albert 2 oklahoma telemedicine

1 © 2013 AliveCor, Inc. All Rights Reserved. Proprietary & Confidential.

The mCardiology Company

Oklahoma Telemedicine Conference 2014

David E. Albert, MDFounder and Chief Medical Officer

AliveCor


Statements, opinions and results of studies contained in the program are those of the presenters/authors and do not reflect the policy or position of the Board of Regents of the University of Oklahoma (“OU”) nor does OU provide any warranty as to their accuracy or reliability.

Every reasonable effort has been made to faithfully reproduce the presentations and material as submitted. However, no responsibility is assumed by OU for any claims, injury and/or damage to persons or property from any cause, including negligence or otherwise, or from any use or operation of any methods, products, instruments or ideas contained in the material herein.

Disclaimer


Disclosure Statement of Financial Interest

• Major Stock Shareholder/Equity

• Ownership/Founder

• Salary & Other Financial Benefit

• AliveCor, Inc.

Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.

Affiliation/Financial Relationship Company


Objectives

• Describe the current status of healthcare delivery in the US and OUS

• Describe how mHealth can help address some of the global issues

• Describe the current status of mHealth in the US and OUS

• Provide real-world examples of how mHealth is working

• Describe the potential in the future


US Healthcare Expenditures


Expenditures Continue to Increase


Healthcare Problems Differ For the Developed

vs. the Developing World

• Developed world (especially the US) spends too

much on healthcare and doesn’t get its money’s

worth.

• Developing world spends too little and gets

exactly what it pays for (i.e., almost nothing).

• We must find solutions and technologies which

can address the problems of both… and that’s

not as crazy as it sounds!


Population Growth (in the Developing World) Demands Action

to Improve Healthcare!


Healthcare Globally Must Go from Reactive to

Proactive: Hygiene & Diet & Fitness & Vaccines, Etc.


The challenge 2013Global HC workforce vs. disease burden*

57Countries below WHO critical

healthcare coverage threshold

4.3 millionWorldwide shortage of health workers

including doctors, nurses, and midwives

$2 billionAnnual cost just for training of needed

HC professionals in India aloneU.S., Canada, and Latin America have 37% of global healthcare workers and only 10% of global disease burden

*: Size of circles proportional to healthcare expenditures

Source: World Health Organization

Inadequate Healthcare Access

AliveCor Company Confidential Oct-14


*: 1 exabyte = 109 gigabytes

Source: Cisco VNI Mobile 2011

92% CAGR

Health Data, like All Information, will be

Shared, Connected & Engaged


And Exponential Change will bring a

New Paradigm to Healthcare


Smartphones Introduced Apps & As the Late

Steve Jobs said, “That changed everything”!

• > 1 Billion Apple and Android devices sold to date worldwide

• Over 70% of US subscribers have a smartphone

• 100 billion app downloads from Apple’s iTunes Store & Android Market

• 5 years from now there will be no dumb phones but only smartphones


Smartphones: The Global Technology Growth EnginemHealth: Bringing Smartphone Dynamics to Medicine

75

38

13

4 2.5

Telephone Radio TV Internet Smartphone

Years to reach 50 Million Users

500M

$26B

Users

Market size

mHealth by 2017


The Smartphone Will be the World’s Healthcare

Portal


p e w i n t er n e t .o r g 3

Demographic trends in smartphone ownership

As has consistently been the case since we began measuring smartphone adoption two years ago,

ownership is particularly high among younger adults, especially those in their twenties and thirties

(although a majority of Americans in their mid-forties through mid-fifties are now smartphone adopters)

and those with relatively high levels of household income and educational attainment.

Every major demographic group experienced significant year-to-year growth in smartphone ownership

between 2012 and 2013, although seniors—defined as those 65 and older—continue to exhibit

relatively low adoption levels compared with other demographic groups. Some 18% of Americans age 65

and older now own a smartphone, compared with 13% in February 2012.

