1. Mayo Clinic Home Connection Thomas R Harman, M.D. Mayo Clinic, Rochester

2. I have no relevant financial relationships to disclose at this time

3. American TeleCare, ATI National Initiative to Provide Alternatives for Managing Complex Patients Initial Focused Program: Mayo Employees and Dependents

4. Outcome Results and Outcomes 73% Net reduction in healthcare cost – Pacificare Secure Horizon Patients 95% Reduction in Inpatient utilization 100% Reduction in ED utilization 0.5% annual admission rate - 310 consecutive advanced heart failure patients (many commercial disease management failure) 2 year period (Natl Avg 200-300% per year) 100% Reduction - Admissions for heart failure patients in 3 years – Allina - New Ulm 9:1 ROI - $2.9M program with 781 patients produced $26 million in 1 st year saving 1,665 patients - CMS telehealth demonstration project, year 7, telehealth group improved across all clinical parameters (New Ulm) (VISN 8)

5. Reduce ER/Hosp/SNF Utilization - Centura Home Health Initial Study Initial study of 17 patients with heart failure 3 years – net 73% reduction in costs for these patients

6. MCHC Goals   Reduce Hospitalizations   Reduce ER Utilization   Improve quality of life   Support established Primary Care provider   Adjunct to current health care provider

7. Keys To Success Frequent contact Frequent contact Attention to patient’s interests Attention to patient’s interests Motivational change Motivational change Patient example Patient example

8. Clinical Delivery Interactive Video Augmented with Intelligent Monitoring LifeView Interactive Video

9. Clinical Delivery Proactive MD led interdisciplinary team care Live AV, stethoscope, peripherals Real time intervention Patient and provider empowerment 24/7 ACCESS Appropriate people for the work to be done Begin with 5/55 population

10. Methods   Technology enabled solutions:   “Face to face” frequent, short video visits   Monitor vital signs   Monitor symptoms   Education   Mayo standards of care   Midlevel provider and Physician team

11. Monitoring Patient Data   Just like an office visit, data collected is reviewed by NP   Action is using Mayo protocols

12. Monitoring   Clinician is able to select monitoring questions   Clinician determines frequency of monitoring   Information is individualized to each patient   Results reported on a “Dashboard”

13. Clinical Delivery Clinician Dashboard for Prioritizing Work Flow

14.   Patient completes assessment questionnaire   CNA obtains vital signs   Clinician reviews results   Clinician develops plan   Patient completes monitoring questions   Vital Signs obtained   Clinician reviews results   Clinician develops plan TELEHEALTH MONITORING: DAILY Office Visits Each Month

15. Clinical Delivery Clinical Team Management - Telehealth Teams Nutrition Social Services Pharmacy Support Services Rehabilitation Dedicated Clinical Teams Physician Leader (350 – 500 pts) Care Team - PA, NC, NP, etc. (50-75 pts ea)

16. Center of Excellence Physician Led Team Prospective fee for dedicated management of high need patients Manage panel of ~400-500 patients with interdisciplinary team Annual Practice revenue of ~$1.2-1.5M Chronic care specialist physician Optimize specialist MD’s Reengineer Hospital Model Capture 3000+ advanced chronic patients in their home Re-capture medical beds for procedures Increase contribution margin Reduce ALOS & ICU demand Improve nursing efficiency, recruitment and retention SNF Reductions ED Acute care models Patients Primary MD Integrate with chronic care practices Align with COE Team offloading complexities of chronic illness Additive prospective fees Focus on primary care Improved Patient Quality Pt ATI American TeleCare Outcomes, operational, and business models TPO Network Management Centralized payor contracting Change & Knowledge Management Turn-key program administrative, clinical, and technical support Solutions, fulfillment, & communications

17. Clinical Delivery COE – Interconnected National Network Leveraging Clinical Expertise Leading institutions collaborate to create new continuum of care for chronic illness Knowledge management with rapid diffusion of best practices Broad clinical network coverage Initial focus on high need patients then prevention Publications and research Develop and refine new clinical team and individual roles and specialization Clinical Trials