Presentation from eHealth 2003 Conference in London, England, in the “eHealth and Patient Centred Care” session at 11:30 am on October 16. http://www.brown2020.com

1. Steve Brown, CEO
Health Hero Network
October 16, 2003
© Health Hero Network

2. Health Hero Network Inc.
q 5 years of experience in implementing chronic care
improvement programs in 50 medical centers and 2 languages
q Patient education and management content for 15 of the most
expensive and prevalent chronic diseases
q Secure, robust systems and monitoring technologies
adaptable to each client’s best practices and medical
knowledge
q Fundamental chronic care and remote monitoring patents
dating back to 1992

3. Networks for Patient Centered
Care in Chronic Disease
3. Why this is important
4. How to do it
5. Success stories and results
6. Why it is good business today
7. Incremental policy changes to inspire adoption

4. 2001 U.S. Hospital Stays By Condition
Condition Discharges Expenditure
• Congestive heart failure 1,049,818 $17.6
Billion
• Chronic obstructive pulmonary disease 603,352 $8.2 Billion
• Diabetes mellitus with complications 461,161 $7.2 Billion
• Hypertension with complications 244,320 $4.6 Billion
• Asthma 389,530 $3.3 Billion
Source: Healthcare Cost and Utilization Project, US Agency for Healthcare Research and Quality

6. 2001 California hospital costs for ambulatory
care sensitive chronic diseases ($)
Commercia Uninsure
Medicare Medicaid l d Other Total
Congestive Heart
Failure 2,337,745,702
1,617,662,367 317,364,720 317,125,495 31,921,050 53,672,070
Chronic
obstructive
pulmonary disease 1,164,626,294
796,343,340 175,002,632 152,248,368 14,498,748 26,533,206
Diabetes with
complications 1,126,010,626
529,606,510 249,102,139 238,704,453 40,560,566 68,036,958
Hypertension with
complications 826,010,222
512,530,192 159,665,770 116,031,548 12,953,115 24,829,597
Asthma 495,632,558
141,085,020 160,507,413 149,895,954 16,945,280 27,198,891
200,270,72
Total 3,597,227,429 1,061,642,674 974,005,818 116,878,759 2 ,950,025,402
Source: Healthcare Cost and Utilization Project, US Agency for Healthcare Research and Quality

7. Why the current model must change:
the age wave is a tidal wave
73%
80%
U.S.2000-2020
70%
Source: U.S. Census, 2000; Age Wave, 2003
60%
54%
50%
40%
30%
20%
10%
8%
7% 7% 3%
0%
-10%
-20%
-10%
Under 14 15-24 25-34 35-44 45-54 55-64 65+

8. How to do it #1
Focus your attention on chronic
patients at risk of being hospitalized
• Diagnosis of congestive heart failure, chronic obstructive
pulmonary disease, diabetes, hypertension, asthma
• Hospitalized in the past 12 months for a complication related
to their chronic illness
• Over $25,000 in claims in the past 12 months

9. How to do it #2
Change your behavior so your high
risk patients can change theirs
q Provide chronic patients with a support network that includes
a care coordinator  break the cycle of isolation and crisis
q Guide patients in daily health self-assessment while
collecting timely, relevant, actionable data  before the next
crisis starts
q Use a systems approach to embed your best knowledge into
decision support tools  continuously improve quality

10. Networks for Patient Centered Care
enabled by eHealth Technologies

11. Guided Self-Assessment: the key to
patient self-improvement

12. Additional Data Collection Options
Health Buddy®
Personal Telehealth Appliance
Blood Blood Peak Coagulation Digital
Glucose Pressure Flow Meters* Weight
Monitors Monitors* Meters* Scale

13. Informed Caregivers:
Decision Support Systems
iCare Desktop™
Risk Stratified
View of Daily
Patient Status

14. Informed Caregivers:
Detailed Results
Detailed View
of Patient Results

15. Informed Caregivers:
Trend Reports
View of Key
Clinical Indicators
Over Time, and
Many Other Reports

16. Veterans Administration Demonstration
• Veterans Health Administration Community Care
Coordination Office, Florida
• Telemedicine-based care coordination
demonstration project
• 791 chronically ill veterans enrolled for 1 year,
compared to comparison group data

