E X C E L L E N C E M A D E P O S S I B L E .

Virtual Health Care Strategies for Tomorrow

An Excellence Canada Webinar

March 5, 2020 at 11:00 AM EST

E X C E L L E N C E M A D E P O S S I B L E .host and speakersKaren Jackson

Senior Advisor

Excellence Canada

Eric Pfeiffer

Senior Health Management Consultant

Manulife

Meghan van Zanden

Head of Clinical Operations

Akira Health

E X C E L L E N C E M A D E P O S S I B L E .

Today’sLandscape

Virtual Health Care

Resourcesand Q&A

Our time today

AGENDA

E X C E L L E N C E M A D E P O S S I B L E .

Standards of ExcellenceWe are dedicated to advancing organizational performance across Canada, through world class Standards

and frameworks in the following areas of focus:

Excellence, Innovation and

Wellness

Healthy Workplace

Mental Health at Work

Financial Wellness

E X C E L L E N C E M A D E P O S S I B L E .

Landscape

Presented by:Eric PfeifferSenior Health Management ConsultantManulife

Today’s Landscape

Eric PfeifferSenior Health Management Consultant

Chronic Disease Landscape

88%

Of all deaths in Canada are a result of chronic disease

Chronic Disease in Canada

Did you know?

44%

Of Canadian adults have at least one chronic

disease

66%

Of all deaths in Canada are related to the top four chronic

conditions (cardiovascular disease, cancer, chronic

respiratory disease & diabetes)

Source: World Health Organization (WHO)

80% of chronic conditions are preventable

Canadian Chronic Disease Surveillance System (CCDSS), 2015–2016

9

1 Public Health Agency of Canada, Tackling Obesity in Canada: Obesity and Excess Weight Rates in Canadian Adults (2017)2 2016 Mental Health Commission of Canada 3 The Canadian Diabetes Association (2019)

64% of adults 18 and over are overweight or obese1

1 in 5 Canadians dealing with a psychological health problem or illness2

Approximately

11 million

Canadians are living with diabetes or prediabetes3

Canadians at risk

All data is from the Canadian Chronic Disease Surveillance System (CCDSS), 2015–2016

Heart disease is the 2ndleading cause

of death in Canada

10%of Canadians have

Chronic Obstructive Pulmonary Disease

25% Of Canadians

have Hypertension

Canadians at risk

Source: World Health Organization - Noncommunicable Diseases (NCD) Global Health Observatory Data and Country Profiles, 2016.

Physical inactivity

Unhealthy diet

Smoking

Excess alcohol

NCDs4 Main risk factors Responsible for

Respiratory disease

Diabetes

Cancer

Cardiovascular disease

What Do Chronic Diseases Have in Common?

Impacts on Employers and Employees

How does it affect organizations?

13

9.3 days per year The average number of health-related absences per full-time employee1

65 days The average duration of a mental health-related leave of absence2

$16 billion or more per yearDirect lost revenue for Canadian employers due to health-related absenteeism1

1Stewart, Nicole. Missing in Action: Absenteeism Trends in Canadian Organizations. Ottawa: The Conference Board of Canada, 2013.2Dewa CS, Loong D, Bonato S. Work outcomes of sickness absence related to mental disorders: a systematic literature review. BMJ Open 2014;4:e005533. doi:10.1136/bmjopen-2014- 005533

Low engagement and productivity levels

Impact on the bottom lineAbsenteeism

Presenteeism

Disability

How does it affect your employees?

14

Unhealthy & Unhappy

Employee/Spouse/Parent/Friend

• Less productive and less

engaged

• High level of stress

• Isolation

• Increased presenteeism,

absenteeism & Disability

• Increased health costs

• Financial impacts

15

We believe that when lives are made better, organizations become healthier.

Better health

High productivity

Healthier organizations

Support through the health continuum

16

Wellness and preventionAbsence and disability

management

At work – healthyAt work – at

riskOff work

Return to health

What else can be done

Leverage Technology

18

Comprehensive Digital Applications and Platforms

19

• Easily accessible

• Help address main lifestyle health risk factors

• Integration of smart devices

• Validated information

• Built in incentives

• Triggered communication and nudge theory

20

Helping Canadians get the care they need when they need it, where they need it

HealthcareOnline

E X C E L L E N C E M A D E P O S S I B L E .

VirtualHealth

Presented by:Meghan van Zanden, Head of Clinical OperationsAkira

What is Virtual C are?

Scheduled appointments with Doctor or Nurse PractitionerTypical wait for appointment: 3-5 daysOnly operates during business hours

Traditional In-

Person Primary

Care

Traditional

Telehealth

Risk-averse ER triage

On-demand, after-hours support

Staffed by Nurses with limited scope of practice

Virtual Care

Marries the broad scope of

practice of traditional in-

person primary care with the

convenience of being

delivered virtually and on-

demand: anytime, anywhere.

TODAY

Remote areasOTN technology/ cart hardware reliance on

physicians

Tech entrants (VC $)Mobile apps & Text Small B2C adoption

2000 – 2015

INNOVATORS MAJORITY MATURITY

Insurer channel adoption Selling vs. educating

Pricing stability

B2B market at maturityWide GHIP reimbursement

Beyond primary carePricing control

The Evolution of Virtual C are

2016- 2018 2020 ->

EARLY ADOPTERS

A Deeper Look at Medic are & ProvidersIn all provinces except ON and BC, the main eligibility requirements for reimbursing

virtual care services is that a patient is located in northern, rural, or remote areas.

