BECKER S HOSPITAL REVIEW

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1 BECKER S HOSPITAL REVIEW

2 Telehealth gained popularity among healthcare providers in recent years as reimbursement models increasingly reward outcomes and value of care over volume. Because of its ability to connect patients and providers with ease and efficiency, virtual care has emerged as an effective way to support population health management efforts, control chronic conditions, avoid unnecessary utilization and satisfy consumer demand for convenient care each of which is essential to success under value-based reimbursement. Despite consumers growing demand for telehealth, the concept itself is not new. For decades, clinicians have used traditional telehealth programs to support clinical decision-making and collaborative care by connecting with other providers to discuss treatment options for certain patient cases. While this type of telehealth remains an important capability, consumer-facing programs can fortify population health management and foster more meaningful relationships between providers and patients. Clinicians are excited by the promise of consumer-facing telehealth. In a national survey by the industryleading telehealth provider Teladoc, 76 percent of hospital and health system executives say their organization has either already implemented a consumer telehealth program or has plans to do so by December More than half 69 percent of survey respondents with a consumer telehealth program in place are currently expanding it to cover more service lines and satisfy consumer demand. However, not all telehealth programs or platforms are designed to serve the same purpose. Some hospital systems with successful clinical telehealth programs have difficulty using the same strategies to build consumerfacing telehealth initiatives. Hospitals are struggling because there is a mismatch between the technology platforms and the way they are used, says Alan Roga, MD, president of the provider market at Teladoc. With consumer telehealth, providers must be prepared to meet patients where they want and on their terms. This ebook presents findings from Teladoc s survey, which assessed hospitals and health systems stage of development and future plans for consumer telehealth across seven categories. Along with the data, each subsection offers analysis on how hospital and health system leaders currently use the technology and how they can better incorporate it into their strategies to improve care outcomes, increase operational efficiency and enhance the care experience for both patients and providers. 2

3 Three Reasons More Hospitals are Adopting Consumer Telehealth Consumer telehealth creates new channels for real-time communication and care delivery between patients and the care team to address a variety of low-acuity conditions and injuries, with consultation and treatment provided via video conference and phone. Common uses for consumer telehealth include minor urgent care, home healthcare, pediatric after-hour needs and concierge services for fee-paying patients. It is also effective for post-hospital discharge care, post-surgical follow-ups, medication management, prescription renewal and support for chronic conditions to help patients maintain positive outcomes and avoid hospital readmissions. There are three main reasons health systems choose to adopt consumer telehealth, according to Dr. Roga. 1. Manage financial risk models To succeed under reimbursement models that shift risk to providers, healthcare delivery must be both costeffective and produce positive patient outcomes, as these factors dictate reimbursement. Whether they re participating in an ACO, expanding population health management or entering into a bundled payment model, hospitals are seeking efficiencies anywhere they hold risk, says Dr. Roga. They re looking for ways to improve their operating margins, control expenses and improve patient outcomes. 3

4 Patient populations currently or planning to serve with consumer telehealth programs Currently serving The general public 68% Own employees 54% Other existing patient populations 52% Local employer groups 39% Planned in 2017 ACO/carrier ACO in which we participate and hold risk 23% Medicare Advantage plan 23% Managed Medicaid plan 20% The general public (tied with local employer groups) 17% Thirty-seven percent of Teladoc s survey respondents with an active consumer telehealth program indicated that their risk-based contracts are a critical part of their organization s strategy. Another 17 percent said they have plans to implement risk-based contracts in the next 12 months. is eliminating unnecessary or avoidable healthcare utilization. Patients who would normally seek treatment in the ER, from a retail clinic or even from their primary care provider can instead use telehealth to address minor issues at home, which is a significantly less expensive alternative. Numerous studies have shown consumer telehealth can result in cost savings for both healthcare providers and patients. The 2 million visits Teladoc facilitated as of January 2017 translated into more than $900 million in savings for its clients, according to a study performed by Veracity Analytics. The study, which used an advanced return on investment methodology and data from 2 million members, found an average cost savings of $472 per provider per visit. There s no question that telehealth has a proven track record of improving the financial risk profile of a health system, says Dr. Roga. One way it does this The cost savings associated with appointments facilitated through Teladoc increase in the month after the initial treatment due to effectiveness of care and diminished need to seek additional medical attention, according to the Veracity Analytics study. When we compared cohorts on whether they went to Teladoc, the ER or their primary care physicians, we found there were significantly fewer visits within 30 days after the telehealth visit, says Dr. Roga. In addition to financial benefits, telehealth enables providers to more closely monitor patients with chronic conditions. These individuals are the highest There s no question that telehealth has a proven track record of improving the financial risk profile of a health system. Alan Roga, MD, President of Teladoc s Provider Market 4

