Teladoc Health, Inc. (TDOC)

Investor Day 2017

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Nov 20, 2017

Welcome, everyone. Thank you for joining us for Teladoc's inaugural Analyst and Investor Day. We are very, very happy to have you here. I'm a little worried we're going to end up with standing room only, which I guess isn't such a bad thing. The turnout and the company and what we've done and where we're going. A lot of the members of management team are here today. Mark's going to join me up here at the front of the room for really the entire session and then we'll have members of management join us over the course of the day to present different parts of the business because you hear from Mark and me all the time, right? What we know that you're probably sick of hearing from Mark and me. We will cover a few of the highlights, me at the beginning, Mark at the end. We sort of bookended the day. And I think even not even, but much more important is that you'll get to hear from a lot of the other members of management. And so you can see here the agenda. I won't go through it in detail, but we're really excited and it's fun to be here because we've sort of done what we said we were going to do when we went public 2.5 years ago, right? We said here's what we are, here's where we're going, here's the trajectory we think we can be on, here's the opportunity in front of us. And my management team is sick of hearing me say, we pride ourselves on being a company that keeps its promises. And we try to keep our promises to our clients, to our members, to our employees and of course to our investors. And so it's nice to be in a position where I can stand up here 2.5 years later and say, we've pretty much done what we said we were going to do and in some cases more. And that's really, really it's gratifying for me, but it's also exciting because it means that we have really delivered on the promise of telehealth, which we all know for a long time was a promise and not a reality. And we're working hard every day to try to make it a reality. So I'm going to go through a little bit of introductory remarks and I'm going to try to hit on some of the hot topics that you all have been asking about that we hear commonly in questions. And in case you're somewhere during the middle of the presentation thinking about trying to run back to the office or doing something else, I promise that there is really good swag at the end of the day. So but you have to stay till the end in order to get the good swag. So we are transforming healthcare. I've been in healthcare most of my career, took a few years off in the middle to do technology based startups. But I've never really felt like I was in a position to transform how people access care until I came to Teladoc. And quite frankly, that's why I came to the company. I came to the company because I thought there was a better way for people to access the healthcare system to get healthcare. And anybody who has experienced a Teladoc interaction, a best doctors interaction knows that it is truly a better way, right? It is meaningfully different than what has been the status quo for generations. And it's more convenient, it's more friendly, it is health care that comes to the consumer and it is health care at the highest level of quality. Over the course of the day, you're going to hear from members of management team of the management team about how we make that a reality, how we bring that to life for the consumer. We had a bunch of investment highlights when we were on our road show. Here are the sort of core tenets of why Teladoc is a good investment now and for the future. We've continued to evolve those, mostly just strengthening and building on them. And again, over the course of the day, you're going to hear different commentary in different context, but all of them support these sort of core investment highlights. We are the only transformative virtual care platform. There are others who are point solutions in the market. There is no one else who is providing a comprehensive virtual care platform that covers the entire spectrum of consumers' needs from coughs and colds to cardiac issues and cancers. We are by far the industry leader. You'll see a slide, I'll do a little bit of a competitive landscape and explain how we see the competitive landscape evolving. And the delta is very, very large and growing. And so it's nice to be in a leadership position because we have the ability, we have the capital, we have the market support to take that leadership position and continue to extend it, right? People always ask me, I've had many, many conversations with a number of the people in the room about, are you sure you want to be a public company? Somebody sitting in the room who shall remain nameless said to us probably 6 months or a year before we went public, do you really want to take the company public because then you have to sit across the table from people like me and explain things time after time after time, right? And there aren't it certainly has its positives and maybe some drawbacks as well. But one of the things that it's done is given us the capital to be able to continue to extend our leadership position. I think in a way that really wouldn't have been possible otherwise. And we try really hard to be good stewards of that capital and put it to use in ways that continue to extend that leadership position. We're going to go through a little bit about our expanding total addressable market. We have expanded it dramatically with the acquisition of Best Doctors. In fact, we would argue that we've basically doubled our total addressable market by acquiring best doctors and entering the expert opinion market. Our growth rates, our utilization rates have continued to accelerate across all of our segments of our business. You all know that this is important as we enter new kinds of relationships with some of our clients. Stephanie is going to spend quite a bit of time talking about how we drive utilization and why our engine and our solution for driving utilization is meaningfully different from anybody else, I would argue, in the healthcare space at all. And then lastly, the comprehensive product suite is tailored to each one of our client segments. So you're going to hear from Alan Roga talk about our provider segment and what our solution is for the hospitals and health systems that we serve. That's very different from the solution that we sell into the small employer market through our broker channel. So we have the same infrastructure, the same core, but we put different tools and capabilities in place and different models for different market segments in order to meet the unique needs of those different segments. We are very, very proud and pleased with the results that we've put up. Have seen most of these numbers many times before. Market leading growth on the top line, consistent growth in our visits. Our visit volume has consistently outpaced our membership, which means growing utilization rates. I've always said good healthy measure of our business is that visit volume is growing faster than membership. And lastly, a PEPM, that subscription pricing that has continued to grow quarter after quarter, year after year as we enter new segments, as the mix shifts, as we continue to sell a different additional products and services into our market. And of course, this helps to give the predictability of revenue, gives us the visibility into our numbers well in advance. So that as Mark and I sit here today, we can say 90% visibility into next year's revenue. This is a slide without the check marks that we put in our roadshow presentation 2.5, almost 3 years ago now. And the check marks are the things that we've delivered on, right? So we said this is what our growth strategy is going to look like. No doctoring. We didn't take anything off, right? This is the slide that was in our roadshow deck. And as you can see, we've executed on almost everything on the page. Some of them we decided not to do. We put our toe in the water like kiosks, for example. We put our toe in the water. We piloted a couple of things. Didn't work. We abandoned it, right? We don't want to chase things just because they're on the slide. But it's important that as a company that keeps its promises, we lay out a strategy, we stick to the strategy and that helps us to execute and deliver for our clients. And we've done a few other things in addition to what was on that slide. So these are color coded products in green, M and A work and activity in purple and financing activities in blue. And you can see that we've been pretty hard at work, a lot of partnerships, things like Accolade and Kinza, obviously, some very high impact acquisitions that have been highly accretive for the business, strategically important as we differentiate ourselves from the rest of the market and giving us what will ultimately be the vision for a comprehensive virtual care platform, the only one in the market. So we've been busy, which is maybe why it's taken us 2 years, 2.5 years to come do one of these. But I think there's no better time to do it than a few months after doing a massively transformational acquisition like the Best Doctors acquisition, which gives us an entirely new dimension to the business. Okay. So I said I'd talk a little bit about the expansion of our total addressable market. What we're showing here is a $28,000,000,000 market opportunity for the expert opinion market. We would argue that this is an extremely conservative estimate. Here's how we build up the model. We take a bottoms up approach. We looked at the conditions, the sort of top ten conditions that Best Doctors does expert opinions for. And within those, we looked at commonalities. So musculoskeletal conditions, cancers, neurological disorders. And we bucketed those to about to conditions that cover about 44% of the total expert second opinions that Best Doctors does. And then we looked at the data coming out of all different sources from the market for how many new cases there are each year, not the total prevalence, right? Not the total number of cases that there are across the entire population, just the new cases each year, new incidents, which is an incredibly conservative way of looking at it because we know that many of the experts' second opinions we do are for people who have had the condition for years. But in order to try to make sure we take a conservative look at it, we said, okay, let's just take the new incidents of them. And then we multiply those, remember 44% of our total new incidents only and we multiply those by $5,500 which is roughly the average case rate that we get when we're selling on a case rate basis into the health plans, for example. And that gets to a $28,000,000,000 market opportunity. So I would argue we've taken 2 massively conservative approaches and still gotten to something that doubles our total addressable market. So I've said many times, I think we're just scratching the surface. It feels like the scratch just got like half as deep in terms of what we are how much we've penetrated this massive market in front of us. So we have a tremendous lead on everyone else, but we still think that we have a huge amount of running room in front of us and massive opportunity to make a giant impact on the healthcare system. Again, I said I'd do a little bit of competitive landscape. So I look at the market along 2 primary dimensions, right? One is how broad is the solution set? Is it a point solution that's really a single solution focused just on expert opinions or just on virtual urgent care? Or is it a full continuum of care with the entire range of conditions covered? And then is it going after a single part of the market, a single slice of the market? Or does the company have solutions that go that stretch across all of the different market segments? And then lastly, we look at just size of the organization, right? This is our estimates at revenue for us relative to our competitors. Of course, none of our competitors are public. So we're doing what we can to take best estimates. And again, we've been pretty conservative, meaning we've probably given our competitors more credit than they really do. So then what you can see here is the blue ones are second opinion companies or primarily second opinion companies. The purple ones are sort of virtual urgent care companies and there's only one that has the full spectrum of care. And the relative size is pretty stark. So we're in a good position because when we go into opportunities like the FEP opportunity, right? We walk into the FEP opportunity and we get them to come to a site visit and the impact of the sheer scale and depth and breadth of our operations and infrastructure is in stark contrast to what we're up against in the market, right? Alan Rogel will tell you about his experience selling into hospitals and health systems. And he's basically has a perfect record. If he gets the client to come down and do a site visit at our Lewisville site in Texas, he basically has a perfect record of winning every single one of those deals. There have been a lot of questions and comments and discussions about our new relationship with Aetna on fully insured side of the business. So we thought it would make sense to do a whole slide, dedicate a whole slide to this discussion and try to address it. So the first thing I want to say is we renewed and extended the contract for the Aetna fully insured business. There is no change to the self insured membership that we have through Aetna. And you can see here this donut chart shows that 62% of our membership from Aetna is actually in the self insured book of business and 38% is the fully insured book of business. So impact on less than 40% of our business coming through Aetna. We expect it and I want to just be really clear, we expect it to be revenue neutral for 2018 and revenue positive for 20 19 relative to what we had what we would have had in the old contract. And we get to that because although we are eliminating the per member per month fee for that population, we are getting almost 4 times the revenue per visit and we're getting that on a per visit basis. Now our history and I've been looking at this data a lot, has been substantial increase in visit volume every year for the Aetna fully insured population. And again, Stephanie is going to show you some data about our overall population and how the visit volume grows over time. So we are very, very confident in our ability because we've seen the growth year over year to grow that visit volume and we're getting access to substantially more data and have the ability and the cooperation of Aetna to do substantially more engagement of that population, right? And so that gives us great confidence and great visibility into the utilization growth, the visit volume growth. And therefore, what I think is this is a much better contract for us because the revenue curve as visit volume grows is much steeper in our new relationship than it was previously, right? Because we get almost 4 times the revenue per visit, every additional incremental visit is worth a whole lot more to us. So the revenue, if you think about sort of visit volume on one axis and revenue on the other axis, our revenue grows at a much steeper clip in this new relationship because it's all all of our all of our revenue is coming from that and it's a substantially higher number per visit. We also got the opportunity to roll out new products, behavioral health, dermatology, the caregiver product across all segments of their business, right? That was all part and parcel of this renegotiated deal. We expanded into the student population as well as their Medicare population, right, new segments of the business that we have the opportunity to go after that we weren't in previously. And as I said, access to greater data to be able to improve the effectiveness and the efficiency of our communications and consumer engagement. So we think this is a win, right? And we think it's a win because we have experience with clients very similar to this. So as I said, we have gone through a similar changeover with the West Coast Blue plan, where we had a substantial population. We shifted them to a model where it's a much lower PMPM, but that PMPM grows along with our visit volume and our utilization. And so when you look at the visit volume growth, that drives a higher PMPM, but it's directly related to the utilization. And what we've seen there is about a 12% year over year increase in our revenue per member by shifting to this new model. And in fact, I look at utilization data every day, every single day And we're now seeing that utilization increase even more as we go into the cold and flu season and all of our marketing efforts hit and have the impact now on driving increased registrations and utilization. So we have experience having done this before, almost an identical situation, greater engagement from the client, greater access to data and revenue that is tied directly to the increase in utilization. I promised on the quarterly call that I would give insight into some of our big wins through this selling season. As I've said before, this selling season was really characterized by much larger deals. So let me go through 3 of them here. First, we're very, very happy to say that the New York City accounts, meaning the employees of New York City and their beneficiaries, it's about 750,000 total members, will be rolling out Teladoc and Best Doctors. So I also promised that I would give some insight into some of our joint wins, some of our cross selling wins. Peter will talk about some of our cross selling. This is a phenomenal early joint selling win. And again, as I foreshadowed, this is an example of a takeaway win. So we are on the Teladoc side replacing an existing telehealth vendor who was in there previously and didn't deliver to the client's expectations. It's a great win for us. We're very, very excited about it and we're excited about delivering on again the full continuum. And in fact, you'll hear a little bit about the IBM Watson program that Best Doctors has rolled out. This will be an example of a large client who's rolling out the IBM Watson product. Okay. 2nd one, we are very, very pleased to have been asked by Optum to be part of their bid for the TRICARE business. Sorry, before I move on from the New York City account, I should just be really clear since the question comes up all the time. This is a PMPM plus visit fee model. Don't want to leave anything unclear. So that was so New York City visit fee plus PMPM. Optum asked us to bid with them on the TRICARE business. They had they were bidding on a very large sort of solution set for the TRICARE business. This is 9,000,000 beneficiaries. And they asked us to be the telehealth inside their offering. And we are very, very pleased to have been selected to have won that business. That gives us access to the $9,000,000 TRICARE beneficiaries. Here's what I can say about that the structure of that bid. Number 1, that's a visit fee only revenue model. Number 2, there is a guaranteed annual minimum of number of visits. We are guaranteed a minimum number of visits that makes it a guaranteed multimillion dollar per year account for us. We do not do the consumer engagement. So we don't have the marketing expense associated with our normal account. And it's going through their nurse line. So their nurse line is doing all the front end customer service and intake. And so we don't have the cold associated with the people taking in an individual case. So actually, this will be our lowest cost per visit on the cost of goods sold and the revenue is higher than our normal $45 visit fee. So we're very, very excited about this relationship. If we can go in and have very, very predictable revenue because we have a guaranteed annual minimum, that puts us in a very, very good position. And of course, it gives us upside because it's going after such a large population. Finally, fantastic and very gratifying to have been selected by Optum, which we hope will continue to open additional doors for us with Optum and the rest of the United family. And finally, I'm happy to say that we have reached agreement with CVS MinuteClinic for a very significantly expanded relationship with them. I think you all know about 2 years ago, we rolled out a pilot. CBS tried with multiple players to do a pilot telehealth program. And we are very, very happy to have been selected as their partner going forward. We are in the process of working through the details of their contract. So I'm a little bit limited in what I can say about it. But what I can say is, it will go after both the direct to consumer as well as the B2B market. They have a large presence obviously through their Caremark business going after the B2B channel. And so this will be a solution that we work together on both sides of it. It contemplates a PMPM and a visit fee on the B2B side and a higher direct to consumer visit fee only model for the direct to consumer, but really leverages on their digital channels and contemplates deep integration with their app, with their website and with other components of the MinuteClinic. So again, very, very pleased that after 2 years of a pilot, CVS MinuteClinic has selected us as their partner going forward. So I tried to end with a bang of my section on 3 big wins. This is indicative of, as I said, a very strong selling season that was characterized by some very, very large deals. So when you put these together with the FEP win, right, we have come this through this selling season with, I would say, with a bang. So I left about 4 or 5 minutes for questions. We will do questions at the end of every section. And then at the end of the day, after all the speakers are finished, I will continue with a wrap up Q and A at the very end. And Mark and I will stay up here throughout the day. So if there's a question that comes up during for one of our management team, we can also be here to help fill in any of the gaps. So I'm happy to open it up, Lisa. Quantify, I think that it's a great tone, Susan, obviously, you have said some of the highlights here, but maybe you have some metrics as far as the how do you think about revenue for next year or visits or some other metrics as we think that trend is? Yes. So I'll start by saying, I don't want to disappoint anybody. We're not going to give guidance today. So we will give guidance at your conference as we have made we've made that a tradition, I think, that in January at the JPMorgan Conference, we give our preliminary guidance. We'll stick to that this year. That gives us the greatest clarity because we've come through January 1st. It's right on the heels of everything that we've put into the business. But we feel very good about delivering on what we think are the sort of macro street estimates for next year. Anything you want to add? I would say with all of Jason's caveats, there's not much more I can add. However, we will give you directionally some additional information on really how we are going to define success and what we believe will be more helpful for you in forecasting our 2018, during my section. We'll break down how in fact we're going to be accounting for these new contracts. And we'll help you distinguish between revenues coming from some of these visit fee only and other primary lives coming in through the more traditional means. I know we've said in the past that there is generally a very good sense as to within the analyst community, what the expectations are for 2018. Sean? So you brought up the Aetna renewal, so I want to just probe on that a little bit. To be clear, is the relationship between visit volume and revenue, is that linear or are there accelerators built into the contract? It's linear. It's linear. It's just a steeper curve than we had in our old relationship. So and the reason it's linear is for every visit we do, we get a claim fee of $40 and then we get a share of savings that's a single number. We get paid by Aetna for every visit in that same amount. So it is a linear revenue curve. Okay. And are any of these business based contracts? Are they asking for accelerators? Or are you asking for Yes. The other one that I described, the West Coast has tiers. So as we get to higher levels of utilization, our PMPM increases to the next tier. Vaguely? Nope. Steve Wardell with Chardan. You mentioned working with Optum on a sale. Can you tell us what are the opportunities available to you in the United Optum universe? Sort of summarize where you are with United Now and what do you think are the adjacent opportunities to where you are now? I could spend an hour on that. So the question is about Optum and where is our current position and where are our opportunities. We've continued to expand our relationship with United. We're up to 1,500,000 give or so members with United today. We are being asked regularly to bid on new pieces of business. We're in discussions with them throughout the organization, both on the UHC side, UMR, their TPA is a big client of ours. We're going through a big rollout to their customers for January 1. And we're continuing to get additional opportunities through the Optum channel. We see that as a great relationship, a consistently growing relationship. And we're also having discussions at the highest level of the organization about sort of big picture strategic fit, because there are some health insurers in the country who are realizing that virtual care needs to be a core part of their strategy. And there's only really one player who can provide a comprehensive virtual care strategy that plugs in and makes everything work harder along their continuum of care management offerings. So very, very excited about that opportunity. And that perfectly honest, it's a conversation that we can have now that we couldn't really have as effectively before the Best Doctors acquisition because look, if we had said 2 years ago, we're going to be a comprehensive virtual care platform, most of the people in the room would have laughed at us, right? They would have said you're doing this narrow slice. But today, between what we've built, what we've partnered for and what we've acquired, we are a much, much different company and have a much different conversation with those type of health plans. I would say yes, across the board we think for the full and again, sorry, the question was revenue Aetna revenue neutral for next year does that include the new services? And the answer is yes. When I say revenue neutral, I just want to focus on I'm just talking about that 38% of our Aetna membership that's in the fully insured business. So if I look at fully insured 2017 to fully insured 2018, I expect it to be revenue neutral versus what we would have had in the old contract. Yes. So the question is how sustainable is that shared savings? And if I'm at $150, dollars 160 per visit, that's almost as much as an urgent care visit. Is that going to last? First of all, that's locked in for the duration of this contract. It's a fixed number. It doesn't float or anything like that. It's not subject to an end of year analysis or anything like that. It just is what it is. 2nd, you'll recall from a lot of our slides, we estimate based on deep, deep claims analysis, a savings of about $4.72 per visit, because you're not just avoiding the doctors' offices that you're avoiding the ER visit, you're avoiding the testing, you're avoiding the follow-up visit that happens because somebody went to the emergency room and then they go to their doctor's office on the instructions of their of the ER doc. And so remember, our estimates of 472, you can do the math on how much less that is than how much less the 150, 160 is versus the 472. And then third thing is it went through deep analysis at Aetna's Medical Economics Group. So we feel very, very comfortable about that. I'm going to get the hook shortly, Ryan. So I'll take 2 more questions and then we'll move to the next section. Yes. So the question is, as we get more data and we have good experience with these shared savings or variable revenue models as utilization increases, will we push for more of that? The answer is, it's right for some clients that are big enough and have a big enough predictable enough set of data that it makes sense for us. I just want to be really clear. Our entire book of employer business comes in, in a standard PMPM plus a visit fee. All of our small health plans, in fact, the vast majority of our health plans, even some of the big ones are on standard PMPM plus visit fee. So it's still a very, very small slice of our business that's on this variable revenue structure where utilization is directly related to revenue. For the right opportunities, it makes good sense for us. But it has to be big enough that we have good insight into it. We can get good predictability out of it. We can get good analytics on what the savings are going to look like and how we're going to be able to drive utilization over time. But we're going to use it selectively where it aligns us and our clients, but I don't think you're going to see it in the foreseeable future, it's not going to represent the majority of our business. And Ryan, I would add, it represents less than 5% of the business today. This year gave us the opportunity to be creative, to be responsive to some of these novel clients that came to us seeking a way for us to model the delivery of our service in a way that obviously gives them the same opportunity to benefit. We have We have experience with Aetna and we've got obviously a contracted minimum on the TRICARE side. So it meets our corporate objectives and clearly we intend to deliver. Last question, Matt. When we think about the slope for Aetna, the normal one Aetna, utilization at Aetna. I would say the self insured book probably runs at about 5x the utilization of the fully insured book, give or take. Okay. So I now have the pleasure of introducing Peter McLennan. Peter, as I think you all know, was the CEO of BEST Doctors. He and I started talking about a year ago now and had a fateful meeting in January in early January, where we said we should really do something together, something bigger, something that can really transform what the industry looks like and makes a big impact. And I've been really, really fortunate to have not only someone come in who has a proven track record of consistently growing and building successful healthcare companies, but a great partner, a great leader, he's built an amazing culture within the best doctors organization, took that company to heights that it had never seen before. And as I announced two and a half weeks ago or so, has agreed to come on as the President, a new role for us, one that we haven't had before. And I couldn't be more excited. Peter is going to lead the charge on our commercial efforts. So he is first going to go through a little bit of an introduction to best doctors since this is the first time some of you are getting to hear about that. And then talk a little bit about commercial strategy and how we're going to take advantage of our market opportunity. All yours. Jason? Okay. Good morning. Three goals for me. First, just to introduce you to myself. Some of you I've known before and some of my other employments. 