1. Copyright © RelayHealth Corporation 2003. All rights reserved. What Happens When Doctors and Patients Can Communicate Securely Online? A Review of Results for Physicians, Patients and Payors Prepared for the the MCOL Healthcare Web Summit Eric Zimmerman Senior Vice President Product Marketing RelayHealth Corporation

2. Copyright © RelayHealth Corporation 2003. All rights reserved. Key Questions How do physicians respond to secure online patient communication in a reimbursed environment? How does it affect patient satisfaction? Access? Perceived quality? How does it impact utilization and cost?

3. Copyright © RelayHealth Corporation 2003. All rights reserved. 95% use the Internet; 65% do so daily. MDs online spend and average of 3 hours/week on medical activities. 23% interact with patients online. 60% of these MDs discuss symptoms or treatment options online. 66% use the Internet (U.S. Adults) 76% seek health information online; 39% do so monthly 90% of those online want to communicate with their doctor online – over 50% say online access would influence their choice of health plan or doctor PhysiciansPatients Sources: Deloitte Research/Cyber Dialogue, Dec. 2000; Boston Consulting Group (Harris Interactive Survey) Sep 2001; Deloitte Research/Fulcrum Analytics, Nov/Dec. 2001; Harris Interactive, April 2002. Doctors and Patients Online

4. Copyright © RelayHealth Corporation 2003. All rights reserved. 73% of physicians rate reimbursement as critical to adopting on- line consults 37% of online consumers would be willing to pay out-of-pocket to communicate online with their own doctor (~ $5-7) Patients Sources: McKinsey & Co., 2000; Harris Interactive, April 2002, Jupiter Research, May 2002; Forrester Research, October 2002 Reimbursement Matters Physicians Will Payors Bridge the Gap?

5. Copyright © RelayHealth Corporation 2003. All rights reserved. HIPAA compliant? –Not secure –Limited audit trail –No access control eMail HIPAA ready Secure servers, firewalls, 128- bit SSL encryption Full audit trail Restricted access One-to-one exchange without workflow support Free-form Non-chargeable Limited feature set Clinical features e-Prescribing, e-Referrals Clinical content and templates Clinically structured Accompanied by PHR Reimbursable Advanced workflow support Message routing by type Distinct roles/proxy rights eMail vs. Secure Web Messaging Web Messaging

6. Copyright © RelayHealth Corporation 2003. All rights reserved. How do webVisits ® Work? Patients Starts a Message from a Customizable Menu of Options

7. Copyright © RelayHealth Corporation 2003. All rights reserved. How do webVisits ® Work? Patients select from 140+ Common Symptoms or Chronic Conditions Allergic Symptoms

8. Copyright © RelayHealth Corporation 2003. All rights reserved. How do webVisits ® Work? Patient Completes an MD-Authored Interactive Online Interview I’ve been sneezing and wake up with itchy eyes.

9. Copyright © RelayHealth Corporation 2003. All rights reserved. How do webVisits ® Work? Physician Receives Concise, Structured Message with Summary Health Record

10. Copyright © RelayHealth Corporation 2003. All rights reserved. How do webVisits ® Work? Physician Replies using Time-Saving Tools

11. Copyright © RelayHealth Corporation 2003. All rights reserved. How do webVisits ® Work? Patient Receives Physician Treatment Instructions and Attached Materials

12. Copyright © RelayHealth Corporation 2003. All rights reserved. What Are Doctors and Patients Talking About Online (in webVisits)? Low acuity symptom (52%) Medication management issue (21%) Follow up on visit or test result (14%) Chronic care management (10%) Consultation about a procedure (3%)

13. Copyright © RelayHealth Corporation 2003. All rights reserved. What Kinds of Symptoms/Issues? Low Acuity Symptoms Colds/Flus Headaches/Migraines Sinus Pain or Pressure Back Pain Abdominal Pain Coughing Urinary Symptoms Allergic Symptoms Muscle Aches and Pains Sore Throat Chronic Conditions Chronic Pain Allergies Depression Hypertension Diabetes Thyroid Disease Asthma Arthritis Anxiety Disorder HRT

14. Copyright © RelayHealth Corporation 2003. All rights reserved. The RelayHealth webVisit ® Study

15. Copyright © RelayHealth Corporation 2003. All rights reserved. Study Background Independent study designed and analyzed by Paul J. Gertler, PhD – University of California, Berkeley Laurence Baker, PhD – Stanford University California and Connecticut 3,688 member treatment group + matched control group 282 MDs Participating Health Plans Blue Shield of California ConnectiCare 10 self-insured employers and 4 ASO carriers Reimbursement Insurers pay $25 Patients pay copayment of $0-$10

16. Copyright © RelayHealth Corporation 2003. All rights reserved. Methods Claims Analysis (Treatment vs. Control Group) Pulled claims data (6/1/00 – 5/31/02) – 100,000+ patient months Analyzed utilization and costs pre- and post- intervention Compared treatment group with matched control group Telephone Surveys (Treatment Group Only) Random sample MD survey (n=54, 61% response rate) Random sample patient survey (n=367, 16% response rate)

17. Copyright © RelayHealth Corporation 2003. All rights reserved. Results: Cost and Utilization Net reduction in office-based claims > $1.50 # PMPM Net reduction in total claims > $3.00 † PMPM Patients who used RelayHealth to communicate with their doctor (vs. those that hadn’t) were: –36% less likely to report having called the doctor’s office –45% less likely to report having had an office visit # –50% less likely to report having missed work due to illness # # p <.01 † p <.05

18. Copyright © RelayHealth Corporation 2003. All rights reserved. Results: Patient Satisfaction Ease of Use 78% 89% Convenience 78% 95% Quality 95% 71% Access 52% 66% Patients with doctor response by next business a.m. (statistically significant vs. those with later response, p<.01). All patients

19. Copyright © RelayHealth Corporation 2003. All rights reserved. Results: Physician Satisfaction Likely to Continue 72% 78% 93% Satisfaction 63% 87% 100% Ease of Use 72% 93% 74% Prefer to Office Visit* 56% 67% 57% * For patients with non- urgent medical needs Physicians with 30 or more RelayHealth messages Physicians under age 45 All patients

20. Copyright © RelayHealth Corporation 2003. All rights reserved. Summary Pent-up patient demand Payor reimbursement stimulates physician adoption Independent controlled trial demonstrated: Significant reduction in healthcare spending Strong patient satisfaction Strong physician satisfaction A shared preference for webVisits for non-urgent medical needs

21. Copyright © RelayHealth Corporation 2003. All rights reserved. Future Directions: QI, Compliance and Pay for Performance Platform IT Investment Clinical Measures Asthma mgt. Diabetes mgt. CAD mgt. Breast CA screening Cervical CA screening Childhood immunization Patient Satisfaction Desired service Enhances communication Improves access Demonstrated impact Low cost Easy to implement Paves way for other IT initiatives Automated reminders Targeted education Self-monitoring Enhances communication with clinicians

22. Copyright © RelayHealth Corporation 2003. All rights reserved. Thank You! For more information contact: eric.zimmerman@relayhealth.com