This document discusses strategies for telehealth companies to succeed, including direct-to-consumer models and organic growth models. The direct-to-consumer approach requires proving trust and quality to patients online, while organic growth involves demonstrating value and efficiency gains to physicians. Both models must satisfy the values of physicians, patients, and the healthcare system to gain adoption. The document recommends starting with organic growth to develop local trust before expanding direct-to-consumer, focusing on quality assurance, and solving issues like access delays and office inefficiency through telehealth.

1. Telehealth Secrets to Success and Failure
September 21, 2017:
R. Michael Greiwe, MD, CEO
Direct to Consumer vs. Organic Growth -- What Works?
“Orthopedics that works for you”

2. “ All we have to decide is what to do with
the time that is given us.”
-- J.R.R. Tolkien
“Be the change you wish to see in the
world.”
-- M. Gandhi
OrthoLive 2017

3. First to Market Orthopedic Telemedicine
“Orthopedic Care that Works for You”

4. Outline: Secrets of Success and Failure
• Understanding the four tenets (and four values) of the American Physician
• Understanding the four tenets (and four values) of the American Healthcare Consumer
• Understanding our Healthcare System
• Direct to Consumer
• Organic Growth
• Solving the Health Care System Problems with Telehealth and Secrets to Success
OrthoLive 2017

5. Developing Winning Strategies
Understanding Consumer Values, Physician Values and the Healthcare System
OrthoLive 2017

6. Telemedicine must serve consumers,
physicians AND the system to be utilized …
Physicians Healthcare
ConsumersTelemedicine
Health Care System
OrthoLive 2017

7. Four Tenets of the American Physician:
• Helpers (compassion, altruism,
trustworthy)
• Driven, competitive people
• Overworked and fatigued
• Frustrated by the current model,
but unwilling to change. Why?
Change decreases efficiency and
throws them from their comfort
zone…
OrthoLive 2017

8. Heirarchy of American Physician Values:
1. Efficiency = Productivity /Time
• GETTING HOME EARLIER
• Improving work flow/processes
• Avoiding duplicative efforts
2. Stability – resistant to change
3. Improving lives of patients
4. Enjoy a Competitive Advantage
• Superior to their peers
OrthoLive 2017
TIME
STABILITY
PATIENT CARE
IMPROVE/COMPETE/INNOVATE

9. Tenets of the American Healthcare Consumer:
1. Requires compassion
2. Desires quality
3. Would like efficiency
4. Can’t explain value, unless
insurer, employer, third-party
adminstrator
Value is best understood by those who have to pay
for healthcare!
Patients aren’t directly involved in $$ decision-making
OrthoLive 2017

10. Heirarchy of American Healthcare Consumer
Values:
1. Trust is paramount
• Word of Mouth
2. Quality matters, but is perceived
• Taj Mahal, team physician
• Just now measuring value!
3. Efficiency
• Only matters if trust and quality are
equal
4. Value – least important for
average consumer
• Insurers/employers have a different
view!
OrthoLive 2017

11. Telemedicine must satisfy Physician and
Patient Values to be broadly accepted:
Physician Values
• Efficiency
• No Change
• Help Patients
• Superiority
Patient Values
• Trust
• Quality
• Efficiency
• Value
What does this mean?
• Prove Efficiency to the Physicians and they will Change
• Prove Trust and Quality to the Patients and they will
flock to your virtual doors …OrthoLive 2017

12. Tenets of Our Health Care System:
• “Fee-for-service” -- Rewards
productivity not value
• High administrative burden:
• Coding
• Claims submission process
• High overhead
• Chronic disease is rising (obesity,
diabetes, etc.) in US
• Businesses (pharma, device,
insurance, etc.) increase the
economic burden
Responsible Party
Physicians/Hospitals
Insurance /Government
Patients/Culture
Healthcare
Businesses
Tenets of US Healthcare:
OrthoLive 2017

