Telewound Management: A Model for Value-Based Care South Carolina Telehealth Summit 2017 Annual Conference Copyright © 2017 Corstrata

The Wound Problem Copyright © 2017 Corstrata

1:500 6.5M $33B The US Wound Problem Not Enough Experts to Meet Need wound nurse patients annual cost Not Enough Experts to Meet Need Millions of Patients in Need Massive Cost to Providers Copyright © 2017 Corstrata

The Problem – High Costs Wound Supplies Dressings Advanced therapy modalities Negative Pressure Wound Therapy E-Stimulation Enzymatic debridement Labor Dressing change frequency Number of wounds Associated wound documentation time Copyright © 2017 Corstrata

The Problem – Quality Wound/Ostomy Related Hospitalizations 29.1% – ileostomy & enterostomy – 30-day readmission rate 23% – amputation of lower extremity 19% – colostomy 30-day readmission rate 7.8% – surgical wound issues Quality Outcomes Wound-related outcome measures Acute Care – acquired pressure ulcer penalties Post-Acute Care – number of pressure ulcers that are new or worsened Wounds impact on quality of patient satisfaction Copyright © 2017 Corstrata

The Problem - Liability Legal Liability Exposure There are 17,000 pressure ulcer related lawsuits filed annually Number of wound related lawsuits are increasing in the home health space Recent pressure ulcer lawsuits in acute & long-term had judgments as high as $312M Families take photos Copyright © 2017 Corstrata

The Problem – Wound Care Barriers Wound care practice relies on: Personal experience with wound treatment Opinion of colleague(s) Lack of knowledge & education: Basic wound evaluation/assessment Wound treatments & management practices Wound prevention protocols Use of advanced supplies and treatment modalities Lack of standardization: Wound measurements Wound outcomes/metrics Wound quality reporting Copyright © 2017 Corstrata

Telewound Model Copyright © 2017 Corstrata

Telewound Model – Literature Review Literature review indicates telewound care: Improves wound outcomes Increases healing time rate Increases % of wounds healed Decreases amputations Reduces number of hospitalizations Increases access to care Increases effective use of scarce wound experts Provides access to wound experts in underserved & rural areas Reduces costs Reduces treatment costs Reduces transportation costs Reduces wound consultation costs Copyright © 2017 Corstrata

Wound Imaging Technology Wound Imaging Software: Auto measurements Increase accuracy of wound measurements Color correction Overlay Documentation Reduces in-home staff wound documentation time Facilitates benchmarking healing/ closure rates HIPAA Compliant Conventional 44% Measurement Error ~60 seconds to measure New Technology < 5% Measurement Error ~25 seconds to take photo & auto-measure Copyright © 2017 Corstrata

Video Technology Utilize Video Conferencing HIPAA Compliant Use for Access to: Wound Expertise Physician Consult Use for: Triaging Ostomies Triaging NPWT Proper Application of Wound Dressings Copyright © 2017 Corstrata

Telewound Process Identify wound etiology Etiology drives treatment Recommend evidence based treatments Treatment protocol drives: Dressing type Frequency of dressing changes Advanced treatment modalities Monitor wound progression Telehealth ‘wound rounds’ with provider clinicians Recommend treatment changes as indicated Copyright © 2017 Corstrata

Telewound Consults: Tele-Wound Consultations Consultation includes: Identification of wound etiology Treatment recommendations Formulary recommendations Triage support: Negative pressure therapy Ostomy appliances Pain and symptom management Copyright © 2017 Corstrata

Outsourced Telewound Delivery Model Copyright © 2017 Corstrata

Telewound Results Copyright © 2017 Corstrata

Ancillary Benefits Nurse workforce: Telewound job benefits: Avg. RN Age = 50 % working RNs > age 50 = 53% Telewound job benefits: Eliminates physicality of nursing Allows for continued passion to improve care and educate provider staff *The National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 2013 National Workforce Survey of RNs Copyright © 2017 Corstrata

Telewound Results – Nursing Homes Quality: Improved wound quality outcomes Improved patient quality of life Reduced days to healing Decreased number of facility/provider acquired pressure ulcers Regulatory/Risk Management: Increased accuracy of wound documentation Decreased litigation exposure Decrease denials related to medical necessity Financial: Access to CWOCN without investment in FTE −net savings $100K/year) Reduced frequency of daily dressing changes Nursing time savings − $400/week for a 100 bed facility Decreased wound supply costs (average savings 30%) Copyright © 2017 Corstrata

Telewound Results – Home Health Quality: Reduction in ostomy- related readmissions from 30% to 10% Reduction in wound- related readmissions Reduction in provider acquired pressure ulcers Improved clinical outcomes & patient quality of life Enhanced patient/family satisfaction & loyalty Regulatory: Improved wound care documentation for compliance audits Financial: Access to CWOCN without investment in FTE − net savings $100K/year) Reduction in number of in- home nursing visits - RN time plus mileage Decrease frequency of dressing changes (one visit per week savings of $750 on a $3,000 episode) Decrease wound supply costs (average savings 30%) Increased accuracy in wound related coding Copyright © 2017 Corstrata

Telewound Success Story At admission to Telewound Program After 10 weeks of Telewound Consults At the time of admission to Telewound program, patient had wound for over 22 months. Copyright © 2017 Corstrata

On the Horizon Payers: Value-based delivery models: Consumers: Medicare Advantage Medicaid HMOs Commercial Insurers Self-insured Employers Value-based delivery models: Accountable Care Organizations Bundled Payment Projects Consumers: Ostomates Copyright © 2017 Corstrata

Katherine Piette CEO & Founder Corstrata Katherine.Piette@Corstrata.com (912) 999-7033 Copyright © 2017 Corstrata