MEDTRONIC OUTCOMES PLEDGE PROGRAMVALUE-BASED HEALTHCARE STARTS WITH IMPROVING OUTCOMES

DECEMBER 14, 2016

2 Medtronic Outcomes Pledge Program

TODAY’S PANELISTS

Cori Johnson Maegley, BS, MS, MBA

Director of Clinical and Portfolio Sales and Outcomes Pledge Program Director

Medtronic

Mary Jo Valentine, MSN, RN, OCN

Director of Nursing Professional Development and Magnet Program Director

Methodist Hospitals

Jeff Ollis, MD

Cardiac Anesthesiologist

Parkwest Medical Center

MEDTRONIC MISSION

ALLEVIATE PAINRESTORE HEALTHEXTEND LIFE

3 Medtronic Outcomes Pledge Program

Our broad portfolio of solutions spans the continuum of care to support minimally-invasive treatment by reducing complications and accelerating patient recovery.

PATIENT MONITORING & RECOVERY (PMR)

IDENTIFYEARLIER

INTERVENEEARLIER

TREAT EFFECTIVELY

IMPROVE OUTCOMES

4 Medtronic Outcomes Pledge Program

INTRODUCING THE MEDTRONIC OUTCOMES PLEDGE PROGRAM

VALUE-BASED HEALTHCARE STARTS WITH IMPROVING OUTCOMES

MEDTRONIC OUTCOMESPLEDGEPROGRAM

FACILITIES PARTICIPATING IN THE PHASES OF THE PROGRAM WILL COLLABORATE WITH MEDTRONIC TO TARGET…

OPTION 1

20% Reduction In events related to respiratory compromise on the medical surgical floor

When implementing a program using Microstream® Capnography for adult patients receiving sedatives and/or opioids/PCA on the Medical Surgical Floor.

OPTION 2

20% Reduction In cardiac surgical complications associated with Major Morbidity and Operative Mortality

When implementing a program using INVOS™ Regional Oximetry for adult cardiac surgery patients

Med Surg Operating Room

6 Medtronic Outcomes Pledge Program

7 Medtronic Outcomes Pledge Program

OPTION #1: RESPIRATORY COMPROMISEMICROSTREAM CAPNOGRAPHY

“Respiratory Compromise is a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death, but in which specific interventions (continuous monitoring and therapies) might prevent or mitigate decompensation.”

- Respiratory Compromise Institutewww.respiratorycompromise.org

Common, Costly and Deadly: • Nearly 30% of post-operative patients and

approximately 7% of all Medicare patients1

• Patients with respiratory compromise that originates on the medical surgical floor are 29 times more likely to die compared to those in other areas of the hospital.2

• Cost projected to exceed $37 billion by 2019.3

1. Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population. 2019. Abstract presented at Academy Health Congress, June 2011.

2. Kelley SD, Agarwal S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012;40(12)-764.

3. Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population. 2019. Abstract presented at Academy Health Congress, June 2011.

Name: Amanda AbbiehlAge: 18Diagnosis: Severe pain from throat infectionMonitoring: Intermittent SpO2 and vitalswww.promisetoamanda.org/amandas-story

8 Medtronic Outcomes Pledge Program

End-tidal carbon dioxide (etCO2):

Noninvasive continuous measurement of CO2 concentration

Helps clinicians detect signs of respiratory compromise earlier, so they may intervene sooner

Normal range: 35-45mmHg*

*http://globalrph.com/abg_analysis.htm

MICROSTREAM™ CAPNOGRAPHY

9 Medtronic Outcomes Pledge Program

Program Targeted Goal

OPTION #1:MEDICAL SURGICAL FLOOR

Respiratory Compromise*

20% Reduction

* For purposes of this program, Respiratory Compromise is defined as respiratory arrest, insufficiency or failure as assessed by the following four metrics: Code Blue Incidents, Naloxone Reversal Agent Administrations, Unplanned Intubations due to Respiratory Compromise, and Intensive Care Unit (ICU) Transfer from the Medical Surgical floor.

