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©2005 IPGDx, LLC
PROGNOSTICHECK®
 Value Proposition:
  Strategy & Focus
STRATEGY & FOCUS
                                     Reliable
                                  information to
                                 base healthcare
                                 decisions upon



                    Scientific      Excellent       Compassionate
                   knowledge        training &         caring
                      base            support       communication



            Structured                                 Specific to:
                                  Pre-Learning
       multi-media formats                         Patient, Physician,
                                  Assessment
                                                     Manufacturer


©2005 IPGDx, LLC
INDIVIDUALLY TARGETED CURRICULUM
         • Patient’s and Families
         • Physicians
                   – Other healthcare providers
                     • Nurses
         • Facilities
                   – Phase of care
         • Manufacturers
                   – Pharmaceuticals/Other Interventions
                     • Prescription
                     • Nonprescription
©2005 IPGDx, LLC
THREE FRONTS OF CHANGE

         • Chronic disease model
                   – Therapeutic efficacy
         • Healthcare delivery system
                   – Changing roles
         • Ethical and cultural expectations
                   – Duties and responsibilities within a new
                     decision paradigm



©2005 IPGDx, LLC
CHRONIC DISEASE
         •     Diagnosis established
         •     Tx limited/repetitive
         •     Course is long/progressive
         •     Complications
                   – Anticipation
                   – Avoidance
                   – Mitigation
         • Speed of progression
         • Scope of deterioration

©2005 IPGDx, LLC
CHARACTER OF CHRONIC ILLNESS

         • Nonfatal (Complication Avoidance)
                   – Occurs with substantial reserve capacity
                   – Progressively long natural course
         • Serious then fatal
                   – Progressively worsening
                   – Serial exacerbations to death
         • Frailty/prolonged dwindling (Cliff Edge)
                   – Little available reserves
                   – Small upset cascades

©2005 IPGDx, LLC
Hospitalizations
         • Severity of disease
                   – Present on admission
                   – Nosocomial or not
         • Overstaying DRG LOS
                   – Complications
         • ICU Resource allocation
                   – SIRS



©2005 IPGDx, LLC
From:
                   ‘Living Well at the End
                           of Life’;
                     Lynn & Adamson
                     2003 Rand Health




©2005 IPGDx, LLC
~20%



     ~20%




     ~40%



©2005 IPGDx, LLC   *~20% other and/or undefined
©2005 IPGDx, LLC
Of the ~2.5M annual
         deaths less than forty
      percent died under hospice
                 care




©2005 IPGDx, LLC
THOSE WITH CHRONIC DISEASE




©2005 IPGDx, LLC
CHANGES IN HEALTHCARE DELIVERY

     • Physician
             –     < economic independence
             –     < professional autonomy
             –     > external review
             –     > administrative oversight
     • Called upon to:
             – Optimize outcome while minimizing costs
             – Proffer decisions with weighted
               administrative and clinical consequences

©2005 IPGDx, LLC
CHANGES IN HEALTHCARE DELIVERY

         • Resource Allocation
                   –   > need
                   –   > cost
                   –   To produce > benefit
                   –   Comparative metric/risk adjustments
                   –   Relative levels of illness and treatment
                        • System comparisons



©2005 IPGDx, LLC
CHANGES IN HEALTHCARE DELIVERY

         • Demonstrated Effectiveness
                   – Assessment of the probability of
                     expected course and outcomes
                     • Assumption of therapeutic efficacy
                   – Intermediate endpoints predictive of
                     long-term outcomes
         • Predictive findings
                     • Pre-symptomatic – occult illness
                     • Predicting consequences
                        – Benefit of advanced interventions
                        – Adherence metrics
©2005 IPGDx, LLC
©2005 IPGDx, LLC
ETHICAL DECISION MAKING

         •     Communication required
         •     Consumerism
         •     Informed consent
         •     Risk (cost) / Benefit
         •     Resources
                   – Availability
                   – Allocation


©2005 IPGDx, LLC
©2005 IPGDx, LLC
END OF LIFE COSTS




©2005 IPGDx, LLC
CULTURAL EXPECTATIONS

         • Futility of intervention (flogging)
         • Outcome inevitability
                   – Likelihood of recovery
                   – Effectiveness v trauma of intervention
         • Justice
         • Beneficence
         • Economy


©2005 IPGDx, LLC
END OF LIFE CARE

         • > Consciousness of EOL care and death
         • ‘Good Death’ v “BAD”
                   –   Control-Comfort-Communication
                   –   Discussed with family
                   –   Planned for
                   –   Meaningful assessments
                   –   Management of
                   –   Home care
         • Physical-Spiritual-Emotional-Social-Cost

©2005 IPGDx, LLC
©2005 IPGDx, LLC
©2005 IPGDx, LLC
©2005 IPGDx, LLC
©2005 IPGDx, LLC
©2005 IPGDx, LLC
PROGNOSTICHECK®
         • If Sick, How Sick®

         • Prognosis
                   – Characterization of disease
                     • Presence-Severity-Progression
                   – Effectiveness of therapies
                     • Optimized individual response
                   – Timing of non-acute death
                     • Palliative care and Hospice

©2005 IPGDx, LLC
TARGETED MARKET SEGMENTS
                   Innovators           First 5% - 10% that adopt the product 
                   Early Adopters       Next 10% - 15% 
                   Early MajorityNext 30% 
                   Late Majority        Next 30% 
                   Laggards             Remaining 20% 
     CHARACTERISTICS:
     Venturesomeness: the willingness and desire to be daring in trying
     something new and different 
     Social integration: frequent and extensive contact with others in
     one’s area 
     Cosmopolitan: point of view extending beyond the immediate
     neighborhood or community 
     Social mobility: upward movement on the social scale 
     Privilegedness: attitude and possession of money (less risky to try
     something new) 
©2005 IPGDx, LLC
©2005 IPGDx, LLC
©2005 IPGDx, LLC

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PrognostiCheck® Value Proposition Strategy and Focus.