2nd, to Jason's point, learn a little bit about best doctors. Jason and Mark say everywhere they go, folks ask about best doctors. So my goal and then Doctor. Levy following me is to give you deeper insight into the company, into the business and how it fits tightly in Teladoc. And third, talk a little bit about our integrated commercial strategy. To Jason's point earlier, we have the opportunity to address nearly every channel in the healthcare ecosystem all around the world. So I'm very excited to have that part of the business as my focus area. So first, a little bit about me. First question is, why are you here? What's important? What are you doing? I'm really here for what I call the double bottom line. And Teladoc is very similar to Best Doctors. And together, it takes it to a different place in that, 1st and foremost, it's a massive opportunity. It's a massive economic and financial opportunity to transform how people access care. I've spent my entire career in healthcare 27 years, and I've never seen anything with a greater magnitude than we have in front of us at Teladoc. So the first part of the bottom line is it's an economic bottom line that's tremendous. The second part, the double bottom line for me is that it's a very important essential service in the world. It is a high quality medical service from end to end. I take very, very personally the responsibility of delivering something that I want to use on a daily basis. Best Doctors was a Teladoc client. I tell Jason, we were his favorite client. He liked us so much he bought us, which is great. But I also personally have used Best Doctors and I take the responsibility of delivering for best doctors very, very importantly for our members. So every day, people can access from base services of coughs and colds all the way to complex cancers and know that they're getting a high quality medical service. So that double bottom line of both having an economic incentive and also having a high quality service that truly helps people, I find very unique. So my background, as I mentioned, 27 years in healthcare, first 10 or so on the delivery side in hospitals doing the real work and then got the opportunity to join GE, which was like a living, breathing, super experience shop, came in marketing and product management and quickly got promoted to running the global P and L of what was PACS. The PACS radiology imaging and information system business was really the foundation of health IT at GE and we grew from about $180,000,000 to $550,000,000 in my time all around the world, number 1 in China, number 1 in Germany, Japan, UK, Canada, United States, really driving that market. Did a startup called DBMotion, if you followed HIEs and interoperability, Medicity, Axolotl, DBMotion, Azixi, all of them turned into some large company, whether it was Aetna, Optum, Allscripts, McKesson, etcetera, but grew that company from the ground up around interoperability and connectivity. We got acquired by Allscripts, which was great, really became the foundation of population health and we grew that business from around $50,000,000 to about $300,000,000 P and L for them and then fell in love with Best Doctors and got the chance to join Best Doctors. Best Doctors went through a lot of change. It had grown to a nearly $200,000,000 business. We had a big insurance business. We had some other complicated businesses. My focus was streamline it, rationalize it and have it be a company that was very, very focused on expert second opinions. That's when Jason made the call and said, hey, maybe these companies should come together. And I got really excited about the depth and breadth of Teladoc with the complexity of service delivery that Best Doctors offers to make something truly unique. So to start explaining about Best Doctors, I figured the best way to do it is with a video. So I'm going to show you a video of a patient. She's actually a Canadian patient and she is an IBMer and this was her quick story. By the way to motivate the sales people to get out there and sell more. She's an incredible story, but this type of work happens pretty much every day in the best doctors network. So what is Best Doctors? What's it focused on? It's really focused on some of these important external statistics and that most Americans will encounter a diagnostic error in their lifetime. Healthcare is very complex. Becoming more and more specialized. And the more we can apply intense virtual rigor to the process, we can make a very, very important difference. You can see on the statistics here, a couple of them are very important. About a third of what happens in misdiagnosis leads to waste. So the opportunity to bend the cost curve in a meaningful way is very, very significant. The statistics from last year are quite impressive. In the cases that we touch, approximately 44% of the time, we correct or find a diagnosis. On top of that, the treatment plan, basically the spending and the costs associated with those diagnosis, we change approximately 75% of the time. So people come into the Teladoc environment now into best doctors with very complex conditions. We do our virtual service and it results in different outcomes for them, but also very different financial implications for the people with first dollar risk, both payers, employers, insurance companies, etcetera. So it is a very, very personalized virtual service that touches millions of members. And again, Doctor. Levy will go into more detail later how it works, what it does, etcetera. Second thing is, it is sort of 3 buckets. First off, it's a network. Best Doctor's network is over 50,000 of the top physicians in their field. The network is global and it represents over 450 different medical specialties. The second piece is, it's a set of solutions, primarily expert second opinion. I like to say expert second opinion is one way we've monetized the best doctors networks, but there's also other smaller ones. And that we provide access online to finding a best doctor. We provide access to a solution called treatment decision support, where you have a defined diagnosis and you'd like to just find the best treatment plan for that diagnosis. So it's currently primarily expert second opinion leveraging that network, but there's a lot of opportunities to expand the solution suite. And then the third is, it is a distribution platform. Best Doctors is available in over 100 countries around the world. It's delivered in 33 different languages. And we primarily focus in the employer market in the U. S, secondarily in the health plans, a little bit in insurance and financial services industries in the United States. And then outside the United States, it's almost exclusively focused on insurance and financial services companies. And I'll give you a little more example of that. It's got very high client retention. It's primarily a PMPM. We'll talk about that. Very high client satisfaction. International is about 40% of the business. If you add up North America, U. S. And Canada, that's about 75%. And then if you include Canada and international, that makes that piece about 40%. And largely, it's got a 2 to 1 up to about a 10 to 1 ROI. So in all of our services we deliver for folks, there's always a cost angle to have them justify the solution. So it's a network and the network is right now monetized largely in expert second opinions and then it's a platform across the world. A little bit more into those three segments. On the employer side, we actually only have 40 overlapping logos between our traditional Teladoc side and our Best Doctor side. And in that Fortune 1,000 tremendous companies, we've got great penetration. Now the expert second opinion market to Jason's earlier point is penetrated at about 27%, 28% in the Fortune 1,000. There's been a number of external studies, Willis Towers Watson and others that talked about the opportunity to sell across that white space. But you can see a lot of tremendous logos. And in this world, it's an employee benefit with an ROI angle. It is sold on a PMPM basis, essentially exclusively in that space. The second is, what I would call global financial service companies. The way Best Doctors is monetized outside the U. S. Is it's included in life insurance, health insurance, disability, critical illness. Ashifa, she's a Canadian member and so when she refers to it as a policy, it's part of her experience as a life insurance customer. And there we have some of the most incredible names in the world. In Europe, we're primarily in the UK, in Spain, in Portugal, in the Netherlands. We're growing in France, Italy, Germany. And in Southeast Asia, small things a bit in Hong Kong, Singapore, but big footprints in Australia and New Zealand. So as an example, in Australia, MLC is one of the largest life insurance companies there. We are a premier partner with them. We've been working with them for many years, and we're in various books of theirs. So outside the U. S, it's about leveraging these insurance and financial services relationships. And there it's about a value add. It's not really about the ROI. It's about I'm buying this life insurance policy or this critical illness policy and it comes with an extra benefit of best doctors. And then the third, which is probably our highest growth area is complex case management business. So this is going into health plans and saying we can help you with your top 1% to 3% of your most costliest cases. These are people where they're spending in excess of $100,000 per individual on very, very intense cancer, intense neurological, intense cardiac, orthopedic, etcetera. And we can go into these super complex areas and make a big difference for them. And that's what you'll hear from later with Chet Burrell, CEO of CareFirst is one of our clients and really leads the charge on how you can apply the expert second opinion methodology to the most costly complex cases in a health plan. This area is growing. There's a number of clients in here and it really represents some of the best cross sell activity we have across Teladoc. So that's sort of the best doctors. Doctor. Levy will give you more on how it works, the process. It is completely virtual. We don't see the patient. We talk to them. We connect with them. But it marries into that Teladoc environment as you climb the ladder on Acuity. So now as you bring them together, that sort of gets into my next area, the 3rd area of focus, the integrated commercial strategy. As you can see, a lot of areas that Best Doctors was in or you know that Teladoc was in are very complementary and overlapping. But there's also a number of areas that are pure green space on either side. And so when I think of them together, I think of access and having an integrated access point. Here, we're showing the member application, which is now out and live. We'll talk about that, but an integrated access for engagement for members to go ahead and use just the routine stuff all the way up to the most complex conditions. The Best Doctors World focused on the top of this pyramid. Basically 1% to 5% of the total volume in an institution driving about 37% of the total spend. So it is a very unique company in that it would go after the hardest of the hard areas and make a real personal and financial impact. And so they were up at the critical care area. At the episodic area, if you've been following Teladoc and I'm sure you guys know this very well, they focus on the base of the pyramid, coughs and colds, bronchitis, all these types of things and that's about 23 percent of the spend. So now we are firmly in the blue area, the top of the pyramid, the purple area, the base of the pyramid and we have networks and services that will start to converge in the middle. The other thing that's tremendous is both solutions are about an ROI. So when you're marketing it in any of those segments, you can do it in a very financially oriented way. Investing in the Teladoc services pays you back. It is probably and having worked my entire career in various healthcare companies, global companies, different segments. Teladoc is probably one of the only ones I'm aware of that literally approaches every segment of the healthcare landscape. And I find this part of it super exciting. This is where I'll be spending most of my time. And to the earlier slide that Jason put up where he showed multiple products in multiple markets, that's what I'm really inspired to drive. So if I first look at the markets employer, as I mentioned, 40 overlapping clients, 100 on the Best Doctor side, 1,000 on the Teladoc side. So the ability to offer an integrated solution that has an ROI to it is tremendous. So one of our primary focuses is in the employer space. It's still where most of the action is. It's where people have the first dollar risk. And so to bring a solution directly to them is a huge focus. The second is health plan. Jason talked a lot about Aetna and Optum. The opportunities in this area on the best doctor side, we've only scratched the service. On the Teladoc side, it's still early in the innings. And the big difference here is utilization. It's a service that people utilize and it's a service that brings tremendous ROI. On the best doctor side, it's going to be more focused on patient centered medical homes, ACOs, places where there's significant risk. On the Teladoc side, really both. And so health plan is a tremendous focus of ours. In the best doctor side, it was just emerging. On the Teladoc side, they have great strength in distribution there and bringing those together will be key. Health systems, you'll hear from Doctor. Roga later. Health systems represents one of the greatest opportunities for us. Best doctors is not really offered in health systems today. We'll think about how we can bring that network, perhaps not one of the current products, but that network to bear in the health system market. And health systems really are looking for strategy. This is strategy for health systems and the ability to virtualize their care models, IDNs, ACOs, practices, hospitals is tremendous and really early in the market. Insurance and Financial Services. As I mentioned, that's primarily outside the U. S, but that's growing inside the U. S. We've been starting to explore how we bring Teladoc outside the U. S. And I can tell you, Dan and I and you'll hear from Dan later, we were just up in Canada presenting it to some of our largest clients. In Canada and in the UK, our biggest markets, telemedicine is really at its infancy. And they're looking for these types of solutions. And to hear from the U. S. Leader, it packs a room with 30 to 100 people instantly. And what we're going to do on the telemedicine side is carefully consider what are the right markets, what's the right economic model, who pays for it, what's the medical environment like. But today, on the best doctor side, we can get meetings in hundreds of places all around the world. So carefully considering where we need to be is a major focus. But next year, our plan is to launch in a number of international markets. And that's primarily international and insurance and financial services sort of go together, but it's primarily we're going to be focused on the large English speaking countries where best doctors has a big footprint. And then consumer, you heard from Jason earlier about CVS. You're probably aware of BetterHelp as a very, very important part of our strategy, but also AARP and Best Doctors. Some folks will come use Best Doctors in a consumer environment, more bringing our services in a direct to consumer environment. I wouldn't say it's our primary strategy, but it's a very important part of the strategy because people want access to these services. My approach will be very metrics driven. I come from a very metrics driven background. And so as we look at all of these segments, we'll identify where we want to focus, in employer, for example, Fortune 1000, and then really drive that in a metrics way. I believe this is a platform and I think it's a platform that truly transforms how people access and receive care. So our pitch will be a very platform centric approach in that we are different than almost everybody else. So the ability to sell the solution suite is going to be our primary pitch. A white space driven approach. As I mentioned, 40 overlapping logos. We're going to go into a little more detail, but the ability to analyze where is best doctors, where is Teladoc, where should we be overlapping all around the world, not just for the primary products, best doctors and Teladoc, but also hospitals and health systems, solutions, Watson Oncology, mental health, all these things, a very white space driven approach to try to get increased share of wallet from each client that we work with. And then selling the solution on the proven ROI. We've got demonstrable results in hundreds of places across both solutions where it truly does bend the cost curve and make an impact for folks in that way. As I change gears and I talk about bringing the companies together and integration and showing how the integrated offering can make a difference, the number one place it shows is in the integrated access point for members and consumers so they can have a consolidated place. I am super pleased that we delivered that above really above the requirements and before it was supposed to be ready. It was ahead of schedule. It's now out in the market. We've had members accessing it and asking and requesting services both through traditional Teladoc and traditional best doctors. Dan will show you that in a lot of while. But having that integrated solution really shows off that platform approach. 2nd is in sales and marketing. The cross sell model has already been established. We have a number of wins, which we'll talk about here in a second, that shows how integrating relationships and integrating the message is really starting to work. I was surprised, having been part of either acquired or acquiree about 26 healthcare acquisitions in my time. I've never seen an uptake as quick as this and that it just makes sense to people. It's something where they look at and said, those two things make sense, I'd like to buy them together. And having integrated pricing, integrated product packaging, all that's coming together. It's not perfect yet, but as we get into next year selling season, we're going to be doing so in a very integrated fashion. And then the third is operations and service delivery. We established a new call center for Teladoc in the best doctors, Quincy operation center. So here as we get into next year, we will be doing integrated delivery as it relates to answering the phone, directing someone smartly to the service line that's best for them and giving them that single platform, both on the app, on the web and on the phone to meet them where they are. We've done a number of other things, centralizing fulfillment somewhat and also aligning physician relations. Best doctors has a lot of experience in that, Teladoc has a lot of experience with that. You're just bringing together a bigger network. And so the ability to leverage physician relations and be really best in class as a place where physicians want to work in a virtual environment has gone very, very well. So as we look at the white space, the white space is probably my primary focus as we move into next year. If we never sold another logo, never had another logo to put on the page, that's about a $200,000,000 opportunity just in baseline Teladoc and Best Doctors cross sell. So just if you looked in the employer book in the U. S, the ability to cross sell across both of them and that's Teladoc people buying best doctors primarily, best doctors buying Teladoc, that's about a $200,000,000 opportunity. And essentially, everyone I've talked to and probably Jason and a number of the other peers, who have these solutions quickly see that they make perfect sense together and then we just hope to work them through their cycles of contracting to have it as an integrated solution. So that's the first sort of layer of white space. The second one as you think of us directly approaching the market, Best doctors is lower penetrated, even though telemedicine perhaps is higher penetrated than the employer world, no other company has the level of engagement and stickiness that Teladoc has. So when you bring them together, we're going to be aggressively next year and next year selling season focused on that net new where we're selling both solutions with an integrated sales representative with the app, the phone number, the fulfillment. Cross selling the core offering, again, PD client, BD client, cross sell across both of them, add on products. I actually think in the future, the add ons filling that gray area, primarily organically, some partnerships or maybe other business development ways, but primarily organically filling that solution pipeline with more services. An example of an extension on the Best Doctor side has been our solution that we call Onward, which was a mental health offering. There's also a solution called Watson, which we call Oncology Insights, which is a cancer offering. So more specialty services coming out of best doctors. The same on Teladoc, behavioral health and other extensions, I see the opportunity to add on, on top of our service suite very significant across the world. And then takeaways from incumbents. I think that the solution we're bringing is so different and it's so sticky with an integrated engagement, etcetera, that we're going to have a great opportunity to do that as well. A number of these down here are new clients on either side, either a TD or BD, they cross sell. Personally, being part of the New York deal, that was tremendous to bring this many members the services and also change healthcare, which is a takeaway from an incumbent where they saw that it's a double takeaway, a double incumbent, 2 different solutions. They saw an integrated solution and they said that that's a much better way to go. They were in contracting and they came to us. So there's been a number of them, over 20 integrated wins representing several $1,000,000 and more than 1,000,000 members. So that wraps it up and I also have 4 minutes, good planning, Stephanie, for questions And then of course, I'll be around. Please. I saw Highmark on the list of clients. I was wondering if you had the opportunity to Well, Highmark was a legacy on both. And so we've started to work across on both sides. Traditionally, Best Actor is sort of on the medical side. Teladoc is more on the commercial side. But it feels like there's tremendous opportunity on both sides. And just a reminder, Highmark has always been a good client. We lost in 2015 the fully insured side of the Highmark business, but our self insured business with Highmark has grown consistently year over year. So they remain a client on both sides of the business. And expanding. Sure. In the health plan segment, do they typically ask you It's our national network. That's one of the primarily value points because you get just such an access to people that you can't get. And typically when they leave those networks, they're out of network. For us, it's part of the integrated solution. So they get sort of access to that global expertise while still having their in network benefit. Sometimes we'll prioritize the experts in their health plan, but we don't sort of break the integrity of what Best Doctors does and just pick whoever is in that region. So it's still sort of the Best Doctors methodology, but expanded on a global base for them. Couple of questions here. Richard Close with Canaccord. Can you give us what the economics of a typical best doctors contract is? And then as you think about the cross sell to integrate it, what the pricing is looking to consider? Let me delve into some of the economics underlying the best doctors expert second opinion. Peter is referring to health plans here in the U. S. There are a number of health plan clients, some of which like Highmark, which have a guaranteed and contractual minimum as well as a set rate. Most of the health plans also have a rate. And if you should look at something between $5,507,000 per case. And then there's an honorarium paid to the respective physicians that are participating in their evaluation, diagnosis and treatment plans for that particular individual and that specific case that could be on average, 1, maybe 2 physicians. Some extraordinary cases may require 3. The margin profile of this business is very similar, in fact, to the Teladoc margins, which I know we've spoken about in the past. But the margin and the experience that Best Doctors has had over the several years is each and every year over the past 2 years, they've brought their margins up a couple of 100 basis points. So they're approaching now that 70 plus percent margin on the entire book of business that's similar in fact to what we have historically shown over the last several years. Do you want to touch on pricing of the commercial side or I could go into that? Yes. The PEPM is slightly higher on the x per second opinion than the traditional telemedicine, but it's an all in model. It's not a visit with PEPM. So it's higher probably for the 3 year deal without the it's all recurring. Yes. And let me add. So Peter has been selling multi year agreements, whereas most of you know