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Agility4Life Quality of Life through
Measured Movement
March 30,
2013
Agility For Life Justin Ho, Uday Chaka http://www.agility4life.com 1
Agenda
Company Overview
Solution Overview
Demonstration
Business Insight
March 30, 2013 2
Who is Agility4Life? Vision – be health monitoring solution for seniors by utilizing
movement signals to predict and enhance health outcomes To help PREVENT adverse events
To help DETECT adverse events
Ultimately – help seniors live independently, away from intensive care or nursing homes
Why now? Aging Population – 10k new seniors / day – existing resources will
be strained to provide sufficient care
Advancements in computer vision technology
Advancements in movement/gait science
Regulatory changes to better incentivize stakeholders to invest in technology to improves quality of care
March 30, 2013
http://newsroom.pamf.org/2012/10/pamf-innovation-
center-developer-challenge-winners/
3
Core Team Uday Kiran Chaka – Founder, Duke MBA
Justin Ho – Founder, Duke MBA
Seshadri Srinivasan, PhD – Founder, Research Lead
Stacy Fritz, PhD – authority in walking science
Tiffany Shubert, PhD – research scientist in Aging
Extended Team Front / Back End Developers
Hardware engineer
Hardware/UI designers
Image Analysis Scientists
Geriatrician
Company Overview Solution Overview Demonstration Business Insight
What is Agility4Life?
Health assessment and risk
detection tool based on
walking speed
March 30, 2013 4
Phase I
Fall Detection/Monitoring System Phase II
- Fall Risk
- Cognitive Declines - Sensory Declines
Advanced Fall Risk Assessment and Disease Prediction Suite based on complex movement patterns
Phase III
Prevention
Prevention
Detection
Prototypes
Built
Company Overview Solution Overview Demonstration Business Insight
Key Solution Features
Real-time detection of falls Ability to distinguish between real falls and false positives (e.g.
lying down, sitting)
Daily monitoring and assessments of overall health based on walking speed
Provide early warnings of health deteriorations based on walking speed
Real-time alerts sent to designated care taker(s) in case of fall
Alert protocols include SMS text, Email, and can be customized to integrate with existing facility alarm systems
Ability by senior to easily deactivate alert if fall is not serious
Online health overview dashboard Summarizes captured data to show metrics, warnings, and trends Accessible only by senior and his/her designated caretaker(s) HIPPA compliant platform that can integrate with hospital systems
if need be
March 30, 2013 5
Company Overview Solution Overview Demonstration Business Insight
Value of Real-Time Fall Detection
March 30, 2013
* http://usatoday30.usatoday.com/news/nation/ems-day2-cover.htm
6
Value to Senior (and his/her primary caretaker) Peace of mind – when fall occurs someone would be alerted
immediately More likely to recover/survive if falls are detected and treated early
Remaining on floor for >2 hours after a fall increases risk of dehydration, pressure ulcers, rhabdomyolysis, hypothermia, and pneumonia
Special urgency for cardiac arrest issues where “3-minute reduction in call-to-shock time improves odds of survival almost 4-fold” *
Value to Providers Improved quality of care for its members Differentiator to attract new members Helping meet organizational service objective of keeping its seniors
living independently
Value to Payer Annual savings of ~$2MM for 3000 unit facility
Company Overview Solution Overview Demonstration Business Insight
Value of Walking Speed Assessment
Value to Senior (and his/her primary caretaker) Opportunity to take control of own health –
Continuous monitoring of a key vital sign – walking speed – to assess health status
Early warning of functional declines and risk of falls – gives opportunity for intervention before it’s too late
Value to Providers Improved quality of care for its members
Differentiator to attract new members
Helping meet organizational service objective of keeping its seniors living independently
Value to Payer Early intervention reduces the likelihood of hospitalization,
disease complications, and moving into nursing homes – saving millions
March 30, 2013 7
Company Overview Solution Overview Demonstration Business Insight
A Bit More on Walking Speed …
March 30, 2013 8
Latest medical research confirms that Walking Speed/
Gait Speed is a good indicator of overall health status,
including – Stability and Balance – Risk of Falling
Dementia, Cognitive Status
Motivation and Mental Health
Survival and Well Being
Musculoskeletal Condition, Joints, Motor Control
Sensory and Perceptual Function (Vision and Ears)
Changes in Walking Speed correlate with changes to health. Studies show that for seniors: Average walking speed < 0.6 m/s is indicative of poor
health status
Walking Speed decrease (change of -0.1 m/s) indicates health deterioration
Walking Speed increase (change of +0.1 m/s) shows improvement
See Appendix for a comprehensive list of walking speed implications
“Walking requires
body support, timing
and power. It places
demands on the
brain, spinal cord,
peripheral nerves,
muscles and joints,
heart and lungs, and
… the blood… thus
when organ systems
are not working
property, gait speed
slows.”
