Consumer Solutions: W orkforce Implications and The Medical Home without Walls

1. Consumer Solutions: Workforce Implications and The Medical Home without Walls David James, MD JD CPE SVP & CEO Memorial Hermann Medical Group

2. Consumer Solutions Innovating to Primary Care 2.0 • Strategic Intent • Environment Assessment • Covered Lives: Primary Care 2.0 • Tactical Infrastructure Build • Bricks • Clicks • TeleFix • Operational / Financial Planning

3. Environmental Assessment: The “Consumer Driven” Medical Home Payer Market: Who’s Paying? • Insurer • Major medical care • Consumer • Routine, low acuity care • High deductible, means tests, HSAs, Exchanges, no coverage • Hospital based revenue models for ambulatory care DOA. Medical Bill 3

4. Environmental Assessment: The “Consumer Driven” Medical Home Provider Market: Who’s the Customer? • Indirect to Consumer: B2B • - Providers sell to Insurers who sell to Employers. • - Employers are the decision makers on what you get. • - Providers give you what they have, when and where they have it. • Direct to Consumer: B2C • Providers/Insurers sell direct to employers and to consumers. • Consumers deciding on structure and pathways for front line care. • I’ll get what I want, when and where I want, whether you have it or not. 4

5. Environmental Assessment: The “Consumer Driven” Medical Home Consumer Market: Who’s the Customer? • Patient Centered Medical Home: • “We have placed you in the center of what we have to offer” • Physical Medical Office Building • Consumer Driven Medical Home: • “I’ll connect myself with what I want, when I want it, where I want it and if I can afford it…..regardless of what you have” • Right sites, right time, right place, right cost, physical/virtual 5

6. Environmental Assessment: The “Consumer Driven” Medical Home Consumer Market: Customer Profile • What do they Want/Value? • - Healthy life? ….Yes. Healthcare itself?....Not so much. • - Great experience of care and care giver • - Convenience is king: the Advisory Board Consumer Choice Survey top 10 • - Cost: affordable, transparent, easy to understand • - Quality?: Generally assumed. Legal recourse if not. • Early Exchange Purchasing Data • - Tradeoffs: affordability and access over quality and complexity • - 1/3 broad network, 2/3 narrow or ultra narrow • Third Party Comparisons (States, Payers, Commercial) • - Transparency on price, outcomes, satisfaction, quality...web based apps • - Must do it to yourself. 6

7. Environmental Assessment: The “Consumer Driven” Medical Home Consumer Market: Market Segments • Walking Well: 80-85% of Pop Health (Revenue Opportunity) • Healthy Non User/Avoider • Healthy Preventive Maintenance • Turn these broadly available people into risk bearing contract models. • Connect and develop relationships through a broad array of consumer channelsas opportunities to hardwire the transition from consumer driven events to provider driven events. • Chronic Disease/Complex: 15-20% of Pop Health (Expense Opportunity) • Virtualize the traditional medical home with robust patient portals, clinical contact centers, home monitoring, home care, telemedicine, CDE and MTM • Lives under Attribution….at Risk • 800-1000 PCP providers for 2 million people…. • 1.6 million walking well….where are they…..where are we? 7

8. Environmental Assessment: The “Consumer Driven” Medical Home Consumer Oriented Marketing/Branding • Market and Deliver on the Baldrige “VOC” • Market your customer convenience experience deliver. (walking billboard) • Don’t market quality, how smart you are or how many awards you get. • Develop and Market a Relationship with the walking well. • Healthy consumers don’t want to develop “relationships” with hospitals.This connotes marketing to “illness”…..because you’re “sick”. • Market the understanding that people don’t have time to be “sick”. Make things easy,less complex, less scary and fragmented, with more transparency and access. • Brand a long term, integrated and seamless relationship through levels of care. (Every Day Well) • Connect and develop relationships through a broad array of consumer channels as opportunities to hardwire the transition from consumer driven events to provider driven events. 8

9. Environmental Assessment: The “Consumer Driven” Medical Home Consumer Oriented Market Channels • The Consumer “Triple Aim”: Convenience, Experience and Cost • Getting it right: Provider, Employer and Consumer Solution Channels • Provider Solutions • - Traditional Primary Care Employment Models • - Self Perform: After hours and weekend access to first line care. • - Remains among the biggest consumer demands in the >65 demographic. • - Non traditional Primary Care Employment Models • - MSO/PPM consumer channel integration. • Employer Solutions • - Executive Health, travel medicine • - Occupational Medicine, Workers Comp • - On Site/Near Site employer oriented clinics • - Narrow network providers with our TPA for small business employees. • Consumer Solutions ….. 9

10. Consumer Solutions – Environmental Assessment Among Many Consumer Demands, Three Are Most Pressing Competitive Ambulatory Assets Meet Patient Demands Top Priorities for Meeting Consumer Preference $ Affordability On-Demand Access Tailored Service • Reasonable price compared to similar options • Clear pricing to streamline payment • Guidance on which sites are most affordable • Immediate availability • Broad range of hours open • Rapid completion of service • Geographic proximity to home, work, errands • Comprehensive visit length • Provider interaction matches expectation • Delivery options tailored to specific need Source: Advisory Board

11. Consumer Solutions – Environmental Assessment The Emerging Era of Consumer-Driven Growth Converting Consumer Preference into Profitable Growth Growing as a Coordinated Network Maintaining Share at Risk III Unlocking Value Through Tailored Service Accommodating Excess Primary Care Demand 5 II Embracing Premium Payment Models 4 Driving Volumes with On-Demand Access Growth Converting Initial Visit To Future Revenue 3 Generating Direct Revenue From Access Points 2 I Preserving Share Through Affordability Attracting Price-Sensitive Consumers with Competitive Offerings 1 Consumer Demands Source: Advisory Board

