1. Patient Generated Health Data: Preventing Readmissions and Achieving the Triple Aim Presented by Brad Tritle, CIPP President / CEO vitaphone e-health solutions USA September 12, 2014

2. Presentation Objectives To define and explain Patient Generated Health Data To define the Triple Aim and identify how Remote Patient Monitoring achieves it To show examples of Remote Patient Monitoring that reduced Readmissions To show vitaphone processes as an example of Remote Patient Monitoring

3. Prediction “within 5 years, the majority of clinically relevant data…will be collected outside of clinical settings.”* Dr. Gregory Abowd, Distinguished Professor, Georgia Tech; 2011 American Medical Informatics Association (AMIA) Keynote Address

4. Definitions Patient Generated Health Data (PGHD): “ PGHD are health-related data—including health history, symptoms, biometric data, treatment history, lifestyle choices, and other information—created, recorded, gathered, or inferred by or from patients or their designees (i.e., care partners or those who assist them) to help address a health concern.” - HHS ONC PGHD White Paper Remote Patient Monitoring (RPM): “Type of ambulatory healthcare where patients use mobile medical devices to perform a routine test and send the test data to a healthcare professional in real-time. Remote monitoring includes devices such as glucose meters for patients with diabetes and heart or blood pressure monitors for patients receiving cardiac care.” -- American Telemedicine Association Triple Aim: 1.Improving the patient experience of care (including quality and satisfaction); 2.Improving the health of populations; and 3.Reducing the per capita cost of health care. -- Institute for Healthcare Improvement (IHI)

5. Telemedicine Service Center Telemedicine Service Center (TSC): A clinical call center that both monitors biometric data – triaging and filtering alerts as they arise – and engages and educates patients. It delivers Remote Patient Monitoring and Patient Engagement/Education Programs. Vitaphone operates TSCs in both Germany and the U.S. The German operation was the first ISO-certified TSC in the world.

6. Examples of Patient Generated Health Data According the US Government (HealthIT.gov) PGHD include, but are not limited to: health history treatment history biometric data symptoms lifestyle choices Examples include blood glucose monitoring or blood pressure readings using home health equipment, or exercise and diet tracking using a mobile app.

7. vitaphone extends the providers’ reach across time and space – into the home – to collect PGHD Physician Patient PGHD: Devices & Questionnaires - Management Organizations - Contract Research Organizations - Telemedicine Service Center

8. vitaphone extends the providers’ reach across time and space – into the home – to collect PGHD

9. And we couple it with health questionnaires and educational content. Goal: An Activated Patient Examples: Weekly questionnaire Alert questionnaire Outline of educational material Supporting collateral What is heart failure? How do I manage my medicines? How can I live with heart failure? And much more…..

10. Telemedicine for the Heart: A Congestive Heart Failure Program Yielding 2 of the Triple Aims Partners: German Foundation for the Chronically Ill Associate Partners: Techniker Krankerkasse Start of Project: January 1, 2006 End of Project: Unlimited (ongoing) Number of Patients: 1,100 NYHA Stage I: 0 NYHA Stage II: 627 NYHA Stage III: 429 NYHA Stage IV: 44 Transmitted Biometrics: Body weight, heart rate, blood pressure Duration: 6 to 27 months per patient Result: 21.5% fewer hospitalizations compared to control group. P=.03 1.Increased Quality 2.Savings!

11. Other Industry Evidence of Reduced Readmissions/Savings (2 of the Triple Aims) New England Healthcare Institute: 60% reduction in readmissions and $5,034 savings/patient/year compared to standard care 50% reduction in readmissions and $3,703 savings compared to disease management without monitoring Veteran’s Health Administration 25% reduction in bed days 20% reduction in readmissions Meridian Health Reduced CHF readmission rates from 14.9% to 4.8% TEN-HMS Study (Europe) 25% reduction in bed days 10% cost savings compared with nurse telephone support 2.1X Return on Investment, compared to nurse telephone support Check out the Oakland-based Center for Tech and Aging for additional positive outcomes here in California!!! www.techandaging.orgwww.techandaging.org

12. The Third Aim: Improving the Patient Experience Patient Experience Survey: 1 = Strongly Disagree; 2 = Disagree; 3 = Neither Agree/Disagree 4 = Agree; 5 = Strongly Agree The courtesy call was helpful in understanding the program 4.62 The equipment was easy to use 4.45 The weekly follow up calls and education were useful 4.62 I learned new information that will be helpful in managing my hypertension 4.41 I better understand my hypertension, risk and key management principles that will help to better manage my condition 4.45 The staff was friendly and courteous4.69 From the vitaphone “30 Days to Make a Difference” hypertension pilot (published in JHIM Fall 2013)

13. Triple Aim #1 - Enhance Patient Care Assisting with accuracy and speed of diagnosis Enabling fast design and optimization of the care path, including medications Identifying and preventing issues before they become acute events Facilitating doctor-patient and loved one - patient communication between visits Providing a case management infrastructure that enables a continuum of care Increasing patient engagement, and knowledge of their disease, combined with the awareness of being monitored (reactivity phenomenon), leads to improved compliance

14. Triple Aim #2 - Reduce Costs Readmission Reduction. Continuous evidence – based medical information provides early intervention and improved treatment analysis. Thresholds and alerts provide a “closed loop” for fast communication and actions. Better understanding of the patient’s condition allows stratification of risk and care. The patient to nurse ratio can increase and still allow the HIGH TOUCH aspects of care. Accurate, timely and organized information provides better diagnoses and treatment and supplements Meaningful Use initiatives. Moving care to the least cost point of care

15. Triple Aim #3 - Increase patient satisfaction Patients feel that you care for them, even when you’re not “there.” Product and services are easy to set up and use. The entire health team, including the patient, is more involved and informed. Weekly patient questionnaires and educational modules support care continuity Satisfaction survey the final week Post-test of patient’s understanding of their disease, medications, risks, complications, etc. (covered in educational modules)

16. The future of PGHD, reduced readmissions and Triple Aim achievement?

17. Brad Tritle – President / CEO btritle@vitaphoneus.com P: 702-374-1270 Sales Bruce Bowers – National Sales Manager Chronic Disease Management bbowers@vitaphoneus.com P: 602-791-3066 Opportunities