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DOCTOR DIRECTINVESTOR PRESENTATION
September 2015
Doctor Direct
Executive Summary
The Doctor Direct (DD) medical remote monitoring technology is complete, live patient tested and has been field deployed.
The DD system automatically connects any Bluetooth health or wellness devices (i.e. Blood Pressure, Blood glucose, Pulse oxygen, digital scale, etc.) to the caregiver
Data is automatically received by VeriSmartPhoneTM, assessed and sent to caregivers.
Patient data with action level is transmitted in real time to Caregiver who can responds to patient via voice, video, SMS or email in real-‐‑‒time through patientʼ’s VSP
The DD system, combined with new Medicare billing/CPT reimbursement codes creates the opportunity for a significant Physician revenue stream with better quality care.
Smartphone based remote monitoring platform providing real time patient monitoring for physicians
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Overview Utilizes Cytta Private Mobile Cellular Network: • Licensed by Cytta (Cytta.com) to use its voice data M2M cellular network to manage an IoT network of unlocked smartphones programmed to ʻ‘thinkʼ’ – VeriSmartPhones™ (VSP).• Proprietary Voice & Data cellular network for real-‐‑‒time health & wellness monitoring• ʻ‘Intelligentʼ’ rooted android VSP IoT control interface
Enterprise GUI (Graphic User Interface): • Auto Alerting and Highly Scalable to millions• Automatically creates Cloud based patient electronic health record• Automatically populates and alerts Physicians office of all patient information
Medical Analytics: • All data contained in Cloud based relational database• All biometric readings stored and available for meta analysis• Power of big data available to Government, Insurers, CDC, Researchers, etc.
State of the Art Compression and Encryption: Far exceeds current day technologiesProvides Quality Video transition over very low bit-‐‑‒rate data links
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Most Competitive with Proven Results
The Heritage Provider Network Report from their three and six months live pa<ent trials using our Doctor Direct
solu<on found:
Immediate and verified savings of over $1,846 per pa<ent, per month
Created beKer overall sa<sfac<on and healthier pa<ent outcomes
Improved care coordina<on with ra<os improved by over 20%
The ACO independent comparison of all remote monitoring solu<ons showed that:
Doctor Direct ranked highest in Cost Effec<veness
Doctor Direct was simpler & easier to use for pa<ents and caregivers
Doctor Direct was the only system in the USA with Cellular, Satellite and WIFI connec<vity
The world’s first successful deployment of Internet of Things technology into the remote medical monitoring industry using Bluetooth/cellular was the 2012 live
pa<ent trial of the CyKa VeriSmartPhoneTM IoT remote medical monitoring technology by California based,
Heritage Provider Network (a Pioneer ACO).
The Doctor Direct VeriSmartPhoneTM monitoring product is pa<ent tested and available today. We have tested and proven the system in the market with great success and rave reviews. Below are a selec<on of the impressive Heritage Whitepaper* results from our
original live pa<ent customer trial.
*Independent Whitepaper from Heritage Provider Network (ACO) by Dr. Terry Olson, October 2012 Titled: “Biometric remote telemonitoring to produce a healthy return on investment, decrease resource u<liza<on, and improve care coordina<on” a 6-‐month live Trial See the Full Report at hKp://www.cyKa.com/whitepapers.php 4
Opportunity The Doctor Direct remote patient monitoring system, combined with the new billing/CPT codes for the service, allows real-‐‑‒time patient monitoring and a significant revenue stream to the Physician for providing better quality care.
On January 1st, 2015, the Centers for Medicaid and Medicare (CMS) began reimbursement for a number of telehealth services that the Agency hasn't covered before. This means that physicians now get paid for using Cytta's remote monitoring system to remotely monitoring their patients' health!
The Doctor Direct program system saves busy practitioners time, generates revenue without adding staff costs and opens up whole new avenues of care possible in the areas of weight control, diabetes, hypertension and cardio-‐‑‒pulmonary diseases.
CMS now covers remote chronic care management using current procedural terminology ("CPT") code, 99490 (with a monthly unadjusted, non-‐‑‒facility fee of $42.60). This CPT code can be bundled with CPT code 99091 for collecting and reviewing patient data, which pays an average monthly fee of $56.92 to the physician.
