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Digital Health: Opportunities for Advancing Healthcare Steve Allan CFA Head of SVB Analytics [email protected] Scott Winder Director [email protected] Alex Lee Manager [email protected] Emily Wengel Associate [email protected] Written by SVB Analytics:

SVB digital health-report-2016

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Digital

Health: Opportunities for Advancing Healthcare

Steve Allan CFA Head of SVB Analytics [email protected]

Scott Winder Director [email protected]

Alex Lee Manager [email protected]

Emily Wengel Associate [email protected]

Written by SVB Analytics:

Table of Contents

Digital Health Report 2

3 Overview: What is Digital Health?

6 State of U.S. Healthcare: What Drives Costs and Outcomes

10 Employers and Payers: Improving Outcomes and Lowering Costs

19 Healthcare Systems and Professionals: Impacting Care Delivery

26 Healthcare Consumers: Engaging Consumers, Empowering Patients

31 Digital Health Outlook: Mapping Digital Solutions for Advancing Healthcare

33 About the Authors

36 About Silicon Valley Bank and SVB Analytics

See Appendix for complete sources and additional information.

What is Digital Health?

Digital Health Report 3

Solutions that use digital technology to improve patients’ health outcomes and/or reduce the cost of healthcare

The convergence of healthcare and technology has arrived. Healthcare stakeholders are seeking solutions to survive and thrive in a fast-changing regulatory and clinical environment. At the same time, enabling technologies are becoming widely adopted. The healthcare ecosystem is aligning around critical areas to bring widespread advancements through digital health solutions. SVB Analytics is examining challenges facing a wide range of stakeholders and identifying opportunities for digital technology.

This is the first in a series of reports on Digital Health. In this report, we will examine:

• What drives costs and outcomes of the U.S. healthcare system

• How employers and payers struggle to contain healthcare costs

• How healthcare systems and professionals are plagued by inefficiencies in care delivery

• How healthcare consumers find it challenging to be involved in and manage their own healthcare

Stakeholder Challenge Example Digital Health Companies

Employers Lowering healthcare costs and improving productivity with healthier employees

Payers Migrating to value-based care and adjusting risk to maintain profitability

Healthcare Systems and Professionals

Reducing operational challenges and adapting healthcare delivery to the changing regulatory and clinical landscape

Healthcare Consumers

Gaining access to information and guidance to better manage healthcare decisions and disease treatment

Digital Health Report 4

Healthcare Stakeholders Face Many Challenges In this report, we look at the some of the largest unaddressed markets in which digital technology can help solve key stakeholder challenges.

Digital Health Report 5

State of U.S. Healthcare: What Drives Costs and Outcomes

Digital Health Report 6

High Costs, Dissatisfaction Drive Demand for Innovation

$- $2,000 $4,000 $6,000 $8,000 $10,000

United StatesSwitzerland

NorwayNetherlands

SwedenGermanyDenmark

AustriaCanada

BelgiumFranceJapan

IcelandFinland

New ZealandUnited Kingdom

ItalyPortugal

Healthcare Expenditure per Capita, PPP* in USD, 2013

U.S. Healthcare Expenditures Far Outpace Other Countries

Digital Health Report

In many respects, the U.S. healthcare system has fallen behind other developed countries – costs more but results in less satisfaction.

7 *PPP: Purchasing power parity

0% 20% 40% 60%

United States

United Kingdom

Luxembourg

Canada

Finland

Germany

Israel

Netherlands

Sweden

Italy

Switzerland

Japan

Korea

% of Population that is Overweight or Obese in OECD Countries, 2013

Obese population, >30 BMI Overweight population , 25-30 BMI

0 2 4 6

United StatesUnited Kingdom

BelgiumNetherlandsSwitzerland

IsraelFrance

IrelandDenmarkPortugal

AustraliaGermany

AustriaSpainItaly

SwedenNorwayFinlandIceland

Death per 1000 births

Infant Mortality Rates in OECD Countries, Death per 1000 Births, 2012

But Health Outcomes Are No Better, Despite Investment

Digital Health Report 8

Despite higher per capita spending on healthcare in the U.S., the health outcomes are often no better. The U.S. system remains focused on sick-care rather than upon improving wellness and providing preventive care.

