TELEHEALTH INDEX: 2015 CONSUMER SURVEY

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1 TELEHEALTH INDEX: 2015 CONSUMER SURVEY

2 Overview Telehealth is a hot topic for technology players, healthcare delivery systems, employers and health plans. But how do consumers feel about the idea of seeing a doctor remotely via video? Are there some conditions consumers are willing to use video visits for, but not others? What concerns or objections do consumers have? To answer these questions, American Well partnered with Harris Poll to run a nationally projectable online survey to get consumer perspectives about perceptions and desires surrounding telehealth services. Our survey was fielded in December, 2014 and gathered responses from a total of 2,019 consumers a nationally representative sample. This ebook reports on what we found and what it means for healthcare delivery. INTEREST IN TELEHEALTH PEAKS IN AGES Most consumers would have a video visit with a doctor. We define telehealth as a remote video consultation between a doctor and a patient. When surveyed, an impressive 64% of consumers reported willingness to have a video visit with a doctor. Their reasons were very relatable. Common reactions were: It would be much more convenient, The wait times would be shorter, If I don't have to drive, it would be wonderful! Of all the reasons consumers provided, convenience was listed 61% of the time. Others mentioned saving time and money, avoiding germs lurking in hospitals and clinics, and the joy of being able to stay in their homes when not feeling their best. On the flip side, 36% of consumers said they were not willing to have a video visit. Some found the concept new and unfamiliar, and others didn t understand how it would work. Top questions for consumers include: Interest in telehealth spans all ages, but peaks in ages This demographic is most likely to be juggling busy careers and scheduling demands, often with children at home. How would the doctor examine the patient? How can you know if there s a real doctor on the other side? Emerging technologies naturally elicit doubts and questions, and we found these types of objections natural, and addressable. Willingness to have a video visit 36% 64% Willing Not Willing 1

3 Consumers think of the ER first, but video visits rank second. When sick, many people won t or can t go to the doctor especially in the middle of the night. For those who do seek care, there aren t many options for those who get sick or injured at odd hours. Options for care are dictated by physician schedules and local emergency care options, which are often inconvenient, expensive, and can require lengthy waits. We were curious: what would consumers prefer to do if they or a loved one was sick with a high fever and needed medical attention in the middle of the night, if they had video visits as an option? Turns out, most people still think of ER first, but video visits came in solidly second and ranked higher than 24-hour nurse lines. What options consumers would select for middle-of-the-night care 21% 44% 17% 9% 4% 5% Video Visits 24 Hour Nurse Line Online Symptom Checker Ambulance Other ER Perhaps not surprisingly, parents with children under the age of 18 at home found this to be especially true, as seen in the graph below. Those with children under age 18 selected a preference for video visits 30% of the time, above the population average of 21%, and well above those without children. Consumer Responses When it comes to refilling prescriptions, an online video visit would be incredibly useful. I am partially disabled and have difficulty getting into and out of the family car which makes doctors visits a painful experience. Consumers who would select video visits for middle-of-the-night care 30% 25% 20% 15% 30% If it's a simple problem like a sinus infection it seems more efficient to do an online visit. 10% 5% 18% 0% No Children in HH Children in HH 2

4 Consumers would rather see a doctor via video to get common prescriptions. At least 70% of consumers reported that they'd rather have an online video visit to obtain a prescription than travel to their doctor's office. This makes sense. The average wait time to get a doctor s appointment is 20 days in the U.S., and doctors are often not willing to take phone calls as they can t get reimbursed for the time they spend answering them. 1,2 It s also increasingly expensive to see the doctor; patients report that they are avoiding it altogether because of rising insurance co-pays and deductibles. Prescription Refills 60% Birth Control (18-34 yo women) Antibiotics Rx 42% 41% Blood pressure Rx 30% Asthma or Allergy Rx 27% To be clear, this is interest in live video visits with a physician to obtain common, appropriate medications at the discretion of the physician - not an interest in online "pills mills". Top medications that consumers would want to get online instead of in-person are: Prescription refills. Consumers often dislike going into the doctor s office for regular medication refills, and they can t always wait for an opening in their doctor s schedule. One consumer responded, When it comes to refilling prescriptions, an online video visit would be incredibly useful. Video visits present a winning option for both patients and providers, as the patient can get what they need, and the doctor can get paid. Birth control: A surprising number of consumers were interested in birth control via online video visits: 42% of women aged expressed interest, and that number increases to 44% for students. In the U.S., 62% of reproductive age women are currently using some for contraceptive method, making the opportunity to provide online contraceptive services enormous. 3 Antibiotics. People often get sick at inconvenient times. Bacterial infections don t plan around doctors available hours, and often the only alternative is the ER. One consumer responded, If it's a simple problem like a sinus infection it seems more efficient to do an online visit. Prescriptions for chronic conditions. When considering the incidence of chronic disease in America, the responses regarding chronic disease medications were impressive. One consumer responded, I am partially disabled and have difficulty getting into and out of the family car which makes doctors visits a painful experience. If just a portion of long-term care, including medication management, could be conducted online, the quality of life for many would be improved Survey of Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates, Merritt Hawkins 2 The Doctor Won t Take Your Call, The Wall Street Journal, July National Health Statistics Report, Number 60, The Center for Disease Control October

