This document summarizes a presentation about using remote patient monitoring technologies to improve outcomes for patients in accountable care organizations (ACOs). It discusses how the Veterans Health Administration has used remote monitoring successfully for over 12 years, improving outcomes and saving money. Remote monitoring is well-suited for ACOs seeking to improve quality and lower costs by focusing on high-risk patients. The document outlines a pilot program between an equipment provider and two physician-led ACOs to study the impact of remote monitoring on costs, utilization, and outcomes for high-risk patients with chronic conditions. Preliminary findings suggest remote monitoring shows potential for cost avoidance and reducing emergency room and hospital visits while improving patient satisfaction.

1. HIMSS 16 Connected Health Experience
Mark Bogart, Director Business Development
Mobile Telehealth = Population Health
Learning from Customers

2. • Founded 2003 by Bayer HealthCare
and Panasonic Corporation
• Since 2003, an authorized supplier to
the Veterans Health Administration
• Now part of NSD Co., Ltd.
 A leading, publicly traded
international IT services organization
 3,500 employees
 Impacting healthcare globally
About Viterion®
Viterion V100
Not for active, real time patient monitoring
Viterion Vitacast 1000SM

3. Pioneering with VA Home Telehealth—
Learnings over 12+ Years
• Remote monitoring works for multiple conditions at scale—
 Hypertension, diabetes, obesity, COPD, heart failure, depression
• Everyday vital signs monitoring + off-the-shelf monitoring devices
+ qualitative information capture
 Customized health questions, patient education, reminders
• Coordinated care for large populations feasible
• Evolved into care management tool, risk stratification, EHR
integration, analytics
• Achieved major VA health promotion-disease prevention goals
—patient self-management, preventing decompensation

4. VA Home Telehealth: Improved
Outcomes, Saved Money
FY2014 (latest report)
 Bed days  42%
 Hospital admissions  34%
 Patient satisfaction at 85%
 Saved $1,999 per year, per patient (2013)
5 year program growth: 43,000 patients 2010 >>
156,000 2014

5. VA largest user of US telehealth—but a closed system
2009-12 Study (4,999 patients in HT)
HT users vs matched non-HT cohort
 Annual healthcare costs  4%--vs  48%
 Annual Medicare cost 45% less
 ~ 7% lower mortality
 Admission reduction savings $8.7 million (est.)
 Supported 28% of patients in VA goal of
independent living
VA Home Telehealth: Improved
Outcomes, Saved Money

6. Technology Advances—Just in Time for
Changing Healthcare Models
Monitoring now increasingly, patient-centric, portable—wireless
tablets, BT/USB peripherals. Challenge—making it cost-effective.
The rise of Accountable Care Organizations (ACO) and shared risk
 Reimbursements based on quality metrics, total cost of care reductions for a
patient population
• 700-800 ACOs cover 24 million lives in commercial, Medicaid and
Medicare models (423 cover 7.8 million lives)
• HHS, CMS drive to alternative quality/value-based payment
models in Medicare FFS
 30% of payments end of 2016, 50% by 2018

7. ACOs: A Good Fit for Telehealth
~ 40-50% of ACOs in the Medicare Shared Savings Program (MSSP)
are physician-owned, funded and led (CMS)
 Lean management, faster and simpler decision cycle
 Focus on meaningful and targeted changes in quality and cost
 Coordinate patient care across multiple settings: primary, specialty, hospital, clinic
 Most likely to adopt fresh approaches
CMS expanding ACO models with Next Generation, increasing
risk/reward levels
 MSSPs encouraged to move to risk/reward model for FY 2017
Expanded Chronic Care Management (CCM) rule in Year 2 includes
telehealth in non-face-to-face care

8. ACOs: A Good Fit for Telehealth
Telehealth included by CMS in June ‘15 Final
Rule as part of health IT in care coordination.
Increased Congressional pressure to expand
Medicare reimbursement (CONNECT Act)
Only 20% of ACOs are using telehealth or
telemedicine (eHealth Institute/Premier)

