Measure, Asses,Treat & Improve THE TELEREHABILITATION REVOLUTION KOUROSH PARSAPOUR, MD MBA

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1 Measure, Asses,Treat & Improve THE TELEREHABILITATION REVOLUTION KOUROSH PARSAPOUR, MD MBA

2 5plus DISCLOSURES Founder, CEO TeleRehab Systems Founder, Board of Directors Specialists on Call Shareholder

3 Physical Disability Burden Stroke Leading (and growing) source of disability in US $43 billion dollars annually Occupational injuries $186 billion dollars Other neurologic (non-stroke) causes MS, Parkinson s Trauma and overuse Rotator cuff injuries

4 Aging Population & Chronic Disease Nearly 1 in 2 Americans with chronic disease

5 Not Enough Rehab GEOGRAPHICAL LIMITATIONS Geographic restrictions Need for frequent travel to the site FINANCIAL LIMITATIONS Limited insurance coverage Additional therapy too expensive PROVIDER SHORTAGE The volume of patients exceeds the availability of qualified therapists. PATIENT ENGAGEMENT DECREASED COST!!! INCREASED ACCESS!!! PT/OT viewed as dull or monotonous

6 Health Care Provider Shortages

7 Crisis in Physiotherapy 12% reduction in Medicare reimbursement Provider Shortage By 2030, the number of states with substandard PT will increase from 12 to 48 states Globally reduced reimbursement Need for Technology Aging Baby Boomer population 1 out of 5 Americans: 65 years or older by 2030 Medicare claims require quantified functional measure for reimbursement More documenting required for reimbursement Affordable Health Care Act 30 million previously underinsured Americans

8 The Frontline 183,000 Physical Therapists 120,000 Occupational Therapists Labor-intensive and physically demanding High attrition 2010: One-third are years of age 33-39% predicted growth Technology NOT a threat

9 Physiotherapy in 2013 Number of Insured Patients Documentation Required Reimbursement Working harder for less money will drive innovation, efficiency, and ultimately the adoption of new technology. -Bill Spath, MBA

10 Mandated Report: Improving Medicare s payment system for outpatient therapy services CMS Lacks Data on Functional Status No widely used standardized tools to measure functional status in outpatient therapy Many assessment tools are discipline specific, and proprietary Providers are not required to report standardized data on functional status to be reimbursed Clinical diagnosis codes are also not clear

11 Progression of technology TELEMEDICINE (2005): -Curative TELEHEALTH: -Preventative -Promotive -Curative DIGITAL HEALTH: -Health 2.0 -Connected Health -ehealth -Telehealth -mhealth

12 Use of technologies and networks by all stakeholders (doctors, patients, scientists, payers and providers) to enhance collaboration and personalization, to reduce the cost of healthcare, and to improve its quality and delivery.

13 Overcoming distance barriers Reducing cost Telerehabilitation Efficient utilization of scarce resources Improving quality of care

14 Limited Resource is Physical Therapist HOW TO SCALE??? Volume Telemedicine Automation Neurogaming May be perceived as a threat by the PT industry Efficiency MULTIUSER TELEREHABILITATION

15 Reachable Work Space ASSESSMENT

16 Full-scale Motion Capture Lab III (I) I (III) z R x L z x IV (II) II (IV) $150,000 - $250,000 Large cost Space & equipment requirements Not very portable Marker-based, obtrusive (active or passive) Non-intuitive data visualization van Andel et al. Gait & Posture 2008

17 Harnessing the capabilities of full-scale MoCap III (I) I (III) z R x L z x IV (II) II (IV) $1,500 From: Kurillo, Han et al. PLoS One 2012 III (I) I (III) z R x L z x IV (II) II (IV) Current prototype: collaboration UC Berkeley and UC Davis