11.5% 15.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1980 2012

Administrative and Insurance Costs Contribute to Higher Healthcare Costs

$27.1 Billion

$386.3 Billion Increase

$413.4 Billion

Annual administrative & insurance-related

costs

9

U.S. Healthcare Expenditures by Category

in annual administrative & insurance-related costs

Other (incl. Insurance and Administrative)*

Nursing Home Care

Other Medical Durables and Non-Durables

Prescription Drugs

Home Healthcare

Other Professional

Physician Services

Hospital Care

*"Other" includes net cost of insurance and administration, government public health activities and other personal healthcare. Digital Health Report

Digital Health Report 10

Employers and Payers: Improve Outcomes and Lower Costs

Challenge Opportunity Example Digital Health Companies

Growing Cost of Healthcare Benefits

Implement platforms that improve healthcare benefit management and lead to employer cost savings

Competition to Attract and Retain Talent

Provide employees access to innovative services, such as telemedicine and genetic testing, to better manage their health

Productivity Loss Due to Employee Health Issues

Offer technology-based tools and services to emphasize wellness and preventive health

Digital Health Report 11

Overview: Employers Face High Healthcare Costs and Lost Productivity

Healthcare Benefits Become Bigger Part of Employee Compensation

Digital Health Report 12

7.0%

7.2%

7.4%

7.6%

7.8%

8.0%

8.2%

8.4%

8.6%

8.8%

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

% o

f Tot

al C

ompe

nsat

ion

Healthcare Benefits as % of Total Compensation

For most of the last decade, the cost of employer-paid healthcare benefits has been on the rise when measured as a percentage of total compensation. Implementing digital health platforms to improve healthcare benefit management and to increase price transparency will lower the overall cost burden of employers, a primary payer in the U.S. system.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Leveraged Benefits Program to Recruit Employees

Leveraged Benefits Program to Retain Employees

Positively Used Health Care Benefits To Recruit

Positively Used Health Care Benefits To Retain

201520142013

Employers Increasingly Use Benefits to Attract and Retain Workers

Digital Health Report 13

Increasingly, employers are leveraging healthcare and preventive/wellness benefits to attract and retain employees. Employers are providing employees access to innovative services, such as telemedicine and genetic testing, to better manage their health.

Percentage of Companies

Unhealthy Workforce Impacts Productivity and Bottom Line

Digital Health Report 14

Improving employee health management can help reduce the impact of health-related productivity loss, which presents opportunities for digital health companies focused on wellness and preventive care.

Management Supervisors spend 4.2 hours/week managing absences

Employees Replacement Workers are 36.6% less productive

Bottom Line Absences cost an average 15.4% of payroll

Challenge Opportunity Example Digital Health Companies

Consumerism is Changing Insurance Market Dynamics, Increasing Pricing Pressure

Use technology tools to be more consumer-friendly and competitive

Lack of Insight and Tools to Accurately Measure Risk

Use big data and machine learning to improve risk management

Shift from Fee-Based to Value-Based Care

Implement population health tools that manage care delivery and control costs by risk population

Digital Health Report 15

Overview: Payers Seek Solutions in Price Competitive Marketplace

Emergence of Public and Private Exchanges Increases Pricing Pressure on Payers

Digital Health Report 16 *Private Exchanges: Healthcare exchange that is created by employers for their employees.

The Affordable Care Act created public exchanges; now employers are embracing private exchanges.*

Public Exchanges Public exchanges

are expected to cover 15 million people

by 2017

Private Exchanges An estimated

20-30% of employers plan to create private exchanges

within 5 years

Consumers on exchanges tend to choose lower-cost plans, impacting payer revenues.