17. VA – Patient Selection
• “High Cost (>$25,000) and High Use” patients
• High Use is defined as:
• Two or more hospital admissions or
• Frequent emergency room visits and/or walk in visits or
• 10 or more prescriptions
• Most common diagnoses: Congestive Heart
Failure, COPD, Diabetes, Hypertension

18. Veterans Administration
Clinical Outcomes
• 40% reduction in emergency room visits
• 63% reduction in hospital admissions
• 60% reduction in hospital bed days of care
• 64% reduction in nursing home admissions
• 88% reduction in nursing home bed days of care
• Significant improvement in Quality of Life (SF36V)
Published in: Disease Management, Volume 5, Number 2, 2002

19. VA - Patient Satisfaction
• 96% of the population said “Yes” to the following
questions:
• Do you think the Health Buddy technology has helped you stay
healthy?
• Has having staff monitor you make you feel more comfortable?
• Would you recommend this project to other Veterans?
• Questions aggregated over multiple locations and
disease states

20. VA - Provider Satisfaction
• 90% of providers reported that communication
between themselves and the care coordinators was
timely and appropriate
• 92% of providers believed the program was
beneficial to their patients
• 95% of providers would refer patients to the
program
Published in: Telemedicine Journal and e-Health, Volume 9, Number 2, 2003

21. VA – Project Growth
• Currently over 1000 patients using the technology
platform in Florida alone
• VISN 8 renewed program for addition 3 years
• Program has been expanded to the Midwest (VISN
19), West (VISN 21), Great Lakes (VISN 10) and
upstate New York (VISN 2), with several other sites
joining in next sixty days
• National VA Office for Care Coordination
established in Washington, D.C.

22. Chronic Care is Good Business Today
q Treat chronic patients in an outpatient setting, freeing
hospital beds for higher DRG patients
q Informed caregivers can be more effective with their time and
focus on the right patients at the right time
q Reduce liabilities: failure to monitor known high risk patients
is starting to be viewed as a patient safety issue
q Increase revenues: Chronic care improvement programs are
starting to be paid for by public health agencies and
insurance
q Provide higher quality care in your community

23. Small incremental policy changes can
alter the behavior of the entire system
Hospital Admissions Over Time

24. Small incremental policy changes can
alter the behavior of the entire system
Hospital Admissions Over Time
Diagnostic Related Group (DRG) includes 30 day readmission

25. Small incremental policy changes can
alter the behavior of the entire system
Hospital Admissions Over Time
Diagnostic Related Group (DRG) includes 30 day readmission
#1 Extend existing DRG to 60 or 90 days

26. Small incremental policy changes can
alter the behavior of the entire system
Hospital Admissions Over Time
Diagnostic Related Group (DRG) includes 30 day readmission
#1 Extend existing DRG to 60 or 90 days
#2 Offer monthly care coordination fee

27. Small incremental policy changes can
alter the behavior of the entire system
Hospital Admissions Over Time
Diagnostic Related Group (DRG) includes 30 day readmission
#1 Extend existing DRG to 60 or 90 days
#2 Offer monthly care coordination fee
#3 Redefine patient safety issues and medical errors to include
preventable complications in unmonitored high risk patients

28. Why are all we here today?
• We are dedicated to transforming our healthcare
systems for the better while facing one of the
greatest challenges of our century
• We know that the current crisis driven models of
care are no longer sustainable and must change to
models that offer continuity of care and prevention
• We believe eHealth Networks and Technologies are
a key enabler of the modernization of this vital
public service

29. Empowering
eHealth
Patients and
Innovations
Caregivers

30. Contact Information
Steve Brown, CEO
Health Hero Network, Inc.
2570 West El Camino Real, Suite 111
Mountain View, CA 94040
Direct: 650-559-1001
Email: stevebrown@healthhero.com
Web: www.healthhero.com