18 Virtual PT TREATMENT

19 Virtual Reality Solutions for Remote PT Current prototype: Collaboration between UC Merced and UC Davis

20 Digital Health Startups Providing virtual physiotherapy Improving patient instruction and compliance with prescribed regimens at home Kinect platform Graduates of digital health accelerators with secured seed funding Preliminary beta-testing

21 Video-based rehabilitation regimens are prescribed and adjusted on computer based templates. Therapy can be provided at home and addresses compliance with therapy Recently accepted to HealthBox (accelerator) Closed beta-testing

22 Neurogaming for Patient Engagement Therapies can be viewed as dull or monotonous which may impact compliance Attentional valence Gaming movements can be designed as rehabilitative exercises Sensorimotor integration Play during non-therapy, personal time

23 Rehab provided in familiar setting would facilitate readjustment to home environment More effective therapy with better compliance Can be monitored and quantifiable Higher frequency of exercises Personalized to deficit, interest, and level of understanding/education (cognition)

24 MORE FUN, MORE USE, MORE THERAPY Instrumented glove drives Guitar Hero Simple accelerometer & switch to play Carnival or Duck Hunt shooting game Splint measures rotation, wrist movements are no longer a boring repetitive exercise, but instead drive different video games

25 Prescribed Modular Therapy

26 Closed seed round of financing - December 2012 In beta testing Therapy at your convenience

27 Enhances the delivery of physical therapy, by gamifying home-exercises.

28 Continuity of Care Across Sequential Sites of Therapy Inexpensive technology and can be introduced very early in the course of therapy Facilitated in-patient to out-patient transition Services may be provided at all care settings, including patients homes, skilled nursing facilities, rehab hospitals, etc. Telerehabilitation services can complement inclinic services. PT/OT can review usage hours, scores, responses to therapy Patient can play as often as desired in any setting

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30 Payer Value Proposition Reduction in readmissions Reduction in length of stays Measures of compliance that provide quantifiable data Surveillance of additional biometrics Competitive advantage and marketing

31 Provider Value Proposition Improved efficiency for patient evaluation and therapy Capability to provide additional therapies to multiple patients at the same time (multi-user care delivery) Measures of compliance Determine the effectiveness of treatment Increased patient volume and turn-over Competitive advantage and marketing

32 Patient Value Proposition Decreased cost of direct care and ancillary expenses (e.g. travel to rehab clinic) Affordable system that can be directly purchased for additional in-home use

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34 We Build Tools Digital health tools to improve efficiency for rehabilitation medicine Average time 25 minutes (both joints) Measurement Writing Recording +/- Accuracy with different therapists +/- Validity with same therapist Measure, record, measure, record, measure, record..

35 Disruptive Technology Innovation Drastic increase in patients Medicare reduction in rehabilitation reimbursement More detailed and frequent documentation for reimbursement Requires more time and effort Revolutionizing rehabilitation medicine by utilizing technology to provide care with limited resources

36 Key Benefits Improved Efficiency Increased patient through-put More time available for patient treatment Less Paperwork Less time measuring, recording, and inputting data Improved data reporting and analysis of function REQUIRED for reimbursement More Engaging Compliance Higher patient satisfaction scores Competitive and marketing advantage

37 What about NOW???? COMPANY PLATFORM PRIMARY PRODUCT CLOSED BETA TESTING CLOSED BETA TESTING CLOSED BETA TESTING CLOSED BETA TESTING CLOSED BETA TESTING CLOSED BETA TESTING CLOSED BETA TESTING

38 In conclusion Lessons Learned: Interoperability Strategic Partnerships Red Ocean Strategies (Competition in known marketspace) Blue Ocean Strategies (Creating demand in and unknown marketspace) Focusing on the Big Picture

39 A DIGITAL HEALTH ECOSYSTEM WHERE TECHNOLOGY MEETS MEDICINE TO BUILD A BETTER SOLUTION 5plustherapy.com Kourosh Parsapour, MD MBA kourosh@5plustherapy.com (424)