1 Confidential | HCTM/BUD | 01/12/2010 | © Robert Bosch GmbH 2010. All rights reserved, also regarding any disposal, exploitation, reproduction, editing, distribution, as well as in the event of applications for industrial property rights.

Strategy – Remote Patient Monitoring System

PDS Meeting (Summit I)May 2009

Strictly Confidential

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Robert Bosch Healthcare

September 2010

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Robert Bosch Healthcare: Overview

HCTM | 1/14/2009 | © 2009 Robert Bosch LLC and affiliates. All rights reserved.

““Innovative Drive and Social Commitment”Innovative Drive and Social Commitment”

Founded in 1886 and still privately held 92% owned by Robert Bosch Foundation, which is a

Charitable Foundation Global corporation

2008 revenues of 45.2 billion Euros/59.7B US; 270,000+ employees

Over 100,000 patients deployed globally over the past 10 years

Deployed over 150K units since our beginning Over 30K patients connected and monitored daily

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Robert Bosch Healthcare: Unique Aspects

HCTM | 1/14/2009 | © 2009 Robert Bosch LLC and affiliates. All rights reserved.

Experience in multiple healthcare delivery systems

Largest installed base of patients globally. Deployed over 150K units since our beginning Over 30K patients connected and monitored daily in the US and EU Largest installation of technology in Physician practices

Proven results in GP Practice Environments

30+ Clinically validated outcome studies with consistently

demonstrated quality improvement and cost savings based on:

Populations that range in size to 43,000K CE-approved technology that drives sustainable behavior change Integration of PERS (Telecare) and Telehealth for the past 8

years

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What Do Assistive Living Technologies What Do Assistive Living Technologies Support?Support?

9/16/2009 | © 2009 Robert Bosch LLC and affiliates. All rights reserved.

Early interventionEarly intervention – by detecting early clinical deterioration and intervening before unscheduled and preventable services are needed

Integration of careIntegration of care – by the exchange of “actionable” data and communication about multiple co-morbidities and complex disease states to various providers

CoachingCoaching – through motivational interviewing and other techniques to encourage patient behavioral change and self-management activities

Trust Trust – by improving the patient’s feeling of “connectedness” and satisfaction with Care Team

Increased efficiency and effectivenessIncreased efficiency and effectiveness – through automated documentation, systematic review of alerts and more efficient use of resources

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Robert Bosch Healthcare

Focus on managing chronic and complex chronic condition(s) that drive disproportionate share of hospitalizations and moves out of home

Support and monitor high risk individuals: Keep them healthier - less need to use healthcare resources,

including the long-term care system; promote adherence to medications and treatment plan

Monitor to ensure we can catch complications early Refer to appropriate health and social/nutrition support providers Provide post-acute support to ensure patient returns home as

quickly as possible – and stays there.

Improve independence of older adults: Maintain “connectedness” Increase self-management Proactively address potential exacerbations.

Confidential | 11/17/2009 | © 2009 Robert Bosch LLC and affiliates. All rights reserved.

6

What Do Assistive Living Technologies What Do Assistive Living Technologies Support?Support?

HCTM/PRM-E | 04/02/2010 | © Robert Bosch Healthcare GmbH 2010. All rights reserved, also regarding any disposal, exploitation, reproduction, editing, distribution, as well as in the event of applications for industrial property rights.

A Transformative Model• Person Centred Care• Empowering people to self manage• Reducing unnecessary hospital admissions• Promoting early discharge

At Home

Technical TriageClinical Triage

•Blood Pressure

•Blood Sugar

•Blood Oxygen

•Spirometry

•ECG

Bosch

Clinical Environments

Local Response

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VA Care Coordination Model

VA over past two decades has moved from hospital-based to outpatient- and home-based care

Initial trials in Florida focusing on telehealth-based care coordination

top 4 percent of population driving 40 percent of costs Usual parameters for inclusion of patients in these

trials/programs: high resource utilization, high cost and chronic diseases +/- comorbid conditionsConcept: Move care from the hospital to the clinic – and to

the home

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88

Darkins A, Ryan P, Kobb, R, et al*

Results of National Home Telehealth Program: July 2003 Results of National Home Telehealth Program: July 2003 – December 2007– December 2007

* Darkins A, Ryan P, Kobb R, et al: Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic Diseases. Telemed & e-Health, Dec 2008, vol 14 (10), pp 1118 -1126

Veteran patients with DM, CHF, HTN, PTSD, COPD and depression

Care coordination including the use of HIT (CCHT) to support both care across the continuum from hospital to home and the promotion of patient self-management

N= 43,430 patients: Mean age = 66.5 yrs Patients ≥ 85 yrs = 16.5%

Urban areas = 58%; rural areas = 40% Explicit enrollment criteria

75%-80% of patients used the Health Buddy System

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Koff PB, Jones RH, Cashman JM, et al*

Single center, randomized, controlled clinical trial

Objective: Determine whether proactive integrated care (PIC) improved QoL (SGRQ) compared to usual care

PIC intervention: disease-specific education; teaching of self-mgmt techniques; enhanced communication with study coordinators; remote home monitoring using the Health Buddy System

Population: GOLD Stage 3 or 4 for COPD

Duration of intervention: 3 months

N= 20 per arm (sample size based on a 2 unit improvement with a SD of 1.9 and an α of 0.05)

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*Koff PB, Jones RH, Cashman JM, et al: Proactive integrated care improves quality of life in patients with COPD. 2009, vol 33 (5), pp 1031 - 1038

Study Design:Study Design:

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What Do Assistive Living Technologies What Do Assistive Living Technologies Promote?Promote?

HCTM/PRM-E | 04/02/2010 | © Robert Bosch Healthcare GmbH 2010. All rights reserved, also regarding any disposal, exploitation, reproduction, editing, distribution, as well as in the event of applications for industrial property rights.

A System of Care: to connect patients and their clinical teams to extend the time people can live in their preferred

environment by increasing their autonomy, self-confidence and mobility

to support maintaining health and functional capability of the elderly individuals

to promote a better and healthier lifestyle for individuals at risk

to enhance the security, to prevent social isolation and to support maintaining the multifunctional network around the individual

to support carers, families and care organisations