- Dr. Studenski S*
Walking Speed is specific, measurable, objective and correlates with health
Company Overview Solution Overview Demonstration Business Insight
9
Agility4Life Detectors
capture and assess
movement signals; process
and transmit relevant data
– including position
coordinates, time, identified
movement characteristics –
wirelessly to CPU hub.
March 30, 2013
Unobtrusive Experience
Company Overview Solution Overview Demonstration Business Insights
Point B Point A
Distance
Agility4Life CPU Hub
triangulates data from
multiple detectors and
sends summarized
information – including
detected fall and walking
speed – to Agility4Life
software application in the
cloud. Also contains manual
override button in case of
false alarm alerts.
* Customized based on facility-specific
system and processes
10
Data
Base
Analytics
Engine
Trend
Generator
Personalized Agility4Life Web Site
March 30, 2013
Agility4Life
Application in the Cloud
Push/pull requests SOAP/REST architecture
JSON/XML
Summarized Information
Immediate Fall Alert
SMS Text Message
Existing Facility
Warning System*
Analytics in the Cloud
Company Overview Solution Overview Demonstration Business Insight
Privacy / Ease of Use
Secure login so only senior and his/her designated caretaker(s) can see data
A4L does not capture or store images in the cloud – assessment of images done on detector device in real time; images discarded immediately
One time set up – takes about 45 minutes pending number of rooms
Unobtrusive usage – senior does not have to wear anything or modify daily routines
Non-invasive look and feel – small form factor, blends into wall
Simple button to press if fall detected is false alarm
March 30, 2013 11
Company Overview Solution Overview Demonstration Business Insight
Validated by Experts
Name Title
Dr. Peter Cheng Physician Lead, Palo Alto Division Geriatric Medicine
Program, Palo Alto Medical Foundation (PAMF)
Stacy Fritz, PHD, PTI Program Director & Assistant Professor at University of
South Carolina – Physical Therapy Program
Dr. Tiffany Shubert, PHD Adjunct professor, Physical Therapy, at UNC, Research
scientist at the UNC Center for Aging and Health
Ken Smith Senior Research Scholar and Director of Academic and
Research Support, Stanford Center on Longevity
Mr. Joachim “Yo” Andersen
Care Center Administrator, Vi Palo Alto, Independent
Living & Assisted Living (IL & AL) Facility
Mr. Al Lewandowski CFO of Secret Harbor, Provider of home care (HC)
services for Seniors
Mr. Jean-Luc Neptune Senior Vice President, Health 2.0
Katy Thomas Fike, PHD Entrepreneur & Consultant, Geriatrics
March 30, 2013 12
Do
cto
r A
ca
de
mic
In
du
stry
IL
/AL/
HC
Fac
ilitie
s
Agility4Life solution has been reviewed positively by a PAMF physician, academics, researchers,
seniors, administrators of Assisted and Independent Living facilities and industry veterans
Runner-Up in PAMF
linkAges Competition!