13. Can Telehealth Help the System?
• “Fee for service”
• Administrative burden:
• Chronic disease:
• Big Business
US Healthcare System Telehealth Advantage?
Lower costs improve ability to
transition to value-based care
Strong value allows work
outside of typical coding/billing
Will multiple touch points/easy
access improve chronic disease?
Can telehealth unify the
healthcare marketplace?
OrthoLive 2017

14. Two Models of
Telehealth
Direct to Consumer vs.
Organic Growth
OrthoLive 2017

15. DIRECT-to-
CONSUMER
OrthoLive 2017

16. Direct-to-
Consumer
Definition: Direct-to-Consumer
Telemedicine is the offering of
telemedicine through an app or
web portal for patients at large
No “brick and mortar”
OrthoLive 2017

17. How does Direct-to-Consumer model fit the
value equation?
Physician Values
• Efficiency
• No Change
• Help Patients
• Superiority
Patient Values
• Trust
• Quality
• Efficiency
• Value
Providers have already bought in:
• How do we prove trust in an online environment?
• How do we prove quality if there is no trust?
OrthoLive 2017

18. CONSUMER TRUST: an issue for direct-to-
consumer
• All technology takes time to gain momentum and trust.
• Healthcare is PERSONAL and requires TRUST (not a taxi service)
• Therefore, the most important barrier for telemedicine to overcome is
TRUST, until it is perceived as mainstream.
• if your Direct-to-Consumer company fails to deliver TRUST, it will fail.
OrthoLive 2017

19. SECRETS to DEMONSTRATING TRUST:
• Hire compassionate people
• Strong value proposition
• Deliver on quality … every time
• Strong QA program
• Your technology must work 99.99%
of the time
OrthoLive 2017

20. How does Direct-to-Consumer model fit the
US System?
US Healthcare System Issue:
• Fee for Service
• Administrative Burden
• Chronic Disease
• Big Business
Direct-to-Consumer Model:
Revolution in our healthcare system can come from direct-
to-consumer telemedicine!
• Major change, eventually will have a major impact
OrthoLive 2017

21. What is the biggest hurdle to
Direct-to-Consumer
Telemedicine?
Trust
OrthoLive 2017

22. ORGANIC GROWTH
OrthoLive 2017

23. ORGANIC
GROWTH
Definition: The growth of
telemedicine in a community-
led effort beginning in small
clinics and private practices.
“Brick and Mortar” +
telemedicine
OrthoLive 2017

24. How does “Organic Growth” fit the value
equation?
Physician Values
• Efficiency
• No Change
• Help Patients
• Superiority
Patient Values
• Trust
• Quality
• Efficiency
• Value
Providers have NOT bought in:
• How do we prove efficiency in the office environment?
• How to help physicians who are so resistant to change?
OrthoLive 2017

25. PHYSICIAN BUY-IN: Issue for Organic Growth
• The busy physician must see value in telemedicine. Not just that it
makes patients happy.
• Physicians appreciate improvements in efficiency/productivity/cost:
• Decrease overhead
• Drive new patients
• Improve office flow
Value = Productivity/Cost
OrthoLive 2017

26. SECRETS TO DEMONSTRATING VALUE:
• Generate new patients
• Improve overhead
• Decrease physicians time spent
doing duplicative work
• Decrease time spent with
recheck patients
OrthoLive 2017

27. Does the Organic Growth model solve the US
System Issues:
US Healthcare System Issue:
• Fee for Service
• Administrative Burden
• Chronic Disease
• Big Business
Organic Growth Model:
Why suggest the use of something that doesn’t solve the
system?
• Because it doesn’t change anything! Status Quo
OrthoLive 2017

28. Less Disruptive = Easier Adoption
• Organic Growth Telemedicine:
• Allows providers to maintain their
practices
• Incorporation of telemedicine is
easier
• Doesn’t require a revolution
• Gives technology value add
Schooling – (def.) When a group of fish swim
in the same direction, its called schooling.
Schooling is a defense mechanism, it wards
off attacks from predators.
OrthoLive 2017