5 utilizers of hospital services and account for a disproportionately large percentage of healthcare costs. Telehealth lets clinicians easily reach patients who face transitions in care, close patient care gaps, reinforce healthy behaviors and track adherence for patients with chronic care management plans. These tools also empower patients to be more proactive about their health and to play a bigger role in their medical care. This is a change that will be vital to their providers success under risk-based payment models, as outcomes are directly linked to reimbursement under such models. As clinicians take on more financial risk through payment bundles, scaling low cost, easy access and communication solutions become extremely important as we begin to place more responsibility on the patient to manage their health, says Sandra Elliott, vice president of consumer technology and service at Edison, N.J.- based Hackensack Meridian Health. 2. Improve brand and increase competitiveness In a highly competitive healthcare market, a strong hospital and health system brand is essential to acquire patients and their loyalty. Organizations that demonstrate a commitment to improving the patient experience and expanding access to care, such as through the adoption of consumer telehealth, will bolster their brand. Many healthcare organizations see consumer telehealth as a sophisticated way to gain a competitive edge. According to Teladoc s survey, more than half of respondents (53 percent) who implemented a consumer telehealth program describe their organization s market as competitive with a number of other systems. In markets where patients and consumers can exercise a great amount of choice over where and how they receive care, hospitals and health systems must ensure their offerings appeal to 5

6 Most common medical specialties in current/planned consumer telehealth strategy: Current Planned in 2017 Primary care/pediatrics/ internal medicine 61% 23% Chronic condition management/monitoring 61% ER/urgent care 23% Orthopedics 49% Psychiatry/talk therapy 23% Cardiology 45% Re-admission prevention 20% Re-admission prevention, oncology, psychiatry/talk therapy 42% Chronic condition management/monitoring 13% Infectious disease, pain management, neurology consumers preference for convenience, otherwise they risk losing out to their more progressive peers. Hospital leaders are realizing they can gain an advantage in the market by offering virtual consultations, says Dr. Roga. They might also be responding to competitive threats because one of their competitors has launched consumer telehealth. According to a 2015 Trend Watch report from the American Hospital Association, 74 percent of U.S. consumers indicated they would use telehealth services. Seventy-six percent of patients said they prioritize access to care over in-person interaction with their healthcare providers, and 70 percent are comfortable communicating with their providers via text, or video instead of face to face. Consumers demand not only more options for care, [but they also] have higher expectations regarding more convenient access and ease of use, says Ms. Elliott. Telehealth capabilities enable us to provide easy access to populations that are demanding easier access to basic levels of care. If we are not looking at how we can provide service access at their literal fingertips, we are losing the opportunity to create a valuable connection with the populations we serve. 3. Expand access to care Telehealth means patients can access clinicians from anywhere with internet connection. This is particularly important for patients who live far from their providers, especially those for whom regular travel to a hospital for necessary follow-ups is costly and time consuming. Patients who benefit the most from telehealth include those in rural areas or those with limited mobility, transportation and income. Although surveys show the majority of consumers of all ages would use telehealth services, the technology is especially promising for patients in rural communities, who might have limited choice in providers and face geographical barriers to care. 6

7 There may be a pocket of remote patients in a corner of the state, says Dr. Roga. With telehealth, providers can give them better care. Or there could be a busy orthopedist who feels he or she could provide better and more consumer-friendly postop care by assessing the patient s wounds through virtual encounters. Teladoc s survey found 69 percent of respondents with a consumer telehealth program in place are expanding their programs to offer greater variety of services. Most survey respondents consumer telehealth programs currently offer primary care and emergency room/urgent care services (61 percent), but plan to expand with chronic conditions management, orthopedics, and cardiology (23 percent) this year. Primary care is the nucleus of a health system and fundamental to success under value-based care, so it s a logical place to begin when implementing a consumer telehealth program. However, after gaining experience with telehealth and building physician support, expanding the program to other specialties, such as joint replacement and cardiology, is a logical next step given how many alternative payment models apply to those specific service lines. The No. 1 opportunity and challenge for every health system I ve seen is to align their telehealth program to their goals. The programs that are most successful, in our opinion, are the ones that have determined their value drivers, set their strategy and use telehealth as a delivery service to help execute that strategy Alan Roga, MD, President of Teladoc s Provider Market 7

