Norwalk Demonstration Project Proposal

1. Norwalk Demonstration Project Proposal

2. Overview • Jasperon proposes a demonstration project highlighting its premier educational material and tools for advance care planning with Norwalk Hospital. • Beginning in mid-August, Jasperon and Norwalk Hospital will work together for a period of approximately six months to demonstrate the effectiveness of Jasperon’s unique products and services in a major metropolitan area medical facility. • Jasperon will contribute access to its products and services. We intend to use web technology to integrate physical/hard-copy education material and to teach and train Norwalk’s health care providers to meet quality standards. • Norwalk Hospital will provide access to their professional staff, patients, operations, and related materials and documentation to implement mutually agreed-upon products and services in the hospital environment. 2

3. Overview • Together, Jasperon and Norwalk Hospital will study the benefits and performance changes in the Hospital as a result of using Jasperon’s products and services. • It is Jasperon’s intent to fine-tune its products and services, while providing Norwalk Hospital access to state-of-the-art resources. These resources would improve the quality and quantity of services the Hospital can provide its staff and its patients around advance care planning. Jasperon’s Phase 1 product, which will be running on August 18, 2000, has a professional component to it, but is largely consumer-focused. Jasperon’s deliverables from this effort will allow us to enhance the site and its functionality further for professional users. • Further, it is Jasperon’s intent to provide Norwalk Hospital with the public recognition that it will accrue as a leader in using Jasperon’s state-of-the-art products and services. 3

4. Demonstration Project A joint Jasperon/Norwalk Hospital demonstration project offers Norwalk a significant opportunity to take a leadership role in the community. • Media focus • This September, Bill Moyers’ four-part PBS special, “On Our Own Terms: Moyers on Dying,” is expected to create a keen national interest in this issue • Anticipated audience of 10 million viewers • PBS will host a dedicated web site • Grassroots campaign is already underway • JAMA • Devoting fall issue to end-of-life care • JCAHO 2001 regulations • AMA EPEC program • Education of end-of-life care provided to every physician • Broader web accessibility and usage across the United States 4

5. Advanced Care Planning Jasperon provides Norwalk Hospital with an understanding of advance care planning beyond today’s common perceptions. • Advance care planning is more than completing a legally binding form. Done properly and with a broad inter-disciplinary approach, advance care planning enriches lives, brings families together, and provides peace of mind. • Advance care planning is a process during which an individual makes decisions about his or her future health care in consultation with health care providers and family members. Advance care planning is an organized approach to reflection, discussions, and understanding regarding preferences for end-of-life treatment decisions. 5

6. Advance Care Planning Jasperon provides Norwalk Hospital with a unique solution to developing its own in-house expertise of advance care planning. • Jasperon’s web-driven solution incorporates insights from a multi-disciplinary expert coalition that guide the presentation of education and informational content • Jasperon’s interactive interface empowers the user with awareness, knowledge, discussion guidelines, and decision-making skills • Jasperon.com is the only site where legal documents related to advance care planning are completed online • Jasperon’s storage and retrieval services will tremendously enhance the effectiveness of advance care planning discussions and documentation 6

7. Advance Care Planning Jasperon provides Norwalk Hospital with skills that will help ensure the success of this effort. • Integrating physical content and material with electronic media in a way that is easy to use, clear, and simple to understand • Delivering education and training using technology • Building and planning to use web technology to deliver products and services that solve problems and increase effectiveness and efficiency • Tailoring solutions to hospitals based on their unique needs and capabilities 7

8. Next Steps To proceed, we propose the following next steps: • Obtain management approval to participate in this effort • Identify an interdisciplinary core group (with a proper champion) within Norwalk Hospital who will oversee the Demonstration Project • Begin discussions with each member of this group to understand their priorities, concerns, issues, and sense of the particular needs at Norwalk Hospital • Refine the project scope, timing, and objectives from both Jasperon’s and Norwalk Hospital’s perspectives • Begin to develop an overall strategy to ensure broad and active professional participation in the education component of the project • Begin to collect important background information about Norwalk Hospital’s current processes, education materials, policies, utilization, etc. • Sign off on Proposal and Agreement outlining scope, deliverables, timing, and accountability 8

