THE MULTI-FACETED ROLES OF TELEHEALTH IN SENIOR CARE 2019 Ziegler - - PowerPoint PPT Presentation

B.C. Ziegler and Company | Member of SIPC & FINRA

THE MULTI-FACETED ROLES OF TELEHEALTH IN SENIOR CARE

PRESENTED BY Grant Chamberlain Managing Director Ziegler gchamberlain@ziegler.com Rob Rebak CEO Forefront Telecare rob@fftcare.com Dan Herbstman Co-Founder & CEO Third Eye Health dherbstman@thirdeyehealth.net Ernie Ianace EVP Sales & Marketing VitalTech ernie@vitaltech.com

JULY 25, 2019

2019 Ziegler Link∙Age Fund Symposium

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MEET THE SPEAKERS

Grant Chamberlain

Managing Director Ziegler Healthcare Investment Banking

gchamberlain@ziegler.com

Dan Herbstman

Co-Founder & Chief Executive Officer Third Eye Health

dherbstman@thirdeyehealth.net

Rob Rebak

Chief Executive Officer Forefront Telecare

rob@fftcare.com

Ernie Ianace

EVP, Sales & Marketing VitalTech

ernie@vitaltech.com

FOREFRONT TELECARE – COMPANY OVERVIEW

Rob Rebak Chief Executive Officer

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• 75% of rural counties in the US (containing >20% of the US population) have

no psychiatrists practicing

• # of MDs continues to contract. NPs are expanding, but the geographical

distribution is trending urban and away from rural areas

• Federal and State Governments and State Medical Boards and facilities are

recognizing the need to shift the clinical delivery models to support this changing clinical landscape – increasing support of Telehealth

• Some rural hospitals and SNFs are struggling financially; innovative support is

needed to meet the market need

• Many rural facilities are currently passing on higher acuity senior BH patients

for fear that they will not be able to care for them

• Forefront’s objective is to enable higher census by supplying the BH

professional resources needed to give facility operators the confidence that their staffing issues are solved for the long term

THE PROBLEM: VERY LIMITED BEHAVIORAL HEALTH SERVICES FOR RURAL SENIORS

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CUSTOMERS: Forefront focuses on meeting the behavioral health care needs where Senior patients go for their most acute care needs: – Skilled Nursing Facilities – Assisted Living Facilities – Hospital psychiatric Units – Psychiatric Hospitals – Hospital Intensive Outpatient clinics PROVIDERS: Forefront has established a network of medical practices, currently in 26 states and expanding to 31 states by the end of 2019, to give us the ability to contract with CMS/insurers and bill for professional services for our own providers TECHNOLOGY: Forefront has developed and provides to its partner facilities all the telehealth technology needed or will integrate with existing telehealth systems at no cost to the facilities. (i.e. – a rural SNF or hospital has no capital equipment to purchase or software to lease to enable Forefront providers to service their patients)

HOW IS FOREFRONT ADDRESSING THE PROBLEM?

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Hospitals: – Forefront provides 24/7/365 On Call to respond to admission referrals and handle after hours patient care needs – Daily rounding for In-Patient Psychiatry units, IOPs, Psych Hospitals to provide maximum quality care and treatment monitoring, plus ASAP discharge processing – Full Unit Professional Permanent Staffing solutions for hospitals:

• MD rounds treatment teams once per week;
• NPs round daily to operate whole program or

– Forefront’s current hospital partners have doubled their average daily census (ADC) in the first 60 days SNFs: – Service is FREE for SNFs – Forefront provides weekly rounding for both psych medication management and GDRs plus talk therapy as needed. – Forefront handles all insurance claims filing for our providers – Document use of antipsychotics or transition to other meds

WHAT ARE THE BENEFITS OF FOREFRONT’S SOLUTION?

