“Measure, Asses,Treat & Improve”

THE TELEREHABILITATION

REVOLUTION KOUROSH PARSAPOUR, MD MBA

DISCLOSURES •5plus

•Founder, CEO

•TeleRehab Systems •Founder, Board of Directors

•Specialists on Call •Shareholder

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

Physical Disability Burden

Aging Population & Chronic Disease

Nearly 1 in 2 Americans with chronic disease

•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 •PT/OT viewed as dull or monotonous

Not Enough Rehab INCREASED ACCESS!!!

DECREASED COST!!!

Health Care Provider Shortages

Need for Technology

Provider Shortage

Aging Baby Boomer

population

Affordable Health

Care Act

More documenting required for

reimbursement

Globally reduced

reimbursement

Crisis in Physiotherapy By 2030, the number of states with substandard PT will increase from 12 to 48 states

1 out of 5 Americans: 65 years or older by 2030

Medicare claims require quantified functional measure for reimbursement 30 million previously

underinsured Americans

12% reduction in Medicare reimbursement

•183,000 Physical Therapists •120,000 Occupational Therapists

•Labor-intensive and physically demanding •High attrition

• 2010: One-third are 50-64 years of age •33-39% predicted growth •Technology NOT a threat

The Frontline

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

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

TELEMEDICINE (2005): -Curative

TELEHEALTH: -Preventative -Promotive -Curative

DIGITAL HEALTH: -Health 2.0 -Connected Health -eHealth -Telehealth -mHealth

Progression of “technology”

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.

Overcoming distance barriers Reducing cost

Efficient utilization of scarce resources Improving quality of care

Telerehabilitation

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

Reachable Work Space “ASSESSMENT”

III (I)

IV (II) II (IV)

I (III)

R

x

zx

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Full-scale Motion Capture Lab

$150,000 - $250,000

van Andel et al. Gait & Posture 2008

Large cost Space & equipment requirements Not very portable Marker-based, obtrusive (active or passive) Non-intuitive data visualization

III (I)

IV (II) II (IV)

I (III)

R

x

zx

z

L

Harnessing the capabilities of full-scale MoCap

$1,500

From: Kurillo, Han et al. PLoS One 2012

III (I)

IV (II) II (IV)

I (III)

R

x

zx

z

L

Current prototype: collaboration UC Berkeley and UC Davis

Virtual PT “TREATMENT”

Virtual Reality Solutions for Remote PT

Current prototype: Collaboration between UC Merced and UC Davis

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

Digital Health Startups

•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

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

More effective therapy with better compliance

Rehab provided in familiar setting would facilitate readjustment to home environment

Personalized to deficit, interest, and level of understanding/education (cognition)

Higher frequency of exercises

Can be monitored and quantifiable

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

Prescribed Modular Therapy

• Closed seed round of financing - December 2012 • In beta testing • “Therapy at your convenience”

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

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 in-clinic services. •PT/OT can review usage hours, scores, responses to therapy •Patient can “play” as often as desired in any setting

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

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

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

Average time 25 minutes (both joints)

Measurement Writing Recording

+/- Accuracy with different therapists +/- Validity with same therapist

We Build Tools… …Digital health tools to improve efficiency for rehabilitation medicine Measure, record, measure,

record, measure, record……..

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”

•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

Key Benefits

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

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”

5plustherapy.com

Kourosh Parsapour, MD MBA kourosh@5plustherapy.com

(424) 241-8778

“A DIGITAL HEALTH ECOSYSTEM WHERE TECHNOLOGY MEETS MEDICINE TO BUILD A

BETTER SOLUTION”