Presentation written by Donna Cusano delivered at HIMSS CHC Nov. 2015 on Population Health, telehealth and preliminary results from pilots

1. Telehealth & Population Health—
What We’ve Learned from Pilots
HIMSS Connected Health Conference, November 10, 2015

2. • Founded 2003 by Bayer HealthCare
and Panasonic Corporation
• Since 2003, an authorized supplier to
the Veterans Health Administration
 Participated in 2000-3 VISN 8 pilot
• 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 using commercial off the shelf
monitoring devices enhanced by qualitative information capture
 Customized health questions based on DMPs, patient education tips, reminders
• Important part of coordinated care for large populations
• Tracking/alert platform evolved into care management tool, risk
stratification, EHR integration, analytics
• Achieved major VA HPDP goals (health promotion-disease
prevention)—at-home self-management, prevent decompensation

4. HT Improved Outcomes, Saved Money
HT supported 28% of patients in VA goal—independent living at
home versus LT institutional care
5 year growth: 43,000 patients 2010 >> 156,000 2014
VA largest user of US telehealth—but a closed system
FY2014  Bed days  42%
 Hospital admissions  34%
 Patient satisfaction at 85%
 Saved $1,999 per year, per patient
2009-12
Study
(4,999
patients)
HT users (CCHT) vs matched non-HT cohort
(MCG)
 Annual healthcare costs  4%--vs  48%
 Annual Medicare cost 45% less
 Admission reduction savings $8.7 million
(estimate)

5. 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
 Provider 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

6. ACOs a Good Fit for Telehealth
~ 40-50% of ACOs in the Medicare Shared Savings Program
(MSSP) are physician-owned and led (CMS)
 Largely funded by individual doctors
 Lean management, faster and simpler decision cycle
 Focus on meaningful and targeted changes in quality and cost
 Data and analytics driven
 Coordinate patient care across multiple settings: primary, specialty, hospital, clinic
 Most likely to adopt fresh approaches
Expanded Chronic Care Management (CCM) rule includes telehealth in non-
face-to-face care
Telehealth included in June ‘15 Final Rule as part of health IT in care
coordination
Only 20% of ACOs are using telehealth or telemedicine (eHealth Institute/Premier)

7. 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

8. 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

9. 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

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

11. Preliminary Key Findings
Coordination with and within practices
 Finding appropriate patients who fit profile
 Appointment setting and follow up procedure setting
 Daily monitoring and reporting
Care coordination model varies by ACO
Some ACOs are more centrally organized than others—
interaction with and buy in from practices vital
Viterion clinical nurse support and liaison with physicians required
Data integration, analytics support varies

12. Preliminary Key Findings
Patients
More varied
 As young as 38, as old as 93—generally 65+
 Urban, suburban and rural
 Many isolated—home environment and support issues (social context)
More co-morbid with 2+ disease conditions
Positive feelings on remote monitoring—appreciative of extra care
Relieved that they are being looked at every day—alleviates anxiety
about their health
Human factors: positive clinician relationship, building a strong
connection adds to motivation

13. Key Findings—Technology
• Vitacast 1000 tablet--proprietary software is new design, not like
others on market
• Patients overall pleased with compact design, wireless access
(versus POTS), touch screen function menu and features
(scheduling, advice messages, reminders)
• Mobile data connectivity not good in some rural areas
• Peripherals--Bluetooth devices generally but not always reliable in
sending accurate vital signs, manual entry needed
• Patients need personalized information—easy-to-follow leave-
behinds at installation and 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

14. Improve
The Care Experience
Affordability
Population Health