Convergence of Medical Devices, Telehealth, and eDisease Management

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.com (208) 395-1197

2. Clicks and Bricks Services/ Bricks Internet Technology 0 50 100

3. Presentation Overview • Background and Terminology • Emergence of Remote Monitoring • Strategy and Business Model Design

4. Background and Terminology

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.htm

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. Distribution of Health Care Claims In A Population % of population % of claims

8. Distribution of Health Care Costs: Conceptualizing Population Health $100,000 $75,000 $50,000 Cost Per Claimant Per Yr. $4,000 $3,000 $2,000 $1,000 $0 0 40 10 20 30 50 60 70 80 90 100 Claimant Percentile

9. 2 Differing Approaches Emerging $100,000 $75,000 $50,000 $$ Per Claimant Per Yr. $4,000 $3,000 $2,000 $1,000 $0 0 40 10 20 30 50 60 70 80 90 100 Disease ManagementServices eDM/eCare Management

10. Differing Value Propositions • DM Services • Care Coordinator = 3rd 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. Emergence of Remote Monitoring

12. A Portable Cure: PDAs for drug research and prescriptions are getting attention • Enhancing Patient Care: In-hospital wireless monitoring • Freedom From Hospitals: Remote monitoring of chronic illnesses

13. Types of Remote Patient Data • Biometric • list • Patient satisfaction • Subjective symptoms • Pain • Fever • Shortness of breath • Etc.

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. 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. 4 Cs of E-Health Care Connectivity Commerce Content

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

19. A Crude Map of the New World: eHealth & Care Management Framework eDisease Management Disease Management Outsourcing Services Personal Online Medical Record Telemedicine Electronic Medical Record

20. Strategy and Business Model Design

24. 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 2nd and 3rd Opinions E-mail Reminder Notices Health Claim Assistance Direct Multiple Sources of Revenue Source: Business model for DiseasesRx.com http://corporate-partnering.com/names/clicks-to-bricks-business-model.htm

26. 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 Services/ Bricks Internet Technology 0 50 100

27. Key Questions to Consider Services/ Bricks Internet Technology 0 50 100 • 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?

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