that the initial agreements we commence with our commercial clients, the you may have noticed that big inflection point in Q3, we were in the mid-60s on a per member per month basis. And with the inclusion of the 2 +1000000 Best Doctors Lives that brought us up to over $0.90 Clearly, there is a nice premium on that. Additionally, so many of you have asked us where is the PPM going and how do I calculate that recurring revenue to give me visibility. So just to make it easier for you, we're trying to get to $1 as soon as possible, so you can just multiply the millions of lives. But we again, we've messaged and we continue to believe that, that PEPM will increase by a nickel or a dime, respectively, each successive year as we are seeing a greater contribution of revenues from that visits included type of model where we get that premium per member per month. And that could be anywhere from 4 or 5 times our average PEPM prior to bringing in best doctors to now still we could see 7 to 8 times at $0.91 dollars with a smaller employer that's paying upwards to $10 per member per month for our coverage. And about 90 percent of the best doctors revenue was PPM revenue come before the transaction. So it gives you a good view into the similar to what Teladoc has, good predictability, good visibility into revenue. And you can understand how we were attracted to that kind of a business model that fits really well with what we do. And I get one more Jamie has been waiting patiently in the back and then we'll move on. Those are the expert second opinions in excess of that number, probably around that 15,000 range for just the interactions with our physicians for expert second opinions. That does not take into consideration all of the other interactions that are done with treatment decision support, find the best doctor, ask the best doctor, a number of different services that come along with the contract and avail individuals have access to those multiple services. Sure. So the question is how much is the best doctors business proactive versus reactive? In complex case management, it's 100% proactive. So it's us working in partnership with the health plan to identify both through analytics, but also through general case management, which cases are the best suited for best doctors. And that environment is very fertile. They have many, many cases just sort by spend, sort by specialty and we can show which conditions we're most likely to have an impact on from a misdiagnosis change in treatment plan. That's on that side. The analytics solution that we use when we talk about identifying the most costly cases, we do that with employers so that we can narrow in the engagement. So later on, Stephanie will talk about engagement. We don't have to market the best doctor services to an entire population. We can just market it to the folks that have conditions that are very prone to be susceptible to misdiagnosis and that's where we can have a greater impact. In the employer side, it's about 80% reactive, 20% proactive. And on the health plan, it's 100% proactive. Okay. Thanks, Peter. So now it's my pleasure to get to introduce Doctor. Lou Levy. Lou was the best doctors' Chief Medical has been for many years, is a Harvard professor, has been recognized really as one of the worldwide leaders in diagnostic accuracy, which of course is the theme for basically everything you just heard about best doctors. And it was very clear from the moment I met Lou that he'd be the perfect Chief Medical Officer for the combined organization on a going forward basis as we massively increase the scope of what we do. So it's my pleasure to welcome Lou and give him the opportunity to talk a little bit more about best doctors from the clinical perspective and then a little bit about his view of the overall organization and his goals and vision for that going forward. Thanks, Lew. Thanks so much, Jason. Or as they say, now for something completely different. So we're not going to talk about total addressable market or margins or anything else. We're going to talk a little bit about medicine here. My own background is practicing general internal medicine in the Boston area for the past 29 years, teaching over in the internal medicine residency program at the Brigham and Women's Hospital, one of the Harvard teaching hospitals and also teaching over at the medical school. I came on board to Best Doctors 10 years ago and have really just terrifically enjoyed working with the organization. I still continue to see patients one day a week. As Peter has already gone over, Best Doctors is a global company. It was started by 2 professors at Harvard Medical School 28 years ago, who are getting a tremendous amount of global business coming over to the Brigham and then increasingly individuals were sending their records over to the Brigham to get these records virtually reviewed. So we really began our whole history as a global company and have continued to be that way to this day. We have offices around the world. We've set up medical advisory boards because we want our medical services to be relevant to the local medical community. So in Australia and New Zealand, we have a medical advisory board in Asia, a medical advisory board Europe as well, as well as North America. And these medical advisory boards have been very, very important in terms of connecting to the local physician communities and also making sure that our service offering maintains its relevancy to all of these regional markets. So I'd like to go into a little bit of detail around what this expert medical opinion process is all about. Certainly, the elevator pitch is it's a virtual second opinion. But I'd like to highlight a few features of this service offering, which I believe make it quite, quite unique and very important and really quite different than how one might think about a second opinion. The first step of this whole process, kind of the bubble on the left, is a very intense intake that we go through with each and every member. So whether this is one of the individuals that might have CareFirst as their insurance and being referred into us as part of the patient centered medical home that they've established there or whether this is a Boeing employee or family member that has a medical problem, the process is pretty much the same, and it all begins with spending time with the member. That initial intake, when that member is assigned to a best doctors team of a physician, a nurse, a medical record specialist, can sometimes take an hour or 2 literally. The next step in the process is where we really put the case together. So the member will identify all the various medical offices, hospitals where they have received care, and then we will go to those offices and get all the records. We'll also get all of the imaging associated with the case. And as was noted in Ashifa's story, we repeat the pathology. Her pathology, that head and neck tumor, the squamous cell carcinoma, was diagnosed at a very good hospital in Canada. We then went to UHN in Toronto, where they disagreed with the pathology. And then we brought that same case to Mass General Hospital in Boston, where it was actually discussed on tumor rounds, and they found that those cells in her neck were very dysplastic. They were very unusual. They actually had a very large case conference on that one particular case, but it was not a cancerous case. And that's what made all the difference. So all of her plans to get chemotherapy, radiation therapy, totally unnecessary because she essentially had a benign condition in her lymph node. A very important part of our whole process, 18% of the time, the initial pathology is refuted after you go to one of these top tier institutions. So it's by no means just kind of a meaningless part of the whole process, but a very important one. The next step is we create a very rigorous clinical summary. So we have over 200 physicians that have interact with the members, and then they create these very in-depth clinical summaries that often have about 15 to 20 questions to the expert. The next step is that that case will then go to a top expert who will render their report. It goes through a very rigorous QAQC process before it is then shared. But after it gets approved, it gets shared to the member, to all of their treating physicians as well as back to the case manager back at the health plan. And it is through this process that we are able to change the diagnosis and change the treatment path. Couple of the elements that I just want to make sure that folks have clear in terms of why this is such an important process and why it is different than a traditional second opinion is, 1, people have been talking about since the days of DV Motion, interoperability of medical records. Well, the reality is, whether you're here or whether you're in Melbourne or whether you are up in the Netherlands, all areas where Best Doctors has a a huge presence, one computer system doesn't talk to the other. So there's so much fragmentation of medical information. This solution solves for that because we spend the time to take all of the information. The other piece of it is really around time, that the pace of medicine today is very, very fast. And that ability to kind of pour through all the records, reflect upon what the person is complaining about and really kind of integrate all the information and put it all together is often quite unique. It's unique in New York. It's certainly unique in India. I was over there and one of the country managers in India talked about his brother who is a dermatologist who sees over 200 patients a day. And he says that he gets home at the end of the night dog tired and people will literally come to his house and say, what do you think this could be? And they're like, I think I need to go to sleep. But he that pace of medicine is very, very fast. In this process, we really take the time with each and every one of the cases. The third aspect of the program that I would like highlight is really around navigation, so that we have been doing this for a really long time. The company has been around 29 years. We not only have this very in-depth knowledge of the medical community, we also have a very in-depth knowledge of top physicians who are truly leaders in their field who take this type of virtual review quite seriously. So you can have the blah, blah, blah professor of medicine at Hopkins, who you can assign a case to, but then that person might give you a whole bunch of 1 liners in terms of the answer to the various questions, and they just may have an attitude of, if you want my opinion, come see me. I'm in Baltimore. That's obviously not what we're looking for. So in this process, we're really looking for folks that are top notch, but who also take this very seriously because we want them to be in discussion mode. We want them to show their math, to explain how they came to their various conclusions. And it takes a while. So in terms of barriers to entry, that's a really important one, just knowing who those individuals are in the global medical community who are willing to engage in terms of this type of process. We are unique in that we are the only organization of our ILC that has been accredited by the ACCNE to give continuing medical education credits for doctors just for reading our reports. This next slide basically talks a little bit about a few years ago, we acquired a data analytics company out of the Chicago area, RISE Health. We've been able to tailor a lot of those analytics to really identifying individuals that we believe will make great use of our services. So part of our engagement approach, particularly on the health plan side, is to use these data analytics to identify cases that would be great cases for best doctors. I wanted to just highlight a case, and I think that this case really does highlight the importance of finding the right physician. This was a case that was identified by one of the care managers at CareFirst. This individual noted that this man was having recurrent problems with pleural effusions, liquid around the lung that was making it very difficult for this gentleman to breathe. They were doing all sorts of drainage procedures, putting in chest tubes, and finally, they decided that this gentleman needed definitive surgery of his lung in order to prevent these recurrent effusions. So it was a massive operation that this gentleman with a chronic myelogenous leukemia was about to undergo. And the case manager said, well, why don't we have best doctors weigh in on this case as well? This case was reviewed and it was found out that dasatinib, which was one of the chemotherapy agents that this gentleman was on, was an agent that was known to this medical oncologist who reviewed the case, who had a lot of cases of leukemia because this individual was a specialist in so called liquid tumors, lymphomas and leukemias, knew right off that it was likely a dasatinib induced pleural effusion. So he said before any surgery, just stop the drug and see what happens. And sure enough, that is exactly what happened. So it shows you really the importance of not just sending it to a medical oncologist, but to an individual who really has that type of granular understanding, that specialty expertise, and it made all the difference in the world. And as you can say, this is the first time in a year and a half that we have some hope, and we are so thankful that this service was available from CareFirst. So a very nice outcome for the member, but also obviously a very nice halo effect for the entire CareFirst organization. You can see on this slide that Best Doctors tackles a lot of different kinds of medical problems, musculoskeletal, cancer, heart disease, GI disorders, really it's the spectrum. It's Harrison's text book of internal medicine, if you will. And we have very significant effect in terms of modification of diagnosis and treatment in all segments as well as cost savings associated with that. How do we calculate cost savings? Pretty straightforward. We basically look at the care that the individual was on and their proposed treatment plan, like the gentleman who is about to go and have that lung surgery done or a Shefa who is about to undergo chemotherapy and radiation therapy. And then we look at the plan following the best doctors intervention. And then it's just a comparative analysis of cost in terms of the avoided medical expenditure. We typically are not including absenteeism, presenteeism as part of this calculation. And we have found that this is very defensible and very conservative type of methodology. And as you might imagine, because of the nature of the best doctors clients, Mercer and a number of the other consulting firms have actually looked at our cost methodology, and we're very transparent about that. Each and every case that goes through the best doctors process, we basically say this is a 50 to 60 year old gentleman who is told that he needs a lung operation. This is what we think the lung operation would have cost. And so it's pretty simple, and then we give the dollar figure for each of them. So all of the ROI calculations that you'll see on the best doctors side of the house really come out of a case by case analysis. Recently, the Milliman Group came in and endorsed this methodology as being quite conservative and quite reflective of what the costs are. And on some of the clients, we'll even do sort of a claims based analysis just so individuals want to have absolute clarity that we're not just kicking the can down the road that the guy would be having the lung surgery at some point 6 to 9 months from now, but it's truly a cost savings. And then I'd just like to talk a little bit about a very exciting partnership that we embarked on over a year ago with Watson Health. IBM is one of Best Doctor's clients, and they really wanted to make all of the various advances at Watson available to IBMers globally. They were particularly interested in their cancer suite. So as Peter mentioned, Oncology Insight. What is that? It's really 3 products. It's Watson for Oncology, which was developed in partnership with MSK down the street. It also includes clinical trials matching, which was developed with the Mayo Clinic. And third, it's Watson for genomics. And these three products are now integrated into the best doctors program that we walk through, where once we get all of that information on the individual, we can then feed it into Watson and then Watson will provide its answers to the case through its cognitive technology. And then we have those answers reviewed by the expert. And I think that the two features that I think I would like to highlight about this is that, obviously, IBM is an enormous company that could have partnered with any company in terms of making Watson Technology available to IBMers globally, and they chose best doctors. And I'd say that they chose us because they realized that in order for Watson to give really great answers, you would have to have really great information going into the tool. So they knew that each of those 50 attributional fields that feed Watson would have to be done with the highest degree of clinical accuracy and fidelity. They also realized that medicine is complicated and that they did not want anything kind of coming out of the computer that might be a little bit off for the individual individual. And they recognize that best doctors with our knowledge of the global medical field would have an expert that would be in a great So we're very proud So we're very proud of this relationship and expanding relationship with Watson. And now a number of Best Doctors clients have developed the Watson Eye solution for their own employees as well. So it's by no means just something that's offered to IBMers. And as you might imagine, because it's very difficult to turn on the TV without seeing 7 Watson commercials, particularly if you like watching major sports events, that many individuals are calling Best Doctors up because they want to know not just what Best Doctors thinks, but they want to know what Watson thinks. And some of the individuals that will call us up will even be calling about non oncologic matters, but because they saw in their benefits information that now they have their ability to have their medical situation reviewed by Watson. So it's been a very, very successful partnership. And now I'd just like to close on just some of the key points that I just hopefully was able to convey is that we really feel as though one thing that is quite unique about the whole partnership is the dedication to medical quality, the dedication to understanding the expert community and the ability to have these global experts really coming into the local situation and providing that top level care. This is a single platform that enables individuals to have absolute assurance that we have developed these systems of care and these systems of quality, so that whether you're living in Melbourne or Bangalore or New York, that you know that when you come into the Teladoc best doctors world, you're going to have a uniformly high degree of medical quality. We have a lot of experience in dealing with all of these medical matters and that experience is meaningful for each and every individual because it is based upon that experience that we have the platform and it's also based on that experience that we are able to navigate to the appropriate medical expertise. And that I think that one feature of the company is really a passion around clinical excellence. So that each and every individual, whether they're calling up with a cough or a cold or whether they've just been diagnosed with a malignancy, the passion in the company is really around medical quality and getting it right for each and every member. So I'd like to stop here and answer any questions that folks might have. Yes? How's the practice? What the experience has been there, if any? Well, we've never been sued. And I think that one of the this question comes up all the time. And I think that, while the shorthand for the service offering is a virtual second opinion, medical legally, this is not considered a true second opinion, because the expert never is directly interacting with the member. So there's not the establishment of a doctor patient relationship. The expert is reviewing the materials that have been prepared by BEST doctors. So as you might imagine, when signing contracts with Prudential and the Boeing Corporation and Procter and Gamble, Microsoft, they have enormous legal teams that review every step of this process and have felt very comfortable that this is not considered within the domain of the practice of medicine, but rather it is developing and delivering tailored medical content at the point of care. But ultimately, the treating physician is the same treating physician that is involved in the case, and they're the ones who are treating the patient ongoing way. I was just going to add, Lou, from paying the bills. The underwriters basically view this as a peer to peer relationship and the guidance between the two, and that's how it's defined for all the underwriting purposes. More driven by the change in the diagnosis. More driven by the change in the treatment. So we're looking at what was the treatment going to be prior to the best doctors intervention and what is the treatment following the intervention. If we massively change the diagnosis, but we agreed with the treatment as still being the appropriate treatment, You don't have ulcerative colitis, you have Crohn's disease, but you happen to be on all the right drugs because in inflammatory bowel disease, often they are the same meds for both conditions. There would be 0 cost savings. Though obviously, we've done a tremendous service because the natural history of those two disorders is quite different. So it's by no means a meaningless exercise, but from the standpoint of the payer, there would be 0 cost savings. Last question. Yes. So other than continued benefits of existing. I would think I'm the world leader and whatever that I'm a really busy guy and if you're the treating doctor and all of a sudden this other second opinion comes in from out of nowhere, How do you now we've got 2 opinions, where's the third one to like triangulate to the side? Right. Two great questions. One, why would an expert want to do this in the first place? And I think that truly the reason for that is that we serve these cases up really on a silver platter. Those clinical summaries are very they are works of art. They are so well laid out in terms of defining what the case is all about and very precise questions. And I think that the reality is that if the expert is sitting at Memorial Sloan Kettering, a lot of their global business are people that just so happen to live in Manhattan who are going and receiving their cancer care at MSK. And I think that the experts really do like the fact that through best doctors, they are not only getting cases from California and Florida, but also Australia, New Zealand and many European countries. So I think that they like the feeling that they are a global expert in perhaps something rather unusual, but now they are able to literally help people from around the world with their expertise. In terms of the reaction of the treating physician, it is overwhelmingly positive. I think it's overwhelmingly positive for two reasons. One, there's a recognition that best doctors has really done their homework. So we're not saying this person has MS and therefore the algorithm would say you should be on this. It's really a very tailored recommendation to the individual patient. And when they read through the clinical summaries and the expert reports that we prepare, they really realize that we've dug deeply in terms of this. And I think that most patients most physicians really want the best care for their patients. So while there is obviously the how dare you question my word, I'm a doctor kind of thing mentality, I think that that's often massively overshadowed by the fact that if this guy could get rid of the fluid around his lung by just stopping the dasatinib and not go for a thoracic surgery appointment with his myelogenous leukemia, I'm all for this program because this program just saved my patient from going through a procedure that they did not need. And the thoracic surgeon was basically there as a hired hand. You asked me to do this procedure because you said you couldn't get the fluid away from the lung any other way. So if this individual can get the fluid off their lung by stopping a medication, there's plenty of other thoracic surgery cases that I can do. So it's very warmly received by the medical profession. I can say from experience, my uncle is a world renowned rheumatologist and happens to be a best doctor. He looks forward to getting the cases. He looks at it like the Sunday crossword, right? It's like it's this great intellectual opportunity to dig through a case that's been served up by the best doctors team. And like it's fun for him, right? That's why he went to med school. That's why he studies. That's why he goes and lectures places. That's and I think that's very consistent among if you talk to the best doctors experts, you'll hear that from them that they like doing what they're doing here. Thank you, Lou. Thank you. So, I now have the opportunity to introduce Stephanie Verstrait. Stephanie joined us almost 2 years ago now, as our Chief Marketing Officer, although she frequently introduces herself as our Chief Medical Officer, that CMO thing. So when I went out to recruit for a new Chief Marketing a deep background in understanding the impact of brands and is a ninja when it comes to digital consumer engagement. And so Stephanie will go through her own background, but she doesn't look like a ninja, but she is a ninja when it comes to that stuff. So my pleasure to welcome Stephanie. Thank you. And I feel so honored that you gave me the time slot right before lunch, Jason. I think that's great. So like Jason mentioned, I don't come from a background of health care. I'm actually a classically trained brand marketer who joined match.com when they were about 50,000 subscribers. I left when they had hit just after they hit the 1,000,000th paying subscriber threshold. I actually did an intercompany transfer into Expedia, again the same high growth phase. And they had just come out of Microsoft and more a newly public company. Like Jason said, I've been at Teladoc now for just about 2 years and definitely enjoying health care. So at Teladoc, we talk a lot about overcoming ingrained behaviors, right? We talk about how do we get people to not necessarily think that they have to make that pilgrimage to the in person location of the doctor's choice in order to get care. We talk a lot and we're very focused on how do we reach this inflection point where virtual care accessing care through virtual care delivery is something that really is the defect of ingrained behavior? Well, when I think about it, when I joined Match, when I was at Expedia, we had very much this similar focus on overcoming an ingrained behavior. And it's really the parallels of these with these 2 successful brands that made me so excited and really confident about not only where we are at Teladoc in the journey and in the process, but about the ability of our trajectory to actually drive that inflection point. So at Match, what was in Grain Behavior, we were trying to convince people that there was a better way to find your soul mate than looking at the back of a newspaper, right, or in a dark bar. At Expedia, we were trying to convince people that there was a more efficient and effective way than pouring over guidebooks and calling a bunch of different hotels at the end of which you didn't know if you got the best price and you didn't know what your hotel was going to look like. In all three cases, right, we had a simple compelling value proposition, better experience, better value and better outcomes. So initially, really it is about how do we drive trial when we think about the life stage, right? And this path and this journey to getting to sustained behavior change, you first have to try and drive trial amongst your early adopters, right? In all three cases, what is common is that this trial was driven through by using one primary customer