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1、 Smart Services Leadership: Trends in Telemedicine The Role of Wireless Communications in Healthcare Jim Sweeney Executive Chairman CardioNet A Case Study Smart Services Leadership Summit July 30, 2008 In Healthcare, Reimbursement Drives Strategy ?Unlike other sectors in business the better mousetra
2、p does not work in healthcare (how many of you have your personal medical record on a stored memory device?) ?Reimbursement in healthcare is still largely third party driven with consumers paying only a small portion out of their own pocket. Therefore, in healthcare knowing how you are going to get
3、paid before you begin developing a new product or service is critical The OpportunityThe Opportunity CarePartners 1988 - 1989 CareGivers 1989 - 1990 CAPS 1989 - 1990 Coram 1994 - 1996 Bridge 1997 - 1999 CardioNet 1999 2008 Caremark 1979 - 1987 The ReturnThe Return James M. SweeneyJames M. Sweeney En
4、trepreneurial HistoryEntrepreneurial History (All start(All start- -ups as Founder/CEO except McGaw)ups as Founder/CEO except McGaw) Merge and turnaround six unprofitable home IV therapy companies with major ethical & legal problems Create new bedside technology to prevent medication errors in hospi
5、tals Regional IV admixture centers for hospitals High Tech home care partnership with a leading health care system Establish a 24/7/365 nursing call center Early return home for premature babies Move IV therapy from the hospital to the home Create Prescription Benefit Management Company First commer
6、cially successful wireless medicine company Caremark 1979 - 1987 CarePartners 1988 - 1989 CareGivers 1989 - 1990 CAPS 1989 - 1990 Coram 1994 - 1996 Bridge 1997 - 1999 CardioNet 1999 - 2008 144x original investment for VCs 5x original investment for IPO Investors Investors recoup 75% 10-1 Return for
7、Investors Currently highly profitable $150 million business growing 15% annually (B. Braun) subsidiary Returned entity to operating profitability Sold to Apria Healthcare for $350 million Raised $70 million System now in use & endorsed by major hospital systems Sold in 2002 for undisclosed amount Pu
8、blic company $671 million valuation Raised $200 million $100+ million Revenue, profitable McGaw 1990 - 1993 Turnaround (LBO, IPO) of “no growth” IV products company McGaw 1990 - 1993 6.5x return for LBO investors in three years 2x return for IPO investors (in under a year) 77% IRR Disruptive Technol
9、ogy Applied to Healthcare CardioNet System Patients are monitored anytime, anywhere Events transmitted as they occur Timely notification Custom reporting based on physician- defined criteria Event Monitoring (Loop and AF Auto Trigger) Symptom driven Patient must transmit events Limited memory Poor c
10、ompliance Holter Monitoring Short recording duration limits diagnostic yield 23 day report delay No timely MD notification In-Hospital Cardiac Telemetry Expensive Restricts patients normal daily activities The Standard New Gold Standard 7% Diagnostic Yield 15% Diagnostic Yield 65% Diagnostic Yield I
11、ntermittent Digital/Tape Recorders Real-time Ambulatory, Wireless Solution CardioNets Integrated Patient Monitoring Platform ?Wireless data transmission network (data partner Qualcomm) ?FDA cleared proprietary advanced algorithms ?FDA cleared medical technology Small, portable, non-invasive Requires
12、 limited patient involvement or compliance ?Internally developed software ?24-hour central monitoring service driven by proprietary technology ?Customized reporting of objective, clinically relevant information in timely manner Developed over 7 years with $197 million investment Market Opportunity H
13、ealthcare Spending - $ 2.3 Trillion in 2008 ?In 2004, Health care spending reached $1.9 Trillion (16% of GDP) ?Projected 2009: $2.9 Trillion ?Projected 2015: $4.0 Trillion (20% of GDP) ?Health care spending is 4.3 times greater than amount spent on national defense ?National Coalition on Health Care
14、 Cardiac Arrhythmias ?4 million Americans affected 750,000 hospitalizations annually 500,000 deaths annually ?Atrial fibrillation: Most prevalent life-threatening cardiac arrhythmia 2.2 million Americans 15-20% of 700,000 strokes annually 5x higher likelihood of stroke ?Syncope (fainting): Common co
15、nsequence 1 million emergency department visits 6% of hospital admissions annually ?Early diagnosis has significant impact on treatment pathway, outcomes and cost of care CardioNet Solution HEARTBEAT BY HEARTBEAT SURVEILLANCE RATE, RHYTHM, MORPHOLOGY ALGORITHM MD NOTIFICATION CRITERIA AT HOMEOR AWAY
16、 24/7/365 PROPRIETARY SOFTWARE IDTF ECG FETCH TEXT MESSAGES DAILY, URGENT AND SUMMARY REPORTS INTERNET, PHONE, FAX REPORT DELIVERY AUTOMATED EVENT DETECTION SYMPTOMATIC EVENTS AUTOMATIC CELL OR LANDLINE TRANSMISSION-NO PATIENT INTERVENTION 96 HOURS OF ECG STORAGE The CardioNet System POTS SOFTWARE /
17、SYSTEMSSERVICE Next Gen (OTS)Next Gen (OTS) Work Order System/Inventory Sensor: Patient Data Acquisition Personal Monitor Data Highway / Warehouse Monitoring System Application (MSA) Patient Enrollment & Management System (PEMS) Payor Acquisition Physician Acquisition Patient Intake Patient Ed Sched