12. Consumer Solutions – Strategic IntentConsumer Driven Medical Home without Walls - Primary Care 2.0 2 Million Covered Lives

13. Environmental Assessment: The “Consumer Driven” Medical Home Consumer Oriented Market Channels Convenience Sites • CCC • Urgent Care • Retail • Employer Solutions ACCESS PCP PCMH Specialists, Hospitals,& Facilities Virtual Space Web Portals Device Apps Consumer ACCESS Consumer “extended hours” Customer Directed MH Directed Clinical Contact Center • Scheduling Referrals • Nurse Triage • Telemedicine PCP PCMH Specialists, Hospitals,& Facilities To Loyalty From Non Discriminating “extended hours” KEY TRANSITION 13

14. Consumer Solutions – Tactical InfrastructureAligning Operational Priorities with Primary Care Access Strategies • Bricks • PCMH Clinics • Convenient Care Centers (CCC) • Urgent Care Clinics (UCC) • Retail Care Clinics (RCC) • Clicks • Patient Portal • Open Access Scheduling (ScheduleNow) • Apps • TeleCare • TeleCare Center (TCC) • Centralized Scheduling • Clinical Support – RN Triage & Care Coordination • Telemedicine • Patient Concierge Services

15. Consumer Solutions – Tactical Infrastructure “Bricks” Patient Centered Medical Home 2.0 • Broad Portfolio of “Bricks” Location Options • Existing Clinic Capacity Fill (campus and community) • New Clinic Sites • Acquisition and De Novo • Inside Convenient Care Centers • Urgent Care Centers • RediClinic (HEB) locations • On-site at Employers work locations

16. Consumer Solutions – Tactical Infrastructure “Bricks” Patient Centered Medical Home 2.0 • From NCQA Recognized to NCQA Operationalized • Population Health Management starts with Site based Panel Management • Real time Registry information (HealtheIntent) • Preventive care/Chronic disease management Inreach (POS) and Outreach • Quality by Performance (People/Process) • Dual dyadic management (CNO, CMO, COO, CFO) all “operational” • Dyadic cascade to front line providers • Quality by Design (Technology) • Default EMR workflow integration for nursing/provider. • Focus on the complex, at risk: hardwiring RAF, HCC, CCM, TCM • Expand Patient Access Reps to Patient Navigators during traditional office hours: utilize a multichannel risk and complexity stratified path to on demand access…. A medical home without walls. After hrs rollover.

17. Consumer Solutions – Tactical Infrastructure“Bricks” Convenient Care Centers

18. Consumer Solutions – Tactical Infrastructure“Bricks” Urgent Care – The Retail Revolution Everyone is Educating the Consumer! Urgent Care Walk in Clinic → Insurance Companies → Urgent Care Facilities → Media → 3rd Party Stakeholders → Employers ER

19. Consumer Solutions – Tactical Infrastructure“Bricks” Urgent Care – 5 Strategic Growth Imperatives • Integrated Network - - Growth & Brand Loyalty • Geographic PCMH - Growth Accelerator • Access & Panel - Growth Accelerator • Employer Solutions – Occ Med Growth Build, buy, affiliate? Depends on Use Cases…. • Consumer Care Continuum – Payer/ACO Growth

20. Consumer Solutions – Tactical Infrastructure“Bricks” Urgent Care – Friendswood

21. Consumer Solutions – Tactical Infrastructure“Bricks” Urgent Care – Primary Care Oriented Advertising

22. Consumer Solutions – Tactical Infrastructure“Bricks” - Retail Medicine Partnership Full Integration Workstreams • IT Integration • HIE • ScheduleNow • ACO Integration • CPC • Adult and Pediatric Protocols • Clinical Operations • Exclusive MD oversite • APP Activities: float pools, CME • Pediatric service • Employer solutions • Vaccines, VFC, flu shots • Marketing • Co-branding re-launch • Website & Collateral • Campaigns • Ambulatory Integration • Centralized Scheduling & PCS • MHDL

23. Consumer Solutions – Tactical Infrastructure“Clicks” - Digitization Transforms Industries

24. Consumer Solutions – Tactical Infrastructure“Clicks” – Customers Demanding Digital Enablement Source: Accenture

29. Centralized Scheduling • 100% MHMG PCP offices FY16 • Roll-over to full-time • On-Call 24/7 Physician Answering Svc. • 100% in-house – all MHMG • Centralized Insurance Auth. & Verif. Consumer Solutions – Tactical Infrastructure“TeleCare” – Strategic Vision TeleCare Center (TCC) • Clinical Support: Rx refill and labs • Nurse advice/triage (telephone or e-chat) • Proactive e-visit for: • Critical lab values • Health outreach campaigns FY17 Project Scope • Warm transfer connectivity • Post-hospital discharge coordination • Patient Navigators • TeleVideo – vetting vendors • Patient portal optimization • Web app exploration

30. Scope of Services Consumer Solutions – Tactical Infrastructure“TeleCare” – Advance to TeleVideo Target Population (Phased) • Virtual Visits for common ailments • Colds, coughs, sinusitis, UTI, allergies, RX refills, etc. Established MHMG Patients Health Solutions ACO Employers Open Market • HIPAA-compliant web-based solution • iPad, laptop & smartphone enabled Infrastructure • Bill to Insurance • Flat Rate Fee (if not a covered service) Billing