acquisition channel. In the case of match.com, it was portal distribution deals, such as Lovett AOL. In the case of Expedia, some of us may remember the dotcom jingle, largely because television was the single channel that could reach the mass that they needed. At Teladoc, it's been our direct mail, whether between the combination of our welcome kits and the seasonal mailers that really have been the early foundation for driving awareness and utilization. And when we think about that early the early foundational approach, it really has been very unique in the marketplace. A lot of players, frankly, I would say my experience in the 1st 2 years here in health care is that a lot of times clients people expect that their clients are going to drive the engagement with the benefit. So really limiting themselves to this on-site piece of the equation. When we marry that with the deep partnerships we have with our clients and we layer in the direct mail, we layer in the other components of our engagement strategy, you'll hear what that foundation looks like when Matt comes up and talks to you about the Bank of America experience. We are the only ones in the market that have even from the very beginning made this level of investment and it is the foundation that has fueled our industry leading engagement and utilization. So when we think about time frame, it's a big question, right? That early adopter phase was something that when you look back at it for both Expedia and match.com, it was about a 7 to 10 year span. In fact, when we looked at actually didn't know this ahead of time, but when we looked back at it, for match.com, it took 10 years to get to the first 1,000,000 paying subscribers. When you think about from Teladoc perspective, it took us 13 years to get to our 1 millionth visit. So when I say that there's parallels around our confidence in terms of where we are in the trajectory and our ability to get to that inflection point, I really feel like we're very much on track if you think about the additional complexity that you factor in when it's Healthcare. So next, you have to get you have to fuel the growth by hitting mainstream awareness. That's when we become much more performance marketers and we're focused on expanding the top of the funnel by having a multimedia mix, right? That's where when we think about it from all when I step back and think about all three companies, there are 3 common characteristics that I've seen in this phase from a successful perspective. The first is, it's always been a data play, right? All three players from Match, Expedia and Teladoc have taken and leveraged the leadership position that we have, the breadth and scale of the data in order to translate that into actionable insights and ways that you can engage. The second is to tap into the evolving media landscape. There's as much sometimes a little frightening and a little creepy on the early adoption side of things, but we are always more sophisticated in our ability to reach people. And the third, to play on that sophisticated and carry that through, it's you have to have a more sophisticated approach. You move out of that one size fits all and you get into an approach that is tailored whether it's by audience or by clients. So as a result for Match and Expedia, we saw them spend about 2 thirds of the time, right? You're accelerating the growth is accelerating and you're spending about 2 thirds of the time in there. From an Expedia standpoint or from a Teladocs standpoint, we're in that multi I would call it sort of we're in our multimedia expansion strategy. We've been there for about the past 18 months. And so we're very early into this. A lot of what we're doing right now and what you've seen from us from a membership perspective is really around a number of pilots and a number of trials that are actually now starting to become woven into our core strategy. The key here is that we've paired it with meeting our members where they are and in their moment of need. Why? Because it's what consumers expect today, right? Frighteningly 40% of consumers say that their health care decisions are informed by information they get on social media. We have Google that tells us that the searches for things like doctors near me has doubled in the past year alone. They're looking for immediate answers and our media mix has to put Teladoc there has to meet them there. The other thing that's clear is that there's no one single communication vehicle that's going to break through. And so while it's really easy to say, oh yes, we do all of these things, there really is no other player in the industry that does do all of these truly this multi touch that's required to break through the clutter. It takes both the scale that we have, right, breadth of clients, breadth of data that I talked about, but it also talks it also requires the deals and the economics that we have baked into our business to be able to afford not only to build it and scale it, but to optimize it over time. So what does that look like, right? I've heard a lot of questions in the past around our ability to really reach our clients directly or sorry our members directly. The key to our confidence in deals like the Aetna fully insured deal that we've been talking about earlier today, and the what did you call it? The West Coast Blues plan, they're really based on a foundation of smart targeting and a media mix optimization that is really what we're using to fund this surround sound and make ourselves more cost efficient when we do these things. Our audience intelligence is taken exactly from the playbooks that I built and executed over my time at both Match and Expedia. And like I said, it's unmatched in the category. So what does it look like? First, it's about reach. Can we identify and directly reach our members, not only based on whether they're eligible for Teladoc, but what product are they eligible for? They're eligible for general medical? Are they eligible for behavioral health? And now increasingly, right, applying that same science and analytics into identifying those that are not only eligible, but are that warrant having best doctors intervention. On this front, we've hit critical mass. I feel very confident about our ability to drive the reach that we need across our book of business. So then the next step is saying, okay, well, now I have to be able to identify who do I want to target. I want to know that by product. I want to know that by message. So we really do leverage, our data science teams leverage, the breadth and scale, machine learning to come up with predictive analytics and predictive models that we apply into our population targeting. What does this mean? Well, practically what it means is that for a population like Aetna, again, I'll go back to the fully insured population, I can not only determine what product is best suited for a given member, but I can also weigh in and take into account the economics to Teladoc related with that visit and suddenly has a very, very different investment strategy when it comes to marketing and driving utilization amongst this population, right? We're making investment decisions on a member level. And then lastly is personalization. So I know how to find you. I know what I know how to actually what product is most likely for you to want to engage with. The key is I have to meet you on the media that's most relevant for you and I need to do it with a message. Suddenly, all the other stuff looks really easy compared this, because no longer am I dealing with 3 simple things, which is are you eligible and which product, which of the 3 products or 4 products. Now I have to deal with a very, very robust and complicated set of criteria. So for example, working moms with young kids, right? This year, the number one response we got to any campaign we've done so far this year was a back to school, did you know that your kids are now susceptible to a wide number of germs, right? So hitting them with back to school germ messaging. That's not really going to be relevant for students and it's really not going to be relevant for business travelers. For business travelers, we put campaigns out there through our geo notifications. We hit them when we know they're traveling and out of state. So what I'm going to show you next is a video that really I've talked a lot about strategies and ways that we can do this, but I'm going to show you a video that brings us to life. What you're going to see in the video is it's not futuristic. This everything that's in there is what we are doing today. I'll ask you to note 3 things as we followed Jesse through her journey. The first is that the process of going from awareness of a benefit through to actual engagement and usage of the benefit, it's a fragmented process, right? Life happens, you get interrupted, it requires multiple touch points, both digital and traditional to really get her to take action. Our challenge is how do we bring her back. The second is the seamless access the seamless integration of the access points. The choice we provide to members across all our multiple access points is what drives engagement. And you'll see mobile is no longer just a smartphone. It's a number different devices and they're all by the way being used interchangeably and sometimes at the same time. Lastly, that we're tapping into everyday behaviors, right? We talked about this need to be where people are and on the go, but it also is our ability to tap into the power of word-of-mouth and really not only have it happened, but have us harness it and then use it as part of our awareness campaigns. But only one piece of the broader conversation that really gets her to be there in that moment of need. And the great thing is we're really seeing the impact. I said that a lot of these things that we've been doing, we've been layering in a pilot test and learn and then put it into mainstream and we're starting to see the results that we're very excited about, right? We're reaching the lion's share of our members. We're doing so multiple times a month, not a couple of times a year And we're doing it at a lower cost per visit. What's fueling this? Well, for those populations where we can deploy our full surround sound, we're seeing a 2 to 3x lift on utilization. We're seeing growth of the brand query. So people that are typing in Teladoc into Google, we're seeing very, very strong growth there, which is really an early indication of people that are turning and looking to Teladoc in that moment of need turning there first. And then we've had we've generated more than 1,000,000 Teladoc download app downloads. And what that does is it really we see it in fact that we're reaching we're able to reach our not just a mobile consumer, but not surprisingly a much younger consumer. We've seen our 18 to 26 actually over the past 90 days has really been the fastest growing demographic within our book of business. So it really complements very nicely that traditional mom with kids demographic. Now when we apply that to the book of business and this is our core employers, you look at and I think this is what we did was that we took the same data that we looked at and showed everybody at JPMorgan in January of this year, and compared it not only with sort of across the 3 cohorts of groups that started in 20132014 and then by year, but also how much within each of those cohorts we've actually seen the growth just so far and year to date, right? And we haven't even had the biggest uptick, which is our fall seasonal campaign factored into this. So what we're seeing is, right, strong, strong growth on the utilization front. So when we think about it, what's next, right? Clearly, fully, because we've seen this On the Go really be very successful for us, we're continuing to expand the top of the funnel. And in fact, we actually just started digital radio with Spotify and Pandora over the course of this quarter. And in doing so, what we know is we're bringing it to life. So think about something like a behavioral health product, right? It suddenly goes from being 2 dimensional, whether it's digital or direct mail all the way up to being very personal. And Doctor. Monica Roets is the voice there. So we can bring our clinical credibility right into the message. The other piece is word-of-mouth enablement and that is something that we actually heard a request of us loud and clear from our clients at the Client Summit earlier this year. And enabling them, they tell us testimonials are the biggest way that they are able to drive awareness within their organizations help me do that at a bigger scale. We're bringing our messaging across all products. So I talked about the fact that not surprisingly we've integrated the legacy Teladoc messaging products from a messaging perspective, but we've also started to bring this total portfolio in support of the new app and our shared clients. And lastly, I did realize as going as I was going through the video, the one thing that is not live today is the virtual assistant, so the Alexa piece, that was in the video. But what's interesting and we talk about choice and how important you see it in that video around how very naturally people are using multiple devices. Virtual assistants are 1 that are growing rapidly, right? So about a third it's predicted that about a third of millennials will use a virtual assistant this year. While that may not be our core target right now, what we know is that's a precursor that's only going to grow. So assuming this works, Stan, it's all you now. I'd love to just end with talking to my dear friend Alexa here. Alexa, ask Teladoc if my pharmacy is open. Yes. Your CVS Pharmacy at 270 Halsted Avenue, Harrison, New York is open 24 hours a day. So what she was pulling there is not just any pharmacy, right? The reason that the value is that she's gone in, she's grabbed the pharmacy that I have in my Teladoc account so that we know if I'm calling Teladoc or I'm going to use Teladoc whether or not my prescription can be delivered. Teladoc ask sorry, Alexa asked Teladoc what the wait time is for a quick visit. The current wait time for New York is 5 to 8 minutes. All right. So again, we talk about people want immediate answers. I want to that is so reinforcing of the value proposition of I can't get in my car and get to an urgent care center in that length of time. All right. Lastly, Alexa, ask Teladoc for a quick visit for Stephanie. Sure. Can I get your 4 digit quick visit PIN? 1234. I heard 1234. Is that correct? Yes. Great. Stephanie should get a call or video chat from a doctor soon. So you can really see I mean these are sort of straightforward examples, but they're not far fetched in terms of really what access becomes. So with that, I will be happy to open it up to questions. Jamie? Are there Got it. So yes, I'm so I mean to paraphrase the question, but really looking to understand, are we at risk with what are we seeing across Facebook in terms of both pricing and are we looking at alternatives. What I would say is that is exactly what drives our focus on having options, right? When I was at Expedia, the Facebook at the time was Google, right? It was both something that was incredibly important and you knew it was there to stay, but you also knew you had to develop a suite of other alternatives that was going to allow it to be part of your mix, so you always had options. I feel that way about Facebook today. And so I think that my immediate reaction reaching them through radio, right, through digital radio that only goes reaching them through radio, right, through digital radio that only goes to my eligible population. Looking at secondly, it's expensive to do it as a paid advertiser and that's why the focus around word-of-mouth enablement is something that allows us to get into that feed, get into people's conversation in a way that is much more cost effective. So and then I guess actually lastly I would say, the stronger our brand gets, really the less cost effective or sorry, less costly, more cost effective that something like Facebook gets. And so really those three things work I think in our favor, and it's something that we manage on an ongoing basis. But I think given where we are in our, Intelladox nacency, we have a lot of room to grow. Steve? Wardell, beyond demographic information that you get from your employer, what other kinds of commonly get about members and how that useful marketing? So I think that we would all be really surprised at how much of a digital footprint we leave just through our everyday behavior. So when I talk about the importance of really tapping into, what people are already doing, so a great example, right, is on Facebook, many of us talk about where we work, right? So that's something that I know on the Teladoc side and you're telling me that. So it gives me a great way to match that up. I can also I also know through Google if you this might be a little scary, but I also know that well, Google knows if you get emails from Premera or if you get emails from your health plan, right? So they are starting to triangulate into what's in your inbox and how do I turn that into insights, right? And then there's all of the cookie based behavior of where you go, and really pulling together the data profiles behind that. We take those raw inputs are really very effective at driving when we talk about this machine learning and the predictive analytics, it's taking a lot of these external data points that we can bring in to develop a proprietary in combination with what we get from our clients. Sure. So the question was, talk about best doctors and where are we on the journey from integrating it from a utilization perspective. I think there's 2 there's really 2 opportunities. The first is, to really reinforce as we look to next year, reinforce that members that have both legacy Teladoc and the best doctor service are really aware now of the full suite of value. So that's things like moving towards, a single welcome kit, right? So where we have that we begin the conversation and help you get an understanding of that end to end value of care you can get. That's an important place for all of the products that you're eligible for, right, or that we can through the back end, right, and working with our clients determine are relevant for you. So that's sort of the top of the funnel, I would say. But then what's really critical is that we take the foundation that we have been building. I talk about the predictive analytics and the models that we've built on Teladoc's side. I think you heard Peter and Lou talk about the fact that their approach was exactly the same. And so now it's a matter of bringing the analytics, the back end analytics together to be able to literally be laser focused in terms of marrying the greater touch points that Teladoc had with the insight and analytics of the eligibility that's always been there with best doctors. And Jason, in the next section, you'll see from Dan Trencher what the product vision looks like and how that all comes together into a single member experience. So Stephanie doesn't actually have to market here's the best doctor's service and the specific application and when you might use it. Rather, it's about bringing someone to the interface. And I use that term very broadly, whether it's over the phone, through the app, through the web or something else like Alexa. And if you can get them there, then we can help them solve their problems. Sorry, I'm not sure. Dan asked me, he said, after you finish your demo, unplug it or somebody's going to say, Alexa. I think we have time for one more. Sean? So Stephanie, you kind of overlaid what's happened so far with Teladog or Telehealth in general, which match and Expedia. So looking forward from here, what do you think the pathway is for Telehealth as a category to go mainstream and what do you think the big barriers are? So I think it's really early innings, right? So I think that Teladoc within that landscape, I would say that Teladoc is actually the only company that's really gotten into that mainstream phase and really driving sort of that the path from a consumer perspective. I think that we have a lot of testing left to do, which is I think very exciting. So that part of it is still very early. And I don't know if you want to add anything on that part of it. Yes. We were talking about this just the other day that we think we've sort of just crossed over from early adopter into the beginning of the mainstream. So I don't know, maybe we're now in the 2nd inning, bottom of the second, if I'm being precise. And we're seeing in fact as we look at the everyday trends with respect to response rates to our fall campaign and things like that, the significantly greater impact that we're having this year than we had last year and the year before. So it's each one of those efforts is working a whole lot harder. And I think that's really where you start to see the inflection and start to see the greater response equals we're becoming part of the mainstream. People know about us more and so they're more likely to respond when they actually see something, get something in their inbox, get something in their via feed, whatever it might be. And so when I think about barriers, I think anytime you're trying to fight for mainstream attention, you're just it's attention span, right? It is that ability to break through, and be one of the 32 apps that's used in a given month and not one of the 90 plus that are not used. So it's maintaining that relevancy. And we shift from trying to explain to people, and we shift from trying to explain to people we're already starting to see this. When I first started, we had to explain to people what it was. Now we're in many, many cases just reminding them, right? Oh, yes, and when you get that, that's when you know you're really starting to make progress. All right. So thank you, Stephanie. I think we are now at break time. Break means it's a you have a job to do. If you want lunch, your job is to go pick up a box lunch and bring it back to your seat. We will give you about 15 minutes or so to check an email, find the restrooms which are down the hall here. And then we're going to follow that with a working lunch as Dan goes through the product vision. Okay. All right. Thank you all. That was very efficient. I'm impressed. Our orderly, nobody ran away. That's good. Thank you. So as we move into the second part of the discussion, you're going to get to hear from Dan Trencher, who leads product and strategy for us. Dan and I have worked together many times, Empire Blue Cross Blue Shield, WellPoint, now Anthem. And he has really been the architect behind the product portfolio and is now on the hook for pulling together these 2 great companies and products into a single member experience. So Dan is going to do that. Then we have the opportunity to hear from 2 of our amazing clients, Chet Burrell, who will be on the video, who is the CEO of CareFirst Blue Cross Blue Shield in the Baltimore area, Baltimore DC area, and Matt Pinnacle, who is here from Bank of America. So without further ado, I'm going to hand it to Dan to give you a little bit of a view into the future of our product strategy. Great. Thanks, Jason. As Jason mentioned, I've been with Teladoc now a little over 6 years, leading product development, product management and overall corporate strategy. I had very similar roles previously with Empire and Anthem here in the city, but so about 10 years prior in health care as well. What's really exciting as I look at this room, when I started at Teladoc 6 years ago, there were fewer people in the company than there are people in this room. So that's always a good thing and it's been great to see that evolution. I'm going to talk about product strategy and really our sort of vision on where we're headed. But I wanted to sort of pick up where Stephanie left off, which is that very similar to and concurrent with the evolution we've seen from a consumer engagement perspective, we're seeing exactly the same evolution from a product perspective, which means we started with a single core product at Teladoc. Really, we're one product company for the first 12 of 15 years as a company. We've since expanded the product portfolio both organically by building new products such as behavioral health and dermatology and obviously inorganically by bringing in new products and services such as through our Best Doctors acquisition. And ultimately where we headed is not just a series or a panel of products, but ultimately an integrated full spectrum solution and that's really what I'm going talk about more today to give you a little more flavor of what that looks like. What we call it is headed towards having a virtual healthcare ecosystem. That's a little hard to grasp. So the simplest analogy that I've come across for thinking about it is maps, right? So many of us here are experienced enough to remember, we used to travel, right? So you started by maybe you had to take an Atlas. At least a little bit later, you could download your directions from MapQuest, print them out. You're trying to drive along, holding on to the map. Maybe you're arguing with your spouse as it shows in this picture about which way to go. If you get hungry, you stop whatever you run into on the side of the road, that's the best you're going to do. And hopefully, you don't run into traffic and hopefully you get to the meeting or the reservation at some point in time, right? That's all changed today, right? So I know when I travel, go into a meeting, I have no idea where I'm going until I get off the plane. I click the link in my calendar invite. It tells me where to go. It starts providing directions. It provides recommendations on where to eat. It tells you where there's traffic and we can move you around. And ultimately, this is exactly the same sort of experience we want to create in health care, right? That's where we're getting used to in the rest of our lives and that's the sort of personalization and guidance, and sort of intellectual, sort of support that we really need to have from a health care perspective. So what does that wind up looking like? What does the virtual health care ecosystem really look like? We think about it in terms of 6 key components, which kind of build up to it. The first one is expansive clinical services. So you've already heard today about many of the products in our portfolio, but the broader this gets, the more we're really going to be a single point of contact, right? So we change the behavior so consumers know, let's just start with Teladoc, right? So it's the general medical services, it's the behavioral health, all the best doctors, expert second opinion services, which we've talked about so much this morning and even taking those to the next level. So a new product we're rolling out is around specialty pharmaceuticals, right? So a pretty tailored window of types of cases that you can apply additional services and additional data to really help patients who are perhaps on a drug and they're not responding to it, maybe they're not on the right drug. And these are obviously the highest cost drugs. So this is going to be a major sort of impact for our clients and a major impact for the health of our members by having this broader set of tailored solutions. Next, we never want telehealth or virtual care to be an island, right? It's not a shadow or separate medical system. It's important that it's interwoven with how you experience health care and really connected into the rest of the system, the rest of the health care system. So just easy example. So we share medical records so and integrate with electronic health record systems particularly when a hospital system is our client. We can pull in information. So we've enhanced some of our integrations with 3rd party, so we could pull in a patient's medication history, right? So not just self reported data, but history from Surescripts, if you're sort of familiar with that space in e prescribing. So we can have that sort of information and then share it back out and make referrals, right? So it's not just care delivered through our platform, but when a patient needs to have a referral to another provider, a community provider, we can help them find a good one. A third piece, which you've heard a lot about today is data and analytics, right? This can take the form of the data and analytics that Stephanie uses to identify and target messaging. It's Watson, right? So the AI that's actually providing decision support to the providers who are providing care. And it's analytics to just find patients who could benefit from a second opinion. Broadening this out gaps in care, right? So we could pull in gaps care information and then enable our physicians to help try to address some of those quality gaps and HEDIS measures and those sorts of things very important for our clients. 