  • 3. STRATEGY & FOCUS Reliable information to base healthcare decisions upon Scientific Excellent Compassionate knowledge training & caring base support communication Structured Specific to: Pre-Learning multi-media formats Patient, Physician, Assessment Manufacturer ©2005 IPGDx, LLC
  • 4. INDIVIDUALLY TARGETED CURRICULUM • Patient’s and Families • Physicians – Other healthcare providers • Nurses • Facilities – Phase of care • Manufacturers – Pharmaceuticals/Other Interventions • Prescription • Nonprescription ©2005 IPGDx, LLC
  • 5. THREE FRONTS OF CHANGE • Chronic disease model – Therapeutic efficacy • Healthcare delivery system – Changing roles • Ethical and cultural expectations – Duties and responsibilities within a new decision paradigm ©2005 IPGDx, LLC
  • 6. CHRONIC DISEASE • Diagnosis established • Tx limited/repetitive • Course is long/progressive • Complications – Anticipation – Avoidance – Mitigation • Speed of progression • Scope of deterioration ©2005 IPGDx, LLC
  • 7. CHARACTER OF CHRONIC ILLNESS • Nonfatal (Complication Avoidance) – Occurs with substantial reserve capacity – Progressively long natural course • Serious then fatal – Progressively worsening – Serial exacerbations to death • Frailty/prolonged dwindling (Cliff Edge) – Little available reserves – Small upset cascades ©2005 IPGDx, LLC
  • 8. Hospitalizations • Severity of disease – Present on admission – Nosocomial or not • Overstaying DRG LOS – Complications • ICU Resource allocation – SIRS ©2005 IPGDx, LLC
  • 9. From: ‘Living Well at the End of Life’; Lynn & Adamson 2003 Rand Health ©2005 IPGDx, LLC
  • 10. ~20% ~20% ~40% ©2005 IPGDx, LLC *~20% other and/or undefined
  • 12. Of the ~2.5M annual deaths less than forty percent died under hospice care ©2005 IPGDx, LLC
  • 13. THOSE WITH CHRONIC DISEASE ©2005 IPGDx, LLC
  • 14. CHANGES IN HEALTHCARE DELIVERY • Physician – < economic independence – < professional autonomy – > external review – > administrative oversight • Called upon to: – Optimize outcome while minimizing costs – Proffer decisions with weighted administrative and clinical consequences ©2005 IPGDx, LLC
  • 15. CHANGES IN HEALTHCARE DELIVERY • Resource Allocation – > need – > cost – To produce > benefit – Comparative metric/risk adjustments – Relative levels of illness and treatment • System comparisons ©2005 IPGDx, LLC
  • 16. CHANGES IN HEALTHCARE DELIVERY • Demonstrated Effectiveness – Assessment of the probability of expected course and outcomes • Assumption of therapeutic efficacy – Intermediate endpoints predictive of long-term outcomes • Predictive findings • Pre-symptomatic – occult illness • Predicting consequences – Benefit of advanced interventions – Adherence metrics ©2005 IPGDx, LLC
  • 18. ETHICAL DECISION MAKING • Communication required • Consumerism • Informed consent • Risk (cost) / Benefit • Resources – Availability – Allocation ©2005 IPGDx, LLC
  • 20. END OF LIFE COSTS ©2005 IPGDx, LLC
  • 21. CULTURAL EXPECTATIONS • Futility of intervention (flogging) • Outcome inevitability – Likelihood of recovery – Effectiveness v trauma of intervention • Justice • Beneficence • Economy ©2005 IPGDx, LLC
  • 22. END OF LIFE CARE • > Consciousness of EOL care and death • ‘Good Death’ v “BAD” – Control-Comfort-Communication – Discussed with family – Planned for – Meaningful assessments – Management of – Home care • Physical-Spiritual-Emotional-Social-Cost ©2005 IPGDx, LLC
  • 28. PROGNOSTICHECK® • If Sick, How Sick® • Prognosis – Characterization of disease • Presence-Severity-Progression – Effectiveness of therapies • Optimized individual response – Timing of non-acute death • Palliative care and Hospice ©2005 IPGDx, LLC
  • 29. TARGETED MARKET SEGMENTS Innovators First 5% - 10% that adopt the product  Early Adopters Next 10% - 15%  Early MajorityNext 30%  Late Majority Next 30%  Laggards  Remaining 20%  CHARACTERISTICS: Venturesomeness: the willingness and desire to be daring in trying something new and different  Social integration: frequent and extensive contact with others in one’s area  Cosmopolitan: point of view extending beyond the immediate neighborhood or community  Social mobility: upward movement on the social scale  Privilegedness: attitude and possession of money (less risky to try something new)  ©2005 IPGDx, LLC