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A Presentation by Cone Health and ECG Management Consultants

September 12, 2017

Improving the Experience of Specialty Care through Scheduled Virtual Encounters

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Agenda

I. Learning Objectives

II. Background and Introduction – Cone’s Virtual Care Journey

III. Selecting a Specialty Pilot Population

IV. Create an Exceptional Patient Experience

V. Taking Virtual Health to the Customer

VI. Current State and Factors of Success

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I. Learning Objectives

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Attendees of this presentation will learn the following about the intersection of specialty care, virtual care, and patient experience:

The session will conclude with an open, interactive discussion about definitions of

success with virtual care for specialty visits.

» Understand the evolution of Cone Health’s (CH) virtual care journey leading to scheduled, virtual care visits.

» Review the steps CH took to design an exceptional, scheduled virtual care experience.

» Review steps taken to create parity between specialty, virtual care and face-to-face visits.

» Understand how to select ideal patient populations for specialty care implementations.

» Understand the process for implementing technologies and processes through smaller pilot programs.

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Continuous Virtual Care Journey

II. Background and IntroductionCone Health’s Virtual Care Journey

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CH was able to build their virtual care platform and brand through continued success on

smaller virtual care initiatives.

CH begins planning a comprehensive telehealth strategy

(e-visits + video visits).

e-Visits were successfully marketed and implemented with over 1,200

visits in year one.

CH conducts detailed video visit vendor selection utilizing build-or-

buy framework and selection methodology.

Video visit platform (MDLIVE) is designed and marketed to CH

employees, community patients, and third-party employers as an

urgent care platform.

CH develops technical integration of video visit platform with Epic at CH

(CH link).

CH now offers e-visits, urgent care video visits, and scheduled, virtual, specialty care visits. Patient device integration now being developed

through broader virtual care strategy.

Over the past three years, CH has gradually developed a virtual care offering that provides its patients with convenient, exceptional care. This offering has evolved over the years, leveraging the success of pilot programs to expand CH’s digital health footprint.

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II. Background and IntroductionGrowing Provider and Patient Adoption

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The gradual progression depicted above allowed CH to build the internal operational,

technical, and clinical infrastructure necessary to support a robust virtual health offering.

CH did not immediately venture into specialty virtual care. Instead, it gradually introduced and educated patients and providers alike on the types of virtual care offerings.

Asynchronous Virtual Care

Live, UrgentVirtual Care

Specialty Virtual Care

Introduce Reinforce Expand

» Patients to the experience of receiving non-face-to-face care

» Providers to the practice of providing parity with face-to-face visits

» Concept that virtual care can take different formats

» Virtual encounter outcomes can align with face-to-face visits

» To introduce virtual care to new services and specialties

» To build a comprehensive platform that is inclusive of all convenient care options

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III. Selecting a Specialty Pilot PopulationThe Benefits of a Pilot

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The virtual care evolution reviewed on the previous slides was supported by a series of successful pilot programs for specific patient populations. The benefits of selecting a pilot population are listed below:

Any organization undertaking novel, virtual care initiatives can use a defined framework for

identifying a pilot population.

Demonstrate clinical, operational, and financial outcomes to key stakeholders.

Educate patients and providers on the use and benefit of virtual care in a controlled environment.

Test marketing and awareness messages as you build your virtual care brand.

Refine any inefficiencies before rolling program out to more specialties and patient populations.

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III. Selecting a Specialty Pilot PopulationPatient Population Identification Framework

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The sample scoring methodology provides a framework for further discussion to identify the potential target

patient populations and quantify the appropriateness of each specialty for virtual care visits.

Key Factors QuestionsScore

(Scale of 1–3)Alignment with High-Impact Chronic/Pre-Chronic Conditions

(HIC)

» Does the use case align with high-impact chronic/pre-chronic conditions and measures from national quality programs (NQF, HEDIS, MACRA)?

» Does the use care align with any quality programs or arrangements of the participating organization?

Potential to Lower the Total Cost of Care

(TCOC)

» What is the potential to control or reduce cost of care by selecting this population?

» What is the impact on total cost of care of stopping or reversing the disease state of this population?

Relative Size of Patient Population and Impact of Improvement

(SOP)

» How expansive is the patient population being considered?

» Given the size of the patient population, what impact would outcomes improvement have on the health of the community as a whole?

Potential to Improve Care Team Satisfaction

(CTS)

» Would using virtual care for this specialty patient population substantially transform and streamline existing, more complex standards of care?

» How would care team satisfaction increase by having greater virtual encounters with this patient group?

Total Rating What is the sum of the ratings for each key consideration?

Scorecard for Patient Population Group/Use CasePopulation/Use

CaseScores

HIC TCOC SOP CTS TotalPopulation Use Case One

Population Use Case Two

Population Use Case Three

Population Use Case Four

Population Use Case Five

Identifying and selecting initial populations is the first step in a process to engage patients in a target population and provide a seamless transition to adopting specialty virtual care visits.

