1. Transforming Healthcare Through Connected Health Technology - A Story from the United States Robert L. Jesse, MD, PhD Professor, Internal Medicine – Cardiology Virginia Commonwealth University Health System and Chief, Office of Academic Affiliations Veterans Health Administration 1

2. Disclosures Robert L. Jesse, M.D., Ph.D. Has no financial interest or relationships to disclose 2

3. Healthcare Will Transform Must 3

4. Why Healthcare Must Transform Priorities are changing: – People will embrace health as a personal attribute – Cost to the individual will be an important driver – Commoditization will occur at multiple levels – Quality will be a given – Efficiency will be the rule – Individuals will own and manage all of their data – Trusted health information will be the new currency – Access will be defined through engagement 4

5. Re-Envisioning Healthcare Health care becomes personalized according to an individual’s needs and values – “Precision Health” – Still evidence-based care… but individualized for me – Quality for an ‘n of 1’ + safety and prevention of harm Control shifts from health systems to the individual – Individuals own the entirety of their health information That record is agnostic to the source and inclusive of all data generated by providers and by the individual – Access is defined by whom patients choose to help: Support health promotion, prevention and well being Navigate complex healthcare decisions 5

6. Team-based care - PCMH ( VA calls it PACT ) – Moving from encounters to sustained relationships Transactional coherent health information Health Management Platforms vs EMRs Data big and small Relationship-based care is Connected health Innovations Driving Healthcare Change 6

7. Connected Health Connected Health is about sustaining the relationship between patient and healthcare system beyond the traditional bricks and mortar walls and thus empowering patients to manage their own health 7 7

8. VA Connected Health Technologies Proudly Serving Veterans since 1984 Telehealth Services Clinical Video Telehealth Home Telehealth Store and Forward Telehealth 8 My HealtheVet Patient Portal VA Secure Messaging VA Blue Button Veterans Health Library Rx Refill/Tracking VA Mobile Health Patient Mobile Apps Provider Mobile Apps/ Devices Annie – Text Messaging The Phone The Smart Phone The Dumb Phone ! 8

9. Telehealth Services Services Provided in 2014:  2.1 million episodes of care to 717,000 VA patients  45% of these patients live in rural areas – 150,000 patients case-managed by home telehealth – 250,000 patients used clinical video telehealth between VA clinics – 4,000+ received clinical video telehealth visits directly into their homes – 380,000 used store and forward telehealth technology – 75,000 implanted devices monitored remotely 9 9

10. Connected Health Technologies - FY14 10

11. 11 VA App Store http://mobile.va.gov/appstore VA Mobile: There’s an App for That 11

12. Telehealth Services - Impact Travel Reduction Savings:  Clinical Video Telehealth $34.45 per consultation  Store and Forward Telehealth $38.81 per consultation 12 Home Telehealth  54% reduction in bed days of care  32% reduction in hospital admissions  $2,000 savings per annum per patient Video Tele-Mental Health  35% reduction in acute psychiatric bed days of care 12

13. VA TeleMental Health Services FY 2003-2014 13

14. The Health Care Reality Health care is an information business It’s increasing - and increasingly complicated Most of which patients can’t access …or understand The current Healthcare industry thrives on information asymmetry 14

15. Patients engage (us) as partners in their care – We focus on preventive health – We focus on chronic disease management – We focus on patient outcomes – They demand convenient, local and timely care – They demand complementary/alternative care – They demand readily available information including the ability to contribute to that data set Changing Dynamics of Healthcare 15

16. What Will Healthcare of the Future Be? Healthcare is an information business Coherent and transactional - Logistics and scale Data big and small – not just in the EMR As information asymmetry is reduced then Commoditization accelerates - the role of AI Managing data and information exchange is the new value proposition in healthcare Connected Health is the platform for this 16

17. Better Information Better Decisions Better Health 17

18. END 18