Norwalk Demonstration Project Proposal

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Norwalk Demonstration Project Proposal
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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 Jasperons 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 Norwalks 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.

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Overview

• Together, Jasperon and Norwalk Hospital will
  study the benefits and performance changes in the
  Hospital as a result of using Jasperons products
  and services.
• It is Jasperons 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.
  Jasperons Phase 1 product, which will be running
  on August 18, 2000, has a professional component
  to it, but is largely consumer-focused.
  Jasperons deliverables from this effort will
  allow us to enhance the site and its
  functionality further for professional users.
• Further, it is Jasperons intent to provide
  Norwalk Hospital with the public recognition that
  it will accrue as a leader in using Jasperons
  state-of-the-art products and services.

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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

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Advanced Care Planning
Jasperon provides Norwalk Hospital with an
understanding of advance care planning beyond
todays 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.

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Advance Care Planning

• Jasperons web-driven solution incorporates
  insights from a multi-disciplinary expert
  coalition that guide the presentation of
  education and informational content
• Jasperons 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
• Jasperons storage and retrieval services will
  tremendously enhance the effectiveness of advance
  care planning discussions and documentation

Jasperon provides Norwalk Hospital with a unique
solution to developing its own in-house expertise
of advance care planning.
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Advance Care Planning

• 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

Jasperon provides Norwalk Hospital with skills
that will help ensure the success of this effort.
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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 Jasperons and Norwalk Hospitals
  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 Hospitals current processes,
  education materials, policies, utilization, etc.
• Sign off on Proposal and Agreement outlining
  scope, deliverables, timing, and accountability

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Jasperon - Norwalk Hospital Demonstration Project
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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

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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 Jasperons integration into the
  education, storage, and retrieval processes of
  the Hospital

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The Goals
For Jasperon, there are three overall goals for
this project.

• Launch and strengthen the community-based
  education and communication model at Jasperons
  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 Jasperons web site within the hospital
  and with professional users
• Identify content/architectural/format/navigational
  issues for professional users
• Identify integration issues between the
  hospitals own records and systems and the
  Jasperon storage and retrieval process
• Refine security, encryption, and privacy
  protocols within Jasperon

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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

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Professional Education
Jasperons 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
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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 Hospitals
  barriers and organizational systems in
  implementing advance care planning

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Advance Care Planning
Jasperons advance care planning materials will
address a broad range of topics with Norwalks
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

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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

The community action campaign portion of this
project should position Norwalk as a thought
leader in advance care planning.
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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

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Increased Efficiency and Effectiveness
By looking at policies and processes, the
Hospital also may identify opportunities for
increased efficiency and effectiveness in its
operations.
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The Professionals
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
Leading
Good
Ease of Use
Completeness of Information
Answering Questions
Facilitating Completion of Forms
Facilitating Sharing of Decisions
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Overview of Jasperons Business Solution
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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

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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

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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

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The Jasperon Solution
Communication Center
Information Education Center

Document Storage Retrieval Services
Advance Directive Preparation Tool
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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

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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

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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

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Document Storage Retrieval Center

• Centralized, secure database
• Fax or online access to documents on demand for
  providers and proxies
• Updating

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Jasperon Brings Peace of Mind
Storage and Retrieval
Education and Service
Caregivers and Health Care Providers
Brand/ Positioning

• Single process that produces a legally valid
  national solution
• Able to create, store and retrieve documents in a
  secure environment

• Clear, senior sensitive, educational approach
• Simple, easy to understand
• Supports sharing of documents between family,
  friends, health care providers, and caregivers

• Robust content developed from multiple
  perspectives- healthcare, education, caregiving
• Sensitive educational approach to advance care
  planning discussions

• Positioning as local company in touch with
  community resources to support personalized
  family-based needs
• Emphasis on family-based decisions

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Highlights

• 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

Why the Jasperon system is unique
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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

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Jasperon is building an unsurpassed network of
relationships
Eldercare Groups AARP Assisted Living
PBS Moyers Special
SNF Hospice Visiting Nurse Hospitals
Hardware manufactures Software manufactures E-Comm
erce 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