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FOREFRONT’S FOOTPRINT

SNFs Hospitals Clinics Jails

FOREFRONT’S FOOTPRINT

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• SNFs are FREE in Rural areas

– We supply all the technology – We supply all the professional staff – We bill Medicare and Medicaid for all services – SNFs supply just an internet connection and organize the patient flows

• Hospitals are billed for On Call and Medical Director fee only. Typically at 30

to 50% of what they are paying now for less than 7 day coverage – We supply all the technology, or we will integrate with existing – We supply all the professional staff for 7 day coverage – We bill all insurance companies for professional fees – Hospitals supply just an internet connection and organize the patient flows

HOW WE PRICE OUR SOLUTIONS

THIRD EYE HEALTH – COMPANY OVERVIEW

Dan Herbstman Co-Founder & Chief Executive Officer

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WHO WE ARE

Technology and medical services organization focused on providing 24/7 telehealth coverage, tasked with meaningfully reducing hospital readmissions. Telehealth Technology – Mobile first with a telehealth focused EHR Physician Practice – 70 physicians and 6 nurses Five Years in Operation – Focused in post acute for three years HQ in Chicago – Offices in Boston, Dallas, and Austin Backed by Industry Leaders

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THE THIRD EYE HEALTH NETWORK

The largest telehealth post acute network in the United States.

• 26 states covered
• 250 centers connected
• 300 centers contracted
• 25,000 patients under care
• 2,000 patient consults a week
• 25% average

reduction in RTH

• 3X average ROI

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WHY WE ARE DIFFERENT Intuitive Technology Physician Team Care Coordination Implementation and Support

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THIRD EYE HEALTH APP

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PHYSICIAN TEAM

Connect to our physicians within two minutes of a request.

• Specially trained doctors – post acute emergency medicine
• House doctor model – same five or six doctors per center
• Proactive visits – visit with all new/at-risk patients to start every shift
• Rounding model – same doctor stays with patient through their shift
• Complimentary to primary care – no billing interference

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CARE COORDINATION

Technology and care team work to eliminate care gaps.

Nurse Coordinator

• Works with DONs and

PCPs to identify high risk patients before every shift.

• Contacts all DONs and

PCPs to transition care of patients.

Physician

• Completes all notes by

end of shift.

• Communicates with

facility and PCP if needed during care transitions.

• Communicates with

patient family when needed.

Technology

• Care coordination portal

to securely communicate

• EHR integration, bi-

directional interface allows for real time view

• f patient.

Health System Relationships

• Work with hospitals to

define protocols and workflow.

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IMPLEMENTATION AND ENGAGEMENT

On the ground team working to continuously improve outcomes.

• MD to MD conversation – in person program overview meeting to

gain trust

• In person training – training team led by former nursing home

administrator

• Account manager model – keep users trained, engaged, and happy
• Weekly reporting and meeting – short weekly meeting to discuss

utilization, engagement, value and hospitalization data

• Marketing Support – help develop materials and content for health

systems and patient/families

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CUSTOMER BENEFITS

Improved Clinical Care, Financial Benefit and Satisfaction

• RTA Reduction – 25%+ reduction for average customer
• ROI – 3-5x ROI based on bed hold reduction and reduction in VBP

penalties

• Partnering with health systems – marketing advantage for getting in

and staying in preferred SNF networks – share data via care coordination alerts

• Staff satisfaction and retention improvement – nursing team is

supported with physicians available immediately and no night or weekend call for your physicians

• Patient and family satisfaction – supported in-house for

all care needs

VITALTECH – COMPANY OVERVIEW

Ernie Ianace Executive Vice President, Sales and Marketing

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Leveraging IoT, Big Data and Advanced Analytics to Lower Costs and Improve Outcomes for a Growing Population

“The future is now….a fully integrated healthcare ecosystem.”

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– A COMPREHENSIVE CARE PLATFORM

Patient care smart platform

iQ

Data Inputs

Smart Home Activities of Daily Living BLE Medical Devices Personal Emergency Response Health and Wellness 3rd Party Databases

iQ

Digital Technology Transforming Connected Health for Seniors

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UNPRECEDENTED INSIGHTS INTO SENIORS’ HEALTH DATA

Streaming data is viewed by users, family and care

• teams. Machine

learning and user inputs trigger alerts when vital signs are out of range. Easily input nutrition and exercise goals to promote subtle changes in behavior. ADL ActivityTags are placed in the home to monitor for deviations in day to day activities. Bystolic 20mg

Last Filled: 5/22/18 Prescriber: Lopez

Atorvasta tin 20mg

Last Filled: 4/28/18 Prescriber: Thompson

Medication adherence through pushed reminders.

