_1MM1495 By Mike Swinford, CEO, Numotion As an industry we have an obligation to be better than we are today. Collectively we must actively raise the bar and deliver a consistently positive customer experience. I am honored to be part of this industry. No matter how you are involved in the Complex Rehab Technology (CRT) space — be it as clinician, payer, manufacturer or equipment provider — we all are in a unique and enviable position to have a positive impact not just on the individuals we serve, but also on society by improving the overall understanding, access and inclusion for people living with a disability. While we are continuously working to improve how we serve those with disabilities in the moment, I also think daily about the future and this objective to push the industry even further forward. To that end, I offer five areas of opportunity to consider. If we, as an industry, can better collaborate and work together to improve in these areas, it will lead to significantly better outcomes and experiences for those we serve.

1. Transform with Innovative Models

We work in a service industry for a constituency that requires as much optimization, communication and coordination as any. When we are not all performing at our best, the impact to the client/customer can range anywhere from a small annoyance to impacting their lives in a significant way. We have an obligation to drive consistency and higher quality, with speed and transparency across all types of interactions. From clinical evaluation, to funding coordination, to equipment fitting and delivery, to service and repair, there must be clear expectations and communication throughout the process. I believe the CRT industry can benefit from some outside perspectives. We can look to other companies as examples of best practices for innovative models that have transformed their industry. Companies such as Amazon, Zappos, Chick-fil-A, Publix, Southwest Airlines and UPS are consistently rated at or near the top of all organizations for customer experience. They personify a customer-centric culture with processes and hiring practices that enable this. They are predictably consistent with a simplified flow of engagement to drive interactions that are both dependable and positive in nature to the consumer. They are responsive and empowered in resolving issues quickly and with little to no hassle. They are accessible and transparent by being easy to work with and communicating well at all steps of the customer interaction. In our industry, the complete dedication and commitment of the individuals who are working in it is where we shine brightest. Countless hours are spent working with clients to ensure their individual medical and functional needs are met and the right equipment is selected for them. There is no shortage of examples of deep personal relationships that have been developed with customers and there are many dedicated people behind the scenes processing orders and doing their best to get the equipment ready for delivery. The personal commitment to advocacy efforts through activities such as walks, camps and awareness events, as well as ongoing local and national level outreach to policy makers, further demonstrates this “all-in” commitment to the mission of serving those living with a disability. However, the ecosystem within which we operate, along with the litany of handoffs and required interactions that consume the process, is getting in the way of individual dedication. We need to work together to overcome this. Organizations that provide the best customer experience are continually looking to improve their processes and policies with new models and methods of operation and customer service. None of us set out to design complexity into our operations, but they accumulate and compound over time. Many of these top organizations have applied principles from the disciplines known as Lean Management, Six Sigma or Total Quality Management (TQM) to attack waste and inefficiencies in their processes. They achieve success by breaking down the steps of the customer journey in an organized manner, and using these methodologies to help unlock improvement opportunities that change process flow, change policy and ultimately improve the customer experience. One way in which we as an industry can innovate is to identify opportunities for payers, care providers/clinicians, equipment and service providers and manufacturers to more seamlessly communicate and work together at all the critical hand-off points. In any process and set of interactions variability is the enemy of efficiency. One of our biggest challenges is that we do things differently across the industry — variability in coding, HCPC usage, ICD codes, etc. By focusing on gaining consistency in some of the fundamentals that are consistent to all of us, we can gain efficiency in operation and once again the downstream impact of this will benefit those we serve. The opportunity exists to transform the industry with new models and perspectives. Everyone needs to participate, including clinicians, therapists and case managers who are an integral part of the transformation given the significant role they have in serving their client’s needs. It is not easy, and it will not come overnight, but collectively we can make it happen! What you can do to help: • Change your historical perspective and emulate the best customer service organizations outside of CRT. • Attack waste and inefficiency by eliminating redundancies and rework across the customer journey

