Telehealth Trends Deck - Advisory

Telehealth Trends Deck - Advisory

Global Forum for Health Care Innovators Telehealth Industry Trends 2015 Ready-to-Use Presentation Slides 2 Making Your Case For Telehealth Case Making Steps Step 1: Provide an overview of global telehealth trends Step 2: Outline the market forces that influence the adoption of telehealth Step 3: Review the benefits of telehealth employment Step 4: Discuss how telehealth can be leveraged at your institution Use the steps and key discussion points to plan your talking points. The following slides can be used to help you shape your discussion around strategic goals 2015 The Advisory Board Company Key Discussion Points 1 How do we currently use telehealth, if at all? 2 Where would telehealth be most beneficial? 3 Do we have the money and resources to launch telehealth services? 4 Who will take the lead in telehealth employment? Delete this slide from the presentation once you are ready to use the ready-to-present PowerPoint 3 Road Map 1 Industry Overview

2 Market Forces Influencing Adoption 3 Benefits of Telehealth 2015 The Advisory Board Company 4 Industry Overview Telehealth Objectives and Platforms Current State 2015 The Advisory Board Company 5 Telehealth Objectives and Platforms What is Telehealth? Several Technologies Fall Under Telehealth Umbrella Telehealth Relevant Modalities, Objectives, and Investment Required Modality Professional Consultation Diagnosis & Treatment Education & Engagement Ongoing Monitoring & Care Coordination Investment Videoconference

Secure internet connection; home & hospital-based tech Store-andForward1 Accessible central storage capabilities Remote Device More expensive hardware; often unit per patient Telephone Requires proper staffing but no IT; used for pre-visit triage Patient Portal High data security needed; must integrate EMR Mobile App Minimal hardware; complex security and data storage 1) Store-and-forward technologies allow for the electronic transmission of medical information, such as digital images, documents, and pre-recorded videos through secure email transmission 2015 The Advisory Board Company Source: Advisory Board interviews and analysis. 6 Telehealth Objectives and Platforms The Time Is Ripe for Virtual Care Global Telehealth Services Market Growth Billions of US Dollars A New Solution $58.8 $27.3

$13.8 Amid rising expenses, an aging population and the increasing prevalence of chronic diseases, the healthcare industry must change the way it operates. Telehealth represents an attractive solution to these challenges, increasing the quality of care while reducing overall health care expenditures. Roeen Roashan IHS Technology1 106% Increase in global telehealth spending expected between 2016 and 2020 1) HIS Technology is a global research firm focusing on technology, media, and telecommunications industries. 2015 The Advisory Board Company Sources: Global markets for telemedicine technologies, BCC Research, available at; Global telehealth market set to expand tenfold by 2018, HIS Pressroom, available at http://; Advisory Board interviews and analysis. Telehealth Objectives and Platforms 7 More Services Being Provided Virtually Continuum of Care Options Based On Case Remote Care (e.g. Prescription refill, minor cough/ cold) In-Person Care Emerging Area (e.g. Physical exam, fracture, complex infection)

Virtual Care Low Medical Visit Need: Diagnoses, treatments follow reliable standard protocols based on evidence-based medicine Suggested therapies are nearly always effective Physical exam not required, visual exam adds nominal value 2015 The Advisory Board Company Management, Maintenance Chronic disease checkups, follow-ups Care plan updates Specialist consults Diagnosis, Treatment Remote diagnostics Self-guided interventions High Medical Visit Need: Diagnoses, treatments more complex, may vary within disease category Therapies may need careful selection and monitoring Physical exam or diagnostic test required to correctly identify issue and select treatment Intervention required (i.e., immunisation) Source: Advisory Board interviews and analysis. 8 Current State Industry Snapshot: Video Platforms Extending Access to Providers for High-Risk, Rural, and Wellness Visits Use Cases I think [virtual visits] will

become a normal part of health care in three to five years. Dr. Harry Leider Walgreens CMO Chronic disease management Rural access to care Major Vendors Behavioural health video consults 24/7 coverage Polycom Cisco Siemens Healthcare American Well MDLive Teladoc Low-Cost Alternative to Traditional Primary Care $49

