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Remote Patient MonitoringDecreasing Costs

Improving OutcomesReimbursement

Connected Population Health for All

HIGH‐RISKCOMPLEX ILLNESSES, COSTING THE MOST

RISING‐RISKRISK FACTORS APPROACHING HIGH‐RISK

AT‐RISKMANAGING A CHRONIC CONDITION

HEALTHYMAINTAINING THEIR HEALTH

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What is Vivify?• End-to-End Software Platform• Wellness + Coordination + Monitoring• Evidence-Based Patient Pathways• Any Patient Consumer Device• Any Bluetooth Biometric Sensor• API for 3rd Party Apps and Devices• EMR / Stratification System Integration

What does Vivify do?• Engage → Educate → Motivate• Remote Monitoring → Virtual Visits• Clinical Call Center Automation• Reduces Overall Costs of Care• Improves Outcomes and Satisfaction

Cloud‐ to ‐Cloud

Vivify Pathways Api

Analytics

Core Functionality

Simplicity Built-In• Clinicians:

• Easy and Fast Clinical Portal• Canned and Customized Reports• Role-Based Access and Views• Patients Auto-Prioritized by Health Score• Unlimited and Anytime Virtual Visits• Immediate 24x7 Tech Support Response

• Patients:• Self-Guided Motivation Without Training or Monitoring• Assistive Text-to-Speech, Help Videos and Multi-Lingual • Simple User Interface with Large, Touch-Friendly Icons• Mistake-Proof Lock-Down with Remote Tech Support• Kits for an Instant-On Experience for Any Age• BYOD for Self-Managed Population Health

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• Role-Based Access and Views• Patients Prioritized by Health Score• Filters by Category of Care• Unlimited Care Path Customization• Unlimited Care Paths per Patient• Biometric Device Management• Intelligent Health Score Algorithms• Population Health Analytics• Integration with EMR workflows

Coordinated by Providers

Often “apps” are not simple enough for complex or elderly patients.  Vivify Homeis a turnkey solution designed specifically for that population, enabling patients of any age and technical ability to accomplish remote care with ease:

• Cellular Built‐In – integrated high‐speed 4G connectivity• Biometric Devices – integrated wireless devices, chosen by you• Virtual Visits – care escalation, to any provider, anywhere• Customizable Pathways – any condition and any language• Educational Videos – any video, with hundreds built‐in• Medication Reminders – to the medication detail level• Health Tips – rich media content, shaping patient behaviors• Text‐to‐Speech – speaking all text content for simplicity• Remotely Managed – remote control support and GPS tracking• Logistics Services – integrated back‐end logistics services

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Integrated Logistics / Asset Management

PatientOnboarding

Vivify Logistics Ships Kit

Vivify Logistics Assisted Install

Daily Self‐CareIn‐HomeKit Delivery

ScheduledKit Pickup

Kit Testing &Recycling

Kit InventoryManagement

Vivify Fully Managed Kit

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Point‐of‐Care Onboarding

Carry Home

2 In‐Home Delivery

Installed ‐OR‐ Self‐Setup

• Integrated Clinical and Logistics Workflow

• Delivery Options:• Self installation• Phone assisted• Technician install

• Intuitive Experience

Vivify  Go is designed for patients to use their own mobile or desktop devices (BYOD) to easily self‐navigate through care pathways, biometric measurements, and appropriate educational content.  Scaling self‐care for Population Health:

• Simplified Onboarding – initiated through text or email• Immediate Engagement – simplified onboarding and activation• Flexible Technology – both web and app, same simple experience• Tailored Pathways – simultaneous provider‐led clinical programs• Automated Coaching – pathway specific educational content• Population Health – designed for self‐adherence, without monitoring• Biometric Data – integrated Bluetooth devices and procurement*• Immediate Interventions – via messaging or virtual visits• Scalable Outcomes – efficient care at low costs

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•Never Discharge• Always Connected• Engage at Scale• Stratify Populations• Retain Consumers

•Never Discharge• Always Connected• Engage at Scale• Stratify Populations• Retain Consumers

Enroll• Discharge Self‐Care• Built‐In Content• Social Determinants• Clinical Escalation• Drive New Business

• Discharge Self‐Care• Built‐In Content• Social Determinants• Clinical Escalation• Drive New Business

Educate• Automated Coaching• Self‐Awareness• Best Practices• Increased Engagement• Drive Outcomes

• Automated Coaching• Self‐Awareness• Best Practices• Increased Engagement• Drive Outcomes