9. Jasperon - Norwalk Hospital Demonstration Project 9

10. Advance Care Planning Jasperon would like to launch its advance care planning support network with Norwalk Hospital in mid-August 2000. • Mid- August 2000: • Establish interdisciplinary working team • Determine hospital issues and priorities through working team interviews • Identify additional issues and priorities through selected professional focus groups (2-3) • Establish overall professional education outline and schedule • Establish consumer education program outline • Mid to Late September 2000: • Conduct initial education program with key members of Norwalk Hospital • Initiate an overall public relations and community awareness campaign timed to coincide with the Bill Moyers special • September through December 2000: • Conduct professional education program with members of Norwalk Hospital and fine-tune as needs emerge • Identify implementation issues and goals to change advance care planning policies and processes as well as an overall implementation strategy • Assess integration issues around incorporating Jasperon into the education, storage, and retrieval processes of the Hospital • Extend community awareness campaign 10

11. Advance Care Planning We recognize that this effort will continue into 2001, and will work with Norwalk to define the activities that will carry over. • Likely Activities Into 2001: • Extend professional education program into parts of Norwalk Hospital system that have not yet participated • Assess effectiveness of alternative approaches to implementation • Continue process improvement implementation to improve compliance with JCAHO standards • Refine methodology to collect and analyze data that will improve compliance with JCAHO and other regulatory standards • Implement revitalized consumer education process and plan • Continue community awareness campaign into new segments of the community • Fine-tune Jasperon’s integration into the education, storage, and retrieval processes of the Hospital 11

12. The Goals For Jasperon, there are three overall goals for this project. • Launch and strengthen the community-based education and communication model at Jasperon’s core. • Implement a community-based education program in the Norwalk area with health care providers, community organizations, and consumers • Provide Norwalk Hospital with an Advanced Care Planning Support Network that can be used to ensure that awareness, knowledge, and skills are being delivered effectively • Learn how to implement Jasperon in a hospital environment • Assist Norwalk Hospital in identifying the implementation issues of advance care planning in terms of education, policy, process, and technology • Understand the effectiveness of different approaches to implementation • Incorporate Jasperon into the education, storage and retrieval processes and policies solution • Refine Jasperon’s web site within the hospital and with professional users • Identify content/architectural/format/navigational issues for professional users • Identify integration issues between the hospital’s own records and systems and the Jasperon storage and retrieval process • Refine security, encryption, and privacy protocols within Jasperon 12

13. State-of-the-Art Products and Services To achieve these goals, Jasperon is providing Norwalk Hospital with its state-of-the-art products and services. • Professional Training and Continuing Education Materials • Online • Physical • Advance Care Planning Process Review, Assessment and Implementation Planning • Consumer Education • Communication Platform • Advance Directive Preparation Tools • Advance Directive Storage/Update/Retrieval 13

14. Professional Education Jasperon’s professional education material has been developed to reorient many prevalent advance care planning behaviors and attitudes. • Focus professional training and continuing education on the ways medical professionals can further advance care planning through understanding, reflection, discussion, and formulating a clear plan • Focus on comfortable, palliative care • Involve family in discussions • Work as an interdisciplinary team that will respect personal choices around advance care plans “Add life to your days, instead of days to your life” 14

15. Professional Education Professional education focuses on skills and competencies that address advance care planning needs of chronically and terminally ill patients. • Objectives of the Education Component of the Project • Differentiate advance care planning from completing an advance directive • Develop strategies for educating health care professionals on advance care planning • Provide educational materials and tools to initiate sensitive discussions with chronically ill and terminally ill patients and their families • Discuss and understand personal and ethical issues relative to end-of-life treatment decisions • Understand the roles and skills required of professionals working as an interdisciplinary team approach • Demonstrate competency in completing and interpreting advance directives • Identify solutions to any of Norwalk Hospital’s barriers and organizational systems in implementing advance care planning 15