9,000 2M Patient cost of Walgreens1 virtual visit, most of which goes to physician Interactions per week via Walgreens Pharmacy Chat virtual visit platform Estimated new patients added to MDLive2 following partnership with Walgreens 1) A US retailer 2) An on-demand telehealth service 2015 The Advisory Board Company Source: Hirst, E. J., walgreens app makes virtual doctor visits a reality, Chicago Tribune, December 2014, http://; Advisory Board interviews and analysis. Current State 9 Industry Snapshot: Mobile Apps Big Market in Early Stages of Development Common Applications EMR Access in and out of care site Similar to the internet revolution, mHealth1 is revolutionising the way of patients receiving their care. Fitness/activity tracking Mary Annecharico CIO at Henry Ford Health Systems Major Vendors

Biometric data collection and transmission Qualcomm Apple GE Healthcare Individuals, small startups to large hospital systems and payers Remote communication with providers Mobile Health Market Rapidly Expanding $49B Estimated global mHealth market size by 2020 1 1) mHealth is the term used for mobile-based or mobileenhanced health care delivery solutions 2015 The Advisory Board Company 100K 1 in 5 mHealth technologies available in 2013 Citizens around the world own a smart phone

Source: mHealth in an mWorld: How mobile technology is transforming health care, Deloitte, available at; McCann, E. mHealth market scales to new heights, Healthcare IT News, March 4, 2014,; Advisory Board interviews and analysis. 10 Current State Industry Snapshot: Remote Monitoring Devices Keeping Providers and Patients Connected Regardless of Location Clinical Benefits Patient monitoring is becoming a necessary measure for hospitals and doctors to measure their business. The focus is shifting whether they like it or not. Jack Young Head of Qualcomm Life Fund Reduced readmissions Improved chronic disease-related mortality Major Vendors Reduced ED visits Improved care coordination Aerotel Medical Systems AMD Telemedicine

Bosch Healthcare Broomwell Healthwatch Philips Healthcare Viterion Telehealthcare Remote Monitoring has Wide Reach 19M Estimated patients connected to remote monitoring devices by 2018 1 1) Figures are global 2015 The Advisory Board Company $5.9B 35% Total remote patient monitoring market in 20131 Compound annual rate for global market growth between 2013 and 2018 Source: Baum, S. Report: 19 million will use remote patient monitoring by 2018, MedCity News, June 2014.; Advisory Board interviews and analysis. 11 Market Forces Influencing Adoption Consumer Needs & Preferences Technological Advancements Provider Caveats

2015 The Advisory Board Company 12 Consumer Needs & Preferences: Aging The Aging Society A Demographic Time Bomb Projected Population Profiles, 2020 Percentage of Men and Women Five Year Age Groups, 0100 Health Care Expenditure by Age Australia, 2004-2005, $millions AUD 9 65-70 Year Olds 8 7 6 5 4 Australia New Zealand 3 2 1 0 0- 54 14 15- 25- 35- 45- 55- 65- 75- 85+ 24 34 44 54 64 74 84 Years of Age Netherlands 2015 The Advisory Board Company China Source: United Nations, Department of Economic and Social Affairs, 2011, available at: http:// ; Kaiser Family Foundation, medicare spending and financing, a primer, 2011, available at:; The Economist, Too much, too young, April 2011; The Wall Street Journal, Baby boomers and the labor force, March 22, 1011; AIHW Disease Expenditure Database; Australian Bureau of Statistics Cat. 3101; Macrobusiness Australia Baby Boomer Bust accessed 26-8-2013; Advisory Board interviews and analysis. 13 Consumer Needs & Preferences: Chronic Disease Chronic Disease is on the Rise Chronic Disease Causes Majority of Deaths Top Causes of Death in the US, 1900 and 2010 Expected Increase in Diabetes Patients, 2000 and 2030 Number of Deaths per 100,000 Global 114% 396.9 Middle East/ Africa 579.6 503.7 Europe 1900 16.2 2010 United States Infectious Diseases Mental Health 2015 The Advisory Board Company Chronic Disease Other