8 The State of Consumer Telehealth There are numerous components to consider when implementing or expanding a consumer telehealth program, such as how the program fits into the overall organizational strategy, how it will be led and staffed, which services to offer and how to measure success. Here is a breakdown on survey respondents approach to seven primary aspects of consumer telehealth. 1. Consumer telehealth emerges as a key strategic priority As the need to expand access, improve the cost-effectiveness of care and enhance the organization s brand emerges under value-based care, consumer telehealth has quickly ascended as one of organizations top strategic priorities, according to the Teladoc survey findings. Among respondents who already implemented consumer telehealth, 89 percent rank the program as a highpriority initiative. Eighty-three percent of those who have plans to implement telehealth in the next 24 months said the same. Yet many hospitals struggle to effectively incorporate consumer telehealth into their organizational strategy at all. According to Dr. Roga, those that experience the greatest difficulty implementing, maintaining and amassing value from their consumer telehealth programs tend to view it a software program and fail to determine how it will drive the organization toward its goals. Software is a critical part of the program, but viewing it simply as a software tool sets the organization up for a challenge, Dr. Roga says. The No. 1 opportunity and challenge for every health system I ve seen is to align their telehealth program to their goals. The programs that are most successful, in our opinion, are the ones that have determined their value drivers, set their strategy and use telehealth as a delivery service to help execute that strategy. For instance, hospitals can apply virtual care to meet demand for a particular service line or to improve certain quality metrics. A hospital whose emergency room is consistently filled with patients experiencing mental health crises could benefit from implementing a telehealth program designed specifically for patients with urgent mental health needs. Connecting with and treating these patients before they arrive at the ED can help reduce unnecessary ED visits. As another example, a health system that sees need to improve its 30-day hospital readmission rates could use telehealth to more closely monitor and communicate with patients after discharge. Consumer telehealth programs have been in place for: Top organizational goals related to consumer telehealth: 20% over 3 years 43% 1-3 years 24% less than a year 13% just launched 57% 51% 44% 36% Improve care/access Create more efficiencies in care delivery Achieve better care coordination/integration Better manage chronic conditions 29% Post-discharge/readmission management 8

9 2. Hospitals leverage consumer telehealth to support similar goals After determining how consumer telehealth can support an organization s overall strategy, health system leaders must also articulate specific objectives for the program. According to the Teladoc survey, the greatest proportion of respondents cited patient access and convenience, as well as increased efficiencies in care delivery as top goals. The majority of survey respondents (57 percent) said improving access to care by making it more convenient to patients is the biggest driver of their consumer telehealth program, followed by the need to create more efficiencies in care delivery (51 percent), achieve better care coordination and integration (44 percent) and better manage chronic conditions (36 percent). Survey respondents who plan to implement consumer telehealth in the next 24 months indicated similar objectives, with an additional 36 percent reporting their program will also be used to manage at-risk populations. Virtual technologies help providers achieve these objectives by growing the modes through which patients can access care and increasing opportunities for the clinical care team to communicate with and monitor patients outside of the hospital walls. Although there is no silver bullet when it comes to thriving under value-based reimbursement, hospital and health system leaders are increasingly realizing how consumer telehealth supports many factors of success: expanding access to care for patients and collaboration among staff; addressing gaps in care; managing high-risk, high-cost patients with chronic conditions; and increasing post-discharge monitoring. 3. Executive-level leadership and a robust physician staffing model are key Strong leadership is integral to increase accountability among stakeholders and reinforce the importance of a telehealth program within the overall organizational strategy. The most successful telehealth models have executive-level sponsorship, says Dr. Roga. This is a healthcare delivery system, and treating it as such with senior-level support is critical. Of the hospitals that have implemented consumer telehealth, the largest proportion (39 percent) indicated in Teladoc s survey that their programs are led by a dedicated director with senior sponsorship. The next most popular leadership model reported by 20 percent of respondents includes the combination of a C-suite executive with a dedicated director. 9

