning Leadership Council - Becker's Hospital Review · PDF fileMarket Drivers...

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Transcript of Marketing and Planning Leadership Council - Becker's Hospital Review · PDF fileMarket Drivers...