Smartphone ownership by demographic group—

gender, age, race/ethnicity % within each group who own a smartphone

Own a smartphone

All adults (n=2,252) 56%

Gender

a Men (n=1,029) 59b

b Women (n=1,223) 53

Age

a 18-24 (n=243) 79cdef

b 25-34 (n=284) 81cdef

c 35-44 (n=292) 69def

d 45-54 (n=377) 55ef

e 55-64 (n=426) 39f

f 65+ (n=570) 18

Race/ethnicity

a White, Non-Hispanic (n=1,571) 53

b Black, Non-Hispanic (n=252) 64a

c Hispanic (n=249) 60

Source: Pew Re s earch Center’s Internet & Am erican Life Project, Ap ril 17-May 19, 2013 Tracking Survey. Interviews were conducted in English and Spanish and on landline and cell phones. Margin of error is +/-2.3 percentage points based on all adults (n=2,252).

Note: Percentages marked with a superscript letter (e.g., a) indicate a

statistically significant difference between that row and the row designated by that superscript letter, among categories of each demographic characteristic (e.g. age).


p e w i n t er n e t .o r g 5

Smartphone ownership by income/age grouping % within each age/income grouping who own a smartphone (example: 77% of 18-29 year olds with an annual household income of less than $30,000 are smartphone owners)

Source: Pew Re s earch Center’s Internet & Am erican Life Project April 26 -May 22, 2011, January 20-February 19, 2012, and April 17-May 19, 2013 tracking surveys. For 2013 data, n=2,252 adults and survey includes 1,127 cell phone interviews. All surveys include Spanish-language interviews.

Trends in platform adoption

Since 2011, the proportion of cell owners who say they own either an iPhone or an Android device have

each grown dramatically. Android owners now represent 28% of all cell owners (up from 15% in May

2011), while iPhone owners now represent 25% of the cell owner population (up from 10% in May

2011). Meanwhile, the proportion of cell owners who say they own a Blackberry device has fallen from

10% in May 2011 to just 4% in our most recent survey.

77%

47%

22%

8%

81%

68%

40%

21%

90% 87%

72%

43%

0%

20%

40%

60%

80%

100%

18-29 30-49 50-64 65+

Less than $30,000 $30,000-$74,999 $75,000 or more


Physicians & Mobile Computing

Devices

Source: QuantiaMD, Tablets Set to Change Medical Practice, 2011


Physicians Support Mobile Monitoring

• Percentage who want to monitor patients at home

65% - Weight

61% - Blood sugar

57% - Vital signs (e.g. blood pressure,

heart rate, respiratory rate)

54% - Exercise/physical activity

36% - Calories/fat content taken in

36% - Pain level

35% - Sleep patterns

28% - Cardiac rhythm

17% - Bladder control

16% - Acid reflux/indigestion

13% - Digestive health

Source: PricewaterhouseCoopers HRI Physician Survey, 2010


Patients Accept Ownership

and Responsibility

Source: IBM Report: The Future of Connected Health

Devices, March 2011

“Among those surveyed, nine out of ten (93 percent) are

satisfied or very satisfied with the basic functionality of their

devices. Although less than 10 percent are paying out-of-

pocket charges for their devices today, more than one-third

expect to do so within two years. Most users are willing to pay

for a device, but will not spend more than US$100 out of

pocket. An increasing number of consumers also

anticipate paying monthly fees in the future; while only 5

percent pay a monthly charge today, 35 percent expect to do so

in two years.”

AliveCor Company Confidential May 2011


A Huge Opportunity To Do Good & Do Well!

mHealthinsights July 2013

The global mHealth market

opportunity and sustainable

reimbursement models

Mobile health (mHealth) is an attractive solution that leverages the ubiquity of mobile devices to address the prevalent problem of access to healthcare and rising costs. According to the International Telecommunications Union, overall mobile penetration rates will have reached 96% globally by 2013, 128% in the developed world and 89% in the developing world.1 The growing rates of mobile adoption, coupled with the pressing challenge of finding alternative ways to reduce healthcare costs, provide a ripe opportunity to expand the mHealth market.