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How it Works ² Doctor Direct utilizes licensed Cytta VeriSmartPhonesTM and technology to create an instantaneous remote medical monitoring connectivity system
² The remote medical data capture 'VeriSmartPhoneʼ’ (VSP) technologyʼ’ works over a private national cellular network license from Cytta Corp. utilizing:
² The Doctor Direct system is completely open source – Automatically connects any Bluetooth health or wellness devices (i.e. Blood Pressure, Blood glucose, Pulse oxygen, digital scale, etc.) to the VSP to the Cloud and on to the caregivers anywhere anytime
² Data is automatically received by VSP, interpreted, assessed and recipients determined² VSP transmits data in real time to the Dr., Nurse, Caregiver and/or family member along with determination of action level or importance.
² Dr., Nurse, caregiver, or family member responds to patient via voice, video, SMS or email in real-‐‑‒time through VSP in patientʼ’s home.
Ø Their proprietary Private Unlocked Cellular Network Ø Any ʻ‘factory unlockedʼ’ Android smartphone (i.e. all US Carrier marketed smartphones have major portions of their functionality restricted or “locked” by the CarrierØ A proprietary ʻ‘intelligentʼ’ VSP rooted android control interfaceØ Any Bluetooth health or wellness device from any manufacturer (open source)Ø A relational cloud-‐‑‒based data repositoryØ Any smartphone or computer of the recipient (Dr., Nurse, family-‐‑‒member, etc.)
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Senior Management Gary Campbell CEO -‐‑‒ Cytta Corp. – Founder, CEO and Chairman; Unified Financial Inc. – CEO and Chairman; Rocketinfo Inc. – CEO and Chairman; Screenphone Inc. President and Chairman; Cancall Cellular Intʼ’l – President and Chairman; Telemac Cellular Corp. – VP Corporate/ Counsel; International Verifact Inc. – Director & Attorney; HC&G Barristers and Solicitors– Senior Partner of Law Firm; University of BC – B Comm., LL.B; www.linkedin.com/in/garymcampbell
Natalia Sokolova President -‐‑‒ SGG World LLC -‐‑‒Founder/ Managing Partner; Designer Holdings Ltd – VP Business Dev; Bidz.com -‐‑‒ Head of Marketing/ PR and IR; United Licensing Group -‐‑‒ Managing Director; US Chamber of Commerce; University of MD Cum Laude Intʼ’l Finance; Member of: National Investor Relations Institute; National Association of Professional Women; www.linkedin.com/in/nsokolova
Raj Matthew CFO -‐‑‒ Raised $1.2BB in public/private placements; Asante Technologies, (NASDAQ: ASNT) CFO; RiskSense, The Brenner Group, Tagged, Narus (NSE:BA), BuildPoint – CFO; PeopleWeb Communications (EBR: BELG), CFO led IPO; Avant!-‐‑‒Synopsys (NASDAQ:SNPS)-‐‑‒ VP Finance & Controller; Seagate Technology (NASDAQ:STX)-‐‑‒ Director of Finance; Airtouch Vodafone (VOD:LN) Staff Director Finance; Price Waterhouse – Senior Associate; University of San Francisco – CPA/ MBA; www.linkedin.com/in/rajmatthew
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Mr. William Casselman II, J.D., An attorney and business advisor highly experienced in information technology and telecommunications matters. He represents U.S. and foreign clients on business and government matters, including commercial transactions, government contracts and federal lobbying and is driven by tackling large issues such as the current Healthcare change mandate. Mr. Casselman served for over 10 years in appointed positions within the Executive and Legislative Branches of the U.S. Government, culminating with his appointment by President Ford as Counsel to the President, after serving as Legal Counsel to Vice President Ford.