Self-Manage• Remote Monitoring• Clinically‐Guided• Biometric Integration• Intelligent Escalation• Drive Cost Reductions

• Remote Monitoring• Clinically‐Guided• Biometric Integration• Intelligent Escalation• Drive Cost Reductions

Monitor• Care Anywhere• Virtual Visits• Text Messaging• Engage Providers• Reduce Cost

• Care Anywhere• Virtual Visits• Text Messaging• Engage Providers• Reduce Cost

Intervene

Enterprise-Scalable Model

Enrollment Text Apple/Google App Store

PIN Entry

App Download Open App Phone Confirm

PIN Text App Welcome EULA Acceptance

Registered

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A True Digital Health PlatformBluetooth

(Vivify + Standard Sensors)

API(Vivify + Sensor Apps via Cloud)

SDK(Vivify + Integrated Sensor Apps)

Vivify Pathways +Api

• Any Voice Device – engage patients with no technology• Speech Recognition – speech or numeric responses• Customizable Pathways – any condition and any language• Vital Measurements – intelligent vital measurement gathering• Medication Reminders – to the medication detail level• Call In or Out ‐ patients can also call in at their convenience• Call Backs – automated call‐back capabilities • Voicemail Recognition ‐ intelligent avoidance of voicemail• Brand Awareness – reminding your consumers that you care• Care Continuation – a solution to assure long‐term compliance 

When advanced technology is not necessary, Vivify Voice is designed to scale to the rest of your population, with a simple and pleasant automated interactive voice experience, assuring compliance with care pathways through any phone:

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Proven Outcomes at Scale• Proven Outcomes:

• >65% reduction in readmissions• >95% patient daily adherence• >95% patient satisfaction• >98% staff satisfaction• >25% Reduction in L.O.S.• >30% Reduction in Homecare visits

• Who Benefits?• Patients:

• Improved Health & Outcomes• Improved Experience

• Providers:• Value-Based Reimbursement• Improved Outcomes & Quality• Improved Experience

• Payers:• Dramatically Reduced Costs

Executive Summary (December 2018)Launched for CHF, COPD, and CABG in Q3 2017

Outcomes:• 4.5% readmission rate within 30 days,

reduced from 12.8%• 3% readmission rate, post 30 days,

reduced from 11.8%• 0% readmission rate with CABG patients• 91% Patient compliance since program

inception• >95% patient satisfaction• Expanding to Palliative and Hospice• Doubled +Home kits in Dec 2018

Watch the Testimonial

Read the Case Study

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Case StudyErin Denholm, RN, MSN, RWJENF, President & CEO, Trinity Health At Home

• Chose Vivify because of user friendly interface for patients and clinicians

Outcomes:• 50% reduction in readmissions• Trinity Poster Presentation at Clinical

Summit 2018• Over 13,000 patients, over 55,000

virtual visits completed, average age 77

Watch the Testimonial

Watch the Overview

Read the News Article

Poster Presentation (Clinical Summit 2018)

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Case Study (Feb 2016)Launched September 2014 as part of Alignment Command Center; expanded to CA, NC, and FL and beyond

Outcomes:• 86% compliance, elderly frail

patients• 84% fewer Admissions in 2016 than

same cohort in 2015• 79% fewer 30-day Readmissions in

2016 than same cohort in 2015• 92% fewer SNF Admits in 2016 than

same cohort in 2015• 55% fewer ED Visits in 2016 than

same cohort in 2015• Also replacing frequent $200.00

onsite nursing visits

Read the Case Study

Case StudyLaunched in March 2015, Solid Organ Transplant Program, including EPIC integration. Expanding into Cardiac, Pulmonary and Home Care Services.

Outcomes:• Virtual visits replacing in clinic visits by

50%• 100% Staff Satisfaction• 95% Patient Satisfaction

Read Case Study

Watch Video

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Webinar (Oct 2017)

Outcomes:• 3% readmission rate for CHF• 0% readmission rate for AMI• 75% compliance Rate

Watch Webinar

PilotChronic Care Management (CCM) with Vivify +GoLaunched June 2016, 6 month pilot, in partnership with Henry Schein Medical.