10 Dr. Roga said director of telehealth is quickly becoming a standard role in hospitals and health systems. This is a relatively new role that we ve seen increasingly recruited and filled within major and mid-sized health systems. This leader is typically responsible for all of the hospital s telehealth programs, including internal ones, such as telestroke and telepsychology, Dr. Roga added. While physicians and nurses often fill this position, clinical experience isn t a prerequisite, according to Dr. Roga. Leaders who have change management experience and positively interact with clinicians are best equipped to thrive in such a role. Hospital leaders must also decide how to staff the consumer telehealth program. The most common staffing model, as indicated in Teladoc s survey, is the organization s own providers (42 percent), followed by a combination of their own and a telehealth vendor network (30 percent). Fifteen percent solely use a vendor s providers. Various factors influence a hospital s decision to enlist a consumer telehealth partner for additional support, such as the scope of the program, need for a higher volume of providers or need for regulatory or subject matter expertise. Vendors with a dedicated telehealth solution, such as Teladoc, have developed proven and reliable technology designed specifically to meet the unique needs of hospitals and health systems. Whichever route hospitals choose, a strong culture of trust, collaboration and commitment to the consumer telehealth program among clinicians is critical. Some of the most common lessons learned among Teladoc s survey respondents were the need to gain physician buy-in and engage leadership, as indicated by 78 percent and 73 percent of respondents, respectively. Giving clinicians a seat at the table during development of the program will increase buy-in and ultimately lead to a program that works better for patients and providers. 4. Consumer telehealth is an effective mode of care for a variety of patient populations The most common patient populations served by consumer telehealth include the general public (68 percent) and the hospital s own employees and covered departments (54 percent), according to the survey. Most respondents said they have plans to expand their consumer telehealth offerings this year with the ACO in which they participate (23 percent), Medicare Advantage plan (23 percent) or Managed Medicaid plan (20 percent). Leaders at Hackensack Meridian Health decided to first implement Teladoc s consumer telehealth program among its employee population to ensure it is easy to use and effective before expanding it to other patient populations. If our employees felt the service was easy to use and was beneficial, they could become telehealth ambassadors in the markets we serve, says Ms. Elliott. The most common services hospitals and health systems offer patients through consumer telehealth are primary care, pediatrics, internal medicine, emergency and urgent care, as indicated by 61 percent of survey respondents. The next most common specialties are psychiatry and talk therapy (49 percent) and readmission prevention (45 percent). Primary care and emergency medicine are ripe for consumer telehealth since hospitals routinely face high volumes of patients who may not require inpatient care to address their conditions, according to Judd E. Hollander, MD, associate dean for Strategic Health Initiatives at Sidney Kimmel Medical College at Thomas Jefferson University and professor and vice chair of Finance and Healthcare Enterprises in Emergency Medicine. Providers are busy. Their schedules are filled, says Dr. Hollander. Making it easier for patients to get care does not increase the number of providers or number of appointments. Using emergency 10

11 physicians with access to the EHR is one way to have providers available to coordinate care without increasing the burden on filled primary care schedules. Care coordination [is associated with] decreased readmissions. As health systems increase the ability to see patients and coordinate care and decrease canceled visits, everyone wins. Most respondents plan to implement consumer telehealth for chronic condition management and monitoring (23 percent), orthopedics and cardiology (23 percent), readmission prevention, oncology and psychiatry, each of which were indicated by 20 percent of respondents. This is consistent with hospitals and health systems increasing participation in valuebased payment models, such as bundled payments, that center on such specialties. 5. Promotion for virtual care programs must be targeted at patients and clinicians A successful consumer telehealth program requires buy-in and engagement from both patients and clinicians. Virtual care represents a significant change in care delivery from what many providers and recipients of care are used to, so the organization should direct promotional efforts at both demographics. Hospitals and health systems promote their consumer telehealth program to patients in a variety of ways, according to Teladoc s survey findings. Fifteen percent of respondents say physician referrals are the most effective type of promotion for consumer telehealth and 11 percent of respondents find in-office promotions when an appointment is requested or when scheduling a follow-up visit and advertising (on TV, online, radio, billboards and social media) highly effective. Promotion of the telehealth program to prospective patients is a vital component of its success. Promotional efforts should emphasize how telehealth can increase convenience and improve the overall care experience for patients, as well as its associated cost benefits. The message should target patients who face barriers to care to show how telehealth can improve accessibility of important services. Physicians and other healthcare providers need to know that the most [common] comparator for a video visit is not an in-person visit. For some patients the only option is no visit at all, or waiting weeks to have a visit; for others it is a telephone call. No one can argue that a video visit isn t a better option for these patients, says Dr. Hollander. Health system leaders must also invest in promoting the telehealth program to the providers themselves, who may otherwise be reluctant. Dr. Hollander says getting physicians on board may require encouraging a new perspective on care delivery and daily workflows. Medicine is no longer about doctors forcing patients to adhere to their schedule, he says. If we want to grow our business, we and you need to be patient-centered. In many ways, being patient-centered means delivering care when and where patients find it It will become more and more important to take care of patients the way they want to be taken care of. patients prioritize cost and convenience over physician loyalty. If you don t want to provide care the way patients want to receive it, you will find yourself without patients. Judd E. Hollander, MD, Associate Dean for Strategic Health Initiatives, Sidney Kimmel Medical College at Thomas Jefferson University and Professor and Vice Chair of Finance and Healthcare Enterprises in Emergency Medicine 11