4th is integration with devices and wearables. Obviously, really hot topic if you think about steps and lots of the other devices, meaning Fitbits and other sorts of things that are out there. We really want to integrate with devices that bring meaningful data. And when I say meaningful 2 services we're providing. Just tracking steps today is not that valuable for what we do. And so the first example was the integration with Kinza. So it's a smart thermometer, which allows us to pull in very simple as possible data you can imagine. But it's really important to have it in not just one data point. We can bring in longitudinal data, so that our doctor can visualize how is the patient's temperature been sort of developing over time and that can be meaningful from a diagnostic perspective. And as we roll into new clinical categories, we'll be integrating with devices that provide the relevant data for that clinical category. So diabetes, it's A1C or blood sugar, right? And sort of cardio, it's bringing in heart rhythms, etcetera. And that's how we're going to always look at innovation that matters for the services that we provide. Another element which Stephanie talked about, we call it ubiquitous entry points, but that's a fancy way of saying we want to be where our consumers are accessing care and services today, right? So mobile has become a bigger and bigger part of our business. We just had fun here with voice. But maybe the next thing is when there really are self driving cars, can all have our opinions about when and what that will really look like. But if you're sitting in your car and you've got nothing to do because it's really driving itself maybe you'll want to have a virtual visit. So we want to be in the interfaces where people are actually spending time and engaging with the world. And finally, the surround sound engagement itself, Stephanie talked a lot about this. We need to wrap around where patients are, be relevant and present from a messaging perspective as well. So what does this actually look like to the consumer? So that was a very much sort of a Teladoc view. This is more starting to go towards a consumer view. So the first thing is as you have as a consumer such a broad set of services you can access or a broad set of conditions, we can't expect the consumer to come in and know what they're looking for and say, oh, I want the Expert Second Opinions product or I want the General Medical product. They need to start by they provide they say what their actual question is, what their need is and we need to provide guidance, smart guidance that enables them to reach the service and be presented with the right information or services that would benefit them. There are sort of 3 components where that guidance can lead. So the first is actual virtual care access. This is, I think, what Teladoc has always done and will continue to do, right? Access to new types of providers, new types of care, literally where you're interacting with that doctor or other type of provider. The messaging from the patient's perspective is I want to talk to a doctor now, right, so we connect you as an example. 2nd key component is information and decision support. So think of best doctors as information and decision support, right? I need to see a specialist. I have a question about the diagnosis I've just been given and what it's going to entail or is it the right one? That's important decision support. And then finally, tools. This can take a lot of different forms. So in some of our business today, we enable patients to save on the prescriptions they've been written, whether it's by us or just prescriptions that they take generally. So it's sort of a prescription discount component. This is where the data from the devices we're integrating with can be relevant. Lots of different things that we want to put in place tools to help drive that sort of dependence and sort of habit of engaging with Teladoc because that will be beneficial to both the member and obviously to us and our clients. A different view is looking at the products themselves, right? So, from a consumer's perspective, they may say, I just my child woke up with a fever this morning. What can you do for me? Or I want to address my anxiety. Again, how can you help? And Teladoc has always played sort of on the bottom left of this chart, the access being higher volume, lower complexity, lower acuity, right? That's the bottom of the foundation of the pyramid as Peter was talking about. What we've done by bringing in the best doctors side of things is now we're helping when what will my recovery from a knee surgery be or is my husband's diagnosis and plan correct. And that gets us towards the other end of the spectrum of lower volume, but higher cost, higher complexity cases, right? And this just lays out and you may not be able to read every single product, but it's sort of a selection of the products that we offer today, touching on treatment decision support, the specialty Rx, etcetera, that I've sort of talked about. And so we almost set it up, right? So there's kind of a gap in the middle there, right? So the next phase after that is filling in so it's a full spectrum solution. So the two components that are most clear in the middle there are around preventive care and around chronic conditions. And let me just stop there for one second because it's important to note that we already touch patients with chronic conditions every day, particularly in the best doctor side of our business. You noticed on one of the earlier charts, heart conditions is a common condition that we touch. Diabetics use our service. A lot of the gastrointestinal diseases that are mentioned are chronic in nature. So it's not like we're not helping people with chronic conditions today. We're just not managing their care over time. It's not chronic condition management. For those, that's where we're looking to partner more with clients of ours, partners of ours, the sort of discussion Jason talked about with some of our health plans. This is really resonating both the full spectrum of solution and then how we can partner with our clients who've got very well developed programs or goals in many of these categories to really work together and have a comprehensive solution. We never want to compete with our clients because many of our health plan clients have disease management programs, care management programs, case management programs and we want to be a real complement to those as opposed to a competitor for those. And I don't want to leave off on the upper right there, post hospitalization care, right? So post discharge, obviously, that's a huge economic issue for our health system clients in particular. But anybody who's sharing risk, that's a big driver. And it's something we're starting to do already on our provider side business, meaning where we're serving health systems with a platform model. But this will be a bigger part of that that will be a big use case as well for when we're working with them. And why does all this matter ultimately? Because this provides more value to the client, their upsell and cross sell opportunities for us. And ultimately, it's also the more the habit is sort of created, the more utilization we'll see as well. So I wanted to touch just on a few of the innovative new products. I think we've sort of touched on many of these already. So the Oncology Insights, it's an upsell. Onward is the name for the behavioral health offering that Peter mentioned earlier and then the specialty pharma product. Each of these have rolled out in various stages. You can see a couple of few logos there tied to initial clients, particularly for the Onward and the specialty product. Those are actually both Canadian insurers, just so if you don't recognize them, right? So what's interesting and what's sort of pointed to on the right side of the slide is that these products are providing critical cost containment solutions for our clients, right? So this is what we want to do. We want to build products that matter to our clients that are delivering value to them and that's what they're going to pay for. What's common is we're using analytics to drive insights which support these offerings, right? So analytics to find the right patients and then analytics to support the actual sort of provider expert themselves as they're as we're creating a second opinion. Global impact and that's the point I was getting to earlier. We don't necessarily have to launch every product in the United States, but what's important is that the products have global applicability, right? So not just the U. S. Market, but international markets as well. And finally, this is what creates cross sell opportunities, right? Each of these was a client that was buying some other product from us and have now layered on these new products as they're from the market. A different way we're innovating not just new products, but new ways to interact with our solution, new engagement features because ultimately that's what we want to drive. So this is an example is around what we call geofencing. So what this means is for any Teladoc member who would have downloaded the Teladoc app, we can sense where you are if you've given us permission for location based services, right? And so this is a feature we rolled out originally in our small business product, our Healthiest View offering. But basically, it can do a little push notification to you if it notices that you've been in an urgent care center for 10 or 15 minutes. And so we've literally geo mapped every urgent care center in the United States. And so if you do that, it will do a little thing. It won't say something obvious like what are you doing there in that urgent care center? You should be using Teladoc. It will remind you gently that you have access to Teladoc. And we can track exactly how when this is delivered, how often it's clicked on, etcetera. And it's not just urgent care centers, it could be other types of clinical settings as well. So just wanted to provide an example of how we're using technology to engage members in sort of interesting ways. I'm going to quickly try to do a demo of the integrated app. So this is literally sort of live. It's what we have out in the market right now. Right. Let's do this first. All right. I'll see how quickly this flips over. That's not bad. Those are my kids. Okay. So we'll move on. Right. So as I said, this is a demo version, but it's exactly the same as what's out there already, right? So this is the Teladoc app, right? And so as Peter mentioned, we launched from the time we did the best doctors deal to the time we launched an integrated app was about 70 days, something like that. So we're measuring in days, which is great. So I'm going to I could spend an hour showing you this, but I'll just hit on a few quick points here, right? So it starts with we want to get people to care as quickly as possible, so request to visit. And you can very quickly here see at the top there's request to visit. And I'll show you that that's sort of traditional Teladoc services, right? Who needs help? Because it could be anybody in your family. It's me. Where will I be? It knows I'm in New York because it's using my location. That helps match me with a doctor who's licensed in the state of New York because that's what you have to do. It says what type of visit, right? So I'm eligible for multiple products, behavioral health, dermatology. I'll just click on general medical. And this is the Kinza integration. I won't bother to do it right now, but that would allow me to sync so I could pull in. It noticed the Kinza apps on my phone and automatically propped me. If I didn't have the Kinza app, it wouldn't have asked me that. Do a quick video call. When's a good time, as soon as possible, I can schedule it. But most people, 95% of people say they want it as quickly as possible. And then I've got the choice now actually of do I want the next available? That's as quickly as that's the quickest option of course or do I want to select from available for providers. And if you do that, there are some profiles and you can pick and choose and filter based on some various criteria. So I will just choose her and then my phone number and you get the idea, right? So reason for visit, I without earache. I do want to share a record. We always ask, do you want to share a record of your visit with your own doctor, which you've put into the system? So I'll say, yes, I would love to do that. Images are really important, right? They're often even easier for the doc. That's what we hear from our doctors. A high definition still image is actually easier to work with and more clear than a video in many cases. So I'll use that. And that's my hand. Very clinically important picture there. And so this upload, this will be in my permanent medical record. The doctor sees this and reviews this before they engage with the patient. I won't do every step. You get the idea, right? We're almost done. I'll do this when this is fun, right? So I'm going to do pharmacy. So I want to do a pharmacy based on where I am within 5 miles, again, using location to make it really easy. So it's just doing a quick search here, hopefully quick search here. Well, there must be a lot of them. Okay. There we go. Right. So here we are. I'm I'm a Duane Reade guy. Okay. That's good. All right. Notice I clicked out it really fast. It showed 20 fourseven, right. So we've highlighted which are 20 fourseven pharmacies, which aren't. So we don't wind up in the situation where it's 11 at night and you've chosen a pharmacy that's closed, right? So you get the idea. The last piece is the payment piece. So this is the traditional Teladoc flow. If I weren't talking, it takes less than a minute to actually do that. So I'm going to go back to the beginning just so you can see. So again, it's me. Oh, no, I didn't go back all the way back to the beginning. Yeah. So again, I'm going to show you just the best doctors so you don't have to take my word for it. It is there. So I'm going to get an expert opinion, right? So what kind of medical case would you like us to review? It's a recent no, it's an upcoming surgery. Why don't I do that? And there's branching logic depending on what I select here. Different questions, right? Okay. So let's get your case started. What kind of surgery are you having? I am going to have a lobe removal, I believe, which is lung, not ear. Okay. Do you have your surgery scheduled? I do. So I do we need to know this so we don't get back to you after your surgery. If know your surgery is within a week, we need to have a different process, right? So the procedure date, actually, I've got a little time. So it's 21st. And what are your concerns? I'm really concerned about is it the right surgery for me? Okay. You can probably put a little more in. And then the last piece is we're going to call you back, right? So we want to know when. So you're scheduling this. I'm only really available on Tuesdays afternoon and evening, and I'm in the Eastern time zone. And there you go. Right. And then I'm going to put in my phone number and my email address. There you go. So your case has been this is all you'd have to do from a consumer's perspective to start this expert second opinion process going, right? And so you get a callback from at the point at the time that you asked for from one of the best doctors' representatives and they get started on the process. So that whole intake that Lou had talked about. So very easy, fully integrated. And we're going to keep building out this experience, over the course of time. And that's what I'm going to show you now. I'm going to get out of here. I'm actually just going to unplug this and then switch back to the presentation and give you a little bit of a view as to where the future vision member experience is, right? Again, that's today. I've been talking about future vision. I'm going to sort of show you an idea of what that will look like. Perfect. Thank you. All right. So this is an illustrative sort of integrated experience. So we'll start over here, right? So when you come in, you may know what you're looking for and you just go to I know what I need and you go straight into requesting a visit or whatever it is. Most likely you're going to need some guidance, right? Because there's so many things that we can offer. So maybe I'll start with leg pain. That's my issue. Get some visualization, right? Show us where it hurts. Again, this is not a sort of automated diagnosis. This is guidance and support to help find the right service for you. Is this related to your previous diagnosis of a torn meniscus, right? We know things about you because you've had a best doctor's second opinion perhaps or you've talked about it with one of your providers through the platform or we have your medical records because you shared them with us. It can be very smart in terms of how we work through this process to narrow down what's most relevant. And then on the right, it's just a screen showing here's based on what we've learned and what you've said are the right services you might be interested in, right? Maybe it's talking to a doctor, maybe it's finding a specialist in your community, using guidance and AI to help make that a reality. And this is just a few of what those endpoints may look like. So it could be a quick visit. So the concept there and Stephanie used that one in the Alexa demo was why can't it be just why can't ordering Teladoc visit be like one click purchasing on Amazon, right? If you sort of reuse the same thing you had before, if you're having a behavioral health service and you've been seeing the same therapist through the platform, why do you need to go through and answer all the questions, right? Let's just go straight to a quick visit. MyCare team, increasingly as you might have multiple types of providers that you've seen through our platform and your own community providers, being able to share information and sort of have that information together on that full virtual care team could be critical. And then finally over on the other side there, the concept of that referral find the best doctor in my neighborhood, I need to really go in person. Maybe it's because that was the outcome of one of my virtual visits was I need to go see somebody in person. We can help you find 1 in sort of a visually simple way and really identify where is their best doctor and maybe it's in the middle of nowhere and we don't have a best doctor there who's a high quality provider that you can see regardless. So ultimately that's the kind of experience we're looking to create over the course of the time. So with that, I think we're at Q and A time. I'll go back. So I think we probably have time for maybe 2 questions and then we have our guest speakers. Jamie? Yes, sure. Absolutely. So we've taken our first step in that direction. Your question was yes, the question was thank you, with labs. Where do we stand on that, both sort of traditional and then perhaps in home? So we've taken our first step there. So we've actually we have a partnership with Analyte that we've announced earlier and we've been working with them for more than a year around sexual health lab testing service that's been available to our members. And so we have that integration set up and it's being used today. We've also expanded and used labs for behavioral health offering. So for types of treatment, types of prescriptions that need ongoing monitoring of certain biometric information we can order those labs and read them today. I think the broader question is what can labs do in the context of this strategy? And the answer is a lot, but we want to make sure that we're using that data in a way that's really meaningful for the services we're providing and that we're being convenient about it, right? Because not everybody necessarily wants to go to QuestonLab or in person. And so we are actually looking at sort of at home models or mail based, sort of mail kit based models as well. We haven't rolled that out yet. A lot of those are very early stage and so not quite ready for prime time, but it's definitely something that we're tracking very closely. I think we have time for one more question before Peter comes up and introduces Chet. Hearing none, we're going to just in the nick of time. I just wonder if you could I know there's nothing there today. I wonder if you could give us a glimpse in the next 2 or 3 years what that service offering might look like from you? Is that a and this for you or the rest of the team, is it something that's going to become more clinically from the merging of best doctors and build out offering that you need to go with wire? So I think the answer is probably all of the above. It may be build organically. It will certainly be, as Dan said, plug into existing programs that our clients have, right? We need to be interoperable with them and be able to work with their existing programs. Some of them will likely take the form of partnerships, where it doesn't necessarily need to be M and A activity in order to have an integrated offering with a great product. And the opportunity is always there if we find the right asset that fits in really well strategically. We like the economics for us to do something along that line. So, I don't think it's an eitheror strategy. It's an and strategy. Okay. So thanks, Dan. And with that, I think Peter is going to introduce Chet and you'll have the opportunity to see Chet, who we have online. There we are. He'll do a presentation, give his perspective on the Best Doctor's product and then you'll have the opportunity for Q and A. The one thing I'll ask is, when we go to Q and A for this, we just need to make sure that the mic comes around so that Chet can hear you. Great. Can we put the slides on 1? Chet, you hear us okay? I can. Wow! High-tech. Okay. Let me just briefly introduce you and then turn it right over to you. You're in a room of 100, 150 folks interested in what's going on with Teladoc and Best Doctors. Chet is the CEO of CareFirst, which is one of the largest blue plans in the country. They largely service Baltimore, DC, those metro areas, and he has an incredible career, really focused as both an operator and an innovator. And on that innovative area, that's where really I think Chet found best doctors or best doctors found Chet. I'm not sure which way that actually started. But we learned a tremendous amount in working with Chet and that before that we were more focused on the employer segment as a benefit. And then as we began to work together, he really focused us more on complex case management for the most challenging cases that a health plan experiences. And so we've talked about clinical impact diagnosis and things. I'll leave that up to him to talk about. But I can just say, Best Doctors has learned a tremendous amount from Chet. They are an innovator at CareFirst and really has been a place where we have grown and grown by helping people and delivering an ROI. So with that, I'll turn it over to Mr. Borrell and he'll talk about his experiences. Thank you. Thank you, Peter, and good to be with you. Let me just start by telling a personal story about the way we found best doctors, which had a lot to do with an experience my son was having, an otherwise very healthy individual, young man, but began to suffer during his graduate program, post getting his BS degree with severe headaches. Nobody could find out why. Went to his primary care physician, then went to a series of specialists that involve neurologists and ENT, immunologists. It was a very, very difficult thing to pin down. And I found myself, even with a sophisticated understanding of the healthcare system desperate to find experts that might advise. Everybody that we talked to gave us a different opinion, including cutting the nerves in the back of his neck, so that the pain would stop, which we said we weren't going to do, to doing massive sinus surgery and a whole array of other ideas. Finally, we found out what it was by sending him to, in this case, Mayo, who put a whole team together and said what your son has is a fungal infection in his sinuses that can be managed, but will likely never fully go away. He doesn't need surgery. What he needs is a certain type of treatment and he got that finally. This was years of suffering to the point of being debilitated by it. And it struck me that it took a team to figure it out, looked at from a variety of different perspectives. It was in my search for a solution for him and anyone like him that we found best doctors. And so we began a relationship. This goes back a number of years, as Peter said. And here's the situation from a large payer's point of view. We cover nearly 3,500,000 people. We serve 25,000 employer groups here in the nation's capital and immediately around it. Is a highly educated population, generally speaking, very demanding of high quality services and expecting to get them. We also have 45,000 providers of all types in our network under contract. Of those, about 4,500, 10% of them are primary care physicians and they are under a particular model with us, financial and incentive model, where they are encouraged and rewarded to get the best possible outcome for their patients, both from a quality point of view and a cost point of view. So what became immediately apparent is this, that in our population here and this would be true of any population in the country, particularly under 65 population, which is the majority of what we serve, that a very small number of people get catastrophically or chronically ill with multiple chronic diseases in any given year. About 50% of people are healthy or stable in any given year. But if you go up, picture a pyramid towards the sickest, what you see is that about 3% of the people consume about 35% to 40% of all of the payout. We pay over $10,000,000,000 a year in claims. So when you have that concentration in a relative few, whereas people at the base of the pyramid are the people who are healthy, consume about $50 a month or $600 a year, whereas the top of the pyramid is $6,000 a month, 100 times more expensive. Here's the situation we found ourselves in with primary care physicians, particularly who are accountable for the total cost of care of their patients. Oftentimes, more frequently than not, you would find situations where the diagnosis was uncertain. There was a different opinion about the diagnosis and then there was a different opinion about the treatment. If you made mistakes in the diagnosis and treatment, you typically really ran it up until by process of elimination, you figured it out. We saw this as a pattern over and over again. So we began through our primary care physicians and through our own medical director to provide cases to best doctors that said, here's a case, here's another case, here's another case. They typically had different conditions and diagnoses. They were often very complex. There was often an elaborate history, medical record involved. And so what we asked was could best doctors take a look at these cases, look at the history, obtain the records and advise as to whether or not the diagnosis was correct and therefore whether the treatment was appropriate. And we found and we have done now thousands of these cases with best doctors that in a surprising number of cases, this will surprise you, in more than half of all cases, we found either a major or moderate change in diagnosis and therefore treatment, and this had huge consequences downstream for what the cost would be and the quality of the outcome would be. This was to a degree that we found surprising. We found that in dealing with best doctors, they were prompt in dealing with the cases. They developed the analysis in a very clear and articulate way in