BRITISH COLUMBIA

ALBERTA

ONTARIO

COMMENTS

• Doc tors bill the same as for in-offic e c onsults

• Virtual c onsults for BC res idents c an be c overed under Medic al S ervic es Plan (MS P)

• C overed only when health fac ilities are inac c essible

• 900 videoc onferenc ing s ites ac ross provinc e must be used

• Eligibility focuses on patients “most likely to benefit from virtual care”

• Physic ians must reg ister with O ntario Telemedic ine Network

• Broad definition of virtual c are inc ludes tests , sync hronous and async hronous tools , and remote health monitoring

• Ontario Health Teams will offer virtual health, introducing the idea of “Digital First for Health”

Source: PwC Analysis, Canada Health Infoway, McMaster University “Understanding the Use of and Compensation for virtual-care Services in Primary Care” Alouette Refresh 2019 PwC

• Many provinc es have a broad definition of virtual c are to allow for its expansion in the near term

• All provinc es have desig nated Telehealth billing c odes using fee-for-servic e remuneration that disting uishes from in-person servic e

• O nly in AB and O N are physic ians paid additional fees for delivering virtual c are

• Physic ians prac tic ing telemedic ine for a patient loc ated in a g iven provinc e or territory must usually hold a valid & ac tive prac tic e permit with the loc al C olleg e

• Practicing using only electronic communication may affect a physician’s liability insuranc e

ACCESS TO:

Millions of Canadians

Thousands

Hundreds

PRICING:

Best Pricing

“Next Best”

Highest Pricing

B2B S ales C hannels

INSURERS

BROKERS & CONSULTANTS

EMPLOYERS

The main players in virtual

c are

• 24/7

• B2B Plans; B2C available

• Nurse Practitioners

• 24/7

• B2C focused, B2B available

• ER Physicians

• By appointment

• B2B

• Physicians & Nurse Practitioners

• B2C focused, B2B available

• Physician-led

• By appointment

• Reimbursable in BC

New entrant in Canadian market • B2C focused

• Physician-led

• Reimbursable in BC

• Flat per-consult rate in ON

Canadian residents don't have

a family doctor

4.5MILLION

74%

of physicians felt that

regular contact with a

family doctor improved

detection of subclinical

illness

is the average number of

absences per full-time employee

9.3DAYS PER YEAR

SOURCE: Canadian Institute for Health Information, Commonwealth Fund survey 2016, Conference Board of Canada - Absenteeism Trends in Canadian Organizations

BOOK AN APPOINTMENT WITH YOUR FAMILY DOCTOR

GO TO A WALK-IN CLINICGO TO THE

EMERGENCY ROOM DO NOTHING

visit the emergency room each year and

wait between 4-24 hours just to renew

prescriptions

40,000CANADIANS

61%

of family doctors report not

being able to

accommodate same day or

next day appointments

68%

of Canadians avoided

seeing a doctor because

of long waits, the inability

to book appointments

outside of normal work

hours, & other barriers

Both patients and employers bear the cost of delays to seek care

What to do When You’re Sick

Average length of mental health-related

leave of absence

Loss of revenue for Canadian employers from

health-related absenteeism

Canadians are on disability due to a psychological

health problem or illness

65 days

$16B +

1 of 5

•Impac t on the

bottom line

•Low eng ag ement &

produc tivity levels

Did you know? 73% of consults are initiated during the work day.

Healthcare’s Impact on the Bottom Line

EMPLOYEE WELLNESS

BRAND

ROI

Employees are healthier - better and more timely access to

care and focus more on their overall health

Employers are creating strong brands in the fight to attract top

talent. Innovative and forward thinking benefits is part of this mix.

Hypothesis of 3x ROI on employer virtual Care investment. Collecting data

with TELUS and an insurer to substantiate.

Employer Value PropositionEmployers are asking for more than ROI

Opportunity to own patients’ digital health relationships

A Dig ital Medic al Home

Healthc are on your phone, wherever you are

On-demand consults Real-time text Image transfer Secure video Personal health records

SPECIALIST APPOINTMENTS

PRIMARY MENTAL HEALTH CARE

FORMS + CASE MANAGEMENT

Providing ong oing healthc are where needed

satisfaction rating

all day, every day24/7

Available nationally

Of consults are resolved on the app85.0%

4.9/5

Source: CMA Study, TELUS Survey

Virtual C are is For All Ag es

of millennials would rather deal with everyday health issues virtually.

of caregivers and those dealing with sick children were likely to use virtual care.

of survey respondents said virtual care would help them miss less work.

50% 70% 47%

Nu

mb

er

of

Pat

ien

ts

A few c ase studies

Mental Health is Well-S uited to Virtual C are

Mental health is one of the most common reasons

for initiating consults.

Our clinicians can triage, diagnose, prescribe,

and refer to therapists and specialists

Continuity of care and strong therapeutic

relationships is critical for patients with mental

health concerns.

PRIMARY CARE

Anxiety Conditions

Depressive conditions

Other mood disorders

Other

42%

30%

19%

9%

have struggled with mental health issues,

but many remain untreated

1 in 5 C anadians

In-Person vs Virtual: a S ample Health J ourney

73% of consults are initiated during the work day.

Without Virtual Healthcare, 48% of patients would have gone to walk-in clinic, 20% to

their family doctor, and 11% to the emergency.

TO TAL: 1-3 days

TO TAL: 10-15 mins

E X C E L L E N C E M A D E P O S S I B L E .

Resources

E X C E L L E N C E M A D E P O S S I B L E .

Excellence Canada

Healthy Workplace Standard

RESOURCES

Employee Wellness Solutions

Akira Health

E X C E L L E N C E M A D E P O S S I B L E .

Questions?

Thank You

@excellencecan

Facebook.com/excellencecanada

www.excellence.ca

Meghan Van Zandenmeghan@akirahealth.ca

Eric Pfeiffer Eric_Pfeiffer@manulife.ca

Karen Jacksonkaren@excellence.ca

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