Outcomes: • 73% Compliance Overall• 92% Improved or Maintained Chronic Condition• 85% Met CCM Billing Requirements

Revenue generated, including Vivify cost:• $ 99,552 using their own Do-it-Yourself monitoring• OR… $ 56,202 with our optional Clinical Monitoring

Services

Patient Satisfaction:• 100% “understood the importance of monitoring”• 72% “did not worry about their privacy after using

technology”• 89% “knew the names of and why they are taking

medications”

West Coast Family Medical

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Chronic Care Management

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Medical Decision MakingMedical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option, which is determined by considering these factors: • The number of possible diagnoses and/or the number of management options that must be considered • The amount and/or complexity of medical records, diagnostic tests, and/or other information that must be 

obtained, reviewed, and analyzed• The risk of significant complications, morbidity, and/or mortality as well as comorbidities associated with 

the patient’s presenting problem(s), the diagnostic procedure(s), and/or the possible management options

This table depicts the elements for each level of medical decision making. Note that to qualify for a given type of medical decision making, two of the three elements must either be met or exceeded. 

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AMA released new CPT Codes for 2019,  beginning January 1, 2019

Chronic Care Remote Physiologic Monitoring

Co‐pay applies(Medicare Part B 20%), can be billed with CCM same month with additive minutes

99453 Remote monitoring of physiologic parameter[s] initial; set‐up and patient education on use of equipment. Proposed one time payment $ 21.00 ($ 19.46)

99454 Remote monitoring of physiologic parameter[s]; device[s] supply with daily recording[s] or programmed alert[s] transmission, each 30 days. Proposed monthly payment of $ 69.99 ($64.15)

99457 Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.  Proposed monthly payment of $ 54.00 ($51.54)

Technical Correction on March 15, 2019:

• CPT code 99457 may be furnished by auxiliary personnel, incident to the billing practitioner’s professional services.

• Below is the exact language from the Federal Register notice, page 11, #2.

• https://www.federalregister.gov/documents/2019/03/15/2019‐04803/medicare‐program‐revisions‐to‐payment‐policies‐under‐the‐physician‐fee‐schedule‐and‐other‐revisions

• On page 59575, column 3, 3rd full paragraph, we incorrectly stated that CPT code 99457 could not be furnished by auxiliary personnel, and instead must be performed by the billing practitioner. CPT code 99457 may be furnished by auxiliary personnel, incident to the billing practitioner’s professional services.

On page 59575, column 3, 3rdfull paragraph we are removing the sentence, “We note that CPT code 99457 describes professional time and therefore cannot be furnished by auxiliary personnel incident to a practitioner’s professional services.” and adding in its place, “We thank commenters and confirm that these services may be furnished by auxiliary personnel incident to a practitioner’s professional service.”

New RPM Reimbursement for 2019

Supplemental information:

• AMA CPT codes for Remote Patient Monitoring

• https://www.ama‐assn.org/ama‐releases‐2019‐cpt‐code‐set

• https://www.icd10monitor.com/ama‐releases‐2019‐cpt‐code‐set

• New CPT codes 99453 and 99454 were added to report remote physiologic monitoring services during a 30‐day period.

• Other codes in this section (99446 ($18.38),99447($36.40), 99448($54.78)‐99449($72.80) and 99091) were revised.

• For 99446, 99447, 99448, 99449, if greater than 50% is in data review and/or analysis, do not bill those codes; according to CPT, this doesn’t qualify

• 99451 may be billed if more than 50% of the 5‐minute time is data review and/or analysis

• These new codes reflect the key role non‐verbal communication technology plays in care coordination between consulting and treating physicians, according to the AMA.

https://www.codingintel.com/interprofessional‐remote‐consultations‐cpt‐codes‐99446‐and‐99451/

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ESRD homes added as originating sites• CMS is also finalizing policies to implement the requirements of the Bipartisan Budget Act of 2018 for telehealth services related to beneficiaries with end‐stage renal disease (ESRD) receiving home dialysis and beneficiaries with acute stroke effective January 1, 2019. CMS is finalizing the addition of renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis as originating sites, and to not apply originating site geographic requirements for hospital‐based or critical access hospital‐based renal dialysis centers, renal dialysis facilities, and beneficiary homes, for purposes of furnishing the home dialysis monthly ESRD‐related clinical assessments. CMS is also finalizing policies to add mobile stroke units as originating sites and not to apply originating site type or geographic requirements for telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.

https://www.cms.gov/newsroom/fact‐sheets/final‐policy‐payment‐and‐quality‐provisions‐changes‐medicare‐physician‐fee‐schedule‐calendar‐year

Substance abuse homes as originating site

• Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder and Other Substance Use Disorders Through an interim final rule with comment period, CMS is implementing a provision from the Substance Use‐Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act that removes the originating site geographic requirements and adds the home of an individual as a permissible originating site for telehealth services furnished for purposes of treatment of a substance use disorder or a co‐occurring mental health disorder for services furnished on or after July 1, 2019.

https://www.cms.gov/Outreach‐and‐Education/Medicare‐Learning‐Network‐MLN/MLNMattersArticles/Downloads/MM11063.pdf

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HCPCS code G2012 ($14.00)‐ Virtual patient check‐in

• allowing physicians and other qualified healthcare professionals (“QHCPs”) to be reimbursed for “virtual check‐ins” with patients who aren’t sure whether or not their symptoms warrant an in‐office visit. 