writing. It was provided to the patient and provided to the treating providers. And at first, we were very curious about whether the treating providers would see this as a threat or would they cooperate and would they more importantly act in accordance with what the recommendations turned out to be, but in order for them to do that, they would have to believe that they were creditable. And we found overwhelmingly that what they did is see them as an assist and that by and large, they follow their recommendations and implemented their recommendations. And then with best doctors, we have followed up these cases to say, well, what happened 6 months later, a year later? How are these patients doing? And so for patients that run up many, many 1,000 of dollars claims expense in a month and they have multiple chronic conditions that get exacerbated, they have uncertain diagnoses, you can imagine what the value might be. And so we wound up with an organized process of having our primary care network identify cases, have our medical director assess those cases and then send them on to best doctors for the workup and for the analysis and the recommendations and then track them over time. And what we've seen is high levels of satisfaction on the part of all the parties involved, the patient included, and we have experienced considerable savings because the correction of the diagnosis and the correction of the treatment path actually yielded very beneficial results. We were curious because the cost of this were charged against the cost of the primary care doctor who was accountable for all costs. They embraced it because they thought it was highly valuable. We also were curious about how employers would look at it because the costs too were reflected for them, particularly large self insured groups, they could see the costs of this service in their data, would they think it was valuable. And I would tell you that this is now based on multiple years of experience, has worked very, very smoothly. And it is rare indeed ever to have somebody question the value of this. And in some employer groups, we justify it case by case and never ever had a case where they have said, don't want to pay for it. So I think that speaks to the quality of the reviews, the importance of the reviews and the value of the reviews and we're strong supporters going forward. We have integrated it into our larger patient centered medical home program on an ongoing basis and have found that the partnership with Best Doctors has been terrific and very, very helpful. If I were to broaden the discussion, I think that there are other opportunities taking into account now what Teladoc itself offers that you have just seen the demonstration on and could see the day where physicians or patients ask questions about their medical diagnosis and treatment just as was described, but where one could see that you could hook more readily to the various experts that might be in the best position to render an opinion on it. And therefore, integrate more directly, what can be done, I would say, as a video visit with a primary care physician and hooking into what the specialist may offer. So if one were to see 2 ends of a continuum here, one is a Teladoc service for the ordinary ailments of mankind, the simple stuff, and best doctors on the other end being much more focused on more potentially very difficult to diagnose cases where it's important to get all the medical records and the history and so on, you could see where you could work towards the middle and offer an array of services over a continuum that might open up not only new markets and revenue opportunities, business opportunities for Teladoc, but would also be extremely valuable to a payer. And it is in that potential that we find our greatest interest in the relationship and we're very supportive of the transaction going through that created the combination of Best Doctors and Teladoc. So I would say from a payer's point of view, just to sum it up, we have found the service to be responsive and to be applicable to some of the greatest challenges we face. One of the things that I would say as a payer, you often are confronted with is patients demanding ever more and being dissatisfied with some of the answers they get and us and then seeing a payer as interfering in that or disruptive of that or creating abrasion in that process. And what we found is this was an effective bridge, the partnership we have, towards meeting those challenges. And I think if one were to take our experience and render it more largely on a national scale, this is very directly applicable to what I know other fellow Blue plans face. I've explained this to a number of other Blue Cross Blue Shield plans that was with many of the CEOs last week for a few days, happened to talk to a few about this. All, I think, are intrigued because they see the same need in their market. So if this were to our experience were to open up more market potential to best doctors and Teladoc together, I think that would be terrific and we would be strong supporters. Keep in mind that the Blues, we are the biggest, we have 58% here of the private market in the Greater Capital Area, Northern Virginia, all of Maryland and D. C. But the Blues in totality serve 110,000,000 Americans, about a third of the country. And so we're hoping that the experience here will be instructive to others and that it would open up greater market potential for Teladoc and best doctors. So let me stop there. I'd be happy to take any questions that anyone has. Thanks. That was fantastic. I think we have some questions. Sean? Thanks for your comments. I was wondering if you could maybe compare, contrast the work you do with best doctors relative to other work you do in the category of utilization management? Why is this not utilization management in your head? That's a good question. I think of it I do not think of it as utilization management. Here's what we do in a nutshell, which is what I would actually physically in every hospital in our service area and we have others that work remotely for any out of area action. But the reason they're in the hospitals is to assess the incoming stream of admissions. As to whether or not the people coming in for admission, not so much looking to deny the admission, which is exceedingly rare, which used to be the main purpose or try to cut a day off the end of the stay, if you could or something like that. Rather, the focus today is on whether they need follow on services post discharge and whether they are actually getting them. That's one form of utilization management. Another would be what we do in the drug area. If you're on a specialty drug or you're about to have a specialty drug, what was considered prior? And is it really suited to your need? If you want to say even in a larger sense, what's interesting is there's been an explosion in genetic testing for the predisposition towards disease. Is the right test assigned to the circumstance of the patient or not? And then what is the course of treatment from it? That's a form of utilization management, just to use a few examples. But what's going on here, at least what our experience has been with best doctors, is much more sophisticated than that. And what it's trying to answer is, was the patient diagnosed correctly over time? What were the presenting symptoms? What were the diagnostic tests that were done? What therefore is the likely course of treatment? Correct diagnosis. The goal is not to manage use in the classic sense. The goal is get people correctly diagnosed so that the treatment can be matched to them. Our belief is this, that if you do that well, particularly on the people who are the most expensive to treat and typically have a longitudinal need, in other words, there's a chronicity to their illness, it doesn't go away. And it may be combined with other illnesses that if you could get them better outcome, you could not only improve the quality of their lives, but you could pretty massively avoid unnecessary costs and therefore control costs through better quality. The idea here is it is only through enhanced quality that ultimately you can control the cost on these really high expense type of cases. And therefore, we and what we were surprised frankly, we always thought there was some misdiagnosis and therefore treatment that wasn't particularly applicable, but we were surprised by the degree of it based on our experience with best doctors. So this is a drive towards improved quality, the drive towards in turn better outcome, the drive towards in turn lower miscues and unnecessary treatments that are ineffective given the circumstances. So I don't think of that. To me, what that involves is a lot of really sophisticated medical judgment. This is where best doctors matters. Can you bring together the experts in these really complicated cases that can render an opinion that truly does matter to the course of treatment for the patient? We found yes, And that the answer to that is yes. And that the outcomes being better resulted in multiples of savings compared to the cost of doing it. So I would say that the world as we see it is moving away from traditional and UR towards this kind of more extensive review that really seeks to get the best possible outcome for the patient. Excellent. We have another question. Steve? Thanks for your time. Steve Wardell. So how does a member know that the best doctors service is available to them through you? Are you telling them every year that it's available and they're raising their hand and saying, I think I have an issue? Or are you reaching out to them because you know that they have a serious condition? That's a really important question, I think. Most of them do not know and will never know. And I don't want to be cavalier about that answer, but here is what we thought. First of all, the best doctors' traditional approach has been to inform employees within a given group that the service is available or that the employer themselves informs the individuals. We think that's a fine model. But this model from the get go was not that. This model was to work extensively with primary care physicians. 70% of our membership and rising has an established relationship with a primary care physician. So we made our audience different. We went after the primaries and educated the primaries through repeated sessions. We also have hundreds of nurses in the field working with primary care doctors. We educated all the nurses. And we thought that between the nurses and the physicians, the primary care physicians, when they were aware, they would become more sensitive to what kinds of cases might be suitable for this more intensive review. And lo and behold, that turned out to be the case. Let me put that in one other context. We take all the data we have on all of our members, the equivalent of 400 Libraries of Congress worth of data, enormous database. And we try to find typically in any given month, the top 2% of the people in the sheer mass of people that we serve, who are the sickest and the most vulnerable. Out of that, the nurses meet with the primary care physicians and decide whether the individual person, the member, needs a care plan or needs some kind of service to support them that they're not getting or might benefit from a more extensive review through best doctors. And we have what we call our expert consult program, which is what this is. So all the primary is aware of it, all of the nurses are aware of it. And when they see a case, even when the member has no idea that this service is available to them, the nurse or the doctor will raise it and they will make that case known to our Medical Director. And what we're finding is they're very, very astute at identifying the cases. We don't often turn down what a primary care physician would recommend. Then the patient is actually amazed that this service is available to them. It has no out of pocket expense to them. And they said, will you do that for me? Would you actually have a panel of experts look at my case? And they become amazed. It becomes a very important satisfaction point for our membership. And then when they find out, I guess you'd find out 1 of 2 things. If there was everything that was being done for you was found to be appropriate by a panel of experts, you'd say, wow, that's got I got peace of mind that way. But if you found out that there had to be, as we often do, some course change, you'd be very, very grateful for that. So this has led to very high levels of satisfaction for that reason. And it has become, because of what I just said, a very, very valuable service. So we don't rely, in our case, as a payer on somebody finding out about it. We have really worked it through and Peter, I think tried to set this up in the beginning, worked it through the doctors and through the nurses who work with the doctors to find the cases where an expert consult would be most applicable. If we were to broaden this out and go towards employees in a particular group of ours calling into a Teladoc service that what appeared to be a simple case at first, but might need some expert review. We're very intrigued with now developing it from that side and that's a different pathway in probably not for the level of complexity these cases are, but, nevertheless, something that could be very valuable. But our approach, Peter said, is completely different. We went through the doctor side and the nurse side before we went through the employee or member side. So most don't know it's available until they need it and when they find out, they're thrilled. Excellent. Well, Chad, thank you so much for joining us by video. Really, really appreciate it. Your My pleasure. Thank you, Jason. Bye bye. My pleasure. Thank you, Jason. Bye bye. And so with that, we're going to go we're going to turn from a best doctors client in the health plan space to a Teladoc client in the employer space. And when I say in the employer space, there are it's hard to find a comparable to Bank of America. I have to say that by the way. The sheer size of the company and the employee base is one thing. The complexity of having put together multiple companies into 1. But also, I think the benefits philosophy that I've witnessed of being very much almost a paternalistic philosophy and being very, very pro employees at the same time having to manage the cost of benefits and the cost of healthcare. And Matt Pinnacle, we're very fortunate to have Matt here who's an SVP on the benefits side, really a healthcare benefits expert, having been a towers consultant before moving over to take on the lead for this at Bank of America. So, we are very, very fortunate to have Matt here presenting. And I've known Matt for a few years. He always has interesting and sometimes controversial things to say. So I'm looking forward to it. Oh, gosh, man. I'm set up on this one. Okay. Which one goes advanced? All right. First, I think we can all admit I probably need a new headshot, but I promise underneath the glasses and the beard that is actually what I look like. So just by way of background, obviously Bank of America, large organization, we've got about 135,000 employees who are eligible for Teladoc. They sit in one of our self funded plans that equates to about 325,000 members. So we introduced Teladoc in 2015. I did not join the bank until September of 2015. So it was already in place when I got there. And the reason we did it, and this surprises people sometimes, it wasn't about saving money. At the end of the day, given our current utilization, if we save $2,000,000 okay, that's pretty much a rounding error. I spent $2,200,000,000 on healthcare per year for my employees. What we did was we had rolled out some consumer directed plans, higher deductible plans, 1 qualified for an HSA, 1 with a $1200 individual deductible. And we felt that telemedicine was of a doctor visit or an ER visit till they get through their deductible. And I think some of the things that we're doing of a doctor visit or an ER visit till they get through their deductible. And I think someone mentioned earlier about $150, dollars 200 for a PCP visit, $1500 for an emergency room visit. So we felt this was an option to provide accessible low cost care to our employees. And throughout the course of 2015, what we found was we had a really good uptake in registration when we first rolled it out, right? Boom, new program, everybody's excited, they register for it and then it started to drop off. And then I joined the bank and started looking into the numbers and I got our team together from Teladoc and my team and Stephanie was there and has actually been an integral part of how we've been able to market this program. And I said, guys, we need to start thinking about this differently. Doing the standard stuff for an organization as diverse as Bank of America. So you think about we still have 6,000 financial centers, bank tellers, people working in the financial centers. We've got the huge Merrill Lynch population, right. They don't have time for anything. They don't want to read anything. They just want you to tell them what to do. So, but getting to this very diverse workforce is difficult. And while we did get some good uptake on some of the seasonal mailers that we did, we felt that we needed to do things differently. So, got Stephanie and my Teladoc team together and we sat in a room and we said, how can we think about this differently? We cannot be an organization with as big as we are and as much information as we share with our employees across HR, let alone benefits, to be able to do things on a monthly basis, to send out emails on a monthly basis. It's just not it's not going to be impactful. So, with Teladocs Health and a company that's been mentioned a couple of times here today, Kinza, we decided to do a promotion, a very simple promotion. We basically said for the first 1500 members that register for Teladoc, we're going to send you a free smart thermometer. These costs about $20 you can get them at Target. And we said 1500 because we were averaging about 7 50 registrations a month. We said, all right, we're going to give away a little thermometer. Some people might like it. We'll do 1500 and maybe we'll get double the registrations. Just with that one campaign alone, we got 5,000 registrations in Teladoc in 1 month. So we started to see, okay, if we do things differently, we can really have an impact. The other thing, as I was out talking to various lines of business, they always have their off sites and they want someone from benefits to come and explain what nobody understands. I would start talking about Teladoc. And I'd ask at the beginning, I said, how many people have registered for Teladoc? And you'd see 5 hands. I said, how many people have heard of Teladoc? And you'd see maybe 10 hands. And then you'd get people who had had experiences with Teladoc and they love it. They absolutely love the program. And so we were finding was the people that knew about it and they used it travelers. I said, how many people that have gone on a business trip travelers. I said, how many people that have gone on a business trip have gotten sick, food poisoning, whatever, come down with a cold? What do you do? You're in a city you don't know, though you end up at an urgent care center or emergency room. So we've started thinking about, okay, how are the different ways we can start promoting this program? And so we actually were able to from 2015 to 2016 actually double the number of consultations we were able to achieve just with the Kinza promotion and thinking differently and being out in front of employees and explaining that this benefit existed. So we felt pretty good about that. And so what we ended up doing is saying, okay, we've got a benefit strategy, right? Just like most large organizations, we have a sort of integrated benefit strategy across the function. I said this service is so unique and so much what I believe it to be the future of healthcare in the U. S. Are a big part of it. I said, we need a strategy that's focused just on telemedicine. What do we really want to accomplish when it comes to telemedicine? So that's it right there. It's a blank page. Do you know why my slides? Oh, no, you don't want to see that again. Okay, there we go. So we came up with what are our objectives. And really the core objective is increase awareness and increase utilization. What we found is when people registered for the service, they were much more likely to use it. We see a direct correlation from increased registrations to increased utilization. It might seem obvious, but it was actually a proof point that we're able to find. As we saw those registrations, those utilizations went up. And what we found is, is people started talking to their friends about it. They had a really good experience. So word-of-mouth really helps when it comes to programs like this. And the second thing is really what I talked about earlier. It's got to be convenient, accessible care at a low cost. So I don't know what you guys market as stats now, but our average callback time on a Teladog visit, something like 8 minutes. So if you think about making an appointment for your primary care physician, which is probably not going to be the same day, so now you're a couple of days out. Now you're at work, you've got to get in your car, you got to drive to the office, sit in the waiting room. The doc sees you for maybe 15 minutes if you're lucky, writes your prescription, does whatever, then you're back. You're driving back to the office. You're now gone for 3, 4 hours versus 8 minutes call back, you get the time with the doc, if you need a prescription, they generally write. So we really wanted to be able to do that. And members are getting that care and it's a lower cost. So as I mentioned earlier, average PCP visits, call it anywhere in the area of $150 if you're in New York City, maybe it's $2.50 but I'm from Charlotte where things are much cheaper. And then you've got a Teladoc visit. So in our high deductible plans, it costs $40 for a Teladoc visit. Once you hit your deductible, we cover 80%, only costs 8 dollars So just that financial impact alone is meaningful for a lot of our employees. Monitor the administrative processes and clinical effectiveness of this program. So and we'll talk about what we're going to try to accomplish in a couple of minutes. As the services that Teladoc is offering are expanding, we've heard a lot today about behavioral health, dermatology, things like that. We need to make sure, which is just kind of the way we do things, that Teladoc's administrative processes are effective. We look at our member satisfaction, which is constantly above 90%. And typically when people do those little surveys after a visit, it's the people that want to complain. So at 90% satisfied, we feel pretty good about that. And we also want to make sure that that being provided with the best clinical care, right? You're diagnosing a cough or a cold, that's one thing. You start to get into behavioral health, dermatology, where you're looking at potentially cancerous moles. We feel very comfortable. We actually did an audit, and found that every single one of the docs our members use was board certified and licensed to practice medicine in the state the employee was 100% across the board. So we felt very confident that the core services are being operated the way they're intended to and it gives us more confidence that we can expand these services and really start to build out the breadth of services that Teladoc can offer. And then finally, we constantly measure results and we do look at the financials, right? We do an analysis. Teladoc provides us with an analysis every month actually that shows what's the savings associated with people using Teladoc versus where they would have gone, right? Every single call, every single visit, the person asks, where would you have gone if you didn't use Teladoc? So they say ER, urgent care, PCP specials, you name it. And our savings numbers have increased every year, which is great. But the other thing that we really thought about is, man, this is really going to have an impact on productivity and presenteeism because of the example I gave earlier. And not just that, think about if any of you have young children, kid gets sick 2 am on a Sunday. Where are you going to go? You can use Teladoc or God forbid you end up at the emergency room, now you're there for 4 hours. Not tell me you're going to be at your best Monday morning when you go into the office after sitting in an emergency room for 4 hours. So we think this service can have a real impact on our employees' abilities to be at their jobs and servicing our customers. And that is a business objective for us. So we feel we're able to positively impact the business by offering a product like Teladoc to make sure people are at their desks doing what they need to do on a normal basis to service our customers. So once we built out our objectives, we said, okay, let's kind of build a multiyear plan on how we're going to execute on all this. So I don't know if you guys can that's pretty big, you'd probably read it. So really focusing on increasing awareness and providing convenient care. And I'm going to focus on the top half, we'll speak a little bit on the bottom. So me and a couple of colleagues got together and we said we need to think about who we're marketing to in different ways. And Stephanie hit on a lot of this earlier, right? You cannot market a program that is for people with sick children to people that don't have any kids, right? So we said, what are the segments we think this program can be the most effective with? And we came up with 1, new hires, right? Get to them early. When they start working at Bank of America, make sure they understand this program is available because once they get into their day to day job, it get lost. So we've done a couple of things. We do new hire orientations on benefits. It's we get 20 or so minutes to talk about kind of medical. We put in a page specifically on Teladoc and those materials. So our new hires recognize off the bat, they've got this benefit available too. We're also doing new welcome letters. So any new employee that comes on board, they get a Teladoc specific welcome kit. We do welcome kits for our health plans too. What we've done is we've customized those. So now there is a page on Teladoc in those welcome kits. We also did something which I think is pretty cool. We basically sort of looked at a continuum of ailments, if you will, everything from I've broken my arm to I have a cold. And we tell people here are the places you might go, right? I don't want somebody with a cold in the emergency room. So we say, hey, you've got Teladoc. If you have these types of things, use Teladoc. If you have these types of things, use an urgent care center all the way to the emergency room. To get people thinking about there are different places you can receive care and the care is just as good. It really depends on what your issues are. We started talking about college students in recent grads, right? You send your kid off to college and they probably got the student health center that they can go to. But again, late at night, they're in a place they're not familiar with, where are they going to go? They're going to have an emergency room. So we're going to do a specific mailing to people with kids of the ages of 18 to 26. Now I'm sure we're going to get some 24 year olds that are still living in their parents' basement, hey, that's fine. But the ones that are actually out in the world are getting a higher education or have recently left home, taken a job, in a city they're not familiar with. This is a great thing to sort of make sure they're aware of the program. We do a pretty basic wellness program. So we ask our employees to get a biometric screening and to complete a health questionnaire. They do it, they get a $500 reduction in their premium annually. Spouse does it, they get another $500 We get unbelievable participation. Maybe 85 percent of our employees actually complete these activities. What we do on-site, because obviously Bank of America, we've got a lot of really big locations. So One Bryant Park here in Manhattan, we've got about 5,000 employees that sit just in that building. So we actually