29. Why is an “Organic Growth” a successful early
business model?
• Success is NOT built on “trust”
with unknown provider
• Built on PHYSICIAN desire for
technology and efficiency
• Drives competition amongst
physicians
• Trust already there with “known
provider”
OrthoLive 2017

30. TIMELINE FOR TELEMEDICINE
ADOPTION:
OrthoLive 2017

31. Direct-to-
Consumer:
Long Tail
Adoption
0
20
40
60
80
100
120
140
160
180
1 month 3 months 6 months 1 year 2 years 3 years 5 years
Direct-to-Consumer Growth
NY CA Midwest
Long Tail Region
OrthoLive 2017

32. Organic
Growth: Short
Tail Adoption
0
100
200
300
400
500
600
700
800
1 month 3 months 6 months 1 year
Organic Growth
NY CA Midwest
Short Tail Region
OrthoLive 2017

33. What is the biggest hurdle to
Organic Growth Telemedicine?
Demonstrating Value to Physicians
OrthoLive 2017

34. Telemedicine: An Instrument of
Change
OrthoLive 2017

35. How do WE improve American healthcare. . .
Current System
• Access issues
• Time delays
• Fee-for-service
• Costly
• High overhead/Administrative
Burden
• Quality in question
• Accessible to most patients
• Responsive
• Value-based
• Affordable
• Low overhead/Administrative
Burden
• Quality is algorithmic/studied
OrthoLive 2017

36. My RecommendationsFour Keys to Success
OrthoLive 2017

37. Finding Direction for your Telehealth
Company --
Organic Growth
• Starts with private practices
• Stronger desire to compete in one
area than hospital based systems
• Allow private practices to
expand reach, provide better
care and obtain new patients
• Improve overhead
• Improve office efficiency
Direct-to-Consumer
• Expect Long Tail
• Deliver on TRUST
• Deliver on Value with Consumers
that get the value equation
• QA extremely important
• Focus on your website, create
trust
• Hire compassionate people
OrthoLive 2017

38. Winning Strategy #1: Acclimatize the populus
Telehealth Acclimatization:
• Organic Growth, paves the way for
change
• Start here
• Easier to accept for patients
• Develops telehealth at the local level.
• Especially beneficial for slow adoption
areas.
OrthoLive 2017

39. Strategy #2: Create Local/Regional Trust
Create local and regional
telehealth patient trust
• Organic growth will give way to
trust in the direct-to-consumer
model in more traditional
environments
• To do this you must prove
efficiency to physicians
OrthoLive 2017

40. Strategy #3: Follow the value chain
Direct-to-Consumer
• Push in areas of high adoption
• Or within areas where value is
understood.
• Quick revenue generation, but
more difficult to gain adoption
Organic Growth:
• Work on physician efficiency
OrthoLive 2017

41. Strategy #4: Quality, Quality, Quality
Work on Quality Assurance
• Personnel
• Hire compassionate people
• Ensure they are providing sound
advice
• Software
• Clean, easy to use, reliable
• Support staff
OrthoLive 2017
Without good quality telehealth fails to grow!
• Hire compassionate people
• NPs/PAs like algorithms
• Kick difficult cases “up the chain”

42. Solve the US Issues of
Access, Time Delay,
Office Inefficiency,
Overhead
Solving System Issues:
OrthoLive 2017

43. AVERAGE TIME TO SEE A PROVIDER in US:
Average Days to Wait for Appointment
Only 20% of total
time spent with
Physician
Mehrotra et al. American Journal of Managed Care, 2015

44. Healthcare Access Issues based on Insurance:
OrthoLive 2017

45. Physician Frustration/Inefficiency:
OrthoLive 2017

46. Remember:
“Be the change you wish to see in the world.”
Summary:
• We are all here to encourage the growth of telemedicine
• Encourage local and regional growth at the office level (especially in
traditional environments)
• Solve value and efficiency issues for physicians and they will change
• Offer quality and compassion for patients
OrthoLive 2017