Improved Care thorough Continuous Actionable Data

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SOS Alerts Automatic fall detection Panic alert button Voice controls for emergency voice call out Alerts are sent to caregivers via text, email, phone Vital Signs Heart rate Respiration rate Sp02 ECG Step count, calorie count Additional Features Fully waterproof & sweat-proof so the wearable is never removed Untethered on wrist charging for 24/7 safety Optional 24/7 emergency services Medication reminders and messaging to the watch Access control with BLE or RFID

*Adds wi-fi and LTE *GPS for geo-fencing and geo-tracking *Vitals are turned off for extended life battery *locking band for memory care patients *GPS for geo-fencing and geo-tracking

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ACTIVITYTAGS (ADL)

Recognizing deviations in patterns of day-to-day living

Creating simple actionable

• utcomes for patients that

improve self care management by creating “nudges in personal behavior”

Data is aggregated and analyzed through an app or web portal view Alerts and alarms are sent to care teams when deviations are detected. BLE Smart Tag (9-12 month battery life) are placed in the home or care facility to track patterns of daily living

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ADDITIONAL FEATURES FOR TELEHEALTH AND REMOTE MONITORING

Improve Outcomes and Save Costs

Multi-party video and audio HIPAA security and privacy provisions View of vitals and access to historical readings Secure messaging between patients and care teams Monitor and set alerts with push notifications Track time spent per patient for appointments, diagnosis, follow up, prescriptions, data entry

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REMOTE PATIENT MONITORING CPT CODES FOR SENIOR LIVING FACILITIES

Include RPM costs in administrative costs

$54

Remote Patient Monitoring 20 minutes per month CPT 99457

$69

Medical Device Equipment and technology CPT 99454

$123

Monthly recurring revenue to better care for Boomers

$21 Initial Setup and training. CPT 99453 $13

Patient sends an image or video to caregiver HCPCS G2010

$15

Virtual Check-In HCPCS G2012

$28

Additional billing for the month

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THE MOVE TO VALUE BASED CARE

CMS Rulings Beginning January 1, 2020

• 1. With the removal of previously held distance restrictions Medicare Advantage

beneficiaries will now be able to access telehealth benefits

• 2. Patients can now be outsourced to private nursing companies.

Improve Outcomes Age in Place Longer Decrease # of Visits through telehealth Gain Competitive Advantage

DISCUSSION AND Q&A

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• Ziegler is a privately-held investment bank, capital markets and proprietary

investments firm

• A registered broker dealer with SIPC & FINRA
• Ziegler provides its clients with capital raising, strategic advisory services, equity &

fixed-income trading and research

• Founded in 1902, Ziegler specializes in the healthcare, senior living and educational

sectors as well as general municipal finance

ABOUT ZIEGLER

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Link•Age Ventures leverages deep consumer insights to identify and invest in the aging services of tomorrow—providing you the foresight required to ignite future growth in a competitive marketplace. Our team provides resources, expertise and relationships that seek to deliver above-average investment returns, and help establish a differentiated position for long-term success.

ABOUT LINK∙AGE VENTURES

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Investment banking, capital markets and proprietary investment services offered through B.C. Ziegler and Company. FHA mortgage banking services are provided through Ziegler Financing Corporation which is not a registered broker/dealer. Ziegler Financing Corporation and B.C. Ziegler and Company are affiliated and referral fees may be paid by either entity for services provided. This presentation was prepared based upon information provided by Management and contains certain financial information, including audited and unaudited information, certain statistical information and explanations of such information in narrative form (the “Information”). Management believes this information to be correct as of the date or dates contained

• herein. However, the financial affairs change constantly, and such changes may be material. Today’s discussion may

contain forward-looking statements, which may or may not come to fruition depending on certain circumstances, including those outside the control of management. Please be advised that management has not undertaken, assumed no duty and are not obligated to update the Information. In addition, please be advised that past financial results do not predict future financial performance.

DISCLAIMERS