$322 is the potential annual savings for consumers actively shopping for coverage in 2016

As many as 66% of employees choose plans with lower premiums when switching to private exchange plans

Exchanges make it easier for consumers to change their health insurance plans, which creates pricing pressure on payers.

Data Remains in Silos, Making Claims and Costs Difficult to Predict

Electronic Health Records

Medical Claims Data

Lab Data

Government regulations and standards are adding to challenges of controlling medical claims and costs.

Disparate data sources impact payers’ ability to accurately access risk.

Regulatory Changes May Increase Medical Claims and Costs

Payers Face New Challenges in Cost Control and Risk Management

Digital Health Report 17

Ongoing difficulty in capturing and measuring standardized data remains the biggest challenge for payers when assessing risk and medical claim costs. An opportunity exists for digital health companies that specialize in providing risk and analytics solutions.

@

@

@

@

@

@

World Health Organization: Implementation of ICD-10

U.S. Government: Minimum Medical Loss Ratio

Payers Struggle in Shift to Value-Based Care

Digital Health Report 18

Payers Rate Value-Based Care Payment Models as More Difficult to Implement

0% 2% 4% 6% 8% 10% 12% 14% 16%

Pay for Performance

Episode of Care / Bundled Payments

Capitation

Global Payment

Other (i.e.Shared Savings)

Fee For Service

% of Payers Rating Model as Difficult to Implement

Value-Based Care

Traditional Payment Model

Payers cite data standardization and analysis measures as major challenges in implementing value-based care, especially in pay for performance and shared savings models. Digital health solutions can help more accurately assess medical claims.

Fee for Service – Fixed fee payment for service rendered Pay for Performance – Incentives to providers based on KPIs Global Payments - Fixed budget of care for population of patients with sophisticated risk adjustments incorporated

Capitation – Fixed budget of care for population of patients Bundled Payments – Single payment per episode of care Other (Shared Savings) –Incentives to encourage cost saving

Digital Health Report 19

Healthcare Systems and Professionals: Impacting Care Delivery

Challenge Opportunity Example Digital Health Companies

High Administrative Costs

Digitize records and improve communications and workflows

Shift to Value-based Care

Develop new ways to analyze costs and patient population risks to deliver more efficient care

Explosion of Data in Clinical Decision-Making

Implement clinical outcomes analysis and personalized medicine

Digital Health Report 20

Overview: Healthcare Systems and Professionals Face Pressure to Improve Care Delivery

$128 $35

$192

$131

$177

$248 Failures of Care Delivery

Failures of Care Coordination

Overtreatment

Pricing Failures

Fraud and Abuse

Administrative Complexity

Healthcare Systems and Professionals Are Plagued by Operational Challenges

Digital Health Report 21

Lack of automation is prevalent in the industry. The majority of the inefficiencies and waste in the healthcare system relates to administrative complexity, pricing failures and fraud and abuse. Overlaying electronic documentation support and data analytics tools across these disparate data silos will better identify outliers and lower total systematic costs.

Estimated Annual Cost of Operational Inefficiencies on Healthcare System ($B) $910 Billion

Estimated annual cost of inefficiencies in the U.S. healthcare system

Provision of Care

Failure of Health System

Healthcare Systems and Professionals Struggle with Basic Communications

Digital Health Report 22

0 10 20 30 40

Prescribing and/orAdministering Medications

Completing Documentation

Communicating and Consultingwith Colleagues

Conducting Patient Care

Minutes per Day Wasted

Estimated Time Wasted by Care Providers Due to Inefficient Systems and Workflow

Main Reasons Time is Wasted in Communicating with Colleagues

Inefficient and outdated communications systems in clinical settings waste, on average, an estimated $1.7 million annually per hospital. Deploying and mandating modern digital health communication tools will improve health system profitability.

Text messaging is not allowed

Pagers are not efficient

Wi-Fi is not available

Email is not efficient

Digital Health Report 23

High Workload Leads to Increased Risk of Medical Error

Today the healthcare professional…

Healthcare professionals often work long shifts, which correlates with a higher frequency of medical errors. Digital health opportunities include electronic medical records, improved workflow management and better communications tools to help reduce medical errors.