12 most convenient. As patients increasingly take on greater financial responsibility for their care, they are beginning to apply the same consumer expectations to healthcare that they hold when selecting airline tickets, hotel rooms or restaurants. It will become more and more important to take care of patients the way they want to be taken care of, says Dr. Hollander. Patients prioritize cost and convenience over physician loyalty. If you don t want to provide care the way patients want to receive it, you will find yourself without patients. 6. Performance metrics help gauge success and illuminate opportunities for improvement Performance metrics are critical to measure how successfully a new program fulfills its goals. By defining success in advance, it forces organizations to think through their strategy and understand why they are actually getting into telehealth in the first place, says Dr. Roga. The metrics will also enable the hospital or health system to continuously monitor progress, evaluate clinical performance, find opportunities to course correct and track spending. The majority of Teladoc s survey respondents (70 percent) say patient satisfaction is the most important measure of success in their consumer telehealth programs, while 44 percent cite physician satisfaction. This is interesting, considering 42 percent of respondents don t measure patient satisfaction, while 54 percent said they don t measure satisfaction among physicians. This discrepancy shows that despite health systems intentions to provide superior experiences for both patients and providers, there is still room for improvement in actually doing so. Other important metrics include utilization (37 percent of respondents), reduction in readmits (37 percent) and increased number of visits/new patients contributed by the consumer telehealth program (37 percent). Under one-third of respondents (28 percent) said return on investment is one of the most important measures of success. That five other metrics were named important measurements of success before ROI is notable. This may be because executives reason that investments that are made to satisfy consumer demand and improve the patient experience will eventually have a positive effect on the bottom line, though the direct 12

13 Biggest barriers to implementing consumer telehealth: 34% 21% 14% 13% Reimbursement IT integration into EHRs Other capabilities command a higher priority High-performing consumer telehealth software relationship between those metrics may be difficult to pinpoint, according to Ms. Elliott. There is a fundamental realization that anything that is easy to use and meets a market demand will likely improve patient satisfaction, she said. However, correlation between patient satisfaction and its impact on the bottom line is not easy to directly [link] to one particular technology such as telehealth. This is not to say that positive ROI is not still a top consideration for health system leaders when considering investing in consumer telehealth. We are still not in a purely consumer-driven market where choice is up to the consumer alone. The operating margins in health system are still frailly thin and continue to require clear return on investment decisions among executives, Ms. Elliott added. 7. Survey respondents reveal the most valuable lessons learned As with any large initiative, the implementation of a consumer telehealth program comes with challenges. Teladoc survey respondents with consumer telehealth programs in place said the most significant barriers to implementation were reimbursement (34 percent), integration into EHRs (21 percent), competing priorities (14 percent) and selecting high-performance consumer telehealth software (13 percent). Hospitals and health systems are best served to anticipate these challenges in their own telehealth programs. Some of these obstacles such as reimbursement are out of hospitals control. However, the tide is turning when it comes to getting paid for telehealth. Forty-nine states and Washington, D.C., require at least partial Medicaid coverage for telehealth, and nearly all states reimburse for live video telehealth, according to an August 2016 policy brief from Health Affairs. Thirtytwo states and Washington, D.C., have enacted parity laws, which require private insurers to reimburse providers for telehealth services at the same rate as in-person services. Other barriers, such as integration of IT infrastructure and competing strategic priorities can be addressed with advanced planning and troubleshooting, while including physicians in the planning process mitigates resistance to the program. Survey respondents noted several key lessons learned after facing these barriers during the implementation period, which could be invaluable to health systems still in the planning stages of their own consumer telehealth programs. As stated previously, the biggest lesson learned was the importance of physician buy-in, as noted by 78 percent of respondents. Respondents also identified ensuring the project aligns with the organization s 13