go on-site and allow employees to come in and get their biometrics done and get flu shot too. Well, I said, wow, what a great thing if we could bring Teladoc out to some of these. And so what we did was we looked at our ER utilization in specific markets. And there are markets where the numbers would blow you away. St. Louis for some reason, I don't know why, has ER utilization per 1,000 that's something in the neighborhood of 325 visits per 1,000 for an emergency room versus our average, which is less than 200. So we said, all right, great. So we have Teladoc going out, sitting at the on sites, they have a little booth, people can come up and they're getting a great response. People have said, I didn't realize this existed, unfortunately. I'm like, you should read the communications, I send you constantly. But they're being explained the program and my guess is out of the 15 or so on sites that they're attending this year, we're going to see utilization spike in all those markets. So we're pretty excited about that. Kinza, which we've talked about, our initial promotion was just giving out the 1500 people that registered got a free thermometer. We're actually looking to do something different. So, one of the worst markets for ER utilization is Dallas, Dallas and Fort Worth. Our ER utilization per 1,000 in that market is 350. It's by far our highest. And if anybody's ever been to Dallas or just driven down the highway, what you will see is every other billboard is for freestanding emergency rooms, but they're not really called emergency rooms. They say, come here, you only wait 15 minutes to get care and then like 2 fonts at the bottom, it says, by the way, this is an emergency room, it's going to cost you $1500 if you come see us. People think they're urgent care centers. And so it's just I've never seen a market like it. So what we're going to be doing is we're going to give to our basically 11,000 employees in that market, we're going to give them all a free Kinza thermometer. When they load the application onto their phone for the Kinza thermometer and they use it, we're actually going to be able to push message that says a thing will fly up and say, by the way, did you know you have Teladoc? Click here just to have an appointment if you're registered or click here to register. So really looking at ways where we think we can impact ER utilization, which ultimately is going to help us in the long run, less people go to the emergency room, our employees, because a lot of times they see these billboards, they think they're going to pay $100 They don't realize they're going to get a bill for $1500 And the average salary in that area is typically less than $50,000 People can't afford that. So really looking to try to have an impact on that specific market with this specific promotion partnering with Teladoc and Kinza. I mentioned business travelers. We're going to try to do specific communications to business travelers. We have a newsletter that basically give you travel more than I want to say it's a couple of times a month you get this business traveler newsletter. We're going to be able to actually put in Teladoc promotion in that. So people that read it, they're on the road. We're giving out wallet cards, so they have them with them, so it's accessible. New parent kits, one of the things you may have read, in 2016, we extended our parental leave for a maternity, paternity and adoption to 16 weeks. In addition to that, we send our new parents, these new parent kits. It comes with a Kinzua thermometer, some gift cards, stuff like that. We're now going to be putting in specific marketing materials for Teladoc into those kits. So that new mother who has a child of especially first one, right, doesn't know what to do when the kid gets sick, they're going to have that information at hand. They can possibly hopefully use Teladoc and get that taken care of without having to go to the emergency room. And then as I mentioned, we're looking to expand our services. I mean, I think the telemedicine industry and specifically Teladoc, who I personally believe is a leader in the industry, which is why we work with them, these services are right? So after the providers right? Talk to the providers, they say they're not going to pay me enough. I can't live off the negotiated rate they want me to take. Talking to insurance companies, they say, well, they're not going to take any discount for them to be in the network, so they're on the network. The worst thing you could have is someone with a behavioral health issue or event calling a psychiatrist or psychologist and saying, okay, great, we'll see in 4 months because then it's just going to get worse. So having ready access to a behavioral health specialist through Teladoc is hopefully going to start to change and cure what is a broad U. S.-based issue. This is not just an insurance company issue or a Bank of America issue. This is a U. S.-based issue. So we personally are excited for behavioral health, dermatology, sexual health, and we will continue to look to expand our Teladoc offering into the future. And because I think it really as you all look to make more strategic acquisitions, best doctors, things like that, it really does become sort of a fully integrated telemedicine model. And I think it can be really beneficial to our employees and their family members in the future. So with that, I've got 8.5 minutes, so I went quickly, but I'm from New Jersey, so I talk fast. I think we can open it up to questions. Yes. So the question was about utilization over time. So in 2015, which is when we introduced it, the utilization was as I mentioned, the registrations and the utilization weren't what we thought they were going to be. We got an initial pickup when we rolled it out and then we kind of were doing the standard mailings and it sort of dropped off. And then again, when registrations are low utilization as well. I think as we focused on more targeted communications, the giveaways, we saw our utilization double in 20 16. I think we're going to see it's not going to double for 2017, but probably go up by around 30%, 40%. I don't like to give numbers. Are you in a 5% to 6% range today for utilization? It's higher than that. Yes, it's higher than 5%. What's your goal of getting into? J. Rice:] Well, my first goal is 100% registration. I would like every single person in our self funded health plans to be registered for this service because I don't think there is one person out there that cannot benefit from the service. Now, will we get there? Maybe over time. I think a lot of this stuff is going to have an impact. And then we're going to be measuring all of these different initiatives. So this thing we're doing in Dallas, if this works, we'll probably roll it out nationwide. So I'd love to get 100% registration. Who is your highest utilizer as far as consultations go? What percentage? I think we're at we had one client at the summit where you were who had 80%, I think 82%. I just want to be better than that. It's a good question. So the question was, do we see more utilization in the high deductible plans and the co pay plans? The answer is yes. For our we do offer a PPO plan still. It's only offered to employees who are in less than $100,000 and it does have PCP visit, a $15 co pay and we charge them $15 for Teladoc. So yes, we do see higher utilization with folks in our higher deductible plans, which kind of expected, right? So but again, we still see fair amount of utilization in our PPO because of the convenience factor. Sorry, did you have another question? Just a quick follow-up. Do you use that doctor right now? We don't. We don't. We don't offer a second medical opinion service. I've spoken to the best doctors folks. Actually, company I was at prior to had best doctors. I think that service and the core Teladoc services is a perfect match, because again, and I know the spectrum slides they showed earlier, one sort of the top 3% generating We will be evaluating best doctors as an organization. We will be evaluating best doctors as an organization. It's a fairly new acquisition in Bank of America. It takes a really long time to onboard a new vendor, which a lot of vendors don't realize when they come talk to us, but it takes at least a year just to get through our information security requirements and things like that, but it's definitely something we'll evaluate in the future. Yes, sir? Sure. Yes, absolutely. So the question was, how collaborative is the development of this multiyear execution plan? The thing the one thing that we did on our own was come up with these objectives. That was us. Once we did, we had the Teladoc team come in and we said, look, here's what we're trying to accomplish. And Stephanie and team have been great about helping us think sort of differently about how they typically do things and how we typically do things. They took the time to understand our organization, the differences in the demographic makeup of our organization. So it's been a very collaborative experience. I have one of my partners on my, what we call, portfolio administration team that works probably daily with the Teladoc team. So this whole idea of measuring productivity, we came up with that together and then Stephanie was bringing in some of their analytics people to say, hey, here's how we might do this. And has really helped us with that analysis as we're sort of building business cases to expand this. They've been at the table the entire time. Sure, sure. So, the first question was we do our own utilization and savings analysis in Teladoc. They're very close. We end up using their average cost numbers because, right, the average cost of a PCP is going to vary wildly depending on where you get it if you're here in New York. So our big concentrations of employees are New York City, Florida, Texas, California, Arizona, all California, I think I said, all vastly different than what the cost of health care is. So we actually use their numbers to do the savings estimate. So we rely very heavily on them for that. And then the second question was on the productivity measure. So we've taken a very conservative approach to that to start because I cannot make the assumption that someone who's utilizing Teladoc on a Saturday night or a Sunday night is the primary person working at the bank or if that really had an impact on them being productive at work. So what we did was, we basically looked at visits that took place between about 8 and 5:30 during the week and then came up with we have an average wage, obviously, And then just basically came up with, okay, what's the average amount of time dependent upon the service that person would have used, ER visit, PCP, and that effectively is our saved work hours. And so that's how we're looking at it right now. We quantified it, but it's really less about quantifying the dollars. It's really more about sort of proving that this type of service is actually keeping people at their desks servicing our customers and we think we have an impact by doing that. Yes? Yes. Well, the bank doesn't pay me unfortunately. So my cost is 0 now. We do. We actually bring in cost of thermometers. What we really don't look at is the amount of time that we typically is like the number of hours that we spend, but anything. So our communications team internally helps with communications. So there's direct costs associated with that. That gets built into it. If we're distributing any of those, so we distributed thermometers through an internal group, costs associated with that, that gets built into it as well. So we try to take as much into consideration to get really that true ROI on it. That way we know, okay, what's really having an impact because we are trying some things that are kind of new and different and haven't really been done. Yes? Any variation in utilization? So the question was any differentiation and utilization by geography and age range. We've not really looked at it by geography. What we had focused on when it came to geography was problem areas for core medical usage. So the Dallas example I gave, I looked at every single market where we have high ER utilization. The Onsites, very high ER utilization. And I actually haven't looked at it from an age basis either, so I can't answer your question unfortunately. But it's interesting. I'll take that back and look. Maybe next year I'll come back and tell you about it. So I think we're out of time. Matt's been very, very kind. He was on the road for 3 weeks leading up to this meeting with employees, certain segments of the population and he's got people flying into Charlotte for Thanksgiving. So he squeezed this in the middle. Feel pressured, Stacy. We're going to let him go, but thanks so much. Thank you so much, Jason. Good to see you as always. And so with that, we're going to move on to 2 last sections. One, Doctor. Alan Roga is going to come up and talk to you about our hospital and health system market. I met Alan several years ago and courted him for a long time as he was the CEO of a company called STAT Health, who was I would say a tangential competitor in the telehealth space. He had focused a lot more of his efforts as an emergency physician, a former hospital administrator on penetrating the hospital and health system market. I said, come join forces with us and we wanted we want you to lead our effort going after that segment because although historically we haven't seen that segment buying, I think the market is poised to go there. And in fact, your company has proven that there's a real market there. So Alan is going to walk us through his market and what the key factors for success are. Thank you. Good afternoon, everybody. I think part of the reason why Jason quoted me is because he looks tall standing next to me. So that being said, a little bit about Jake, obviously, had a nice introduction. And I think as Matt was talking about before, ER is bad, they're getting a bad rap today, expensive areas. Well, that was the first half of my career. So, I don't know, I don't practice anymore. Along the way, I took care of what was Chairman of a midsized hospital system, very brief bio, 3 hospitals, we saw 150,000 patients in a year and what was my job, how to get more in faster, right? So I took over an ER that was struggling, ERs that were struggling, We had 4 hour wait times. We had 60 percent outpatient satisfaction scores. And by doing a throughput project, ended up taking that to a 15 minute wait time and 95% of patient satisfaction. That was great. And then after that, took over running a practice management group where the job was drive more revenue in. So in 3 years, took it from $15,000,000 to $30,000,000 put that on path to acquisition by a public company, But then had an epiphany in 2,009, a lot of what we heard about before, which was charging someone $2,000 because their kid had pink eye and ended up in my ER because they couldn't get their primary care doctor was no longer professionally satisfying. So did a startup, called stat doctors, led that ultimately acquisition by Teladoc, and it's been a great run. So I've been in this space now 8 years. I love being in it. It's a very smart spot. You're all smart for being here. And we're going to talk about the health system market. So you're very familiar with the core Teladoc value proposition. By the way, three things we'll talk about today. We'll talk about really why hospitals are buying, we're the value drivers, how does our solution meet those needs And then why are we winning? We've had great success in this market, 120% growth in number of hospitals year to date through 2017 and doing wonderfully in it. So you're familiar with the core value proposition in Teladoc. We keep employees and patients have plans out of the ER and urgent care centers, save the health plan money and keep people at work. In the provider space, in the health system market, it really is a strategic alignment of the telehealth program to the organizational goals. Number 1 criteria for success for a system. And there are 3 main value drivers. They're around finance, they're on access to care and then really around a growth strategy to grab market share. And each of them have use cases around them. So on the finance side, anywhere where a system is taking financial risk, there's an ROI and there's an ROI year 1. So whether it's with their employees as a large self funded employer or they've got an ACO, a pop health program, readmission payment bundles, anywhere where they have dollars at risk, we provide a viable solution. On access to care, this is, of course, where we're extending their reach, so they can load all of their providers and be having virtual consults with their patients, balance load resources between the facilities. So all the neurologists might be at one hospital and has to consult another one, graduate medical education, and of course, all this information integrated into the electronic health records. And the last one is around a growth strategy, which is to grab market share. It really comes down to 2 things, around new patient acquisition and retention of their existing patients. And they did that either through local employers, messaging their populations that they currently serve or through direct to consumer programs. So a little bit more around the value drivers of what works for health systems. So I've been in telehealth now for 8 years like Jason and have seen this market evolve. I've started firmly in the employer space, had great results and success, went to the payer space and now we are seeing it in the provider space. So in the provider space, in the health system market, great, great growth and interest. And we didn't see this 5 years ago, but we've really seen it in the last few years. We've had 250% increase in the number of RFPs year to date, year on year. Again, I told you about 120 percent growth in the number of hospitals that we're serving now and the hospitals are now buying. And let me back up for a second around this market. So it's a big market and has sub segments in it. So on the hospital side, you have acute care hospitals, long term care facilities, psychiatric hospitals, rehab hospitals, so lots of hospitals. You have freestanding facilities. So the bad freestanding ERs that we heard about from Matt in Texas, they're charging a small fortune, urgent care centers, retail centers, physician practices, so individual, multi specialty, IPAs, payer owned provider programs. So 40% of the payers that have over 10,000 lives in the United States are actually owned by a provider. What we are focused on right now in today's timing is the acute care hospital market. If you think about it, that's the market that's buying right now. And if you think about it, it makes sense. So because the tailwinds are strong. They're under intense pressure to reduce their operating costs. There's a shortage of providers and they're having payment reform. How they get paid is different. And if you think about the tailwinds for telehealth, positive regulatory changes, right, they have these electronic health records that have been installed, so they're better integrated and better connected than they've ever been, and there's a lot of consolidation. Those features unlock the potential for telehealth. Two reasons mainly why they come to us. So we talked about the value drivers. They come to us because they're looking to better manage their financial risk and they believe they have a competitive advantage in the market, either as a first mover or responding to a competitive threat. So we took a look at the health system market. We did a survey of 180 hospital executives on their thoughts of telehealth and here are some of their insights. First off was and we just did this in December 2016, 37% were actually going to be implementing telehealth in the next 4 months. So they were looking at telehealth programs actively. We hadn't seen that before. 83% rated as a high priority initiative, so that's good. It's important to them. They've declared it. But we found this one interesting. So 80% of the programs, if they had 1, which was the minority, had in place for less than 3 years. And you might say, well, is that good or bad? That's actually we found a really good thing, because the minority, which actually did have a program in place, they were testing the waters with either something they did internally or they looked at a video solution only, and they realized they needed a delivery system. So actually we've been successful now in displacing those companies, because the Axcelsus has now realized they need a more comprehensive program. And 81% have a dedicated person in charge of it. So they're actually installing now directors of telehealth. So the market needs are actually driving their operational needs, which are now driving buying processes for them. So we now have formalized buying processes with these folks in place. Last thing I'll leave you with around the market, 69% actually are increasing their telehealth programs, which for us represents upsell opportunities and increased revenue opportunities. So a little flavor for what the hospital and the health system market looks like. So what is the solution that we sell? So when we work with employers or players, it's predominantly our engagement marketing, our technology and our doctors to drive to an outcome. When we work with health systems, we're ultimately looking to build their business and brand. And at the core of our offering is a SaaS based model that's able to be private labeled. And really, there are a few features that we enter this market with that are our competitive moats. First is, we operate a dedicated team. So we develop subject matter expertise, there's technology resources, marketing, sales, account management that it's not news to us that they're going to care about how do we integrate with their electronic health records or what do those things need. So the needs of this market are different and actually helps us be better able to meet our clients' needs. At the core of our solution is a licensable software, so it's a SaaS based model. We have an extremely strong partnership with Microsoft. We've hosted in Azure for years. We've actually built in Azure. But what's important about that is that we give each system their own instance of software. And that yields a great degree of reliability and configurability because what they want is to make sure the software meets that health systems workflows, and that's unique in the market. And the last is that we surround that software with really unmatched operational support. So going around the dial, not only as a private label solution, so their own mobile app and Itunes and Google and their own brands, but we're the only company that has internalized all the end to end touch points with a member and a patient, which allows us to control the satisfaction. As Jason indicated, when we bring a client to Lewisville, it's great, because then they see what it takes to do telehealth at scale and they select us. And they realize that they need an entire delivery system model, not just software. And that is what this is about for them. They can use our network. So of course, our network provider network does general medical care, behavioral health dermatology. They can use our network for those features. That's different than if they want to put all their orthopedists on the platform to do post surgical care. But often they use our network in some capacity at least for general medical care. And as you heard Stephanie talk about our success with driving adoption, which is very important to these systems. So we have not only assets, but the intellectual property know how to help them drive adoption. So we give them really this comprehensive solution and that's how it meets their needs and the value drivers. Briefly just to introduce the software and the pricing. So again, SaaS based model, features that are germane to this market, they care a lot about mobile. So mobile app in Itunes and Google, not only on patient side, but provider side, heavy use of videos, about 8%, 9% actually we use video in this market, because the providers want to actually see their patients a lot, especially on some of these use cases that we've talked about. And how do we drive or what do we actually price and where the solution look like. So own instance, private label software, we surround it with all the Teladoc capabilities that I mentioned, but it's a SaaS model. So there are really 3 components of the pricing structure. The first are one time fees, so professional services fees to get them implemented, EHR integration, training for the physicians, so we get them up and running. Then there's the SaaS model. So that's our annual license fees, which has very typical SaaS margins. And then we have transactional fees, if they use our service, if they use our providers or every time they hit the platform with their providers. So those are 3 broad strokes of the components for pricing. On the solution itself, so why are we having great success? Why are we winning? I would tell you that when Jason and I started talking many years ago, we had a vision if we could take that core software and surround it with the Teladoc capabilities, we'd have an unmatched product in the market. And we've executed that very well together. So on the left hand side of the puzzle, I'd say these are sort of the Telvac capabilities. The Telvac brand, very strong, right? These systems are risk adverse. They want to make sure we obviously are financially solvent. We've got the infrastructure to help them succeed. We have brand recognition, putting a team around it. So we are again nimble, better able to meet their needs on the software side. So their own instance is powerful, right, protects their security and data, also provides them the reliability and configurability they're looking for. And then we've talked about all those operational components. They see what it takes to do this at scale, and either they and they come to realization that either they have to build those capabilities or they have to work through us. So how have we done? Intentionally entered the market around January of 2016 post acquisition of STAT Doctors and post integration. So failing during the market, 2016 to 2017, of course, we had the growth to about 90 hospitals and then now we're at 206 as of November of this year. So about 120% growth this year and very, very strong going into next year. As we look at recent wins, so some nice logos there. Our clients span from critical access hospitals all the way to prestigious academic medical centers. I'm pleased to report that we are 11 and 0 head to head with the 2nd largest competitor in the space, directly competing with them on her last 11 deals. We're really getting a lot of traction right now. And we have some strong partnership chips, I should say. So Microsoft, we're a Tier 1 solution with them. So that's the highest level of partnership you can have with Microsoft. And we've earned the endorsement from the American Hospital Association. So they did a competitive process where they looked at all the software vendors out there. And of course, we're more than just a software vendor. But specifically for our software, they've given us their exclusive endorsement for software in this space. And the last thing I'll leave you with partnership before we open up to questions is you've heard about some of our existing distribution partners, Aetna, UMR, Blues, these all have relationships with provider organizations. So what's exciting for us is we're actually now starting to see the ability to capitalize on those existing distribution partners as we bring the solution to the health systems and hospitals. So I think you took time away from me, but I'll go. I did not. I gave you your allotted time. You filled it well. We have time for about one question before we move to Mark's financial section. Jamie? Sure. So the question was how important equipment is to provider organizations. And there's 2 full parts of that I'll answer. The solution that we offer software based has open APIs, we integrate with the components out there, blood pressure, pulse, stethoscope, all the peripherals that people are looking for. What we found in practice is that a lot of the systems, I would say