74% of Nurses cite stress and overwork as top concerns

Is Stressed

Only 6% of Doctors describe their morale as positive

Faces High Workload

Over 20% of Physicians report workload has likely contributed to patient transfers, morbidity or even mortality

Adding a nurse FTE leads to a 16% reduction in the odds of death in a surgical setting

Value-Based Care Creates New Challenges for Systems

Digital Health Report 24

Healthcare Systems Rate Value-Based Care Payment Models More Difficult to Implement

0% 5% 10% 15% 20%

Pay for Performance

Episode of Care / Bundled Payments

Capitation

Global Payment

Other (i.e.Shared Savings)

Fee For Service

% of Payers Rating Model as Difficult to Implement

Episode of Care / Bundled Payments

Other (e,g, Shared Savings)

Value- Based Care

Traditional Payment Model 50% of Medicare payments

expected to be value-based in 2018

Only 20% of healthcare CEOs say they are ready to fully implement value-based care

Shift to value-based care is coming…

But healthcare systems are unprepared:

Adopting value-based care requires improving outcomes while controlling costs. Healthcare systems also face difficulty in allocating payments in value-based care models. Digital health companies can help create tools to analyze patient risk and generate actionable insight on how to provide more efficient care.

Fee for Service – Fixed fee payment for service rendered Pay for Performance – Incentives to providers based on KPIs Global Payments - Fixed budget of care for population of patients with sophisticated risk adjustments incorporated

Capitation – Fixed budget of care for population of patients Bundled Payments – Single payment per episode of care Other (Shared Savings) –Incentives to encourage cost saving

Clinicians Face a Deluge of Medical Information

Increasing drug approvals (~1600 cumulative in 2015)

Alert fatigue

More treatment & diagnostic options

Impacts decision-making, causing errors

Over 80% of primary care physicians believe they receive an

excessive number of alerts.

Clinicians Need Tools to Tackle Information Overload

Digital Health Report 25

Increased academic literature & research ~2M articles published in a single year

Increased genomic & mutation data >187M DNA sequences recorded (200 terabytes of data)

Increased clinician stress

Imprecise clinical judgment

Clinicians struggle to keep up with rapidly advancing medical research. They and their patients can benefit from effective data analysis and personalized medicine to improve clinical outcomes.

Digital Health Report 26

Healthcare Consumers: Engaging Consumers, Empowering Patients

Challenge Opportunity Example Digital Health Companies

Lack of Choice and Price Transparency

Provide tools and services to access quality healthcare at a reasonable cost

Poor Health Literacy

Create access to online educational material and training to improve decision-making

Lack of Tools to Manage Health and Wellness

Empower patients to manage their own health, including disease treatment and wellness

Digital Health Report 27

Overview: Empowering Patients Is Key to Fixing Healthcare System

Digital Health Report 28

Patients Are Often Uninformed on Costs, Treatment Options

Healthcare consumers and patients struggle to manage their own healthcare due to limited access to relevant healthcare information. Digital health companies can empower patients through better search tools, pricing transparency solutions, disease management apps and other patient engagement solutions.

Lacks information on disease As few as 13% of patients with chronic disease were provided health education

Only 13% of patients were given a range of treatment prices

Lacks information on cost

Lacks health literacy Up to 35% of patients have no or only basic health literacy

Today the patient…

$966

$840 $783 $799

$500

$600

$700

$800

$900

$1,000

Pred

icte

d co

sts

per p

atie

nt

Engaged Patients Correlate with Lower Costs and Better Outcomes

Digital Health Report 29

Lower readmission rates Higher survival rates

• Higher rates of medical errors • Less likely to follow healthcare

professional’s advice

Poorer Outcomes Better Outcomes

Higher Costs Lower Costs

Healthcare costs for the least-engaged patients are 21% higher than those for the most-engaged patients

Least Engaged Most Engaged

24%

38%

31%

6%

1%

To be Completely in Charge

To Make Final Decision with Doctor input

To Make Joint Decision with Doctor

To Give Input with Decision made byDoctor

For Doctor to be Completely in Charge

Patients Want to Be Active Decision-Makers

Digital Health Report 30

More than 90 percent of adults say they want to be actively involved in decision-making with their doctors, and 24 percent want to be completely in charge. Looking ahead, patients’ interest in their own healthcare represents opportunities for digital health technologies that empower patients.

