Clinical Solutions for Lung Cancer Screening (LCS) Tom Tynes Oncology Solutions May 2015

Invivo Clinical Solutions More than just boxes

Lung Cancer Huge Problem, Fragmented Solutions Lung cancer is the number 1 cancer killer globally Life expectancy: 1.1 years after diagnosis 1.3M deaths/year worldwide; more than breast, colon, prostate, pancreatic cancers combined US: 160,000 deaths and 220,000 new cases/year Emerging Markets burden even greater (China: 390,000 deaths and 490,000 new cases /year) NLST demonstrated significant benefits, USPTF recommended CT lung screening for long-term smokers ‘Private’ cash-pay programs continue to expand ACA requirements for private payors effective January 1, 2015 CMS reimbursement expected this year Increase in hospitals/centers offering comprehensive lung cancer programs to more effectively manage disease Screening, diagnostics, staging, multi-modality therapy (surgery, radiation oncology, interventional therapy) Benefits: improved survival, reduced long tern costs (high cost to treat advanced disease) Early diagnosis, accurate staging and timely treatment is critical to better clinical outcome 65-70% Stage III or IV Only 15% will survive 5 years Stage 0, I, & II

Lung Cancer Screening (LCS) Program Extensive product & service offering for successful implementation of a comprehensive CT lung screening program throughout the continuum of patient care This is our overall value proposition and setting us up to help enable a high quality clinically relevant CT Lung Screening Program

CT Lung Cancer Screening (LCS) Solution Intelligent Integration throughout the Continuum of Patient Care Education and awareness programs for physicians and at-risk patients Local connections to patient advocacy groups Assistance with reimbursement landscape Marketing and public relations materials Consultative Services Patient & Data Management Radiology Workflow Computer-Aided Detection Education Resources Structured online education courses Measured performance against large clinical database Helps ensure and document proficiency Education resources for new physicians Standard clinical protocols (ACR Lung-RADS) Automated, real-time 360° patient status Integrated IT interfaces (HIS, RIS, PACS, EMR) Reminder letters & program KPIs Auto-detection of suspicious nodules Second reader for added confidence Workflow integrated Proven clinical performance Vendor-neutral chest CT review Automated temporal comparison Integrated Lung-RADS reporting Results synced with patient manager

CT Lung Cancer Screening Reimbursement A brief, recent history June, 2011 NLST releases initial findings for CT lung cancer screening for high-risk individuals February, 2015 CMS issues a final national coverage determination that provides for Medicare coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) December, 2013 USPSTF gives low-dose CT lung cancer screening “B” recommendation 2011 2013 2015 2014 April, 2014 MEDCAC recommends against Medicare coverage for lung screening June, 2013 USPSTF releases draft recommendation What USPSTF “B” Recommendation Means for Lung Screening Programs A grade “B” by the USPSTF means that the USPSTF recommends the service and that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial The Affordable Care Act requires that all new private health insurance plans cover all preventative services that are rated at a grade “B” or higher by the USPSTF Source: "Screening for Lung Cancer, U.S. Preventative Services Task Force Recommendation Statement,” USPSTF Final Recommendation Statement, Dec. 2013; Oncology Roundtable interviews and analysis

Primary Care Physician Radiology Imaging Facility CMS Lung Cancer Decision Memo Participants Age: 55 – 77 30 Pack-years smoking and less than 15 years since quitting No signs or symptoms of lung cancer Marketing Services Primary Care Physician Shared Decision Making Visit – Benefits/Harms of Screening, Follow-up diagnostics tests, over-diagnosis, FP rate, radiation exposure. Counseling on adherence to the screening program and smoking cessation Marketing Services Radiologist Board Certified, Training in diagnostic radiology and radiation safety Supervision and interpretation of 300 chest CTs in past 3 years CME to ACR standards Radiology Imaging Facility LDCT with CTDIvol < 3.0mGy for standard patients Utilizes a standardized lung nodule classification and reporting system Collects and submits data to a CMS-approved registry