18、uling Patient Education Monitor End of Service Product Prep and Distribution Return Product De-Activate Billing Collections Product Reprocess Proprietary Software is the Core of the CardioNet System Personal & Local RF Wide Area RF Communication Data Input & Analysis Data Presentation & Reporting Qu
19、alcomm Data Center PRODUCT ECG Acquisition Arrhythmia Detection Algorithms CARDIONET MONITORING CENTER PHYSICIAN NOTIFICATION AND REPORTING Clinical Experience ?133,000 patients monitored ?Unprecedented diagnostic yield 53% of patients previously unsuccessfully monitored with other technologies were
20、 diagnosed with clinically significant arrhythmias 10% of patients experience symptoms with events ?Approximately 60% of events sent via wireless (when patient is mobile) ?Daily life-saving interventions 20-30% of patients trigger physician notification criteria 67% of patients experienced change of
21、 management by physician as result of CardioNet System diagnosis ?Pacemakers ?Implantable cardioverter defibrillators ?Ablations Reimbursement Drives Strategy Life Cycle: “Crawl, Walk, Run”CardioNet History Create high value-added solutionJanuary 2003 launch Secure initial customers/reimbursement st
22、aying “below radar” $0mm (2002) to $31mm (2005) revenue in 3 years Move “above radar” and develop evidence of superiority through clinical trials or lose payors ?Late 2005 2006 21 payors deemed “experimental and investigational” Paused expansion awaiting clinical trial results ?Q1 07: Randomized cli
23、nical trial published ?2007: Expansion resumed Secure long-term reimbursement2009: Unique CPT code Reimbursement Momentum 0 15 30 45 60 75 90 105 Q3-03 Q4-03 Q1-04 Q2-04 Q3-04 Q4-04 Q1-05 Q2-05 Q3-05 Q4-05 Q1-06 Q2-06 Q3-06 Q4-06 New Covered LivesExisting Covered Lives 0 25 50 75 100 125 150 Q3-03 Q
24、4-03 Q1-04 Q2-04 Q3-04 Q4-04 Q1-05 Q2-05 Q3-05 Q4-05 Q1-06 Q2-06 Q3-06 Q4-06 New ContractsExisting Contracts Covered Lives - Commercial 142 mm covered lives (101 mm commercial) 143 contracts ?Substantial progress in absence of randomized clinical trial ?Achieved premium pricing by differentiating te
25、chnology Covered Lives (mms) Contracts Direct Contracts - Commercial Randomized Clinical Trial 15% 41% 0% 10% 20% 30% 40% 50% Loop Event MonitorsCardioNet System (p 0.001) Diagnostic Yield: Clinically Significant Arrhythmias ?300 patients, 17 centers ?CardioNet System vs. “Loop” Event Monitoring ?Al
26、l patients had failed Holter Monitoring ?Journal of Cardiovascular Electrophysiology March 2007 issue Online publication in mid-January 2007 ?Conclusion: CardioNet System has nearly 3x higher diagnostic yield than “Loop” Event Monitors 23% 0% 8% 17% 0% 5% 10% 15% 20% 25% 30% All AFAll Asymptomatic A
27、rrhythmias Loop Event MonitorsCardioNet CardioNet System Superior to Loop Event Monitors 16% 52% 0% 10% 20% 30% 40% 50% 60% Loop Event MonitorsCardioNet System (p 0.001) Diagnosis of Clinically Significant Arrhythmias (p 0.001)(p 85 member sales team (post-PDS acquisition) ?133,000 patients monitore
28、d Financial Overview Core Business Actual and Planned Revenue ?2003 revenue $ 8 million ?2004 revenue $ 22 million ?2005 revenue $ 31 million (moved above radar, stopped expansion, started clinical trial) ?2006 revenue $ 34 million (completed clinical trial, expanded payor support, expanded geograph
29、y) ?2007 revenue $ 77 million (published clinical trial, expanded payor support, expanded geography) ?2008 revenue $ 120 (projected) million, profitable. IPO in March 2008, stock appreciation 75% as of last week. $690 million market capitalization The Future of Wireless Medicine ?Wireless Medical Te
30、chnology is projected to grow 289% over the next 5 years representing $7 billion growth Remote Monitoring Growth Projections FDANews, Wireless Medical Technology: A Strategic Analysis of Global Markets Healthcare Unbound will top $5 billion by 2010, and will skyrocket to $34 billion by 2015 Forreste
31、r, The $34 Billion Market For Personal Medical Monitoring Wireless Medicine System Expansion Opportunities POTS SOFTWARE /SYSTEMS Next Gen (OTS) Next Gen (OTS) Work Order System/Inventory Sensor: Patient Data Acquisition Personal Monitor Data Highway / Warehouse Monitoring System Application (MSA) P
32、atient Enrollment & Management System (PEMS) Wireless Expansion will Require New Sensor Development and Public Platform for Backend Processing Personal & Local RF Wide Area RF Communication Data Input & Analysis Data Presentation & Reporting Qualcomm Data Center PRODUCT Data Acquisition Detection Al
33、gorithms Any Sensors OPSMSA PEMS FAX Internal Apps Data Center CN Database Application Server Customer Apps PEMS Reporting Server In Summary ?CardioNet is the first commercially successful wireless medicine company whose success is due, in part, to the vision of Qualcomm in partnering with us in this area in 2002 ?We are now entering an era in which wireless medicine companies will proliferate proximate to their ability to provide cost effective alternatives to hospitalization July 2008