Asked how much they want to be involved in their healthcare decisions, patients wanted…

For Doctor to Be Completely in Charge

To Give Input with Decision Made by Doctor

To Make Joint Decision with Doctor

To Make Final Decision with Doctor Input

To Be Completely in Charge

Patient Actively Involved

Doctor Makes Final Decision

Digital Health Report 31

Digital Health Outlook: Mapping Digital Solutions for Advancing Healthcare

Clinical Operations

Patient Surveillance

Image Management / Analytics

Electronic Medical Records

Decision Support & Analytics / Predictive Medicine

Marketing / Customer Experience

Networking / Education

Care Coordination / Communication

Population Health Management Practice Management & Operational Workflows

Digital Health Companies Are Changing the Face of Healthcare

Digital Health Report

Patients / Consumers

32

Digital health companies are innovating in the healthcare space by focusing on improving outcomes and reducing costs. In the next report, we will evaluate the most promising opportunities and solutions that address the needs of patients and healthcare consumers.

Focu

s on

Hea

lth O

utco

mes

Employers / Payers

Life Science / Other Systems / Healthcare Professionals

Focu

s on

Hea

lthca

re C

osts

Telemedicine Remote Monitoring

Patient-Clinician Communication

Digital Therapeutics / Pill Plus

Patient / Professional Interaction

Fitness / Wellness / Wearables / Tracking

Insurance Search Genetic Screening

Education

Social Support Professional Search

Disease / Medication Management

Enterprise Wellness

Risk Adjustment / Payer Administration

Value-Based Care

Enterprise Health Management

Data Driven Payers Patient Engagement / Benefits

R&D

Operational

About the Authors

Digital Health Report 33

Steve Allan, CFA Steve Allan is the Head of SVB Analytics, responsible for the three areas of information services provided to the innovation economy: Strategic Advisory Services, Compliance Valuations, and Insights. Strategic Advisory Services provides consultative guidance around valuations, benchmarking and inorganic growth strategies. Compliance Valuations issues valuation opinions for private companies. Insight focuses on studying trends and opportunities in the private venture-backed innovation ecosystem. Steve brings a strong financial background and passion for entrepreneurship to his role at SVB Analytics.

Steve earned a master’s in business administration from Duke University's Fuqua School of Business and a bachelor's degree in finance from the University of Notre Dame.

Head of Analytics [email protected]

Emily Wengel Emily Wengel is a Valuation Associate with SVB Analytics, responsible for conducting due diligence and financial analysis on valuation engagements for early-stage, venture-backed life sciences companies.

Prior to joining SVB Analytics, Emily worked as a business analyst at BioMotiv, an early stage biotech accelerator. Emily graduated cum laude from University of Pennsylvania, where she earned a bachelor of science in economics and a bachelor of arts in biology.

Associate [email protected]

Alex Lee Alex Lee is a Valuation Manager at SVB Analytics, responsible for conducting due diligence and financial analysis on valuation engagements for venture-backed companies in the Life Science sectors.

Prior to joining SVB Analytics, Alex worked as a consultant for biopharmaceutical companies, diagnostic companies and medical research institutions, assisting in corporate development, product commercialization and strategic advisory activities. Alex holds a master’s of bioscience degree from Keck Graduate Institute and a bachelor’s of science degree in biochemistry from the University of Nebraska-Lincoln.