• These virtual check‐ins may be “audio‐only” (e.g., a telephone call between the patient and the QHCP) or live two‐way audio with video “or other kinds of data transmission.” 

• If the check‐in does not lead to an in‐office visit and does not occur within seven days of a prior E/M service by the billing practitioner, it may be billed as a standalone service” to check in with an established patient on a care plan

• the check‐in has to be conducted by the physician or a qualified healthcare professional, rather than office staff. And patient consent to use telehealth is required each time the provider connects with the patient.

• the new service should help providers who want to check in with their patients to make sure a care plan is being followed at home. It may prove especially helpful, he says, for behavioral healthcare providers who might need to check on patients with mental health issues.

• https://mhealthintelligence.com/news/cms‐gives‐telehealth‐a‐nudge‐with‐coverage‐for‐virtual‐check‐ins

HCPCS code G2012 (cont.)

• Established Patients. The patient on the other end of the check‐in must be an “established patient” of the billing physician/QHCP. The rule defines an established patient as one who has received professional services within the past three years from the physician or qualified health care professional or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice.

• Billing Practitioner. The new code explicitly requires direct interaction between the patient and the billing practitioner. It is NOT billable if the evaluation is performed by clinical staff or a practitioner not qualified to furnish E/M services. (Note: incontrast, CCM codes CAN be billed for check‐ins provided by nurses and other clinical staff, and can be billed concurrently with G2012 if the patient qualifies for such codes.)

• Copayments. As with other Medicare Part B services, the patient is responsible for a copayment for each billed service. 

• Consent and Documentation. Verbal consent by the patient for each virtual check‐in must be documented in the medical record. There is, however, no service‐specific documentation requirement. 

• Timing of In‐person Visit. If the virtual check in (i) takes place within seven (7) days after an in‐person visit, or (ii) triggers an in‐person office visit within twenty‐four 24 hours (or the soonest available appointment), the service is NOT billable, and its payment is considered bundled into the relevant in‐office E/M code. 

• Frequency. There is no frequency limitation on the use of the code by the same practitioner with the same patient. However, the billing practitioner should be mindful that each service must be medically reasonable and necessary to qualify for payment by Medicare.

https://www.nixonlawgroup.com/nlg‐blog/2018/11/5/how‐to‐get‐reimbursed‐for‐virtual‐check‐ins‐under‐hcpcs‐g2012

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CMS final rule (CMS‐1689‐FC) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2019

• Fostering Innovation• The Use of Remote Patient Monitoring under the Medicare Home Health Benefit

• CMS is finalizing its proposal to define remote patient monitoring in regulation for the Medicare home health benefit and to include the cost of remote patient monitoring as an allowable cost on the HHA cost report. Studies note that remote patient monitoring has a positive impact on patients as it allows patients to share more live‐time data with their providers and caregivers, which will lead to more tailored care and better health outcomes. CMS believes that defining remote patient monitoring and including such costs as allowable costs on the HHA cost report could encourage more HHAs to adopt the technology.

FQHCs‐ G0071  remote evaluation• Effective January 1, 2019, FQHCs can receive payment for Virtual Communication services when at least 5 minutes of communication technology‐based or remote evaluation services are furnished by an FQHC practitioner to a patient who has had an FQHC billable visit within the previous year, and both of the following requirements are met:

• The medical discussion or remote evaluation is for a condition not related to an FQHC service provided within the previous 7 days, and

• The medical discussion or remote evaluation does not lead to an FQHC visit within the next 24 hours or at the soonest available appointment.

• To receive payment for Virtual Communication services, FQHCs must submit an FQHC claim with HCPCS code G0071 (Virtual Communication Services) either alone or with other payable services. Payment for G0071 is set at the average of the national non‐facility PFS payment rates for HCPCS code G2012 (communication technology‐based services) and HCPCS code G2010 (remote evaluation services) and is updated annually based on the PFS national non‐facility payment rate for these codes.

