1. Convergence of Medical Devices, Telehealth, and eDisease Management Presented at SAINT IEEE Workshop on Global Telehealth/Telemedicine & the Internet San Diego, CA January 9, 2001 Vince Kuraitis JD, MBA Principal, Better Health Technologies www.bhtinfo.comwww.bhtinfo.com (208) 395-1197

2. © www.bhtinfo.com 2 Clicks and Bricks Internet Technology Services/ Bricks 500 100

3. © www.bhtinfo.com 3 Presentation Overview Background and Terminology Emergence of Remote Monitoring Strategy and Business Model Design

4. © www.bhtinfo.com 4 Background and Terminology

5. © www.bhtinfo.com 5 Better Health Technologies Strategy, business models, partnerships Disease/care management and e-health Consulting/Business Development E-Care Management News –Complimentary e-newsletter –2,500 subscribers in 27 countries worldwide –www.bhtinfo.com/pastissues.htmwww.bhtinfo.com/pastissues.htm

6. © www.bhtinfo.com 6 Recent BHT Clients Pre-IPO Companies –Life Navigator (remote monitoring connectivity and health intermediary services) –DiabetesManager.com (Internet diabetes DM) –CogniMed (highest cost/risk patient management software) –Caresoft (consumer focused DM) –Benchmark Oncology (oncology DM) –SOS Wireless (cellular phone technology) –Click4Care (Internet DM) Established organizations –Medtronic -- Neurological DM (medical devices/chronic disease solutions) -- Cardiac Rhythm Patient Management –Disease Management Association of America (trade association) –PCS Health Systems (PBM) –Varian Medical Systems (oncology equipment & systems) –VRI (behavioral health care management services) –Washoe Health System (integrated delivery system) –S2 Systems (medical transaction processing software) –CorpHealth (MBHO) –Physician IPA –Centocor (biopharma)

7. © www.bhtinfo.com 7 % of population % of claims Distribution of Health Care Claims In A Population

8. © www.bhtinfo.com 8 Distribution of Health Care Costs: Conceptualizing Population Health

9. © www.bhtinfo.com 9 Disease Management Services 2 Differing Approaches Emerging eDM/eCare Management

10. © www.bhtinfo.com 10 Differing Value Propositions DM Services Care Coordinator = 3 rd Party Cost containment Save $$ short term on behalf of health plan Prevent unnecessary hospitalizations and ER visits Done to the patient 5-10 top diseases Local/regional focus eDM/eCare Management Care Coordinator = patient Health care consumerism Save $$ long term on behalf of the patient Optimize patient health status Done by the patient 100+ conditions/diseases Not geographically bound

11. © www.bhtinfo.com 11 Emergence of Remote Monitoring

12. © www.bhtinfo.com 12 1)A Portable Cure: PDAs for drug research and prescriptions are getting attention 2)Enhancing Patient Care: In-hospital wireless monitoring 3)Freedom From Hospitals: Remote monitoring of chronic illnesses

13. © www.bhtinfo.com 13 Types of Remote Patient Data Biometric – list Patient satisfaction Subjective symptoms –Pain –Fever –Shortness of breath –Etc.

14. © www.bhtinfo.com 14 Characteristics of Remote Monitoring (RM) Data Real time Multiple sources –Across multiple devices –From the patient Subjective Patient satisfaction Passive (gathered by the device) Integrated with other data across multiple providers, e.g., EMR, lab, pharm, claims Longitudinal Data warehouse, data mining opportunity

15. © www.bhtinfo.com 15 Timing of Biometric Data Quarter-to-Quarter (q/q) Month-to-Month (m/m) Week-to-week (w/w) Day-to-day (d/d) Hour-to-hour (h/h) Minute-to-minute (m/m) Second-to-second (s/s)

16. © www.bhtinfo.com 16 4 Cs of E-Health Connectivity Content Commerce Care

17. A Crude Map of the New World: eHealth & Care Management Framework

19. Personal Online Medical Record eDisease Management Electronic Medical Record Disease Management Outsourcing Services Telemedicine

20. © www.bhtinfo.com 20 Strategy and Business Model Design

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24. © www.bhtinfo.com 24 Multiple Sources of Revenue Sponsorship Fees Advertising Health Data Fees & Infomediary Sponsorships Marketing & Product Launch Fees Pharmaceutical Sponsorships Clinical Trial Recruitment Electronic Prescriptions Pharmacy Sponsorships Delivery of Health Care Directory Advertising (provider and non-provider) Consumer Advice and Research Services Online Disease Monitoring and Disease Management Services Disease Testing Services 2 nd and 3 rd Opinions E-mail Reminder Notices Health Claim Assistance Direct Source: Business model for DiseasesRx.com http://corporate-partnering.com/names/clicks-to-bricks-business-model.htm

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26. Internet Technology Services/ Bricks 500100 Marginal Cost Per Unit of Service Scaleability Valuation Operating Model IT Connectivity Value Proposition Geography Close to zero High Hi Lo 8-15 x Revenues 2-3 x Revenues (valid in 3/2000, not today!) Web enabled tools Services ASP Client/Server Internet Fax, phone, mail Ride the wave Identify leverage points of health consumerism of behavior change Ubiquitous Regional markets

27. © www.bhtinfo.com 27 Key Questions to Consider Where are you today? Where are you headed? –Direction? –Speed? –Momentum? What is the optimal mix of bricks and clicks? Are any extreme business models viable? Where will contemplated capital investments move you? Should you make or buy Internet technologies? Internet Technology Services/ Bricks 500 100

28. © www.bhtinfo.com 28 END