Manager [email protected]

Scott Winder Scott Winder is a Director at SVB Analytics, responsible for managing client valuation assignments and issuing valuation opinions. Prior to joining SVB Analytics, Scott was a manager in the Business Valuation practice of Deloitte Financial Advisory Services LLP based in San Francisco. While at Deloitte, Scott provided financial advisory services related to mergers and acquisitions, accounting compliance, tax reporting and strategic planning for clients in the technology and life sciences industries, with particular experience in the biotechnology and biopharmaceutical industry segments.

Scott holds a master's degree in business administration from the Haas School of Business (University of California at Berkeley), and a bachelor’s degree in human biology from Occidental College.

Director [email protected]

Appendix: Sources

Digital Health Report 34

Slide 7: U.S. Healthcare Expenditures Far Outpace Other Countries • “OECD Health Statistics 2015.” Slide 8: But Health Outcomes Are No Better, Despite Investment • “OECD Health Statistics 2015.” Slide 9: Administrative and Insurance Costs Contribute to Higher Healthcare Costs • Centers for Medicare & Medicaid Services, Office of the Actuary. Data

released January 7, 2014 Slide 12: Healthcare Benefits Become Bigger Part of Employee Compensation • “Employment Cost Trend.” US Bureau of Labor Statistics. Last

modified June 30, 2015. Slide 13: Employers Increasingly Use Benefits to Attract and Retain Workers • “2015 Strategic Benefits Survey – Leveraging Benefits to Recruit

Employees.” Society For Human Resource Management (SHRM). Slide 14: Workforce Impacts Productivity and Bottom Line • “Total Financial Impact of Employee Absences in the U.S, 2014.”

Society For Human Resource Management (SHRM).

Slide 16: Emergence of Public and Private Exchanges Increase Pricing Pressure on Payers • “Potential Savings from Actively Shopping for Marketplace Coverage

in 2016.” Kaiser Family Foundation. • “Examining Private Exchanges in the Employer-Sponsored Insurance

Market” Kaiser Family Foundation. September 2014.

• “Private Health Insurance Exchanges.” Kaiser Family Foundation. • “The Budget and Economic Outlook: 2016 to 2026.” Congressional

Budget Office. Slide 18: Payers Struggle in Shift to Value-Based Care • “The 2014 State of Value-Based Reimbursement and the Transition

from Volume to Value in 2014.” McKesson Corporation. Slide 21: Healthcare Systems and Professionals Are Plagued by Operational Challenges • Donald M. Berwick and Andrew D. Hackbarth, “Eliminating Waste in

US Health Care,” JAMA 307, no. 14 (April 11, 2012):1513–6. Slide 22: Healthcare Systems and Professionals Struggle with Basic Communications • “The Imprivata Report on the Economic Impact of Inefficient

Communications in Healthcare.” June 2014. Slide 23: High Workload Leads to Increased Risk of Medical Error • Sandeep Jauhar. “Why Doctors Are Sick of Their Profession.” Wall

Street Journal. August 29, 2014. http://www.wsj.com/articles/the-u-s-s-ailing-medical-system-a-doctors-perspective-1409325361

• Paul G Shekelle. ”Effect of Nurse-to-Patient Staffing Ratios on Patient Morbidity and Mortality.” in Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Mar. (Evidence Reports/Technology Assessments, No. 211.)

• Henry J. Michtalik. et al. “Impact of Attending Physician Workload on Patient Care: A Survey of Hospitalists.” JAMA Intern Med. 2013;173(5):375-377. doi:10.1001/jamainternmed.2013.1864.

Appendix: Sources (continued)

Digital Health Report 35

Slide 24: Value-Based Care Creates New Challenges for Systems • “The 2014 State of Value-Based Reimbursement and the Transition

from Volume to Value in 2014.” McKesson Corporation. • “The State of Population Health: Numerof Survey Report.” 2016. • “Just 20% of health care CEOs are ready to get rid of fee-for-service.”