162% 43% 102% % Increase In Prevalence Source: Jones, D, et al, The burden of disease and the changing task of medicine; RAND Statistics; Ferri C et al, Global prevalence of dementia: A Delphi Consensus Study, Lancet, 2005, 366, 21122117; Orgenesis, Diabetes market growth, 2008:; Advisory Board interviews and analysis. 14 Consumer Needs & Preferences: Convenience Consumers Increasingly Prefer On-Demand Care Survey Finds Email Visits Preferred to Clinic Near Errands or Work Preference for Location of Services Clinic location near work Clinic located near errands Emailing provider with symptoms Clinic located near the home Increasing Consumer Preference Profile of Potential Telehealth Patient1 18-29 yrs olds Individuals making more than $71K per year 1) Based on highest percentage of interest in telehealth among all categories within age, income, and working hours categories 2015 The Advisory Board Company

Individuals working more than 35 hours per week Source: 2014 Primary Care Consumer Choice Survey; Advisory Board interviews and analysis. 15 Technological Advances Technology Getting Faster, More Widespread Enables Growth in Telehealth Advancements in Technology Rising Demand Remote monitoring devices with cellular or fixed-line modems enabling data transmission without computer or smartphone Expanded memory and processing capabilities Geospatial tracking Movement tracking Touch-screen technologies

2015 The Advisory Board Company ~100% population within developed nations covered by mobile network 134% increase in page hits for health care content from between 2010-2011 Global Growth in Telehealth Services 19% Compound Annual Growth Rate (CAGR) of global telehealth market from 2014-2019 Sources: mHealth in an mWorld: How mobile technology is transforming health care, Deloitte, available at; Infiniti Research Limited, Global telehealth market 2015-2019, 2014, available at http://; Advisory Board research and analysis. 16 Provider Caveat: Workload & Utility Providers Express Concerns About Workload, Utility Fears are Beyond Finances Provider Concerns Regarding Telehealth Email Overload Liability For primary care doctors in particular, [email to doctors] has created a sense of information overload the unceasing volume of messages reaching them has expanded beyond the number they believe they can handle diligently.

Doctor-Patient Relationship Usefulness of Data Its just one more data set they have to deal with, and theyre already wrestling with lots of data every day. 2015 The Advisory Board Company If the data fell into the wrong hands it could expose the hospital to privacy violationsOr what if an ambulance chaser claims we should have taken action for a patient who stopped walking daily? For many doctors, telemedicine seems to depersonalise the relationship and sabotage trust. Source: Friedberg, M et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy, RAND/AMA 2013 Physician Satisfaction Study,; Sullivan, M. Guess what? Doctors dont care about your fitbit data, Venture Beat, August 2014,; Chen, P. Are doctors ready for virtual visits? The New York Times, January, 2010,; Advisory Board interviews and analysis. 17 Provider Caveat: User Compliance Consumer Interest Difficult to Sustain Wearbles Require Continued Use to Achieve Change Rate of sustained utilisation Sustained Utilisation of Wearables Over Time Reasons for User Drop-Off

Unfulfilled expectations Lost interest 75 % Data isnt valuable/no instruction 50 % Poor battery life Privacy and security issues Smart phone does the same thing, is easier to use 100% 25 % 3 6 9 12 15 18 21

24 Time (months) The Dirty Secret of Wearables More than half of U.S. consumers who have owned a modern activity tracker no longer use it. A third of U.S. consumers who have owned one stopped using the device within six months of receiving it. Consumers stop wearing devices that are too conspicuous or uncomfortable or that need to be removed frequently. Endeavour Partners 2015 The Advisory Board Company Sources: Endeavour Partners, September 2013, Inside Wearables,; PriceWaterhouseCoopers, The wearable future, October 2014,; Advisory Board interviews and analysis. 18 Benefits of Telehealth Case Study #1: Cost Management Case Study #2: Stakeholder Satisfaction Case Study #3: Capacity Expansion Case Study #4: Business Opportunity 2015 The Advisory Board Company 19 Case Study #1: Cost Management Telephone Consultation Achieving High ROI Collaboration, Not Complexity Crucial to Forge Linkages RACE1 Program: Key Elements for Success Easy Investment Quick Decision Support Connectivity Hospitals extend primary care providers quick connection with

