ADT Well Health for Chronic Conditions

David J. Whellan, MD, MHSAssociate Professor

Director of Clinical Trial Outcomes Department of Medicine

Jefferson Medical College

Consulting/Grant◦ NHLBI◦ Medtronic◦ Schering Plough◦ AstraZeneca◦ Johnson and Johnson◦ GE◦ Unipath/Inverness/Biosite◦ excellRx◦ Tyco/ADT WellHealth

Note: Hospital discharges include people discharged alive and dead

AHA. 2006 Heart and Stroke Statistical Update

Heart Failure Discharges

0

100

200

300

400

500

600

700

79 85 95 03Years

Dis

ch

arg

es

in

T

ho

us

an

ds

Male Female

Worsening chronicheart failure (75%)

De novo heartfailure (23%)

Advanced/ end-stageheart failure (2%)

Fonarow GC. Rev Cardiovasc Med. 2003; 4 (Suppl. 7): 21

Cleland JG et al. Eur Heart J. 2003; 24: 442

The Major Reason for Heart Failure Hospitalizations

Pat

ien

t S

tatu

s

Acute event

TimeDefinition and Epidemiology of Acute Heart Failure Syndromes, Nieminen MS,Harjola VP: American Journal of Cardiology, Supp to Vol. 96, #6; 13G

Natural History of Heart Failureand Goals of Treatment

Achieve Goals:

• Medications

• Devices

• Surgery

Patient Care in CHFPatient

HealthcareCosts

Physiologic ChangesPrecede Symptoms

Goal of HF Care

Patient

HealthcareCosts

Early Detection ofPhysiologic Changes

and Change in Treatment

Baselin

e Risk F

actors

InitialLoss of Stability

WorseningSigns and Symptoms

Ho

spitalizatio

n/

Mo

rtality

HF

DM

Mech

anism

Reducing Risk Monitoring

Improve accuracy of knowledge about self-managementPromote Self-Management SkillsDevelop Self-Efficacy

Required to

continuebenefit

Conceptual Mode of HF Hospitalizations and HFDM Mechanism

Patient FunctioningDomain

PsychosocialDomain

PhysiologicDomain

Demographic Domain

Resource UtilizationDomain

ADT® WellHealth™ Process and Infrastructure

Triage and

connect

Patient’s home

Patient risk stratification

Med Compliance Symptoms

Bill Turner 50% wt + 5

Mike Lynch 50% wt + 3

Mike Calhoun 71%

Katherine VanNiel 99%

PhysicianYo

ur h

ea

lthc

are

pro

vid

ers

Health Coach

PBM

EMS

Monitoring Center

Alerts

Verify / Notify

Notify healthcare providers and family Provide help 24/7

Conduct daily survey Remind to take meds Verify status if an alert

• Best devices

and health

services

• Connected

with ADT for

complete

solution

ADT ValueADT Value

Requires Easy and Simple Process

Unit dials out immediately if there is an alert situation

Did you take your medication today?

Y/N

Why did you not take your medication?Forgot?Side effect?Out of medicine?

Complying with your medication regime is important to your health. An ADT operator will contact you shortly.

Participant is connectedto help needed

Call center operator is immediately notified

Physician Health Coach PBM EMS

Participant is enrolled in program

Participant connects the

unit

Unit dials out and

downloads a session

Phone support is available if

needed

Unit shipped to participant

Successful Tyco Trial With Potential for ROI

110 Chronically ill patients already under disease management care

◦Congestive heart failure◦Diabetes◦Asthma

6 months of daily surveys conducted for all patients

Alerts monitored by ADT

Patients with problems get help when needed

Dedicated monitoring units were drop-shipped to users’ homes

100% successful self-install of devices

90% satisfied with the program, 70% felt better able to manage their condition

95% completed daily surveys on schedule

Statistically significant 24% reduction in ER visits for patients under 45 years old

ADT triaged out 40% of alerts with SOPs

◦Self-resolution◦Rx refills◦False alarms

60% of alerts were verified and handed off to nurse for next steps

Overview Results

*Based on preliminary data

ADT Can Integrate Several Different Devices

Devices can be dropped shipped directly to the member

ADT’s Unprecedented Scale 7 Customer Monitoring Centers (CMCs) in N.A.

The CMC’s act on more than 29 million alarm signals each year◦ 93,000+ alarms daily◦ 200,000+ total calls daily (inbound/outbound)◦ 8,000+ customer contacts an hour 24/7

More than 19 million customer calls per year – (3.3 calls per second)

ADT operates the only virtual monitoring centers in the industry. If one monitoring center becomes non-operational, all calls are automatically rerouted to another of ADT’s five centers, with no interruption in service

All CMCs engineered, built and operated in full compliance with the strict requirements of Underwriters Laboratory (“UL”) standards

As a Department of Defense contractor, facilities are further required to pass annual DOD inspections in order to maintain certification.

Fleet of 6800 truck in the US

6800 truck fleet in the United States

7 redundant call centers across the US

ADT’s scale equals lower costs, enabling better ROIs

Better Health, Lower Costs and Save Nurse Time Better health through enhanced compliance with doctor’s orders

◦ 24/7 support to help keep users on medication programs and detect problems early

◦ ADT® response - get the help they need when they need it◦ Encourage healthy behaviors - daily interaction and reminders

Lower health care costs through daily communication and early intervention◦ Healthier employees use fewer health care resources◦ Daily health checks avoid hospital stays, ER visits and trips to the doctor’s office

Increased efficiency through ADT procedures that save valuable nurse and doctor time◦ ADT verifies information from patients to determine whether intervention is

needed◦ ADT links patients directly to all needed help, e.g., Rx benefits manager for

refills

ADT® Increases Nurse Caseload To 4X Traditional Disease ManagementTraditional DM

Nurse-to-patient ratio = ~320

2Need help

30Okay

Tech-Based DM

Nurse-to-patient ratio = ~640

With remote monitoring nurse calls 32 people

who actually need help

32Need help

0ADT

reinforcement only, user error, etc

18

ADT WellHealth

Nurse-to-patient ratio = ~1100

Patient’s doctor

PBM

With ADT only ~60% of the 32 need a nurse

032Need help

The Challenges Which patients need what? How engaged are patients? Who and how are DM providers

responding to signals? What is the evidence?

◦ Incremental value?◦ Class effect or system specific?

Who will pay for this?

Amount Needed by DM Provider vs. Amount CMS Could Pay

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000

Clinic Telephone Home

Card limit

Hospital

IHS Limit

CMS limit