Mr. Michael Chermak Mr. Chermak has 30 years of experience in the healthcare industry and has raised over $200 million for his various enterprises, both private and public. Mr. Chermak is the Founder and Principal of MD Capital Advisors a firm focused on assisting emerging medical companies access equity capital markets. Mr. Chermak has been a CEO, Board Member, and Principal, Investor in projects in the US, China and Europe in both private and public companies. Mr. Chermak and his partner purchased controlling interest in a publicly held CRO, Covalent Group (CVGR) https://www.linkedin.com/in/mchermak
Mr. Erik Stephansen BA (Econ) Mr. Stephansen is a private equity adviser and former investment banker who is experienced in corporate development, technology and sales management work with Cisco, Microsoft and other Fortune 500 companies. He is the President of Cytta Corp, he is the architect of the entire Cytta Connect system and ecosystem. Mr. Stephansen is an innovative business executive with documented knowledge in medical, financial and professional services, hardware and software technologies. https://www.linkedin.com/in/erikstephansen
Other Team Members
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Dr. Binoj Joseph Matthew, MD is a Resident Physician (psychiatry) at UCSF Medical Center. Prior to this he was a Co-‐‑‒Founder, Vice-‐‑‒President, Corporate Secretary for Youth Resilience, Inc. He self-‐‑‒financed and co-‐‑‒founded a California State Department of Social Services licensed 501 (c) (3) non-‐‑‒profit corporation providing housing, treatment and services abused youth. He also held positions as direct care staff for Ohannesian Homes and as Senior Research Associate (molecular biology/microbial genetics) at Tularik, Inc., (currently Amgen, Inc., San Francisco). Dr. Matthew holds several US patents. Dr. Matthew holds a B.Sc. from Berkley, an MD from AUC and is a resident at the University of Calif. (San Francisco) https://www.linkedin.com/pub/binoj-‐‑‒joseph-‐‑‒matthew-‐‑‒m-‐‑‒d/68/711/94
Leading manufacturers of remote-‐‑‒monitoring equipment include Medtronic Inc., Philips NV and St. Jude Medical Inc. Sales are expected to total about $32 billion this year, with a compound annual growth rate of 9.2% between 2014 and 2019. Such a merging of wireless technology and medical care is still in its infancy, but health systems that began pilot programs with the technology in recent years say they see signs that it is keeping patients healthier. By enabling doctors to continuously monitor patients, they say, the systems can detect problems well before they grow serious. WSJ Feb 16, 2015
Remote Patient Monitoring Lets Doctors Spot Trouble Early
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For patients with chronic conditions, tracking of vital signs allows quick care adjustments
Benefits of Doctor Direct Reduce costs and improve care coordina3on with Doctor Direct monitoring
services.
For pa3ents with chronic condi3ons, tracking of vital signs allows quick care
adjustments
Take preventa3ve measures before condi3on gets cri3cal and increase
survival rates
Shorten length of stay when admission is
necessary
Enable constant and engaging pa3ent-‐provider
connec3ons
Increase compliance with lifestyle changes, such as
diet, exercise and medica3on
Increase pa3ent sa3sfac3on and contribute to improved quality of life.
Provides safety and security from any place for the pa3ent with available 24/7 alerts to the doctor’s
office with unusual readings.
Doctor has his pa3ents EMR readings displayed in graphic and other formats
for easy diagnosis.
Our device not only monitors and sends signals
but can be a regular cellular phone and video conference solu3on
Pa3ent has a choice to use this device as a main mobile number and
transfer the prior number to this line.
Secure remote access, HIPPA compliant
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Competition
Qualcomm -‐‑‒Qualcomm is an American global semiconductor company that designs and markets wireless telecommunications products and services. The 2net™ WiFi platform is an excellent cloud-‐‑‒based system that securely gathers your health information from various medical devices and health applications into one easily accessible spot for you and your health care team. Cons only works with WiFi no cellular connectivity
There are a number of competitors in this space. Below we list the most popular players in medical remote monitoring. What separates the Doctor Direct platform is the Cytta private cellular network combined with IoT VeriSmartPhones™ that can be reprogramed at an operating system level to perform multiple functions and ʻ‘thinkʼ’.
Honeywell HomeMed -‐‑‒ Leverages an Android tablet for an intuitive, consumer based interface with access to a full range of LifeStream applications, services and devices. This personal health device revolutionizes how care providers interact with patients by enabling simple, one-‐‑‒touch, video-‐‑‒based communication in addition to traditional telemonitoring. A patient education feature encourages healthier choices and compliance with a personalized care plan. Support for peripheral devices meets the needs of patients with different risk factors and specialized monitoring requirements. Cons: expensive, not automatic, limited devices available.
Validic -‐‑‒ Solves the accessibility and integration challenges for healthcare organizations by providing a one-‐‑‒to-‐‑‒many connection to digital health technologies. Validic is a cloud-‐‑‒based technology platform that connects patient-‐‑‒recorded data from digital health applications, devices and wearables to key healthcare companies like hospital systems, providers, pharmaceutical companies, payers, health information technology platforms, health clubs and wellness companies. Validic provides a great solution for our data.
