Confidential property of UnitedHealth Group. Do not distribute or reproduce without the expressed permission of UnitedHealth Group.

UnitedHealth Group’s Vision and Strategy

for Telehealth / Telemedicine

American Telemedicine Association

September 27, 2010

Presented By:

Reed V. Tuckson, MD, FACP

Executive Vice President and Chief of Medical Affairs

HealthBenefits

HealthServices

Dataand

Information

Services

• Health Information, Analytics,

Exchange and Technology

• Integrated Pharmacy

Management

• Clinical Care and Disease

Management

• Revenue Cycle Management

and Administrative Services

UnitedHealth Group Is A Fortune 25 Health And Well-being Company

UnitedHealth Group

Commercial

Individual

Medicare

Medicaid

Military

Patients:

75

Million

Network:650,000 Physicians

5,000 Hospitals

Health

Benefits

Health

Services

Data

and

Information

Services

Commercial

Individual

Medicare

Medicaid

Military

UnitedHealth Group Is A Fortune 25 Health And Well-being Company

UnitedHealth Group

Data

and

Information

Communication

Channels

Prevention and

Care Support

Services

• Health Information, Analytics,

Exchange and Technology

• Integrated Pharmacy

Management

• Clinical Care and Disease

Management

• Revenue Cycle Management

and Administrative Services

Claim

Platforms

Individual

and

Employer

Senior

and

Government

Commercial

We Invest Heavily In Actionable Data And Analytics As A Core Competency

Converting diverse data streams into meaningful information

55 million lives

Eligibility

Claims

Cost

Network

Pricing

Clinical

10

Terabytes

20

Terabytes

26

Terabytes

Reference

DataRx LAB

Applications (40+ Standard &

Custom) – Predictive Modeling,

Clinical Profiling, Provider Pathways,

Fraud & Abuse, HEDIS, Contracting,

Underwriting, Trend Economics

Data Warehouse (GALAXY)3 Years Online, up to 7 Years Archived

Value Added

Data

Subjects

Member, Customer,

Provider, Product

Claim, Financial, Rx,

Time, Geography

Analytic Components –

Interpretive, Analytical and

Regression Models

Our Focus: Modernize The Delivery System To Solve Key Problems

1. Suboptimal Quality and Safety of Care Delivery

$-

$100

$200

$300

$400

$500

$600

$700

$800

1980 1990 2000 2008

$253

$714

$1,354

$2,394

$-

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

2008E 2011P 2014P 2017P

$2,394

$2,905 $3,524

$4,277

Source: Centers for Medicare & Medicaid Services

Total for All Categories

Hospital

Physician / Clinical

Other

Nursing Home Health

DME

Retail Rx Drugs

GR

AP

H K

EY

:

Our Focus: Modernize The Delivery System To Solve Key Problems

2. Unsustainable Cost Escalation (For Commercial Purchasers)

Our Focus: Modernize The Delivery System To Solve Key Problems

2. Unsustainable Cost Escalation (For Public Sector Purchasers)

Projected US Federal Spending (pre Recession, Pre Health reform legislation.)

From: CBO, 2008

Our Focus: Modernize The Delivery System To Solve Key Problems

3. Fragmented Non-Patient Centric Care Delivery

Solutions Must Be Focused On The Individual,

Comprehensive And Integrated Across The Care Continuum

Community

and

Population

Prevention

Individual

Prevention

and

Wellness

Early

Diagnosis

Optimal

Disease

Treatment

Disease

Management

and

Care

Coordination

End

of

Life

Care

Stay Healthy Get Healthy Living with Illness

Improving Value = Optimum Clinical Outcomes and Health Status

X Efficient Use of Resources

• Optimize health outcomes: prevention and curative

• Make care simpler, less complex and more convenient to deliver for

care providers and consumer/patients

• Get to the source of problems: not halfway intermediary additive steps

• Decrease unnecessary ER visits, admissions, LOS, and readmissions

• Move hospital care to the out-patient setting and then move out-

patient care to the community- home environment

• Disruptively replace more expensive traditional interventions by

meeting new performance criteria

Innovations, Just Unto Themselves, Are Not Exciting:

They Must Produce Value!