16. Advance Care Planning Jasperon’s advance care planning materials will address a broad range of topics with Norwalk’s professional staff. • Potential Advance Care Planning Curriculum Topics • Definition of Advance Care Planning - Understanding the Language, Concepts, and Tools • Medical Choices That Are Faced - a Decision-Making Model • Ethics, Laws, and Policies - An Overview • Pain and Symptom Management • Communication - Breaking Bad News, Triggering Discussions, Assessing Decision-Making Capacity • Roles of Professionals - Forming and Working as a Team, Improving Professional Skills • Facilitating Completing an Advance Directive • Specific Physician End-of-Life Responsibilities • Continuous Quality Improvement - Focusing on Advance Care Planning Outcomes, Measuring Strategies, and Data Utilization 16

17. Advance Care Planning The community action campaign portion of this project should position Norwalk as a thought leader in advance care planning. • What - A series of town meetings along with appropriate media coverage • When - Fall 2000 - in conjunction with or after “On Our Own Terms” • With Whom - Patients, Local Employers/Businesses, Civic Groups, Clergy, Legal Community, Financial Planners • Goals of the Community Action Campaign • Learn and Discuss - Engage the community in talks about the care they want at the end of life, provide education about the choices that are available, and encourage people to consider and express their advance care choices • Act and Communicate - Increase the number of people in the community who talk to their family members and physicians about their choices, complete advance directives, and ask their physician to place their documents in their medical records 17

18. The Demonstration Project… offers Norwalk an opportunity to test its compliance with 2001 JCAHO regulations, and establish itself as a “best of breed” site. • Systematic Data Collection and Analysis Supports JCAHO Quality Improvement - Sample Data That Should Be Evaluated • Where People Die - % in hospital, nursing home, home, hospice, other • Hospital Resource Distribution and Policies • Number of palliative care units/services/consults • Number of patients served by palliative care • Protocols and/or guidelines in place to support delivery of quality palliative care • Arrangements between hospital and hospice for coordinating care • ER protocols for seriously ill patients with DNRs, without DNRs • Protocols for transferability of DNRs between healthcare facilities and providers • Local emergency/911 protocols to honor DNRs and DNH • Number of physicians certified in hospice/palliative care • Number of nurses certified in hospice/palliative care • Number of physicians trained through AMAs EPEC program • Hospice • Number of hospices • Community awareness of hospice • Referral rate • Length of stay 18

19. Increased Efficiency and Effectiveness By looking at policies and processes, the Hospital also may identify opportunities for increased efficiency and effectiveness in its operations. 19

20. The Professionals Nurses Doctors Patients Area The professionals at Norwalk Hospital can provide us with valuable insights about the ease of use, completeness, and helpfulness of the Laggard Behind Average Good Leading Ease of Use Completeness of Information Answering Questions Facilitating Completion of Forms Facilitating Sharing of Decisions 20

21. Overview of Jasperon’s Business Solution 21

22. The Big Picture • Advance care planning enriches lives, brings families together, and provides peace of mind • Individuals are not empowered with the knowledge or tools to communicate their wishes regarding advance health care planning and treatment • Jasperon provides education and communication solutions to facilitate the process of advance care planning 22

23. Detailed Problems • Technical advances in medicine have outpaced the ethical discussion over how best to use those advances • high-tech medicine seeks to prolong life at all costs • 25% of Medicare budget spent in the last year of life • more than 80% will endure a period of incapacity at the end of their lives during which they are unable to make their own health care decisions • Patient preferences are often not known or respected • most individuals (90%) would prefer to die at home, but 80% actually die in institutions, often in intensive care settings • studies show that physicians are often unable to predict their patients’ preferences with respect to life-saving treatments, and their predictions are often based on their own values rather than the patients’ 23

