1. ADT Well Health for Chronic Conditions David J. Whellan, MD, MHS Associate Professor Director of Clinical Trial Outcomes Department of Medicine Jefferson Medical College

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

3. Note: Hospital discharges include people discharged alive and dead AHA. 2006 Heart and Stroke Statistical Update

4. Worsening chronic heart failure (75%) De novo heart failure (23%) Advanced/ end-stage heart 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

5. Patient Status Acute event Time Definition and Epidemiology of Acute Heart Failure Syndromes, Nieminen MS,Harjola VP: American Journal of Cardiology, Supp to Vol. 96, #6; 13G Achieve Goals: Medications Devices Surgery

6. Patient Healthcare Costs Physiologic Changes Precede Symptoms

7. Patient Healthcare Costs Early Detection of Physiologic Changes and Change in Treatment

8. Baseline Risk Factors Initial Loss of Stability Worsening Signs and Symptoms Hospitalization/ Mortality HFDM Mechanism Reducing RiskMonitoring Improve accuracy of knowledge about self-management Promote Self-Management Skills Develop Self-Efficacy Required to continue benefit Patient Functioning Domain Psychosocial Domain Physiologic Domain Demographic Domain Resource Utilization Domain

9. Triage and connect Patient’s home Physician Your healthcare providers 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 Value

10. 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 connected to 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

11.  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 OverviewResults *Based on preliminary data

12. Devices can be dropped shipped directly to the member

13.  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

14.  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

15. Traditional DM Nurse-to-patient ratio = ~320 2 Need help 30 Okay Tech-Based DM Nurse-to-patient ratio = ~640 With remote monitoring nurse calls 32 people who actually need help 32 Need help 0 ADT 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 032 Need help

16.  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?