Company Overview Solution Overview Demonstration Business Insight
Demonstration
March 30, 2013 13
Company Overview Solution Overview Demonstration Business Insight
Fall Detection Videos show various fall
patterns detected
Falling backwards
Falling forward
Falling straight down
Non-fall (sitting down / slowly lying down)
Walking Speed Assessment See
Appendix for description
Successful Beta Prototype
14
Actual screen shots from the beta website for the participant
Measures Walking Speed accurate to 1/15th of a second
Trends are vivid and easy to interpret
“The charts are easy to understand. They
give valuable feedback and incentive to
exercise” – Angie H (Beta Test Participant)
Participant Profile Name: Angelina H (Patient A) Age: 86 Sex: Female Health Care Provider: PAMF Palo Alto Resident
Lives Alone
Agility4Life signed up a senior to participate in a beta to test the solution to measure Walking Speed
Overview
Trends Risks Details
March 30, 2013
Company Overview Solution Overview Demonstration Business Insight
Health Monitoring has business value
Preventative Care: Early detection of potential problems by seniors, care-givers or family members, community programs, and doctors/therapists, by reviewing Walking Speed summaries helps prevent adverse or catastrophic events Better quality of life for seniors
Less dependence on others for daily activities
Delay the onset or reduce the likelihood of transitioning from home to nursing homes
Avoid significant financial burden placed upon family members – avg. of $70k / year
Living at home or in a Low Cost facility with similar care: Providers and Senior Living Facilities deliver higher standard of service at lower cost, realize better occupancy rates and revenues Improved quality of care away from hospitals and physicians means less re-visits for same issue, improving
bottom-line for hospitals
Improved quality of care in senior living centers or assisted living facilities means less flow into nursing homes, where the margins for operators are typically less attractive
March 30, 2013 15
Hospital Nursing Home
Assisted Living
Independent Living
Home
High cost
Walking Test May Predict Heart Surgery Risks
WebMD article
Monitoring activities and health saves money for seniors and health system overall by preventing falls and helping seniors live in lower cost facilities – like home
Low cost
Company Overview Solution Overview Demonstration Business Insight
Agility4Life - Addressable Market for
Health Monitoring
Two main addressable markets worth $3.5B Seniors living alone in private homes
Independent and assisted living facilities
Private home seniors 11.3M non-institutionalized seniors live alone (1.1M in CA)
Total Market size of ~$3.3B annual revenue in US (assume $50 initial purchase/senior + $20 monthly fee/senior)
Independent / Assisted living facilities ~1M seniors live in ~40k independent/assisted living facilities
nationwide
Top 10 assisted living and top 10 independent living facilities combine to serve ~260K seniors, totaling ~$75M market
Total market size of $250M (assume $1000 initial purchase/facility + $20 monthly fee / senior)
March 30, 2013 16
http://www.consumerreports.org/cro/money/retirement-planning/choosing-an-assisted-living-facility/overview/index.htm
Company Overview Solution Overview Demonstration Business Insight
Agility4Life Pricing
March 30, 2013
* http://www.elderlawanswers.com/resources/article.asp?id=8717&Section=4&state
17
Alternatives Monthly Cost
w/o Insurance Monthly Cost w/ Insurance Key Differences to Agility4Life
Full monitoring at
Nursing Homes $7,000 * $7,000
- Loss of independence
- Pain and suffering
Moving into
Assisted Living $3,300 $3,300 - Loss of some independence
Treatment due to
illness/falls $1,600 $400
- Pain and Suffering
- Temporary / permanent decline in
mobility
Get-Up-and-Go
Tests $100 $15
- Monthly Hospital Visits
- May not be as accurate
- No comprehensive historical records
BeClose Full
Monitoring $80 $80 - Does not provide walking speed
Agility4Life $20/senior monthly subscription fee + $20 Wireless access (3G models) $40-50 one-time product price
Company Overview Solution Overview Demonstration Business Insight
Agility4Life Intellectual Property
Agility4Life has filed a provisional patent on “Fall identification, posture detection, temperature identification and reliable estimation of walking speed using Passive Infrared array and Optical Cameras: Subsequent assessment of general health, including fall risk, using posture, fall history and walking speed”
A broad-based family of patents in this area will protect Agility4Life’s interests in the long term
March 30, 2013 18
Company Overview Solution Overview Demonstration Business Insight
Agility4Life – Competitive Analysis
March 30, 2013
Agility4Life is the best solution!