Philips Telehealth -‐‑‒ Takes vital signs and customized surveys with Philips monitoring devices. With specialized algorithms, Philips data server processes clinical data into manageable information with bi-‐‑‒dreictional data communication with electronic health records (EHR). Results are automatically sent to a website (via a land line or cellular signal). The telemonitoring nurse monitors the patient daily and physically alerts the patient and care team when results fall outside predefined limits. Requires full and part time field installation and ongoing nurse monitoring
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Competitive Advantages
Most medical devices rely on landline telephone connec<vity and/or WiFi connec<vity to send health data to
caregivers. Many elderly pa<ents have no WiFi access and can’t be monitored outside their home. Doctor Direct
cellular monitoring gives the security, safety and flexibility to communicate
with their doctor anywhere and any<me.
Most remote monitoring apps leave the data uselessly trapped on the cellphone or on a web portal. Doctors are not permiKed to u<lize this data. Our VeriSmartPhone solves this issue by
automa<cally passing the FDA approved data to the Doctor for his review and ac<on, without any pa<ent input.
Our system does not require that you purchase or have to install an expensive
and cumbersome EMR technology, although we can integrate your pa<ent
data with any exis<ng EMR.
Our Doctor Direct system is fully opera<onal in any US loca<on, HIPPA compliant and our exis<ng clients are currently achieving remarkable results
with the Doctor Direct Program.
We are the first highly scalable, mobile plajorm for collec<ng verifiable and objec<ve data for anyone needing FDA or Non FDA approved monitoring; from the Chronically Ill to 30-‐Day Readmission
preven<on to fitness and wellness tes<ng.
Our Compression/ Encryp<on technology gives Doctor Direct an unparalleled advantage to all our
compe<tors.
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Target Market
Three million patients around the world were using connected home medical monitoring devices in late 2013, this number will jump to 19.1 million by 2018.. Remote patient monitoring revenues reached $5.8 billion in 2013 and are expected to grow to $26.4 billion by 2018.
Our primary markets are primary care physician offices and small group practices. Individual and small group practices possess the required patient base, and the clinical and financial incentives to adopt this program.
We will address this market through a sales affiliate marketing program which not require a costly in-‐‑‒house sales infrastructure. The program will be two tiered, the first -‐‑‒sales team development and management and second -‐‑‒the actual field sales reps.
We have identified key opinion leaders, regional medical sales rep associations and clusters of independent medical sales reps.
In addition to the affiliate program, the primary marketing function for the company is largely creating effective communications materials for the affiliates, physicians, and their patients.
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Funds Raised to Date and their Use² Total funds raised to date $1.2 million² Licensing and Development fees for Cytta VeriSmartPhoneTM IoT technology and Private Cellular Network
Current Round² Angel Round $1,250,000 with Valuation of $6,000,000
Use of Proceeds² Marketing² Sales ² Operations² R&D Assumptions based upon our market research² Average size of Family Practice -‐‑‒ 5,000 patients² Patients with two Co-‐‑‒morbidities eligible for Medicare reimbursement of $100 per month ($56 RPM and $44 for virtual visit)² 30% Patients fall in the range of Co-‐‑‒Morbidity. ² We assume that doctor will provide/ prescribe monitoring to 25% of his co-‐‑‒morbidity. ( i.e. it will be 375 patients per doctor)² Doctor will be responsible for paying for reps $10/ patient and for VeriSmartPhone (lease for $10-‐‑‒20/ month) ² Doctor pays DD $10/ patient on the network/month = 3750 x 12 = $45,000 per doctor/year plus one time setup fee² In Year 1 we can sign 42 Family Practices, which will result in $1,900,500 gross revenue² In year 2 we can sign 252 Family Practices, which will result in $11,345,250 gross revenue² In year 2018 we can sign 700 Family Practices, which will result in $31,473,000 gross revenue² Plus revenue from operating the AT&T network -‐‑‒ TDB² Less Marketing/ Operating/ Salaries/ Licensing royalties/ Office/ Administrative -‐‑‒ Net Margin approx. 33%² Additional revenue -‐‑‒ Mandatory $15/ phone prepaid credit for emergencies (we net $10) -‐‑‒ Advertising revenue
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Financials
Year 1 Year 2 Year 3
Revenue 1,900,500 11,345,250 31,473,000
Cost of Sales 760,200 3,403,575 11,015,550
Operating Expenses 1,793,840 4,397,240 7,993,530
Net Income (Loss) (653,540) $3,544,435 $12,463,920
-‐5,000,000
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
Year 1 Year 2 Year 3
Pro Forma Financials Revenue
Cost of Goods Sold
Opera3ng Expenses
Net Income
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Financials
How this Company was Born
• The principals of this Company began working on this project in 1999 when they decided over a glass or two of wine that medical peripherals should dam well be connected to the Internet. They visited A&D Medical in Menlo Park and discussed their novel concept. A forward thinking engineer at A&D (now their head of Engineering) thought the idea interes<ng and donated a box of A&D blood pressure (BP) monitors.
