1. Michael Michael L. Moore, MD FACP Vice President –Chief Medical Director Nationwide

2. Exponential Growth

3. “We are moving from an environment of sick care to health care. The changes are as likely to be as disruptive as never before seen in medicine” Daniel Kraft MD

4. How disruptive?

5. ExpoMedicine – Take aways 4 main categories of disruptive technology: INNOVATION BIG DATA GENOMICS HEALTH CARE

6. INNOVATION Already in use:

7. Coming Soon

8. Winner of the Xprize

9. BIG DATA Sensors that are wearable, implantable and ingestible will generate data uploaded to smart phone  cloud  data analytics Will be able to share data worldwide For use in rare diseases For healthcare providers For health researchers For consumers – IODINE.com- crowdsourcing data on medicines

11. BIG DATA continued Machine learning – Computers will be able to remember AND interpret data – For example, will be able to look at photos and interpret the results Use with video glasses, look at a rash and give you an answer, look at pathology slides for cancer – Google glass during surgery: share, consult Artificial Intelligence – Computer will be able to learn Gaggle- open sourced data analytics – Allstate used to predict future PC claims

12. BIG DATA continued Access to the cloud and thus all of the world’s information will be available to all.

13. GENOMICS Every cell carries the complete instruction manual for every part of the human body in its DNA Progression of the science Learn the letters: Watson & Crick discovered DNA Learn to read: Gene discoveries Learn to write: Where we are going.

14. GENOMICS continued “Once you have the code it is completely transmittable”. – H7N9 –deadly flu virus in China, can make vaccine on demand – Distant space travel. Cost of having your DNA decoded is rapidly falling, will soon be $1000 Review of previous “failed” drug trials with genomic data added (only 10% got better, why?)

15. Genetic Engineering CRISPR/CAS9 – Process to: Knock in Knock out Genes Edit repair

16. Genetic Engineering The human brain has 300 million neuro units – May soon be possible to implant nanbots to double, triple etc the number of units that connect with the cloud. More traditional uses: Single gene diseases Correct disease already active Pre-implantion genetic selection – Already in use – Uses IVF to select out embryos without genetic disease

17. Microbiome The human body is made up of 10 trillion cells On & in the body are 100 trillion cells- – the second genome Necessary for human life Disruption in “normal flora” can lead to diseases – Inflammatory bowel disease – Rheumatological disease

18. What affects the Microbiome? Environment Diet Antibiotics Genetics Toxins Other illnessess

19. Fecal Microbiota Transplant Introduction of “good” bacteria into the colon by scope or enema C. Difficile Irritable bowel syndrome, inflammatory bowel disease Obesity studies

20. HEALTHCARE 21-47% of $ spent on healthcare is of no value – Failure of care – Overtreatment – Administrative complexity – Failure of care coordination Sentrian, the first remote patient intelligence company, aspires to eliminate all preventable hospitalization by leveraging the revolution in remote biosensors and machine learning to detect patient deterioration early, before it becomes acute. Sentrian's value proposition to healthcare organizations is to provide a cloud-based remote patient monitoring and analytics platform intended to dramatically reduce preventable hospital admissions

21. HEALTHCARE The future of medicine is to place healthcare into the hands of the patient Self diagnostics Devices such as scanadu, otoscope viewers Xprize –tricorder that can out do 15 docs Lab testing- uses only microliters of blood (fingerstick) to run hundreds of tests for pennies – Will be moving into retail stores and pharmacies – Able to upload data to cloud  dx  Rx

22. How will Expo changes in medicine affect Insurance Industry? Look for a financial firm to develop AI software that loaded with personal information and industry products makes the “best selection” for you. More accurate information about life span may encourage less life ins, postpone purchase or shift to accidental death. More predictive health information in the hands of consumers will encourage adverse selection. Artificial intelligence will allow more automated underwriting The Paramedical examination may become a thing of the past given devices like scanadu or miroculus

23. How will Expo changes in medicine affect Insurance Industry? Genomic technology will have the ability to cure the incurable leading to longer lifespans which will benefit life policies and adversely affect annuities. In general life spans will lengthen for all with access to medical care There will be unprecedented consumer access to medical information about themselves with no medical professional involved. With 24 hour life monitoring available, look for policies to be developed that mirror car insurance which reward good behaviors

24. Summary Advances in medicine will soon begin to rise exponentially and dramatically New innovative devices will increase the speed and accuracy and availability of diagnostics New technologies will create massive amounts of data which will be able to be analyzed globally and rapidly Healthcare will increasingly be put into the hand of the patient. The cascade effect from medicine will have major affects on the way life insurance and annuity products are marketed, underwritten and sold.

25. Where’s Waldo?