A Lesson We In Healthcare Should Learn To Appreciate:

“Many of the most powerful innovations that

disrupted other industries did so:

by enabling a larger population of less skilled people to

perform their work in a more convenient, less expensive

setting …

… and do things that historically could be performed only by

expensive specialists in centralized, inconvenient locations.”

Clayton Christensen

Harvard Business Review

We need to be more courageous and disciplined in

applying technology to drive costs out of health care…

as in other industries

Our Organizing Framework For Telemedicine Is Guided By the

Crossing The Quality Chasm Report of Ten Years Ago

2001Defined the Aims for the

21st Century Healthcare System

• Efficient

• Equitable

• Patient-Centered

• Safe

• Effective

• Timely

• Evidence-based

Decisions

• Safety

• Decrease in waste

• Customization based on

patient needs and values

• Anticipation of needs

• Patient as source of control

• Transparency

• Care based on

continuous healing

relationships

• Cooperation among

clinicians

Shared Knowledge and Free Flow of Information

Data and Information Assets

• Population health and epidemiology

• HRA‟s

• Consumer encounters

• Claims

• Pharmacy

• Lab

• Employers and other health plans

Patients

• Population and community prevention

• EB Information and decision support

• Customization based on needs and values

• Anticipation of needs

• Patient as source of control: transparency

Free Flow

Data and Analytics To Support Population Prevention

Integrated Data And Analytics To Support Personally

Appropriate Individual Prevention And Treatment Decisions

eSync Platform and Analytics

Stay Healthy Get Healthy Living with Illness

HRA

Daily Rx Feeds

Daily Lab Result Feeds

Network and Premium Utilization

Daily Pre-Adjudicate Mx Claims

Creating a

“Personalized

Opportunity

Profile”

Smart

Phones

and

Apps

Direct

Mail

Personalized Portal, and Secure Email

Worksite

resources

such as

biometric

kiosks

We Invest In Getting People The Wellness, Reminder, Science-based

and Performance Information They Need … The Way They Want It!

Personal Health Coach

Data and Information Assets

• Patient specific information: risk status and gaps in

recommended care

• Decision support

• Performance assessment

• Efficiency and appropriate use of resources

• HIE-EMR-Practice Management System Connectivity

Delivery System

• Evidence-based quality, safe and efficient care

• Support for continuous healing relationships

• Cooperation among clinicians

Free Flow

• Connecting patients telephonically to network physicians “24/7” via two-way

video secure chat or phone (OptumHealth‟s “NowClinic”)

• Employing satellite/broadband advanced video conferencing and telemedicine

devices to connect

• Primary care and rural clinics to specialists

• Worksite settings to clinical care sources

• Patients to comprehensive allied health support services

Our Telemedicine Model Envisions “Connecting Care” Seamlessly

Across The Delivery System And With Patients

• Scheduling and

configuration of

appointment content

• Support application

of video, medical

devices and encounter

management

• Data collection and

transfer for PHRs,

EHRs and PMSs

“Connected Care”

Software Platform

SolutionMoving from the „back

room‟ to the front office

• Coordination

• Integration

• Facilitation

Public

InstitutionsHome Worksite

CONSUMERS

Primary

CareSecondary

Care

ACOs /

Medical

Homes

FQHCs HospitalsEAP and

Behavioral

Care

Pharmacy

Services

Dieticians

Speech

Rehab

Delivery System

Health Company

Clinical Services

• Health Coaches

• CME and

Disease Managers

“NowClinic”: 24/7 Supplementary Access To Our Network Physicians Via Two-Way Video, Secure Chat Or Phone

• Broadens access to care and facilitates the Crossing the Chasm goal of going beyond “face-to-face” visits for 24-hour a day responsive care availability

• Interactions supported by our eSync data and decision support tools

• Interesting New York Dept. of Health Pilot to extend reach of Medicaid physicians into homes via computers brought by case managers