14 objectives (75 percent), engaging leadership (73 percent) and securing operational support (49 percent) as great lessons they learned when rolling out a program. Dr. Roga advises executive teams to clearly define objectives and understand how the consumer telehealth program will enable the organization to achieve its goals. I think it can be very difficult for organizations to figure some of this out on their own because it s a new market, he says. To mitigate that, Teladoc has developed a proprietary readiness assessment through which we help clients think through their use cases and pressure test them against value, complexity and urgency. The readiness assessment, which hospital officials and Teladoc leaders complete over a four-week period, helps clients solidify thinking around the strategic value of consumer telehealth; explore use cases, as well as their risk and success factors; and create a three-year telehealth roadmap. The process is intended to take some pressure off the client, says Dr. Roga. They can also assess us as a partner during this time to learn about our experience and see if we are a cultural fit. After completing the readiness assessment, hospitals receive a summary report that describes the organization s current position on Teladoc s Telehealth Maturity Scale; best consumer telehealth use cases and priorities; a defined solution, support, budget, FTEs and metrics; a multi-year roadmap for the program; and success factors and key risks. Among the 24 percent of survey respondents who said they had no plans to implement a consumer telehealth program in the next 24 months, most said the reason is because their health system puts other priorities first (38 percent). However, with tools like the Teladoc readiness assessment, hospitals might be surprised by how a consumer telehealth program can position the organization to better achieve its goals, according to Dr. Roga. Conclusion As hospitals and health systems reconfigure strategies to thrive in a value-based healthcare environment, consumer telehealth is one effective tool for providing high-quality and cost-effective care, as well as a competitive distinction. Survey respondents would like to see additional features integrated in their consumer telehealth programs going forward, such as in-network referrals (indicated by 50 percent of respondents), wearable technology (48 percent) and claims submissions (41 percent of respondents). For now, though, hospitals that have identified the opportunity to support their goals and better serve patients through the deployment of a consumer telehealth program must consider how to implement such a system with buy-in from clinicians and patients. Teladoc s survey findings create a portrait of how hospitals and health systems that have consumer telehealth programs in place have progressed, where they target their efforts, plans for future expansion and challenges they faced when rolling out the program. They create a benchmark for hospitals that seek to adopt consumer telehealth in the future and a foundation from which to build their own plans. 14

15 About Teladoc Teladoc has been involved with many consumer telehealth initiatives that support the Triple Aim while also helping individual hospitals and health systems meet their specific clinical and financial goals. Teladoc provides a licensable platform that hospitals and health systems can configure to create targeted programs. The American Hospital Association (AHA) has exclusively endorsed the Telehealth Technology Platform and Licensable Software Solution from Teladoc, Inc. Following a proprietary due diligence process, Health Forum, the strategic business enterprise of the American Hospital Association (AHA), awards the AHA Endorsement to products and services that help member hospitals and health care organizations achieve operational excellence. BECKER S HOSPITAL REVIEW About Becker s Hospital Review and Becker s Healthcare Becker s Healthcare is the leading source of cutting-edge business and legal information for healthcare industry leaders. We take advantage of multiple channels to reach these industry leaders and decision-makers. The contents of this document are protected by the copyright laws of the United States. This document is provided for the recipient s sole, personal use; copying and publication are expressly prohibited. The methods and results described herein are the valuable intellectual property of Teladoc, Inc. All rights not expressly granted herein are reserved by Teladoc, Inc. Teladoc, Inc. (NYSE: TDOC) is the nation s leading provider of telehealth services and a pioneering force in bringing the virtual care visit into the mainstream of today s health care ecosystem. Serving some 7,500 clients including health plans, health systems, employers and other organizations more than 17.5 million members can use phone, mobile devices and secure online video to connect within minutes to Teladoc s network of more than 3,100 board-certified, state-licensed physicians and behavioral health specialists, 24/7. With national coverage, a robust, scalable platform and a Lewisville, TX-based member services center staffed by 400 employees, Teladoc offers the industry s most comprehensive and complete telehealth solution including primary care, behavioral health care, dermatology, tobacco cessation and more. 15

16 Visit teladoc.com/healthsystems or call Technology that works the way hospitals need it to work.

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