5 Consumers perceive HD video as better quality care than phone or . Today, anyone can go on the internet and seek a diagnosis. There are options available such as question and answer chat boards, services, and phone-based call-back services. At the most robust level, there are visits that engage both audio and video streams. What model do consumers percieve as highest quality for health care needs? When it comes to accuracy, patients believe that video is the most effective method to get a diagnosis. This is most pronounced for smartphone owners, where 69% of them believe high-definition video is the best way to see a physician. A recent patient recalled the benefits of video-based telehealth appointments for post-surgical follow up: The video part of the appointment played a big role for me. I could see the doctor s face clearly on the screen, and it felt normal speaking to him over video because I m so used to doing it with friends and family. When [the doctor] asked to see the scar and observe movement in my toes, all I had to do was lift my foot up to my laptop camera. 4 What consumers believe results in best remote diagnosis: 7% 30% 63% HD Video Telephone And physicians agree: The first thing I do when I treat a patient is I look at their face, said Dr. Peter Antall, President and Medical Director of the Online Care Group, which provides telehealth services. A person s facial expressions and body language give me an understanding for their overall well-being that could be missed over the phone. Beyond that, video gives me an opportunity to see skin rashes or tonsils important signs when making a diagnosis. With the HD-quality video, I can assess the patient closely and provide a diagnosis that will produce the best possible outcome. Importantly, this aligns with the guidelines set by the Federation of State Medical Boards Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine, which endorses the use of audio and video as a best practice when establishing a telehealth relationship. 5 Amwell's consumer app lets patients select their doctor 4 American Well Patient Testimonial, Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine, Federation of State Medical Boards, April

6 Consumers want to select their doctor, not be randomly assigned. In some instances it s not reasonable to expect the option for choice; for instance, when you visit the emergency room. But when given the option, would consumers prefer to make the choice themselves? The answer is overwhelmingly, yes : 88% of people wish to select their physician. That number climbs as high as 94% for retired individuals, who may be making choices about their medical care for more serious conditions. Those that have high incomes seem to also value choice: 92% of those with household income of $100k+ want to select their doctor. The ability to know what doctor you re connecting with - to have information about what medical school they attended, to know their specialties, and to ensure they are U.S. board certified - relates to consumer questions about online doctors that we uncovered earlier in our survey. If patients can review the doctor s credentials, see their picture, and verify their board certification - they ll likely be more satisfied with the service. When it comes to a new doctor, what would you prefer? Randomly Assigned 12% Select Doctor 88% Consumers want online visits to be affordable. Many consumers responded that they were willing to see a doctor online if the cost was right. When surveyed, most believed that telehealth visits should cost less than an in-person visit. Fortunately, online video visits are typically priced at or below typical in-patient copays. 6 Increasing access to care without breaking the bank is one of the core tenants of telehealth services. How much should online visits cost compared to an in-person visit? 7 Cost of care 22% 11% 62% $750 5% $140 $95 $49 Less More About the same Not Sure Emergency Room Urgent Care PCP Telehealth 6 Milliman (2011) actuarial analysis and American Well client data 7 American Well Consumer data,

