Last year, our medical director for digital health and telemedicine in the Office of Physician Leadership Group for Johns Hopkins Medicine. I oversee digital health strategy for the delivery system, as well as our office of telemedicine, which coordinates our telemedicine operations across all six hospitals, the four here in Maryland, the one in DC, and our children's hospital in Florida, as well as all of our regional ambulatory sites, as well as our home care group and Johns Hopkins international, and coordinate with our insurance plans at Johns Hopkins HealthCare to understand how it impacts our payers. I'm an internist and pediatrician, so I'm doing board in telemedicine and pediatrics and see kids and adults in primary care in Baltimore City through Johns Hopkins Community Physicians. So Mark, then I'm going to go ahead and pop up a presentation if that works. Great. Just a couple of quick disclosures. I have had experience with an Early Stage Digital Health Company, and it's disclosed here. A company that we grew and ultimately integrated with all scripts. One of the larger electronic medical records and currently serve on the board of our Johns Hopkins Medicare Advantage insurance plan, and so have a fiduciary duty to them as well. We're going to start here and just level set because Mark had said, yeah, things have changed, and I do just want to give context to the things that we're talking about here. The ideas and concepts and problems you all are trying to solve is levels set in a healthcare industry that is just fundamentally different than it was now about 10-and-a-half months ago. This is our ambulatory scheduled telemedicine volume, our virtual visit volume by both video and then phone or audio only over time through the end of this past calendar year. A couple of 100 visits there from July to February, July of '19 to February of '20. Then 670,000 since March of 2020. That number is now 730,000 in total as of our live dashboard this morning. That's covering over a quarter of a million patients underneath 730,000 visits, two-and-a-half visits per patient, a lot of returning customers. Our total volume definitely rose and fell with broad shut down and COVID cases and then reopening notably in December, and we're going to see this on the next slide. As cases started to really increase in the Mid-Atlantic region and nationwide in November, December, we clearly had a sustained increase in the use of telemedicine in November and December, and that is also sustained here into early January. But overall, unprecedented evolution in the use of virtual care across our ambulatory space, and we'll be tracking towards a million total encounters by the time we reach the end of our fiscal year which will be this upcoming summer. This is how it compares between in-person and telemedicine. In-person care plummeted in March. In March, April, and May telemedicine was a majority of our care. It's definitely rebounded obviously, as different areas of the enterprise have reopened. In general, has been in the last quarter of Calendar '20, we were about 27 percent telemedicine in the areas that can be impacted by telemedicine. It's not distributed equally. As you look to solve particular problems in different types of care, understanding that at least in our system, different verticals of care have turned to virtual technologies with different proclivity. Obviously, one would expect there's a lot of intention on the mental and behavioral health space, and that's all the way on the left-hand side of our chart, 85 percent of our Department of Psychiatry Care in the last three months of Calendar '20, where generally lots of things were pretty open, honestly in October in particular, was by video or telemedicine. Not just by video, by video or phone. Some things that you don't immediately think about, it's not just about physician and advanced practice provider care. Definitely, allied health is a critical component to healthcare delivery and nutrition as its in apartment stands out, one can understand why nutrition is likely very usable through virtual means. Then some surprises, when we take a look at this data and neurosurgery in particular always stands out for most, but we definitely have surgical specialties who are close to the mid average or above average, and neurosurgery stands out there. A lot of their workflows are dependent on talking through images and imaging findings with patients. All of which can be done virtually prior to determining whether or not you're even a surgical candidate when it be nice to not have to drive three hours to come and just to be told, no. Different clinical areas solving different problems and yes, ophthalmology all the way on the right down at 0.3 percent, but still every department at Hopkins has used telemedicine, just not all as equal as others. It's not just about no longer your addressable market, isn't just those immediately around you anymore in health care, obviously? Hopkins operates hospitals, as I said, in two states in the District of Columbia. As of October, this information is just a little dated at this point, 54,000. It's now 63,000 or 64,000 total encounters to patients who live outside of the states where we have building. That's almost nine percent of our total telemedicine care. But it is regional, as you would expect that lots of those patients used to drive into Baltimore to get to their visits. Eighty-five percent of our out-of-state care is in our top four states that surround Maryland, and you can see those outlined in the bottom bullet. But you can also see that we touch patients in every state including North Dakota up there with two visits. But we could stand everywhere, and so the reach of the addressable patient population for our care is definitely extended, and we're going to get to some of the flip sides of that about legal regulatory at the very end, but the addressable market for health care is clearly different than it used to be. We've built a lot of tools to visualize everything that you just saw. This is as of yesterday morning, our total utilization, 727,000. Comparing in-person versus video, there's the 27 percent that you saw there for the last quarter of 2020. But also more importantly, in thinking about addressable market is disparities and how that addressable market may formulate. We have our drafts and sorry, this came through, is below the image. But we now have in production, our telemedicine equity access dashboard, which breaks down how patients are accessing us by video or phone but by relevant specific demographics. Recognizing that not all access is distributed equally, and especially true for telemedicine as well. Older patients using phone more often. Underneath this bottom image, you would have seen that Medicare and Medicaid insured patients are using phone 2.5-3 times as often as commercially insured patients. You can see a clear breakdown and disparity between those who identify racially as White or Caucasian compared to those who identify as Black or African American, 16 percent phone versus 26 percent phone. All the way beneath this is a breakdown by zip code. Access to video and broadband is actually not so much a rural and urban thing, as much as a socioeconomic zip code thing in our data. Baltimore City and ward 7 and 8 in Washington DC, those zip codes that have lower socioeconomic status disproportionally use phone more often. When you take a look at all the things we've just covered, just general trends in utilization, geography, as well as equity and health care. Just to think about how does telemedicine use or virtual care use more broadly by type of care. You saw the breakdown by department, by a patient demographics and what that can mean for equity, and where they are geographically. How does that adjust your addressable market?