24. Jasperon – Business Structure and Organization • Start-up Company – Founded April 2000 • Privately Funded by Venture Quest/Jesse Fink (Co-Founder Priceline.com) • Management Team • Robert Mitchell, MD - Founder • Jesse Fink – CEO • Rob Caione – VP Operations • Steve Resch – VP Business Development • Anticipated Expert and Vendor Affiliations and Alliances • Joanne Lynn, MD and David Introcaso, Ph.D • Bud Hammes, Ph.D, Linda Briggs, RN and Fran Rybarik, RN • Russell Portenoy, MD • Angela Rowley, Chaplain • Alan Lieberson, MD, JD • Peter Strauss, JD • Partnership for Caring – Choices in Dying 24

25. The Jasperon Solution Information & Education Center Communication Center Advance Directive Preparation Tool Document Storage & Retrieval Services 25

26. Information and Education Services • Centralized source of information, consumer education, professional training, and communication tools on an interactive web site • Alignment with experts to begin solving issues across multiple disciplines • Opportunity to provide accredited continuing medical education courses in advance care planning for professionals • Opportunity to create a support network of health care professionals who are interested and trained in advance care planning 26

27. Communication Platform • Internet chat between family members, friends, and caregivers • “Ask the Expert” service provides Jasperon users with direct access to expert knowledge • Discussion forums around specific topics available for individuals, their families, caregivers, and health care professionals • Guidance and outreach services to provide training on initiating discussion on difficult topics 27

28. Advance Directive Preparation Tool • Up-to-date legal forms for all 50 states • Jasperon user is guided through an online process of completing an advance directive and related legal documents • Interactive “Just-in-time” Help functionality • Easy notification of health care proxy • System informs users of changes in the law that may affect their advance directive document 28

29. Document Storage & Retrieval Center • Centralized, secure database • Fax or online access to documents on demand for providers and proxies • Updating 29

30. Jasperon Brings “Peace of Mind” Complete “Peace of Mind” Offering Brand/ Positioning Caregivers and Health Care Providers Education and Service Storage and Retrieval • Positioning as local company in touch with community resources to support personalized family-based needs • Emphasis on family-based decisions • Robust content developed from multiple perspectives- healthcare, education, caregiving • Sensitive educational approach to advance care planning discussions • Clear, senior sensitive, educational approach • Simple, easy to understand • Supports sharing of documents between family, friends, health care providers, and caregivers • Single process that produces a legally valid national solution • Able to create, store and retrieve documents in a secure environment 30

31. Highlights Why the Jasperon system is unique • Multi-disciplinary expert coalition guiding the presentation of educational and informational content • Interactive interface allows user to participate in online activities that build awareness, knowledge, and skills • Only site where legal documents related to advance care planning can be completed online • Storage and retrieval services have the potential to greatly enhance the effectiveness of advance care planning discussions and documentation 31

32. Everyone Benefits All parties involved in advance care planning will benefit from the Jasperon total solution • Patients • Peace of mind, better advance care planning experience, enable family communication, and participation in decision-making • Friends and families • Enriches experience and cohesion, improves education and communication and relieves financial burden • Physicians, caregivers, hospices, and hospitals • Efficient time-saving conversations, improves relationship with patient/family and addresses regulatory and compliance requirements 32

33. Jasperon is building an unsurpassed network of relationships SNF Hospice Visiting Nurse Hospitals Eldercare Groups AARP Assisted Living PBS – Moyers Special Hardware manufactures Software manufactures E-Commerce Financial Services Pharmaceutical Not-for-Profit Organizations Experts Technology Innovation Community Based AMA, ABA NCQA, HEDIS, JCAHO Government HCFA Physicians Managed Care Long-Term Care Reinsurance Disease Management Employers Benefits Managers Brokers/Benefit Portals Unions Employee Assistance Programs 33