7 Online video visits are changing doctor-patient relationships. We wanted to know: How does the availability of telehealth impact doctorpatient relationships? To start with, we asked about the longevity of consumers primary care relationships. We found that 76% of people have a physician relationship of 2 years standing or more and that the remaining 34% either had a new primary care doctor or no such relationship. Surprisingly, 7% of consumers said they were actually willing to switch doctors to get online video visits. While this number may sound low, it is already high enough to be a cause of serious concern for most practices. Doctor-patient relationships of 2-4 years standing are most at risk for online switching even more than new relationships. Some of this is related to demographics younger adults value online video visits more but it may also reflect a core sense on the consumer s part that they are not entirely satisfied with how long it takes to get in to see a doctor. Least at risk are relationships of 10 years standing or more. How long have consumers had a PCP? (years) 27% 14% 19% 20% 20% 34% have had a primary care relationship for 2 years or less. A closer look at the demographics shows that as many as 11% of young adults aged would switch doctors to get video access. This may mean that younger consumers are less loyal to their physicians, but it also correlates with the age groups who are most willing to have a video visit in the first place. While the number of people who would switch doctors for video visits is still low, if younger healthcare consumers are the most likely to switch to a doctor that offers video visits, this may indicate a wave of change to come. Doctor's who incorporate video visits into their practice may be better positioned in the long term. Don't have one < Would switch doctors based on availabililty of online visits Would switch doctors based on availability of online visits 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% 10% 8% 7% 6% 12% 10% AVG 8% 6% 4% 11% 8% 5% 5% 3% 2% 0% < Years with same PCP Age AVG 6

8 Market Impact While there is still much we don t know about the future of telehealth, we believe we have uncovered information that is valuable to many players in the marketplace, including healthcare delivery systems, large employers, and health plans. Health systems can retain existing patients and acquire new patients. Healthcare organizations already find telemedicine services valuable for cost savings as financial incentives under ACA shift from a feefor-service model to one that makes payments based on patient outcomes. Eighty-four percent of health care executives surveyed in 2014 reported that telemedicine services were important to their organizations, and 90% reported they are developing or implementing at least one telemedicine solution. But most of these solutions are equipment-intensive and not designed for acute urgent care services. Now that 64% of consumers want to have a video visit for general services such as prescription refills and after-hours care, it s important to consider how telehealth services can enable healthcare delivery systems to compete with retail and urgent care models to reach new patients and keep existing ones. Telehealth also allows health systems to surround patients especially at-risk patients and those with comorbid conditions with needed primary and specialty care. This will keep patients healthier, prevent readmissions, and retain more of their capitated payments. Employers can recognize cost savings. For employers who bear the risk of employees healthcare consumption, offering their employees a lower-cost, more convenient alternative to emergency department and urgent care visits is of high value. Towers Watson projects that as much as $6 billion will be saved through the adoption of telehealth, and 71% percent of employers are expected to offer telehealth services by There is also the important issue of productivity as consumers express interest in telehealth as a time-saving measure, employees can get back to work faster. Hourly employees especially benefit from telehealth services as missing work often results in a smaller paycheck, and can leave employers short-staffed. Health plans can retain large accounts, win new consumers and save costs. As employers increasingly adopt telehealth, they look to health plans to cover these services. Health plans must cover telehealth in order to stay competitive, retain large accounts and win in the new era of healthcare exchanges. Telehealth also enables health plans to directly realize cost savings by offering telehealth to fully-insured members. 8 Current Telemedicine Technology Could Mean Big Savings, Towers Watson, August

9 Telehealth resources. As your organization considers telehealth, American Well can assist the decision-making process with resources and support. American Well has helped health systems, employers, government agencies, and health plans through adoption and implementation of telehealth services for a range of clinical and business applications. Below is a list of content to inform you along the way. Additional ebooks Why ACO are Hot for Telehealth ebook Delivery System Best Practices ebook Employer Best Practices ebook Articles and Literature Frost & Sullivan Telehealth Services Award, 2014 Federation of State Medical Boards Telehealth Policy Article: Becker s Health IT & CIO Review, "Best of Both Worlds" Article: Medscape, "Virtual Visits Benefit Physicians as Well as Patients" Blog Posts and Hot Topics Five Surprising Specialties Using Telemedicine Top 10 Stats You Need To Know About Telehealth Telehealth Myths De-Bunked Author: Mary Modahl, Senior Vice President American Well, January 2015 Methodology: This survey was conducted online within the United States by Harris Poll on behalf of American Well Corporation from December 1-3, 2014 among 2,019 adults ages 18 and older. 8

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