hospital specialists in over 22 clinical areas. All doctors remunerated for calls through provincial health billing codes Specialists available to speak to GPs and give immediate treatment advice. Bulk of conversations happen in 10 minutes, often over speakerphone while the patient is in their GPs office Better informed GPs provide better care, often avoiding unnecessary specialist follow-ups or ED presentations Tangible Benefits Across the Care Spectrum 60% $200 32% Reduction in face-to-face specialist consults Cost savings per call Reduction in ED visits 1) Rapid Access to Consultative Expertise 2) Canadian dollars 2015 The Advisory Board Company Source:; Advisory Board interviews and analysis. 20 Case Study #2: Stakeholder Satisfaction Following Trial, Strong Preference for Virtual Care Telehealth Pilot Suggests High Satisfaction and Willingness to Refer

92% Of a virtual visit providers patients said they would use the service again 91% Of Zipnosis users would recommend the service to at least three friends 71% Of mid- to large sized U.S. employers anticipate offering employees telehealth services within three years Case in Brief: Medical Associates Clinic Four-physician practice in Kentucky, US 1 1) Zipnosis is a 24/7 online diagnosis and treatment service for common medical conditions 2015 The Advisory Board Company 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 Source: 2014 Primary Care Consumer Choice Survey; Teledoc, available at, accessed July 2014; The virtual primary healthcare revolution, Beckers Hospital Review, available at http:// w.html , accessed July 2014; Just how far in usage and savings can telemedicine take US healthcare? mHealthNews, available at, accessed August Case Study #3: Capacity Expansion 21 Increasing Patient Panel Size with Virtual Services Treating Chronic Conditions Online at MGH Beacon Hill 20% of patients consumed 5-10 virtual 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 40% 4+ 29% Of the virtual users have one or more chronic conditions

Number of annual visits consumed by the average patient in this group Increase in available time and panel size by shifting 2 of these 4 visits online 2015 The Advisory Board Company Source: Advisory Board interviews and analysis. 22 Case Study #4: Business Opportunity Connecting With New Patients and Expanding Reach Telehealth Enables Access to Multiple Patient Volumes Home Care Chronic care patients in community access acute care nurses via encrypted webcam or iPad Nursing Home Care Prison Care Provides videoconference-consults in 20 specialties to 22 prisons across country 69% of long-term care consults allow patient to remain in prison Airedale FT Telehealth program in 200 nursing homes across England, serving 4,000 patients

50-69% reductions in A&E attendances Case in Brief: Airedale NHS Foundation Trust 550-bed, 3 hospital system and integrated provider of full range of community, acute care to 200,000 residents across 1,812 square kilometers in Yorkshire and Lancashire, England The trust launched their telehealth services to expand reach by providing prison care across the country; then extended their offering to other patient groups after observed success 2015 The Advisory Board Company Source: Advisory Board interviews and analysis. 23 Additional Resource Offering Available through Additional Channels Telehealth : Driving Adoption of Virtual Vi sits Telehealth : Scaling Remote Patient Monitor ing Programs Virtual Briefing The Forum On-demand online presentation and discussion with Advisory Board research experts Within The Forum blog, we provide up-to-date intelligence on the newest trends and ideas shaping health cares future On Demand Web-conference Infographic Enables those ready to take telehealth to the next level to learn about ways to expand telehealth

services to new patient groups Learn about the past, present, and future of virtual medicine strategies and ideas on who to target next This briefings outlines clinical areas best for virtual visit programs, how to design and invest in a telehealth model that meets your needs, and how to maximise your ROI 2015 The Advisory Board Company Read this brief to learn 10 tactics that detail how to effectively scale remote patient monitoring programs that address the needs of diverse patient populations 2445 M Street NW I Washington DC 20037 P 202.266.5600 I F 202.266.5700

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