• Our intrepid Vancouver programming team thereupon cracked open the BP devices and connected a serial cable to the inside of the BP monitor. The other end of the serial cable was connected to the Samsung Anyweb serial port (this was before USB) and with some reprogramming of the Anyweb, the blood pressure readings were sent from Vancouver via the Internet and to an Anyweb in scenic San Clemente and not so scenic Suwon City, Korea.
• Eventually our team were moving the data from 10 different medical peripherals through the Anyweb, including readings from a 12 lead EKG designed for veterinary use. Interes<ngly, in the first trial with a live young Canadian programmer, our US doctors both looked at the EKG results from Vancouver and iden<fied a serious heart problem. The test was stopped and the kid immediately went to the hospital where he was immediately placed on heart medica<on. Was this the first life saved by remote monitoring?
• By August 2001 the medical community was placing their first orders for the Anyweb Medical ScreenPhone and its medical peripherals. Unfortunately the internet appliance market died with 9/11 as PC prices fell drama<cally and their was no ability to source Anyweb Internet appliances. Advanced remote medical monitoring systems were just another vic<m of 9/11.
• The market stayed in its primi<ve technology status un<l the advent of Obamacare which changed the healthcare paradigm and tried to ship the emphasis to quality of care and value based care. Believing the opportunity once again existed to radically change the way medicine was prac<ced, the now longer in the tooth members of our intrepid ScreenPhone crew decided to get the band together and try again. And since smartphones were now ubiquitous, we decided to make them the control interface for the system.
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(Optional reading)
• The beauty of this model is that it is completely automa<c. You take a reading and the smartphone receives it automa<cally and then sends it to the Cloud and on to the Doctor with the appropriate no<ces. Simple and elegant. Unfortunately, all US carrier cell phones are factory “locked” so that the root or automa<c func<ons are not accessible. These are “network protocols” and prevent cellphones from thinking and ac<ng on their own or independently of the user. These constraints prevented our model from working.
• Not to be deterred by the fact no US cellphone was permiKed to do what we wanted, we went out and found a small private cellular network that allowed us to use factory unlocked android cellphones and gain root access to the smartphone’s control interface. Basically we hacked them. We reprogrammed the smartphones (we began calling them ‘very smart phones’ or VeriSmartPhonesTM) to do our bidding and began opera<ng on their private 2G cellular network. The system worked flawlessly and a live pa<ent trial was undertaken with 27 very sick pa<ents who swore the CyKa Connect technology changed their lives.
• Interes<ngly, some enterprising AT&T execu<ves were watching our progress and once we demonstrated the efficacy of our system on the Network, we were offered the opportunity to play in the big leagues and use the AT&T 4G LTE domes<c and interna<onal network for our VeriSmartPhones. We accepted and now have the opportunity of making our VeriSmartPhones (VSPs) do different and amazing things on our unlocked por<on of the na<onal cellular network. We have developed the original demonstra<on system as a complete independent remote medical monitoring system, but that is merely one ver<cal our VSP’s can control. The VSP’s are a very smart connected control interface which allows us to empower the Internet of Things (IoT) in many different ways.
• And as we cynically said before, nothing happens in US medicine unless someone can make money from it. This miraculous event occurred on January 1, 2015 when CMS introduced two codes so Doctors could bill monthly for remote monitoring and make recurring revenue. Instantly the medical community was ready to embrace the wonders of our remote monitoring technology. Hallelujah! J
17
(Optional reading)
How this Company was Born