The Advisory Board Company. 2015 Slide 25: Clinicians Need Tools to Tackle Information Overload • Amanda Hall and Graham Walton. “Information overload within the

health care system: a literature review.” Health Information & Libraries Journal, 21: 102–108. doi: 10.1111/j.1471-1842.2004.00506.x

• Information Overload and Missed Test Results in Electronic Health Record–Based Settings JAMA Intern Med. 2013;173(8):702-704. doi:10.1001/2013.jamainternmed.61.

• FDA • “GenBank and WGS Statistics.” National Center for Biotechnology

Information. August 2015. • Lutz Bornmann and Rüdiger Mutz. “Growth rates of modern science:

A bibliometric analysis based on the number of publications and cited references.” Journal of the Association for Information Science and Technology. 66: 2215–2222. doi: 10.1002/asi.23329

Slide 28: Patients Are Often Uninformed on Costs, Treatment Options • Ritsema TS, Bingenheimer JB, Scholting P, Cawley JF. Differences in

the Delivery of Health Education to Patients With Chronic Disease by Provider Type, 2005–2009. Prev Chronic Dis 2014; ;11:130175. DOI: http://dx.doi.org/10.5888/pcd11.130175

• Blumenthal-Barby, et al. The Neglected Topic: Presentation of Cost Information in Patient Decision Aids. Med Decis Making May 2015 vol. 35 no. 4 412-418

• “America’s Health Literacy: Why We Need Accessible Health Information.” US Department of Health and Human Services. 2008.

Slide 29: Engaged Patients Correlate With Lower Costs and Better Outcomes • “Chronic Care: A Call to Action for Health Reform.” AARP Public

Policy Institute. • Suzanne Mitchell, et. al. Patient Activation and 30-Day Post-

Discharge Hospital Utilization. Jornal of General Internal Medicine. 2013. 2014 Feb;29(2):349-55. doi: 10.1007/s11606-013-2647-2.

• Judith H. Hibbard, et. al. “Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores.’” Health Aff February 2013 vol. 32 no. 2 216-222. doi: 10.1377/hlthaff.2012.1064

• David H. Gustafson et al. An eHealth System Supporting Palliative Care for Patients with Non-small Cell Lung Cancer: A Randomized Trial. Cancer. 2013 May 1; 119(9): 1744–1751; doi: 10.1002/cncr.27939.

Slide 30: Patients Want to Be Active Decision-Makers • “The State of Patient Engagement and Health IT” HIMSS. 2014.

About Silicon Valley Bank For more than 30 years, Silicon Valley Bank has helped innovative companies and their investors move bold ideas forward, fast. SVB provides targeted financial services and expertise through its offices in innovation centers around the world. With commercial, international and private banking services, SVB helps address the unique needs of innovators.

Digital Health Report 36

This material, including without limitation to the statistical information herein, is provided for informational purposes only. The material is based in part on information from third-party sources that we believe to be reliable, but which have not been independently verified by us and for this reason we do not represent that the information is accurate or complete. The information should not be viewed as tax, investment, legal or other advice nor is it to be relied on in making an investment or other decision. You should obtain relevant and specific professional advice before making any investment decision. Nothing relating to the material should be construed as a solicitation, offer or recommendation to acquire or dispose of any investment or to engage in any other transaction. SVB Analytics is a member of SVB Financial Group and a non-bank affiliate of Silicon Valley Bank. Products and services offered by SVB Analytics are not FDIC insured and are not deposits or other obligations of Silicon Valley Bank. SVB Analytics does not provide investment, tax, or legal advice. Please consult your investment, tax, or legal advisors for such guidance. ©2016 SVB Financial Group. All rights reserved. Silicon Valley Bank is a member of FDIC and Federal Reserve System. SVB>, SVB Financial Group, and Silicon Valley Bank are registered trademarks. 0416-061

About SVB Analytics SVB Analytics, a non-bank affiliate of Silicon Valley Bank, serves the strategic business needs of entrepreneurs, corporates and investors in the global innovation economy. For more than a decade, SVB Analytics has helped global business leaders make informed decisions by providing market intelligence, research, and consulting services. Powered by proprietary data, SVB Analytics has a unique view into the technology and life science sectors.