In fact, a PwC and GSMA study predicts that global mHealth revenues will increase by nearly six-fold to $23 billion by 2017.2 Most of the market share will be in Europe and the Asia-Pacific regions with 30% of share each, followed by North America with 28%. Latin America and Africa are expected to have smaller markets with estimated shares of 7% and 5% respectively.3

mHealth has the potential to revolutionise the healthcare industry yet organisations are still uncertain how to capitalise on the technology. To make gains, healthcare organisations, payers, mobile operators and regulators should work together as part of an ecosystem to introduce consumer-centric, scalable business models that empower the patient and provide reimbursement for mHealth offerings.

Key mobile market opportunities

According to the PwC and GSMA report, Touching lives through mobile health: Assessment of the global market opportunity, monitoring services and applications are expected to represent 65% of the market in 2017, driven primarily by the rapidly ageing population in developed countries and the high levels of chronic disease in emerging markets.4

Highlights

PwC and GSMA predicts that global mHealth revenues will increase to $23 billion over the next four years

The market opportunity for mHealth is promising, yet conflicting financial incentives has created uncertainty on how stakeholders can capitalise

Reimbursement models are largely dependent on patient involvement and a gradual evolution of medical models that help familiarise providers and payers to new modes of care delivery

1 International Telecommunications Union, The World in 2013: ICT Facts and Figures report, http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2013.pdf 2 PwC and GSMA, Touching lives through mobile health: Assessment of the global market opportunity, February 2012. 3 Ibid. 4 Ibid.


Global mHealth Market Relevance

US & Western Europe Empower consumers Improve effectiveness of existing

systems Reduce costs

Developing World Create health infrastructure Leap-frog bricks and mortar Provide accessible health solutions


Outcomes are Improved When We Connect


App-Drug Synergy will Enable Patient

Self-Management

• Diabetes: Sanofi iBGStar

• Hypertension: Withings BP

• Atrial Fibrillation: AliveCor ECG


Smartphone & Cloud Computing Enable Global

Telemedicine


Smartphones & Big Data Will Rely on CLOUD

COMPUTING To Create Connected Innovations!


BIG DATA will allow innovation in everything

from weather to energy to medicine!


H1N1 Virus


1919 Spanish Influenza Epidemic


The New Vectors of Social Virality


Idea Epidemics can Literally Span the Globe in a Day


Ideas Spread At the Speed of Light With No Control


Atrial Fibrillation Chronic HeartFailure

Heart Flutter Coronory ArteryDisease

Hypertension

Cardiovascular Disease: A Large Market

Opportunity

6M

78M

3M

30M

47M

US Cardiovascular Annual Disease Expense $273 Billion

US patient population


Growth in Heart Disease –

US population 2000 - 2050

Beller GA. Circulation. 2001; 103:2428 – 2435

Foot DK, et.alo. J Am Coll Cardiol. 2000; 35:1067 -1081


Hypertension: The Statistics


Summary of studies

investigating the prevalence of

atrial fibrillation in various

populations and age groups1

1Cairns J, Connolly J. Nonrheumatic atrial fibrillation: risk of stroke and role of antithrombetic therapy.

Circulation. 1991:84;469.

%

Age (years)

< 40 60 64 74 > 750

2

4

6

8

10

Prevalence of Atrial Fibrillation


Thousands of Hospital DaysThe Lancet, 1993;341:1319.

Unspecified

Conduction Disease

Sick Sinus Syndrome

Premature Beats

Junctional Rhythms

Atrial Flutter

Atrial Fibrillation

Ventricular Tachycardia

Ventricular Fibrillation

Cardiac Arrest

0 400200 600 800 1000

Annual Utilization/Primary DiagnosisMore than $1.3 billion spent annually due to AF primary diagnosis


Primary Healthcare Expenditures

Annual Economic Burden

0

5

10

15

20

25

30

35

40

Bil

lio

ns

of

$ U

S

HF AF VT/VF Brady


5.0 million

6.5 million

Heart failure management

A Growing Medical Challenge

400,000 250,000

Annual

Incidence

Heart Failure

Prevalence

Annual

Mortality

U.S.