19
Alternatives Features
Agility4Life Stop watch & tape
Motion detector
WebCam/ Kinect
Radar Pedometer, strap-on devices
Accuracy * * * * * * * * * * * * * *
Frequency * * * * * * * * * * * * * * *
Automated * * * * * * * * * * * * * *
Cost effective * * * * * * * * * * * *
Ease of set-up * * * * * * * * * * * * * * * *
Supporting technologies
* * * * * * * * * * *
User Interface, EHR/EMR link
* * * * * * * * *
Company Overview Solution Overview Demonstration Business Insight
Agility4Life – Roadmap/ Go to Market
Strategy
March 30, 2013 20
Public Beta Launch w/Partners (ALF), Managed Care Organizations (MCOs)
Pilot: Homes of seniors, Assisted Living Facility (ALF)
Partner w/Insurance companies, Providers
Partner w/Retailers, Medical Supplies Distributors
Public Launch w/Direct sales, Distributors
Improve analytics
Improve person recognition/filtering, add connectors to EMR, EHR, PHR
Add new form factors for detectors
Add new signals, enhance website to improve user experience
Q1/Q2 2013
Q3/Q4 2013
Q1/Q2 2014
Q3/Q4 2014
Company Overview Solution Overview Demonstration Business Insight
Agility4Life – Partnership Plan
Current Status - completed proof of concepts, rough prototypes, received validation from experts; now we need to: Validate there’s a need of this product from senior homes If so, continue to invest money, time, energy to build up product for
real trials (~2 month effort)
We want to be a pilot partner of senior living facilities, and conduct beta tests Two Evaluation Trials, each contains:
5 senior units
1 month span
Pre-trial walk through of facility and one time set up of system
Post-trial interviews with senior, caretaker, and facility member(s)
As an initial partner – we will: Customize our solution specifically to your facility so to leverage
existing warning systems/alarms and processes Once productized, free 1 year usage of product for seniors who
participate in trial
March 30, 2013 21
Company Overview Solution Overview Demonstration Business Insight
Agility4Life – Founder Bios Uday Chaka
Entrepreneur and management consultant with deep strategy, technology, and execution experience
Co-founded mobile social gaming company, advised Fortune-100 firms on product development and supply chain operations
Worked at Pricewaterhouse Coopers (PwC), Cisco, HP, Infosys
Holds MBA in Health Sector Management from Duke University and BS in Technology from Indian Institute of Technology (IIT)
Justin Ho Experienced healthcare and management consulting professional
Deep product management, marketing, sales operations, and technology experiences
Worked at Accenture, Boston Scientific, Cardinal Health, and Genentech
Holds MBA in Health Sector Management from Duke University and BS in Biomedical Engineering from Johns Hopkins University
Seshadri Srinivasan – Sr. Staff Scientist, Product Lead, Feature Lead & Research Lead
Expert on Image Processing, Medical Imaging & Systems Engineering
Worked at Siemens Medical Solutions and startups
Authored 11 patens overall, including 5 patents on color doppler imaging, all of which were granted: (7946990, 7887484, 7887487, 8047991, 8098910)
Holds Ph.D in Electrical Engineering from Houston University and B.S. in Electrical Engineering from Anna University
March 30, 2013 22
Company Overview Solution Overview Demonstration Business Insight
Agility4Life - Summary
March 30, 2013 23
Captures and Analyzes Activity Patterns to
Monitor Health
Improves Quality of Care for Seniors
Helps Seniors Age Independently Away
from Hospital / Nursing Homes
Agility4Life hopes to win the Startup Challenge!
Great team
With a Unique solution
In a Growing market
Social Mission
Preventative Care
Need of the hour
Company Overview Solution Overview Demonstration Business Insight
THANK YOU!