** *Adult patients receiving sedatives and/or opioids/PCA on the Medical Surgical Floor

Total# of Adverse Events

Code Blue Incidents +

Naloxone Reversal Agent Administration

+Unplanned Intubations

+ICU transfers from GCF

# of Qualifying Patients*

10 Medtronic Outcomes Pledge Program

OUTCOMES PLEDGE PROGRAM STRUCTURERESPIRATORY COMPROMISE

REBATE: If program requirements met, but outcomes not achieved

50% rebate on Microstream® capnography sampling lines

TIME REQUIRED: Measurement Period

12 months (maintain in Years 2-5)

PLEDGE: 20% Reduction in adverse events

Respiratory Compromise

11 Medtronic Outcomes Pledge Program

OPTION #2: MAJOR MORBIDITY AND OPERATIVE MORTALITYINVOS REGIONAL OXIMETRY

Cerebral Desaturation is Common, Costly and Debilitating:

• 60-75% of high risk cardiac surgery patients experience cerebral desaturation1

• CABG patients with prolonged desaturation have 3x greater risk for prolonged hospital stay>6 days,2 costing up to $31,0003

• CABG surgery patients with prolonged desaturation have higher rates of MMOM than CABG patients without prolonged desaturation4

The INVOS™ system provides real-time monitoring of changes in regional oxygen saturation (rSO2) of blood in the brain or other body tissues beneath the sensor for effective oxygen monitoring in adults.

1. Deschamps A, Lambert J, Couture P, et al. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. Available online 18 June 2013, ISSN 1053-0770.

2. Slater JP, Guarino T, Stack J, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009;87(1):36-44.

3. Cleveland Clinic Patient Price Information List. 16-CCC-237.4. Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth

Analg. 2007;104(1):51-58

12 Medtronic Outcomes Pledge Program

Program Targeted Goal

OPTION #2:OPERATING ROOM

Major Morbidity and Operative Mortality (MMOM)*

20% Reduction

* Major Morbidity and Operative Mortality is a composite endpoint defined as having one or more of the following six complications: permanent stroke, reoperation for any reason, renal failure, prolonged ventilation > 24 hours, mediastinitis or death (per STS version 2.81).

** Adult Cardiac Surgery patients.

Cardiac Surgical Patients Exhibiting MMOM*

# Qualifying Patients**

13 Medtronic Outcomes Pledge Program

OUTCOMES PLEDGE PROGRAM STRUCTUREMAJOR MORBIDITY AND OPERATIVE MORTALITY

REBATE: If program requirements met, but outcomes not achieved

50% rebate on INVOS Consumables

TIME REQUIRED: Measurement Period

12 months (maintain in Years 2-5)

PLEDGE: 20% Reduction in adverse events

Major Morbidity and Operative Mortality (MMOM)

14 Medtronic Outcomes Pledge Program

EXPECTATIONS OF PARTICIPATING CUSTOMERSOUTCOMES PLEDGE PROGRAM REQUIREMENTS

Measurement & Reporting1

• Identify appropriate Clinical Sponsor and Program Manager• Provide 24 month historical aggregated baseline data• Kickoff Meeting and regular progress check-ins during implementation• Quarterly Outcomes Review with Medtronic

Protocol2 • Adopt clinical protocol(s) governing use of applicable technology on qualifying patients• Draft written protocol and approve via standard hospital processImplement Technology3 • Ensure necessary equipment is ordered and installed • Ensure consumables are ordered and stocked Training & Education4

• Training required for all Staff Members on participating units• Online Module and Live Training required for at least 80% of staff• Documentation and quarterly attestations required, to ensure

training requirements are maintained

Implementation Period

• Establish baseline measurement

• Create policy/protocol

• Implement technology

• Train relevant staff

Measurement Period

• Quarterly outcome reviews

• Ongoing training and education to maintain required competency

Maintenance / Expansion

• Maintain outcomes improvements

• Expand program to other facilities within a system

15 Medtronic Outcomes Pledge Program

OUTCOMES PLEDGE PROGRAMIMPLEMENTATION APPROACH

~ 90 days 12 months Years 2-5

16 Medtronic Outcomes Pledge Program

OUTCOMES PLEDGE PROGRAM METRICS & REPORTINGDASHBOARD OVERVIEW

Clinical Outcomes Financial Outcomes

SPEAKER:

Option 1 -Respiratory Compromise

Mary Jo Valentine, MSN, RN, OCNDirector of Nursing Professional DevelopmentMethodist HospitalsGary and Merrillville, Indiana

SPEAKER:

Option 2 -Major Morbidity & Operative Mortality

Jeff Ollis, M.D.Cardiac AnesthesiologistParkwest Medical CenterKnoxville, Tennessee

Q&A

©2016 Medtronic. All Rights Reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. 15-RE-0021(2)

THANK YOU