580,000 300,000Europe

Congestive heart failure worldwide markets, clinical status and product development opportunities. New Medicine, Inc. 1997:1-40.

Wilkerson Group Survey, 1998.


mHealth Cardiology Solutions are Growing

Rapidly


One Small mHealth Solution:

AliveCor Smartphone ECG


The AliveCor Smartphone System is a Global,

Cloud-Based ECG Monitor

Patient Takes ECGVia Hands or Chest

ECGs Stored Locally

ECGs Securely Stored & Processed In the Cloud

ECGs Accessed Via HIPAA-compliant, Secure Login

ANYWHERE INTHE WORLD


In-Flight Arrhythmia Diagnosis CASE

Patient Profile and History

• A male patient in his mid 20’s experiences

shortness of breath, palpitations, and chest

pain during an intercontinental flight. Physician

unable to diagnose rhythm with stethoscope.

Clinical Assessment Using the Heart Monitor:

• An ECG recorded with the Heart Monitor

showed runs of Ventricular Trigeminy

(Premature Ventricular Contractions every

third beat).

• Patient was instructed to see a doctor when

arriving at home and take the ECG to the

appointment

Value of the Heart Monitor:

• The Heart Monitor in this instance was able to assist the doctor in diagnosing PVCs.

• This allowed the plane to continue on its journey without an expensive emergency landing to care

for the patient.

• The patient was given the peace of mind that their symptoms were not life threatening and could

see their primary physician when arriving at home.


AFib Screening & Stroke Risk Identification

Concord Hospital, University of Sydney, Australia (PI, Dr. Ben Freedman, Professor of

Cardiology and Deputy Dean of Medicine)

Presented at the American Heart Association in November 2012

109 patients evaluated with standard ECG and AliveCor 70 sinus rhythm, 39 AFIB Blind evaluation

Cardiologist A Cardiologist B AliveCor AF Algorithm*

94% 95% 97%

*AliveCor AF Algorithm in testing, not currently available for sale in the US or elsewhere


Database Currently Contains Over a Million

ECGs- Following Them Over Time.

TachycardiaBradycardia

Heart Rate Distribution From Customer Database


mHealth Transforming Heart Health By

Empowering Self-Care

Traditional ECG AliveCor ECG

Difficult to access Expensive Limited to institutions Appointment driven

Data driven Instantly available Accessible & affordable Consumer-centric


Physician-Directed Patient Self-Management of Left Atrial

Pressure in Advanced Chronic Heart Failure

Ritzema J et al. Circulation. 2010;121:1086-1095


Patient Self-Management Case Study

Patient with atrial fibrillation (AFIB), an erratic heart beat, on the drug Amiodarone which causes severe side effects

Patient buys the AliveCor device with subscription, using it on a daily basis for remote monitoring

Patient and physician adjust prescription dosage while monitoring ECG real time from home, eliminating side effects and controlling AFIB

Expensive hospital and office visits avoided Money saved for payors

Ubiquitous ECG monitoring can transform healthcare delivery, reducing cost while improving outcomes!


Veterinary mHealth Opportunity

AliveCor Company Confidential Oct-14

• From dogs & cats to horses and

exotic animals, mHealth presents

opportunities to take state-of-the-art

care to the patients.

• Vets have always made house calls

especially for farm animals and

horses- they are true “mobile care

providers”

• Owners can source biometric data

as it’s always easier to “move data”

than to “move patients” , especially if

they are LARGE!


Impact of Digital & Mobile HealthChanging the paradigm – creating a new S-curve

Extends reach of healthcare institutions to home & mobile

Cellphone-based disease management improves outcomes

Enabled by consumer electronics cost structures and channels

Physicians embrace mobile monitoring for their patients

Patients accept ownership and financial responsibility for

better health and wellness tools

Mobile health solutions present major business opportunities


What’s Going to Happen to mHealth?

1. Consumerization is early but it’s coming to

cardiovascular and all healthcare.

2. Technologies like Smartphones & Cloud

Computing are enablers but Changing

Economics & Increased Personal

Responsibility are the Drivers!

3. Change creates Opportunity so embrace it!

THANK YOU!