March 30, 2013
Contact: Uday.chaka@agility4life.com
24
Company Overview Solution Overview Demonstration Business Insight
APPENDIX
March 30, 2013 25
Agility4Life: Summary Screen
March 30, 2013 26
Agility4Life
recommendation for
the senior
Senior
profile
Account
Information
Daily and weekly
average speeds and
changes
Company Overview Solution Overview Demonstration Partnership Opportunities
Agility4Life: Trends Screen
March 30, 2013 27
Trend line of walking
speed over a period
of time
Senior
profile
Account
Information
Large fluctuations
could indicate certain
medical conditions
Company Overview Solution Overview Demonstration Partnership Opportunities
Agility4Life: Risks Screen
March 30, 2013 28
Risk factors based on
walking speed
Senior
profile
Account
Information
Senior’s risk level based
on the average
walking speed
Company Overview Solution Overview Demonstration Partnership Opportunities
Agility4Life: Hours Screen
March 30, 2013 29
Does the walking
speed vary widely?
Senior
profile
Account
Information
Does Walking speed vary
widely during the day –
morning vs. mid-day?
Company Overview Solution Overview Demonstration Partnership Opportunities
Use Case –
Disease Maintenance
March 30, 2013 30
Has
depression,
often times
forgets to
take
medication
Has not
taken
medication
on schedule
the past 3
weeks, and
does not tell
anyone
Depression
worsens in
following
weeks, leads
to general
health
deterioration
Without Agility4Life
Lynn, 68 year old
grandmother, lives alone
in private home, primary
care taker is her son
Thomas, who lives in
another state
With Agility4Life
Thomas no
longer thinks
Lynn can live
indepen-
dently,
moves her to
assisted living
Total Cost: $3,300/month for Assisted Living1 Decreased independence
Lower quality of life
1http://www.assistedlivingfacilities.org/articles/assisted-living-costs.php/
Has
depression,
often times
forgets to
take
medication
Has not
taken
medication
on schedule
the past 3
weeks, and
does not tell
anyone
Agility4Life
sends
warning
signal to
Thomas
Thomas calls
Lynn, asks
clarifying
questions
and finds out
she has not
been taking
medication
Thomas reiterates
importance of
medication, asks
neighbor to check
up on Lynn.
Depression does not
deteriorate, Lynn
stays in her home.
Use Case –
Disease Maintenance
March 30, 2013 31
Has Multiple
Sclerosis,
knows from
experience
decline in
mobility is sign
of
exacerbation
of disease
But both
Nancy and
Pam do not
notice
visually
minor
mobility
declines
Exacerbation
of MS occurs,
severe urinary
tract infection
develops,
causing pain
and suffering
Without Agility4Life
Total Cost: $1,000 for treating urinary tract infection and MS exacerbation
Pain and Suffering
Nancy, 79 year old
grandmother, lives alone
in private home, primary
care taker is her daughter
Pam who lives close by
With Agility4Life
Has Multiple
Sclerosis,
knows from
experience
decline in
mobility is sign
of
exacerbation
of disease
Pam notices
minor
mobility
declines via
Agility4Life
notification
Pam asks Nancy to
check for common
MS exacerbation
factors and
schedules
appointment with
Nancy’s physician
for checkup
Nancy, along with
her physician
catches the onset
of urinary tract
infection and is
able to treat it
effectively before
it becomes serious
Use Case –
Preventative Diagnosis
March 30, 2013
1http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html
32
Has minor
dizzy spells
for the
past 3
weeks
During
doc visit:
does not
bring up
symptom
for fear of
being sent
to nursing
home
Condition
worsens –
falls and
suffers hip
fracture
Without Agility4Life
Has minor
dizzy spells
for the
past 3
weeks
During
doc visit:
does not
bring up
symptoms
for fear of
being sent
to nursing
home
But via
Agility4Life
doc sees
average
walking
speed varied
greatly from
past week to
past month
Doc asks
clarifying
questions:
discovers
dizziness;
suspects
vestibular
disorder and
prescribes
physical therapy
Ted follows
treatment – doc
verifies
improvement
with Agility4Life
report – Ted
stays in
independent
living
Total Cost: $20k for treatment/therapy1 Pain and Suffering Decreased long term mobility
Increased risk of fatality
Ted, 74 year old
grandfather, recently
moved into independent
living center.