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IV. Create an Exceptional Patient ExperienceThe Technology and Capabilities

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CH took measures to ensure that the designed work flow aligned with the experience of

receiving face-to-face care.

Once CH developed its target specialty populations, it began to design the work flow and patient experience. Once complete, the project would allow specialty virtual visits to be scheduled and conducted directly in CH’s Epic system.

Patient at Office

Patient at Home

Patient is seen for an initial specialty visit

Provider evaluates suitability for virtual

follow up visit

Virtual scheduling ticket is issued or

appointment is made

Patient schedules appointment using

issued ticket

Patient reminded of visit and launches

via MyChart

Patient is “roomed” by clinical staff and seen by provider

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IV. Create an Exceptional Patient ExperienceMeasures to Create an Exceptional Patient Experience

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The steps above can be applied to the development of any new, unfamiliar specialty

virtual care offerings.

By following the directives below, CH was able to design a specialty, virtual care experience for the selected target populations.

Conduct Detailed Walk-Throughs

In attempting to re-create the face-to-face experience, CH conducted detailed walk throughs of the specialty areas receiving virtual care capabilities. A gap assessment was done to determine the steps that deviate most from the normal standard of care.

Implement Patient Friendly

Functionality

In recognizing that patients normally schedule follow up appointments at a later date, CH accommodated this by designing a ticket scheduling system. This system allows the patient to receive a virtual ticket to schedule an appointment at a later date.

Patient Involvement in Solution

Development

Being a novel way of receiving follow up specialty care, CH involved patients in the development and implementation process where possible. Patient involvement ensures that all components of the encounter are closely considered from the patient perspective.

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IV. Create an Exceptional Patient ExperienceMeasures to Create an Exceptional Patient Experience (continued)

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As the specialty virtual care solution is rolled out to different specialties, the steps above will ease the transition to this care delivery option

for patients and providers.

The measures below transform an unfamiliar visit method into a valuable experience for patients and providers alike.

Provide a High Level of Training and

Patient Education

Training and education is a vital component of any new technology venture. CH conducted a detailed training of impacted providers and staff, that included scripting for how to explain specialty virtual care to patients. CH also developed patient education collateral walking through each visit step.

Promote New Functionality as

Integrated Part of Existing Offering

In promoting the new specialty virtual care capabilities, CH presented this as part of its existing care choices. Presenting this as part of a whole, allowed CH to build a brand around providing exceptional, flexible care options to its patients.

Remove All Barriers To Full Parity

The biggest barrier to full parity is having real time information and biometric data during a virtual encounter. CH is working closely with device platforms to remove this barrier and integrate data from patient devices into the virtual care experience.

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V. Current State and Factors of Success Current State at CH

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As CH continues to build on its virtual care capabilities it continues to consider and build

on the definition of success for virtual care initiatives.

The accomplishments below summarize the current state of specialty virtual care at CH.

» The specialty virtual care integration between Epic and MDLIVE is now live at oncology and primary care practices at CH. Testing is underway in employee pharmacy and THN Nursing home partners

» CH has an established, repeatable process for implementing this integration, training and educating patients and providers, and customizing the work flow to each specialty.

» CH is working with its population health management and improvement platform, Wellsmith, to integrate patient devices into the virtual care experience.

» CH has developed a connected care website that integrates all aspects of virtual care in single page: http://connectnow.conehealth.com.

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The next frontier: Putting digital health in the customers’ hands

WILDNEST

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Healthcare must reach the consumer“where they are”

In our current model we have on average less than 4 hoursof direct contact a year!

We need to be “digitallypresent” with our consumers

toinfluence their health choices

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It’s not the type, it’s the frequency

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660

920

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Primary caregivervisit

Candyadvertisements

Sugary drinkadvertisements

Alcoholadvertisements

Fast foodadvertisements

Wellsmithtouchpoints

Cou

nt

Wellsmith Sends Over 10 Notifications Per Day, More Frequently Than Advertisements for Products With Negative Health Consequences

Impressions per person per 90 days

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Creating simple, memorable and actionable solutions to improve health

Customized care planTask reminders

Goals & baseline comparisonsKudos & encouragement

Mobile Portal

Prescribing portalDashboard oversightDirect message capabilityIndividual patient view

Care Team Portal

Engages local community and merchants to provide support “in the Wild.”

Community Portal

Care Platform

“I need to deliver better health

outcomes”

“Tell me what to

do”

“We can help, too!”

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VI. Current State and Factors of Success Virtual Care: How to Measure Success

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As virtual care continues its evolution into specialty care, organizations will define

success in different ways.

From its inception, CH has diligently measured certain outcomes related to its virtual care offering.

QQuestions

» Whether your organization has developed a virtual care offering or not, what do you feel are some of the defined measures of success in an offering?

» What are some perceived barriers in measuring the success of your virtual health program?

» What are some of the perceived barriers in virtual care expanding into the specialty care space?

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John Jenkins, M.D. Johne.jenkins@conehealth.com

Jake Fochettajfochetta@ecgmc.com

Connected Care Page: http://connectnow.conehealth.com

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Questions & Discussion