Minuteclinic – Using Technology to Connect the Dots Friday, January 20Th, 2017 Gillette Stadium Clubhouse

Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 MinuteClinic – Using Technology to Connect the Dots Friday, January 20th, 2017 Gillette Stadium Clubhouse

Tobias Barker MD VP Medical Operations CVS/MinuteClinic

Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 MinuteClinic®: High-Quality, Lower-Cost Care Largest retail clinic provider: over 29 million visits since inception

THE FIRST RETAIL HEALTH 1135+ CARE PROVIDER TO BE Full-time Clinics in 33 FULLY ACCREDITED BY THE States and D.C. JOINT COMMISSION

1 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 MinuteClinic: Largest Retail Clinic in U.S. with 1,135 Locations Across 33 States and Washington, D.C.

1,135

Total Clinics in 2016

Legend: Clinic State MinuteClinic Target Clinic

More than 50% of the U.S. population is within 10 miles of a MinuteClinic

3 3

Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 MinuteClinic®: High-Quality, Lower-Cost Care Largest retail clinic provider: over 29 million visits since inception

THE FIRST RETAIL HEALTH 1135+ CARE PROVIDER TO BE Up to 80% Full-time Clinics in 33 FULLY ACCREDITED BY THE JOINT COMMISSION savings over higher States and D.C. cost settings >2,800 Providers (NPs/PAs) nationwide

50% of visits evenings and weekends

Nationally 40-50% of MinuteClinic Patients Do Not Have PCP

2 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 Comparing Cost And Quality Of Treating Common Illnesses Across Medical Settings High Quality & Affordable Care

Emergency Emergency Departments 55% Departments $26

Physician Physician 61% $21 Offices Offices

Urgent Care 63% Urgent Care $22

MinuteClinic 64% MinuteClinic $21

Notes: N = 2,100 care episodes compared across venues. Aggregate quality scores based on 14 objective measures of quality. Source: “Comparing Costs and Quality of Care at Retail Clinics With That of Other Medical Settings for 3 Common Illnesses,” Ann. Intern. Med. 2009;151:321-328. 5

Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 MinuteClinic HEDIS Performance: Avoiding Antibiotics

AVOIDANCE OF ANTIBIOTICS IN BRONCHITIS IN ADULTS PUBLIC DATA FROM MN

MinuteClinic • Medical Group Average = 26% • Source: HealthCare Quality Report from Minnesota Community Measurement http://mncm.org •HEDIS = Healthcare Effectiveness Data and Information Set 6 6

3 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 MinuteClinic®: High-Quality, Lower-Cost Care Largest retail clinic provider: over 29 million visits since inception

50% of visits 60+ evenings and major health system weekends affiliations

Nationally 40-50% of MinuteClinic Patients Do Not Have PCP

Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 Support of PCMH through 60+ Health System Affiliations Primary Care Collaboration • EMR integration and exchange of clinical data • Health system medical director collaboration and supervision with MinuteClinic NPs & PAs • ACO and PCMH development • Virtual “medical neighborhood”

4 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 Increased Connectivity Improves Patient

Care Patient Presents At Electronic Clinical MinuteClinic Information Exchange

5 Patient 1

Affiliated Minute Health Clinic 4 System Nurse Practitioner 2 Nurse Practitioner Treats Patient Accesses MinuteClinic EMR 3

MinuteClinic EMR Link To He a lt h Sy s t e m

Health System Patient Notes: • Allergic to Penicillin • Current medications • Hypertension: needs BP check

Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 TeleHealth Efforts at MinuteClinic

5 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 Major shifts in healthcare landscape are setting the stage for the disruptive potential of telehealth

Healthcare costs are rising, fueling HDHP and ACOs 20% 5.6% 10X 48% U.S. adults living with Projected U.S. Increase in ACOs from Large employers two or more chronic healthcare spend 2011 to 2015 offering consumer- health conditions (CAGR%) directed/high deductible health plans

DemographicsThe U.S. health are system Driving is falling Need short for Care on providing care… 20% 19.5 (90,000) Patients living in areas with Average wait time in days Expected shortage of insufficient primary care for appointment to family physicians by 2025 doctors practice nationwide …just as consumer expectations for convenience are rising and technology scales 98% 30% 40% US population that can US consumers who used a American adults who access mobile LTE service same day delivery for retail have used an on- purchases in the last year demand service such as Uber

• Source: Telehealth Trends 2015, CMS 2015 fact sheet; Marketing and Planning Leadership Council, The Advisory board Company; Mercer 2014 National Survey of Employer- Sponsored Health Plans ;Whitehouse.gov (2016): www.whitehouse.gov/connect-america; Market Innovation Center research and analysis. Packaged Facts. “American Consumers in 2020,” 2015. Murson Marsteller. “The On-demand Economy Survey”

Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017

B-Side A-Side

6 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 CVS MinuteClinic Telehealth Pilot

PATIENT SITE PROVIDER SITE

• 48 sites in California and Texas—allowing patients from a busy MinuteClinic to be seen by available NPs elsewhere in the state through high-quality, live video and audio •NP (Nurse Practitioners). CVS Health uses and shares data as allowed by applicable law, our agreements and our information firewall.

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Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 Majority of Patients Were Highly Satisfied

SATISFACTION SURVEY RESULTS COMPARED TO A TRADITIONAL VISIT, PATIENTS THOUGHT EXPERIENCE WAS: >1,812 PATIENTS1 COMPLETED A SATISFACTION SURVEY 61%

95% 34%

were highly satisfied with:

QUALITY EASE CONVENIENCE of the of and care they integrating timeliness 4% received telehealth of experience 1% technology into the visit BETTER AS WORSE NOT GOOD SURE

Source: JM Polinski, T Barker, N Gagliano, A Sussman, TA Brennan, WH Shrank. Patients’ Satisfaction with and Preference for Telehealth Visits. J Gen Intern Med, August 2015. 1. All patients who responded to the survey. N=2383.

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7 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017

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Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 Exploration of “team care”

. . Receiving Site Sending Site Physician

•More clinical collaboration on behalf of our patients – NP & physician are able to consult on best care approach – Patient consultation is richer, improving service/satisfaction – Possible to reduce number of patients who are currently referred out

8 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017 Strategic Relationships to Expand the Future of Telehealth

MinuteClinic to serve Telehealth vendor MinuteClinic providers as site for in-person physician care consulting Telehealth exams to facilitate accessible through physicians to expand Telehealth medical CVS Health digital scope at MinuteClinic visits properties

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Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017

Expanding Services and Increasing Access

2013 2014-15 Among Existing Physician MinuteClinics Consults

Outside of Home / MinuteClinic Mobile 2014-15 2015-16

9 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017

Source: Deloitte

Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017

10 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017

Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017

11 Do Your Job! – Strive to Make Your Revenue Cycle Thrive 2017

Thank you