With Agility4Life
March 30, 2013 33
WS value
(m/s) Functional Link to Walking Speed Author Year Article Title Journal
< 0.6 Dependent in ADL's and IADL's Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
>1.0 Independent in ADLS Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
< 0.6 More likely to be hospitalized Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
>1.0 Less likely to be hospitalized Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
< 1.0 Need interventions to reduce falls
Montero-
Odasso 2005
Gait velocity as a single predictor of adverse events in
healthy seniors aged 75 years andolder
J Gerontol A Biol
Sci Med Sci.
>1.0 Less likely to have adverse events
Montero-
Odasso 2005
Gait velocity as a single predictor of adverse events in
healthy seniors aged 75 years andolder
J Gerontol A Biol
Sci Med Sci.
>1.0 Less likely to have adverse events Cesari 2005
Prognostic value of usual gait speed in well-functioning
older people-results from the Health, Aging and Body
Composition Study J Am Geriatr Soc.
<.15 d/c to SNF Rabadi 2005
Admission ambulation velocity predicts length of stay
and discharge disposition following stroke in an acute
rehabilitation hospital.
Neural Rehab and
Repair
> 0.15 d/c to home more likely Rabadi 2005
Admission ambulation velocity predicts length of stay
and discharge disposition following stroke in an acute
rehabilitation hospital.
Neural Rehab and
Repair
> 1.3 Extremely fit Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
<1.0
Higher risk for Persistent Lower
Extremity Limitation Cesari 2005
Prognostic value of usual gait speed in well-functioning
older people-results from the Health, Aging and Body
Composition Study J Am Geriatr Soc.
<1.0
Higher risk for Persistent Severe Lower
Extremity Limitation Cesari 2005
Prognostic value of usual gait speed in well-functioning
older people-results from the Health, Aging and Body
Composition Study J Am Geriatr Soc.
<1.0 Higher risk of death Cesari 2005
Prognostic value of usual gait speed in well-functioning
older people-results from the Health, Aging and Body
Composition Study J Am Geriatr Soc.
<1.0 Higher risk for hospitilization Cesari 2005
Prognostic value of usual gait speed in well-functioning
older people-results from the Health, Aging and Body
Composition Study J Am Geriatr Soc.
<1.05 Cognitive Decline within 5 years Inzitari 2007
Gait speed predicts decline in attention and psychomotor
speed in older adults.
Neuroepidemiolo
gy
< 1.0 Death and hospitalization within 1 year Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
<0.8 Mobility and ADL disability at 2 years Ostir 2007
Measures of lower body function and risk of mortality
over seven years follow up Am J Epidemiol.
<0.8 Mortality risk at 2 years and 3.8 years Ostir 2007
Measures of lower body function and risk of mortality
over seven years follow up Am J Epidemiol.
<0.7
Risk of death, hospitalization,
institutionalism and falls
Montero-
Odasso 2005
Gait velocity as a single predictor of adverse events in
healthy seniors aged 75 years andolder
J Gerontol A Biol
Sci Med Sci.
<0.6 Functional and cognitive decline Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
<0.42 Functional impairments Atkinson 2005 Predictors of combined cognitive and physical decline J Am Geriatr Soc.
<0.42 Severe walking Disability Atkinson 2005 Predictors of combined cognitive and physical decline J Am Geriatr Soc.
<0.2 Extremely Frail Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
<0.15 Institutionalism and high dependence Friedman 1988
A prospective trial of serial gait speed as a measure of
rehabilitation in the elderly. Age and Ageing
~0.67 Self Care Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
~0.89 Husehold Activities Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
~1.11 Carry Groceries, Light yardwork Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
~1.33 Climb several flights of stairs Studenski 2003 Physical performance measures in the clinical setting. J Am Geriatr Soc.
References
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