1. http://www.providenceoregon.org/video/?view=6d5 adc34ecb94x480x293 http://www.providenceoregon.org/video/?view=6d5 adc34ecb94x480x293

2. The new reality http://www.kptv.com/video?autoStart=true&topVideoCatN o=default&clipId=7329325

3. Fighting rising costs Finding innovative ways to stop the trend of rising health care costs Providing appropriate care at the right time and place Easy access, same day care, no cost to patient Connected experience that rivals office based care Reduce time loss, ED and Urgent Care utilization

4. Care delivery redefined Who: Employers determine who is eligible to use the service What: Over 50 low-acuity medical conditions, which account for 30% to 50% of non-emergent conditions When: Same-day care to evaluate, diagnose and treat Cost: No out-of-pocket costs to the patient for the visit Providence Health eXpress provides quality health care and excellent service to your eligible employees directly from your workplace. Unlike traditional models of care, Providence Health eXpress consistently offers care that is fast, convenient and affordable. Your eligible employees will have no out-of-pocket costs to access this worksite service. Employees access the level of care you and they have come to count on from Providence using technology solutions that are friendly, secure and private. Nurse practitioners engage in face-to-face interaction, where patients discuss their minor medical conditions, get a treatment plan and are back to work in minutes. Patients and their primary care providers receive a summary of the visit. It’s easy, low cost and designed with your business goals in mind.

5. Meet the provider team Our licensed, board-certified Providence Family Nurse Practitioners can provide diagnosis and treatment recommendations, which may include prescriptions or labs. Larlene Dunsmuir, FNP Lindsay Kleps, FNP Thanh Nguyen, FNP Melissa Sanchez, FNP

6. Clinical scope Cough, cold & allergy Flu Rash Oral lesions Diarrhea Bladder infection Smoking cessation Pinkeye & stye Ear pain Acne Joint pain Low back pain Short-term Rx refills Headache Wellness services Burns Sunburns Yeast infection

7. Patient experience “I liked the quick access, the privacy, and most of all, it prevented me from having to take time off work. I was able to accomplish this easily on my break because of the handy location to my work site. Without this service, I would have had to take time off work, drive almost seven miles to my doctor’s office, and wait. It also saved me fuel costs.” - Providence Health eXpress patient BeforeDuringAfter Patient calls direct line to Providence Health eXpress to schedule a same-day appointment, conveniently located at the patient’s workplace. Family Nurse Practitioner provides a diagnosis and treatment recommendations, which may include prescriptions or labs. Rx faxed to pharmacy After-Visit Summary sent to patient and patient’s Primary Care Provider Patient satisfaction online survey sent to patient Nurse Practitioner follow- up phone call

8. PEBB Lessons Learned – What We Know Established accurate clinical scope – 93% of patients who called for an appointment had one scheduled (of 354 patient encounters) A connected experience of care – 98.4% of surveyed patients would recommend the service to a friend or co- worker Avoided duplicate costs to employer groups – only 0.7% of patients sought additional medical care within 5 days of a Providence Health eXpress visit. 3% were escalated Improved productivity by getting employees in for same- day appointments – 73.5 minutes average time between initial call and visit, including patient preference for specific appointment times (e.g., during lunch hour) and travel time to/from the telehealth station 8

9. PEBB Lessons Learned – What We Know 69% of visits resulted in at least one prescription 5% of visits resulted in a lab or radiology test ordered from the clinic 20% of visits are by repeat patients 9

10. PEBB Lessons Learned – What We Know Attended stations in existing clinics for on demand load leveling, broader scope Distributed hub sites with Providers in other on demand care settings Community outreach into underserved areas Coordination with other telehealth services Migration from subscription to claims-based Web-based visits Transform Health eXpress into a virtual clinic with separate cost center, management staff, and system support and overhead 10

11. PEBB Lessons Learned – What We Know Currently 5 Spoke sites (Salem, Umatilla, Pendleton, Portland, Camas in Washington State) Currently second hub site with 2 nd APP located in Immediate Care Clinic Currently one Spoke site in a traditional exam room, Medical Assistant, tele-exam equipment in exam room and APP in Clinic. Specialty telemedicine Clinic, 7 specialties with Hub sites in specialist Office PSA, spoke site in Seaside go- live April 30, 2013 Future iterations include leap frogging Retail Clinics, load leveling in on demand services, patient guide, scribe 11

12. PEBB Lessons Learned – What We Know SUMMARY Primary CARE Telemedicine Getting the right care, in the right place, at the right time Easy, instant, inexpensive patient access Integrated with On Demand,PCMH, Specialty Services Interstate access Full range of access from home computer, Kiosk, Attended/Presentor stations to fully staffed Clinics A connected experience for the patient and Provider 12