We Are Excited By Our Progress In

Organizing Networks Of Telemedicine Systems

Wireless Diagnostic Tools

We have the essential components:• The patients

• The networks

• The data and information systems

• The technology relationships

• The software

We Are Especially Interested In New Wireless Interventions That

Move Us From „National Broadband‟ To „Individual Bodyband‟

Wireless

Sensor

Smartphone

Broadband

Wireless Diagnostic Tools

Wireless Cardiac

Event Monitor

We See Promise In Integrating Wireless Monitoring

For Heart Failure Management Via “Smart Band-Aids”

• Approved by the FDA February 2009

• A wireless, water-resistant sensor that monitors heart rate,

respiratory rate, bodily fluids, and overall activity

• Transmits data to a central server for analysis and then to devices

• New algorithms predict when a patient is slipping into CHF

Corventis' Remote Monitoring

Wireless System

We Are Focused On Facilitating Immediate Access To Cardiac And

Neurologic Experts To Eliminate The Barriers Of Time And Space

• Many Cardiac ICUs have a

difficult time achieving compliance

with staffing criteria

• Meeting the four hour critical

window for expert stroke care is

a significant challenge: TeleStroke

pilot

• Specialists are challenged in

providing adequate follow-up

care, especially in shortage areas

• We use our coordination capabilities

to arrange access to rehab services

such as speech therapy, vocational

therapy and dieticians

Consults

with specialists

Our Telehealth Capabilities Are Significantly AdvancingCare And Disease Management Post Acute Illness

:

Supported by member empowerment and

behavior change through our web-based

and print education programs

Heart Failure Program

Heart Failure Program - Alert Report STAT

595 Double Eagle Crt #1000 Reno, NV 89521 Phone: 866-766-8280 Fax: 888-922-5373

Patient: Health Plan:

DOB: Nurse Contact:

Date:

PCP: Health Plan:

SCP: Facility:

CM: Med Group:

Other:

ALERT Report - STAT

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Comments:

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Wei

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Patient Reported SYMPTOMS to daily questions

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2

Wake up SOB

Extra Pillow

Missed Exercise

Missed Medication

Breathlessness

Pedal Edema

More Tired

Coughing More

Stomach Bloated

Feeling Worse

Feeling Dizzy

• All of us must be supportive of Clinical

Effectiveness Research: “Optimal quality

and affordable access rests on the strength

of the evidence that compares the benefits

and harms of alternative methods to prevent,

diagnose, treat, and monitor a clinical

condition or to improve the delivery of care.”

• We need cost-effectiveness

data to assist providers,

policy-makers, payers and

consumers to make

informed decisions about

new innovations in

telehealth.

Innovations, Just Unto Themselves, Are Not Exciting:

They Must Produce Value!

Key Policy And Regulatory Barriers Requiring Attention

• Reimbursement: variability and lack of clarity in regulation by states/ CMS

• We reimburse for services that CMS recognizes

• “Medical information is communicated in real-time with the use of

interactive audio and video communications equipment between the

performing and a distant physician or health care specialist

(interactive telecommunication).”

• “Remote real-time interactive video-conferenced critical care,

evaluation and management of the critically ill or injured patient.”

• Medical Boards: Variability in regulations state-to-state

• Some require that a patient-physician have a prior established

relationship through previous in-person exams, or through a „site

presenter‟ facilitating the interaction

• Significant impediment for patient self-initiated engagement such

as our NowClinic

Key Policy And Regulatory Barriers Requiring Attention

• Malpractice: determination of liability between remote physician and on-site

attendant

• We urge uniform clear standards that don‟t penalize practitioners

• Licensure: Lack of clarity and restrictions in requirements for state specific

licenses; inconsistent guidelines for “attendants” licensure

• Technical Standards: inadequate uniform standards to ensure

interoperability between devices that may impede physician and facility

acquisition

• Ambiguous HIPAA Rules Concerning Data Privacy and Security: inconsistent

state by state laws that inhibit acceptance

• Continuing expansion of Broadband Into remote areas

We Will Continue To Invest Heavily In This Field And Will Realize

The Vision Of The Crossing The Chasm Report Of A Decade Ago!

We are not just about technology but in

bridging the gap between data and device

and personalized patient care!