9. What’s Important to ACOs
Improve Quality, Lower Costs—And Prove It
• Of 333 ACOs in 2014 MSSP program, only 92 (28%)
earned shared savings bonus
• Disproportionately physician-led (Healthcare Finance)
• Drivers: maintain quality care, avoid cost, achieve
population health metrics
Greatest savings leverage: highest
utilizers/highest risk chronic disease patients
• 5% of ‘SuperUsers’=50% of health spending (NIHCM)
• Over half of high utilizers of emergency rooms (Healthcare Benchmarks)
Keeping them at home, out of the hospital/ER
Need resources which can deliver this leverage
MSSP—Calculating
Minimum Savings Rate
CAPG, 7/15

10. Viterion’s Programs—Physician-Led ACOs
• Comparative 90-day experimental study design (pilot)
 Experimental group: Remote Telehealth Monitoring. N=60
 Control group: coordinated care without telehealth. N=60
• No charge to ACO
• Theoretical framework: TElehealth in CHronic Disease
(TECH) and parameters for success
 Engagement of patients and health professionals
 Effective chronic disease management, including subcomponents of self-
management, optimization of treatment, care coordination
 Partnership between providers
 Patient, social and health system context

11. Viterion Programs—Patient Criteria
Inclusion criteria
 Evaluated as high risk with chronic
disease(s)
 Diabetes, hypertension, congestive heart
failure (CHF) or COPD
 Multiple chronic conditions and medications
 “Frequent Fliers” : multiple hospital
admissions and/or ER evaluations
 Elderly who live at home or have travel difficulty
 Age 50-90
 >$50,000 annual expenditures
 High risk patients
 Consent to participate and to share Medicare
claims data
Exclusion criteria
 End-stage disease (e.g. ESRD)
 Undergoing current cancer treatment
 Current substance abuse
 Psychological or neurological conditions which
would prevent effective use of monitoring
 Unable to legally consent to participation

12. Viterion’s Programs—Physician-Led ACOs
1. ACO with ~300 physicians, 50K Medicare lives
 Rural Southern state, relatively new ACO (approved by CMS 2014)
 Phase 1 August 2015
 Moving to phase 2 starting mid-2016
2. ACO with ~400 physicians, 25K Medicare lives
 Suburban/rural Southwest state, early CMS ACO (2012)
 Joint venture with local medical center
 Starting mid-2016

13. Preliminary Key Findings
Coordination with and within practices vital
Recruiting patients who fit profile is complex
 Appointment setting and follow up procedure setting
 Daily monitoring and reporting; PHI sharing
 Buy in from practices
 Patient consent
Adjust plan to care coordination model
Adding required support
 Viterion clinical nurse as liaison with physicians, patients
 Data integration, analytics support required for benchmarking—utilization analysis

14. Preliminary Key Findings
Patients—Phase 1
Wide age range—average 65, youngest 37 and oldest 91
 Urban, suburban and rural
 Many isolated—home environment and support issues (social context)
More co-morbid with 2+ disease conditions
 All were hypertensive
 Asthma, CHF, COPD, chronic renal failure (on dialysis)
 HIV
 Behavioral health: depression, schizophrenia

15. Preliminary Key Findings
Patients—Phase 1
“I hope [the practice] decides to continue this program. I feel so much
better knowing someone is looking at me and watching out for me.”
“You have really helped me. I wasn’t sure what I was going to do when I
found out my food stamps were being cut. Thank you for taking time with
me.”
Positive feelings on remote monitoring—appreciative of extra care
Patient relief on being looked at every day—monitoring alleviates anxiety
about their health
Human factors: positive clinician relationship, building a strong
connection adds to motivation
Social needs are a factor

16. Preliminary Key Findings
Patients—Phase 1
Success to date in
 Demonstrating cost avoidance
 Positively impacting ER visits
 Positively impacting hospital visits
 Improving patient satisfaction

17. Key Findings—Technology
 Vitacast 1000 tablet--proprietary software is new
design, unique to market
 Patients overall pleased with compact design,
wireless access, simple touch screen function
menu and features, twin USB-A ports
 Mobile data connectivity can be a problem
in rural areas
 Telephone connectivity being evaluated

18. Key Findings—Technology
 Peripheral—connectivity and vital sign entry
 Bluetooth devices generally reliable in sending accurate data
 Manual entry or USB cable connection
 Patients need personalized information
 Easy-to-follow leave-behinds at installation
 In-person coaching on use
• Clinical staff relationships and understanding
 How technology fits into care coordination
 In-person program explanations, documents, patient FAQs for discussion
and ‘go-to’ person contacts

19. Improve
The Care Experience
Affordability
Population Health
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