1. Telemedicine Meet George Jetson…. Kevin Cowden, MS Vice President Mid-Atlantic Health Strategies Practice Leader Wells Fargo Insurance Services USA, Inc. Kevin.cowden@wellsfargo.com Fauquier/Prince William SHRM August 23 rd, 2013

2. Defining the problem: Have changes in healthcare effected you and your family? 1 Delivery? Cost? Quality of Care?

3. 2 Increasing cost, lack of access, gaps-in- care The Challenge

4. Turning the crank: Employer mandate Individual mandate Migration into plan (>30 hours) Minimum actuarial value (60%) Affordability (<9.5% HH income) Looming Cadillac Tax Employer Health Plan Lost productivity 3 Increased morbidity Possible delayed care The consequences: Risk shifting Cost shifting Higher Costs Healthcare reform…

5. 4 Dysfunctional system… Access Avg. ER Wait Time 4 hrs/ 7 mins 71 % have difficulty getting timely access to a physician Avg. Wait Time in Urgent Care up to 60 mins According to the 2009 Marritt Hawkins Survey the avg. time to secure a family practice appointment… 20.3 days Quality Avg. wait time in doctor’s waiting room: 22 minutes 5-10 mins Length of face-to-face time with the physician Chronic disease patients are not receiving adequate evidence based care

6. One chart tells the story Cumulative Increases in Health Insurance Premiums, Workers’ Contributions to Premiums, Inflation, and Workers’ Earnings, 1999-2012 Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2012. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2012; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2012 (April to April), accessed on January 28, 2013, available at http://ehbs.kff.org. http://ehbs.kff.org 5

7. Seven factors driving health care costs 6 We pay providers in ways that reward doing more, rather than being efficient. 1 1 We’re growing older, sicker and more obese. 2 2 We want new drugs, technologies, services and procedures. 3 3 We get tax breaks on buying health insurance, and the cost to patients of seeking care is often low. 4 4 We don’t have enough information regarding which medical care is best for us. 5 5 Our hospitals and other providers are increasingly gaining market share and are better able to demand higher prices. 6 6 We have supply and demand problems, and legal issues that complicate efforts to slow spending. 7 7 Source: What is driving U.S. Health care Spending?, Bipartisan Policy Center, September 2012.

8. A Solution 7 Meet George Jetson…

9. 8 From To

10. 8 Meet George Jetson It’s all about interactivity and mobility 9 Because it’s often better and smarter. Generation Y wants it; Generation Z will expect it: Hunter and Ashley (Generation Y) changed the rules. Prepare for Skylar and Madison (Generation Click) who couldn’t imagine having it any other way. Generation Y wants it; Generation Z will expect it: Hunter and Ashley (Generation Y) changed the rules. Prepare for Skylar and Madison (Generation Click) who couldn’t imagine having it any other way. Yesterday’s future is here today Things are moving crazy fast. This isn’t a fad. How we select benefits, submit a claim, check a balance, change coverage and interact with benefits service is becoming increasingly device- centric. Yesterday’s future is here today Things are moving crazy fast. This isn’t a fad. How we select benefits, submit a claim, check a balance, change coverage and interact with benefits service is becoming increasingly device- centric.

11. What is telemedicine? 10 Leveraging a variety of technologies to deliver healthcare

12. 10 What services can be delivered? Can be the solution 70% of the time… 11 Diagnostic  I have recurring acid indigestion. Is this something to worry about?  My child is awake with a fever. Should I go to the emergency room?  I need to refill my regular medication. Diagnostic  I have recurring acid indigestion. Is this something to worry about?  My child is awake with a fever. Should I go to the emergency room?  I need to refill my regular medication. Common Conditions  Allergies  Asthma  Bronchitis  Cold & Flu  Diabetes  Ear infections  Gout  Headache  Nausea  Sinus conditions  Etc. Common Conditions  Allergies  Asthma  Bronchitis  Cold & Flu  Diabetes  Ear infections  Gout  Headache  Nausea  Sinus conditions  Etc. Informational  My back is sore. Should I apply heat?  Which over-the-counter medication is best for a sore throat? Informational  My back is sore. Should I apply heat?  Which over-the-counter medication is best for a sore throat?

13. 7 What are some of the benefits? Bringing back the house call… 12 Convenience No more weekend trips to urgent care or the ER because your doctors office is closed Convenience No more weekend trips to urgent care or the ER because your doctors office is closed Reduce healthcare costs, out-of- pocket expenses, travel & time wasted waiting for appointments and sitting in germ filled waiting rooms Productivity Less sick days to just visit the doctors office Productivity Less sick days to just visit the doctors office

14. How does it typically work? 13 Log into a web account, app., or call a toll free number 1 1 Triage (history and assessment) by registered nurses 2 2 Identify and follow appropriate pediatric or adult protocol based on symptoms, history and assessment 3 3 If applicable, provide recommendation (disposition) to caller and ensure understanding of recommendation OR 4 4 Escalate if necessary to a Board Certified Physician 5 5 Physician determines if prescription is required 6 6 We have supply and demand problems, and legal issues that complicate efforts to slow spending. 7 7

15. Near future trends? 14 Improved Chronic Disease Management & Evidence Based Medicine Leading to Closures of Care Gaps

16. Questions 15

17. Thank you for your time and attention. Telemedicine: Meet George Jetson… 16