there's not a uniform approach to equipment and devices, if that's where you're headed. So the software component, they like consumer facing, mobile, they can reach them where they want. As Dan indicated earlier, on the device side, they're kind of all over the map and the use cases are all a little different. We found that while we have the capability to integrate with a lot of them, the use cases are very narrow by system and their desires seem to be shrinking, as far as unless they're looking at having that patient self administer, putting an otoscope in their ear or blood pressure cuff on their own, then they're usually going to have a nurse assistant, the nurse tech or someone clinically able to put that on there. Then the integration needs are not as important as having that other provider there to help facilitate the exam. So the question was, do we see ourselves having a lot of equipment in the long run? I can give you my answer, but I'm going to look at the boss for a second. We would give the same answer, which is that we don't really want to be in the device manufacturing business. We want to be interoperable with whatever technologies emerge. If we can integrate with sort of many to many past. But yes, that manufacturing devices isn't really our business. All right. I think all right, Steve. Alan will be around after, but we're going to move through. We're trying to keep everybody on time. And I know everyone wants to get to the section on financial metrics. And I don't think I have to introduce Mark. I think you all know Mark well enough and he can take us away. I'm going to be uncharacteristically rapid in trying to complete this in my 15 or 20 minutes. But I think what was very apparent to me and should hopefully come across to all of you over these past few hours, People have always asked us what's your competitive advantage. Well, all of my colleagues that just came up here to present and also some of the passion of some of our clients. With both Matt and Chet, it should be apparent to everyone that as a result of not only the skill and the passion of our colleagues up here today that you've met, since most of you have only really met me or Jason in the past, the fact is we execute and we deliver that ROI and we deliver that very high satisfaction level. And the fact is, we are generating that return for our clients across the entire spectrum. If you if we were fortunate enough to have Matt as well as Chet and individuals who are that educated and aware of the benefits to their respective companies throughout our entire 10,000 plus base, utilization would of course come up to levels that we think are potentially achievable over the next several years. We're not talking about high single digits. We're talking about 30%, 40%, 50% and not just with products that we have today, but those additional services that you know will continue to roll out over the next several years. Most of you are familiar with the financials and the results that we've had over the last several years as Jason began today's presentation with the fact that we want to keep and we come to work every day looking to keep our promises. Our revenue growth today, if you annualize where we are in the Q4, we're already at a $304,000,000 run rate. Most of the numbers out there and expectations for 2018, 25 plus percent growth, you could see where we are today and what we would need to do to achieve that level of growth into 2018. Members, we're going to go through the next several pages and I'll help describe how we're going to actually address the membership numbers in addition to those 3 new contracts that Jason spoke of today, we also introduced obviously the fully insured Aetna population, how we will be accounting for that, how we'll be reporting that so that you can track individually certain distinct lines of our business and the returns on that business. Visits, you can see as well, we've grown 100 we've grown 1,000 basis points each year 2014 to 2017. I think what's compelling is that in 2015, just 2 days 2 years ago, we completed $77,000,000 We'll probably exceed that number in the Q4. Rapid growth. Coming down to the PEPM, we spoke about how best doctors has impacted our PEPM from 2014 where we always spoke about how we'd start achieving a nickel, maybe a dime each year as we keep growing forward. You see we went from $0.40 to $0.52 in $0.16 We're now at about $0.91 We'll be hopefully moving past $1 in 2018. This is all about keeping promises. The fact is we are extremely transparent. We give a great level of detail and we set our expectations to numbers that we believe we could achieve. We obviously have a great degree of visibility into each subsequent year's financial results. Why is that? Because traditional Teladoc has been anywhere between 80% 85% subscription access fees. Those fees come under contract, committed contracts from thousands of employers around the nation and we are under contract at the beginning of each calendar year. The remaining 10% to 15% of our revenues are generated by those variable transaction fees each time we complete a visit. Now, there's certainly a good degree of contracts today that are at the high PPM that include unlimited number of visits up to a certain cap and those don't generate additional visit fees. But those that do, we have a great degree of predictability as to both the number of visits, the breakout between the number of visits that generate additional visit fees, those that are in the visits included contracts and of course the revenue that we expect to generate from those visits. So when we talk today about having visibility beyond 90% into our 2018 revenues, that comes about from a consolidated view of about 85 percent of our revenue coming in from a subscription access fee base, again, those that are under contract as we enter the New Year and the remaining 15% coming from the delivery of those respective visits. If we look today about what we had promised to do, as you can see, that $76,000,000 $77,000,000 or so, we are currently generating positive adjusted EBITDA. That was we hit this big inflection point this year. That was a promise that we made 2.5 years ago. We obviously went through a couple very significant transactions. But as we've noted in the past, on a standalone basis, we hit positive adjusted EBITDA. Obviously, with the addition of best doctors this summer, that positive EBITDA is a little bit stronger. When you think about where we are on a reported basis, you can see exactly where we are now getting some leverage, dollars 232,000,000 and that is the GAAP numbers for this year. Again, on a run rate basis, we're at $304,000,000 for calendar year 2017. You should expect to see the continuation you expect to see OpEx as a percentage of revenue continue to decline. I've spoken in the past, in fact, many times we've addressed the fact that we are going to see OpEx continue to decline as revenue growth outpaces OpEx growth. We're clearly on a path today where positive EBITDA is going to be the story or positive adjusted EBITDA will continue to be the story through 2018. The PEPM we've spoken about, we have also I've told you we expect a $0.01 to $0.10 per year. We continue to see very, very high priced PPM product coming through the Healthiest You platform, coming through the best doctors contribution. And obviously, as Alan just spoke, if you think about the 3 fastest components of revenue, those that are contributing to the growth today, the fastest component in absolute percentage is Allen's provider product. The next would most likely be our behavioral health, which is When you think about the visits included, you should think about a number that is often anywhere from 5 to 6 times the $0.70 and obviously 3 to 4 times that $0.91 Those sales continue to bring our average per member per month fees up on a quarter to quarter basis. So we've been asked throughout the last several months now, following the Aetna news, following the FEP news, if we could give a little more granularity into helping people model what we believe and what we measure as our or what we use as our key performance metrics and how we measure success. So we've now and this will be commencing January 1, 2018. I'm going to go through these areas so that in great detail, you can all appreciate and understand how we're going to be reporting going forward, again, giving you the opportunity to track our progress throughout the year. U. S. Paid members, and I see some of you writing this down. This presentation is on the Teladoc IR website and will be there for the rest of the month. In fact, it will be there for 4 weeks or so. U. S. Paid membership, everybody's into acronyms, so USPM, that's going to be our paid membership. As you think of it today, every single individual that's got a sponsoring organization, a health plan or an employer that is actually paying for access to Teladoc services. We are receiving a fee from them. What does it exclude? Well, you already know that it excludes the Aetna fully insured lives, about 4,000,000 lives. That Aetna body of lives, that 4,000,000, their per member per month revenue has been decreasing from October 1. We told most people that where it was for multiple years, it was coming down October 1 and it completely we completely eliminated on January 1st in lieu of that much higher visit fee. We've dropped out the Amerigroup lives, which we've addressed before about $1,700,000 lives. We sat behind and had very limited usage on that. We've spoken to people about the insignificance and how that was only a couple of 100 visits. FEP, 9,000,000 individuals that are eventually going to have access to Teladoc. It's going to exclude the TRICARE 9,000,000 FEP we spoke about, which was about 5,000,000 Complex cases is when we think about the traditional best doctor services from the health plans, again, that's what Chet Brown, CareFirst as well as a lot of the other health plans in the U. S. Pay for. On a case by case, episode by episode basis. Think of those again in excess of $5,000 per occurrence. And international, we've spoken about and you heard from one of our members regarding and actually identifying yourself as a policyholder, people who receive a vast array of benefits through their financial services companies or through their insurance companies and they get access as one of many, many services in their benefits and their policies, they get access to best doctors. And of course, in certain countries as we expand, they'll have access to best doctors and Teladoc. We'll exclude those from this USPM number. Per employee per month, very simple. The revenues from the U. S. Paid membership divided by those subscription access fees. U. S. Paid members, paid member visits, visits from the top, the USPM. So we're going see in certainly in Matt's case, for instance, at Bank of America. He looks at utilization the same way on a macro basis we'll be identifying utilization from a client that's paying a subscription access fee for each of their employees, giving access to employees and beneficiaries and dividing that annually over the number of actual visits that are completed, that's your utilization rate there. Visit fee only visits, we identified in the second bullet up here under USPM, those lives that are excluded. Visit fee only visits will include all of those lives that we don't have experience with today other than the Aetna fully insured. People have asked and I'm going to address it now just to, of course, what is behind everybody's mind. We have spoken about the tens of thousands of visits we do for Aetna fully insured today. The understanding is that we have to increase Aetna fully insured utilization by somewhere around 50% between 2017 2018 to get to that neutral production, to make sure that whatever 1,000,000 of dollars and again I appreciate there's a number out there or a range of numbers out there, but whatever 1,000,000 of dollars was generated in 2017, we're extremely confident through Stephanie's team's initiatives and other things that we're doing that we'll be able to replace that revenue on a full visit fee only basis in 2018. FEP is 5,000,000 members. TRICARE is 9,000,000 members. This is 14,000,000 members who are just being introduced to the Teladoc services in 2018. We'll obviously experience a tremendous amount of variability because we'll start seeing utilization increasing as exposure to and awareness to our services increases throughout 2018. Complex cases in other groups we've spoken about as well. Utilization, I think I spoke to also. And now we get to the revenue metrics, those numbers that you're normally used to seeing on our 10 ks. We obviously get into much more detail in the 10 Q and on the ks than we do in the press releases. We've always reported a and we've been consistent in reporting some of these metrics in the press release, but I would suggest that all of you go to those 10 Qs and look at the finer levels of detail that we'll provide in order to give you some good retrospective understanding of what we have done in the past. But prospectively, looking at your models, you'll see a greater level of detail that we'll be providing in order to help you build out that model throughout 2018 and beyond. Subscription access fees, as you know, the USPM times the PEPM. International access fees, we're only going to report one line. Again, international today is going to represent around 15% of our revenues. That's all going to be subscription access fees. Today, there isn't a client, there isn't a current client that's generating episodic revenues that are going to lead to this. However, we do have growth expectations and we do believe that business development opportunities will help us achieve a certain number of business opportunities that will add to and help us create a greater international presence on the revenue side. U. S. Paid membership revenue, I think we've gone into enough cases. Visit fee only revenue, again, this is what we'll be breaking out on the face of our press releases and again giving more detail behind that as number of lives that are generating those respective revenues. When people ask about the average per visit fees, now you're going to have a number of components. When we were tracking to $38, dollars 40 dollars 42 over the last several years, everybody is going to begin to start seeing some jumps. As Jason noted, we didn't get into much detail behind TRICARE, but the TRICARE visit fee is in excess of $45 Couple of dollars in excess of that. As we start seeing that rolling in, that's going to positively impact our average visit fee. You've got an average visit fee with the Aetna fully insured, again, about 4 times that, which they had paid previously. FEP is a visit fee as well. Again, I want to make sure everybody appreciates the fact that with TRICARE, it's not just the visit fee that we encounter. We have a contractual minimum that we will be reporting each and every quarter. It's up to us, it's up to TRICARE to make this contract work. But in order for us to get behind this and to operationalize the business to ensure that we could deliver on a very fast ramp and that we could execute where millions of members are going to be turned on to a service. And while we may see tenths of a percentage of utilization creep up, those are all material amounts. Just to give you an idea, this level of visits, right, from the visit fee only, we'd expect that on a run rate basis to be in excess of 100 of 1,000 at the end of 2018. When you think about numbers of visits approximating 1,500,000 at the end of this year and run rate, this is going to start contributing very substantially to the company's revenues exiting 2018. Okay. We've gone through most of the revenues. I think some of the questions and the detail and the actual granularity of both PEPM and members has come up a number of times, so we want to address that here. I expect a few questions after this as well. Let me just make sure that everybody appreciates that the green that you see, the green bars you should be familiar with those because that's the PEPM that we've been reporting over the last year. You see quarterly from $0.55 up to $0.91 You see a few jumps, why that jump took place, best doctors in the Q3. What our pro form a has done is as we've taken out and what we've done in removing the Amerigroup lives, you see where we are today. And on the same in the same vein, members, we've reported in the green bars, the $23,000,000 most people are familiar with. As we enter January 1, if nothing else has affected us and if there's other contracts that we may close between now and then. You're going to start the year with membership as defined U. S. Paid membership of 18,000,000 dollars Balance sheet, and again, we'll get back to those pages when questions come up. We've got plenty of liquidity. On the financing page, we addressed equity financings. Obviously, most of you know that in the summer, we completed $450,000,000 of debt financing of convert for $275,000,000 senior secured about 8.5%, Now it's 8.7 percent LIBOR has moved up a little bit, on $175,000,000 senior secured piece. While we've got outstanding that $450,000,000 the covenants are extremely light, basically revenue growth of about 10%. Clearly, if we don't exceed those numbers, Jason and I are looking for other careers. We're in good shape. We have over $160,000,000 I repeat that we are already operating at adjusted EBITDA positive results. So we find ourselves in an enviable position to both have the liquidity, have the flexibility to continue going through 2018 to be opportunistic about potentially inorganic opportunities, but focusing on the integration of best doctors, the cross selling opportunities and achieving so many of the things that Dan and others had presented over the past several hours. So that might have been the first time in my entire life that I left myself with 5 minutes for questions. Lisa's hand went up first, Mohan. Approximately 50%. Right. So I think, had Matt been presented with the question of, do you think another company could have generated this type of return for you and this type of success without a PEPM, I'm sure the answer would have been consistent with what I'm going to tell you. So we are going to use what in the past we knew we were investing and reinvesting into that membership. So in this case, we've identified programs, we've identified incentives for Aetna members and we've identified for Aetna the amount of money we believe we're going to have to invest to generate those revenues that are equivalent to what we had in 2017. While that is going to be several 1,000,000 of dollars, that's all part of and incorporated into our multiyear plan with Aetna to generate again not only those returns, but a net margin and a net profit on each member's visit that will be consistent over a 2 or 3 year period to what we had seen in the past. I know you always want exact numbers, Lisa. They're not going to come out on a per client basis. Can't do that. 2018. We'll call out the fact that if you think if we didn't change utilization at all today, we'd already have in excess of half of that contract's value if we just left it completely alone and left it to Aetna. So when we think about those 1,000,000 of dollars, it's a couple percent of our revenue. If we're addressing the opportunity to increase couple percent of revenue with a disproportionate spend that's so egregious, there's something wrong there. And we're not doing that and thus to call it out doesn't really it would be exceptional to call it out on a per client basis. If there's an opportunity with another client where there's a brand new opportunity, again, being very creative and taking a bespoke contract opportunity like TRICARE or something that evolves with FEP over the years, we'll call those things out. But in this case, we don't think it's warranted. Moe? Two questions. I think you and Jason, both of you said So the question was, how do we frame up our 90% visibility into our 2018 figures? And that's really based on our internal numbers, those that we have provided to our Board as our objectives for 2018. Again, we're familiar with the range of revenue growth, the range of all the different metrics that are published out there today. So I could at least tell you that we're in an appreciably small range of the minmax. So we're in a number that you'd all find you wouldn't be shocked with the number. Sean? Are you going to give us the number of lives in your fee based business? I don't know your the acronyms yet. Yes. So the fee based business that underlying a PEPM relationship? No. Not a PEPM. So visit fee only? There you go. VFO. Yes. So VFO, you're going to get number of lives in the U. S. You won't have number of lives internationally because it's an irrelevant number. We'll be able to track the utilization of the Fizz FD? Exactly. Exactly. So many of you have asked to have the ability to track visit fee only results or returns from those, let's say, half dozen significant clients today that have joined us over the last several quarters, you clearly will be able to do that. Yes? The rate base is today, what percentage of your revenue comes from the provider for you business? That's under 5%. But again, that business is growing faster on an absolute basis than any other aspect of our business. Yes? Question was how many members that we had through Best Doctors. Best Doctors had somewhere slightly over 2,500,000 members. There was some overlay where with those similar 40 or so logos, there was about 650,000 lives that are paying for both Best Doctors and Teladoc under standalone contracts. So if you net out, you're at about 2,000,000 The difference was at that time, our inability to actually pull out those lives that were in fact handled they were both Teladoc lives and best doctors lives as well as the fact that there were some contracts in flux and we wanted to make sure following that quarter how many lives were staying on in Best Doctors. Yes. Yes. So I would say our secret sauce is several folds. I would say that Optum chose us because there isn't another player in the market who could deliver at that scale, meet the government's requirements from an infrastructure security scale perspective. So the delivery and scalability of the model is just as important as our engagement. Having said that, we probably wouldn't have signed up for the deal if it didn't have a minimum number of visits attached to it because we're not doing the consumer engagement. Again, having said that, we're working very closely with Optum. The government for the TRICARE population is driving very hard for the consumer to go into sort of a very broad ranging nurse support line for that population. And we're a resource for that population for the nurses to use when that population presents with something that would be appropriate for a Teladoc visit. So that is really the engine that's driving the volume to us. We signed up for it because we got a minimum that equates to a multimillion dollar per year revenue stream and gives us comfort that it's worth making the investment of integrating with the Optum service center and delivering for that population. Ann Marie, I would just add that this opens up an opportunity for us that initially, again, we were unwilling to entertain this without a minimum because we realized what we would have to do to ensure success on their side, but we're just scratching the surface today. As this relationship builds, we'd expect to have much more interaction and far more capabilities to provide to them in order to increase utilization. So we're going to give additional guidance obviously or I'd just say guidance on January 8 in San Francisco. We have made it very clear in the past that we look at this company as having the capability of generating outsized revenue growth, 25%, 30% for the next several years. We obviously brought on Best Doctors this summer. Best Doctors had growth closer to 10% for the last several years. And we've been very clear in suggesting to people that we intend to bring best doctors up to that corporate goal in 2019. So we'll take a year and a half. We're 4 months into it right now, but we think we can achieve that. Does that investment, does that combination dilute our numbers slightly? Obviously, it's going to have a slight dilution to those top line numbers, but we are still extremely confident that in the next several years growth is going to be in excess of that 25% figure. Steve? There are metrics that employer customers use to evaluate you such as if you can get ROI, if you can get engagement over 5% and if the ROI can't get it over 5%. Yes. So you've heard now from 2 clients, 2 of them who look at our services in distinctly different ways. Chet Burrell over at CareFirst looks at an ROI and he realizes that each case is generating in excess of $30,000 We spoke to you about that case cost on the client side of about $5,500 or so. I've already addressed the fact that we may be spending $1,000 maybe $2,000 to deliver that service. They're looking at an ROI of, let's say, 5, 6 to 1. That's clearly suggesting to them that economically this is an extremely valuable program. He also shared with you a number of other characteristics, which is driving him suggest to his contemporaries that the other Blues plans that they also look into a Teladoc best doctors type program. But then you've also got Matt, who shockingly to some says, we don't look at the ROI, right? We look at satisfaction and we look at bringing people to work to ensure that they could be at their best, we're looking at presenteeism. We're looking at the value of delivering a service that could be used to offset so many of the other things that are in fact somewhat disabling to his workforce. For the majority of companies that are smaller than both of those companies and clearly, let's say, above 1,000 employees, they're strictly looking in ROI. They may have a Mercer or a Willis Towers Watson. They may have a consultant coming in and selling them and guiding them in many regards based on what type of ROI they get for each additional dollar spend. And in that case, we're hard pressed to validate our ROI. And just as Matt said, with 100,000 plus employees, we're sending them a monthly reconciliation of their ROI. We're doing that same thing to a company 1 100th of that size. Now our clients in that other segment, the real small employer clients, 1,000 employees and below, they're looking at presenteeism. They're looking at offsetting the high deductible health plan costs when they are looking to introduce new benefits on January 1 and they have to have that unfortunate and uncomfortable situation in sharing what the new out of pocket will be and the new monthly cost for benefits will be for their employees. As an offset to that, they introduce many times the Teladoc visits included model, in which case they're offering people access to primary care, dermatology, behavioral and number of other services with no co pay, no out of pocket. And those employers are really looking to, in a very benevolent fashion, provide their employees with something that's usable and cost effective. So I think I get to bring us to a close. Nicely done. I wanted to say thank you all for joining us today. The goals here were to give you a deeper dive into the Teladoc business, our customers, our markets, our financials to understand our utilization engagement strategies to understand the product vision, give you a lot more insight than you've had into the best doctors business and most importantly to give you the opportunity to hear from some of our colleagues who are helping us to carry the ball every day and deliver on our promises. So, I would echo what Mark said, couldn't be prouder of the team that I have to work with every day, consider myself incredibly fortunate. And I would say without hesitation that that's why we're delivering the kind of results that Mark has been able to share with you. So we thank you for your support. We can't do it without the capital that comes from the markets. It has given us the opportunity to do things that are truly transforming how people access healthcare. And so to that end, I will bring our inaugural Investor and Analyst Day to a close. Thank you.

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