• RHC face‐to‐face requirements are waived when these services are furnished to an FQHC patient, and coinsurance applies.

https//www.cms.gov/Center/Provider‐Type/Federally‐Qualified‐Health‐Centers‐FQHC‐Center.html

https://www.nixonlawgroup.com/nlg‐blog/2018/11/5/new‐code‐hcps‐g2010‐provides‐reimbursement‐for‐remote‐evaluation‐of‐patient‐transmitted‐images

https://www.cmhealthlaw.com/2018/11/digital‐health‐updates‐in‐the‐2019‐physician‐fee‐schedule‐pfs‐rule/

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Pending Telehealth Legislation (telemedicine)RUSH Act The Reducing Unnecessary Senior Hospitalization Act (RUSH) Act of 2018, (H.R. 6502), introduced by Reps. Adrian Smith (R‐NE) and Diane Black (R‐TN), seeks to reduce unnecessary hospitalizations by allowing for the use of technology in SNFs, to treat patients in place rather than transferring them to the hospital. Specifically, the legislation allows the Medicare program to selectively enter into value‐based arrangements with qualified physician group practices furnishing a combination of telehealth and on‐site first responders. With a telehealth connection to an emergency physician, an on‐site first responder equipped with mobile diagnostics would coordinate treatment for patients with acute care needs. The Department of Health and Human Services would also have the authority to determine the reimbursement level for these services. The anticipated savings will be shared between the physician group practice, Medicare, and SNFs.

RUSH Act (cont.)

• provide participating SNFs with a 12.5% share of the cost savings.  

• Encourage the use of two‐way video conferencing for SNFs in urban areas;

• Provide SNFs with an increased facility fee, that adequately covers the cost of having the technology and administering telehealth services;

• Allow a “patient’s home” to be included as an eligible originating site; and

• Expand eligibility of reimbursement to other long‐term and post‐acute care (LTPAC) professionals that can administer chronic care management in the community using store‐and‐forward telehealth and remote patient monitoring (RPM).

• Services can be provided by physician, nurse practitioner, or physician assistant

• https://www.leadingage.org/legislation/rush‐act‐seeks‐improve‐opportunities‐telehealth‐services‐snfs

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Mental Health Telemedicine Expansion Act

• filed by U.S. Rep. Tom Reed (R‐N.Y.). TheMental Health Telemedicine Expansion Act (H.R. 6781) takes aim at well‐documented barriers to the use of – and reimbursement for – connected care services in mental health programs, many of which are being brought to bear on people with substance abuse issues.

• The bill proposes to amend the Social Security Act to increase access to mental health services through mHealth and telehealth technology. It would do so by including the patient’s home among locations that can be reimbursed for telemental health services and eliminating originating site facility fees.

Substance Abuse Acts

• SUPPORT for Patients and Communities Act (H.R. 6), versions of which were passed by the House earlier this year and the Senate this week. That bill contains all or parts of close to 70 other bills.

• It is not known if Reed’s bill or the Medicaid Substance Use Disorder Treatment via Telehealth Act, by U.S. Rep. Ben Ray Luján (D‐N.M.), will be included in ongoing negotiations to combine the two bills into one.

• Opioid Crisis Response Act• September 17, 2018, the U.S. Senate voted overwhelmingly (99‐1) in support of the Opioid Crisis Response Act (OCRA) of 2018

• Building on efforts previously authorized in 2016 via the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act, OCRA seeks to launch and fund an array of opioid prevention and response efforts through multiple federal agencies in collaboration with state and local governments.

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4/22/2019

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Medicaid Substance Use Disorder Treatment via Telehealth Act• The bill has three primary goals:

• It would direct the Centers for Medicare & Medicaid Services (CMS) to guide states on options for providing services via telehealth that address substance use disorders under Medicaid;

• It would direct the Government Accountability Office (GAO) to evaluate children’s access to Medicaid services to treat substance use disorders, including options to improve access through telehealth; and

• It would direct CMS to report to Congress on best practices and potential solutions to barriers to furnishing services to children via telehealth to compare services delivered via telehealth to in‐person.

Industry AnalystsFrost and Sullivan Award (2018)

• Remote Patient Monitoring Award• 2018 Strategic Product Line Leader

KLAS Report (2018)• Top Vendor in Preliminary Mid-Year

RPM Report• “More of a partner, rather than just a

vendor”

ECRI Report (2018)• In-depth product and market

analysis• Vivify receives market-leading 5-

Star rating

Chilmark Report (2018)• In-depth analysis of Telehealth

market• Vivify leading in the RPM segment

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