2. Advocate and Educate with Relentless and Unified Focus

As the landscape in which we operate changes almost daily, we cannot advocate and educate enough about the challenges and issues our customers face. This is the case when positioning for needed legislation and policy, and also when educating ourselves on the latest technology developments available to improve lives. Advocate While there is a broad awareness about CRT, many lack a deep understanding of the distinctive needs of those who benefit from it. CRT is a very unique subset within the larger Durable Medical Equipment category. One in which the individualized needs of the person vary to such extremes there is no one- size-fits-all solution. Whether addressing use of tilt and recline, standing technology or an ultralight configurable manual wheelchair, it is important we make clear the tremendous clinical needs and Activities of Daily Living (ADLs) that these technologies and features address. In my experience, too many different voices and messages can create confusion among legislators and policy makers as they struggle to fully understand the issues at hand, such as access, barriers to employment and cost containment. Therefore collaboration and alignment is critical for our overall challenge to advocate and educate in a unified way. When we are all fully aligned, each investment of time spent on Capitol Hill, with State policy makers or coordinating efforts with industry associations, is well worth the investment and will ultimately reduce overall costs in the system. The permanent fix from CMS for Group 3 accessories is a great example. This was a well-coordinated effort over an extended period of time that started with awareness of the issue and education of the impact, accelerated to gain a groundswell of support and ultimately resulted in a policy change that has a huge impact on people living with disabilities. Educate For those operating in the industry every day, issue awareness is not the challenge. However, as with all industries, there is need for continuing education at all levels, as well as a need to develop an understanding and appreciation for the full range of activities across the spectrum of the industry. We have a duty to teach one another and conversely an obligation to invest the time to learn from experts. Speed, efficiency and accuracy comes from repetition, but also from how we are taught to do things. For example, if you are not an expert in funding documentation or the latest studies on the benefits of standing, seek help from the experts. Attend a symposium, class or webinar. Read a whitepaper, subscribe to key industry publications. If the particular role you are in does not give you the opportunity to know what it is like to be on the “front lines” in a clinic, visit one. These resources and opportunities are readily available, but we often put them off in the hopes of getting to them “when I have time.” Given the pressures in our industry, the free time is not coming! The reality is that we need to make the time to invest in continuing education and best practice sharing from within and outside of our CRT industry. Our clients/customers will appreciate that we have. What you can do to help: • Extend your personal reach to advocate on behalf of those we serve via better intra-industry alignment • Invest in education for yourself and across your organization

3. Strengthen and Enforce Compliance Standards

It is no secret that fraud and abuse have historically been a challenge in the healthcare industry. We cannot think that we are immune from this in CRT just because of the tremendous impact of the work we do. It is imperative that we hold ourselves to the highest standards to avoid institutional abuse or, perhaps more likely, individuals skirting laws or regulations. As leaders in CRT, we must educate our collective employees and deliver the proper communications and training on laws, policies and best practices in the areas of fraud, inducement and overall compliance. We can learn from the past. For example, think about how the concerns of overutilization resulted in devastating financial cuts and many companies going out of business. While the most damaging of these situations was not directly in the CRT space, the residual effects impacted us all. We can avoid repeating history by adhering to best practices with respect to medical necessity. It is our obligation to ensure the best possible clinical solution, and it is also our duty to ensure products are not over-prescribed — the two go hand-in-hand. In the vast majority of cases, overutilization and overprescribing is not happening, but we cannot assume these behaviors are entirely relegated to history. We must continue to audit ourselves, foster cultures centered on compliance and, when we discover improper behaviors and practices, demonstrate that we will not tolerate such misdeeds. Likewise, we must continue to promote zero tolerance for inducement and similar behaviors. There is no place for providing monetary rewards or gifts intended to encourage specific actions or “quid pro quo” arrangements. Our products and services should stand on their own merits. Relationships should be developed on historical performance and trust built from fulfilling commitments and delivering results that benefit those we serve, not from lavish dinners or tickets to a ballgame. Clarity, consistency, transparency and rigor ought to lie at the foundation of all that we do in this industry. We are partners in this fight. Those we serve deserve nothing less. What you can do to help: • Educate your employees and deliver the proper communications and training on laws, policies and best practices • Set an example with your own actions and hold one another accountable

4. Promote Connected and Integrated Outcomes

While I am not personally living with a disability, and I would never pretend to understand all of the challenges, I have come to understand that independence, mobility, access and overall health, along with inclusiveness and equality are fundamental needs everyone deserves. Within and outside of the CRT industry, many companies, healthcare professionals, and health plan providers aim to deliver on many of these outcomes. There are a multitude of solutions targeted at various aspects of mobility. But while all these entities are trying to deliver quality results for our customers, we are doing so independently. What if we studied and drove the clinical and economic outcomes in a more integrated fashion? Might this change our perspectives and strategic actions on technological innovation and investment? I believe it would. A complete 360-degree view of the customer’s needs provides a different perspective of how our processes and products could be optimized. A relevant comparison is how Apple® approached application development. When they created an open architecture for the iPhone and iPad encouraging external developers to create apps on their platform, it opened up innovation acceleration never seen before. I believe we have a similar opportunity across CRT and the adjacent spaces that service the same customer such as home accessibility, accessible vehicles, prosthetics, transferring devices, medical supplies, wound care, medication and the like. For us, it may not be about app development necessarily, but a more connected approach to better outcomes would create a focus on creating products and services to be more compatible and synergistic in how they benefit the end-user. Of course to effectively make this happen we would need to address the lack of cohesion across our industry that makes compatibility a challenge, as well as monitoring and reporting on outcomes. As discussed, more innovative and progressive models will produce consistency and standardization in data collection and processes that will facilitate the promotion of connected and integrated outcomes. The impact of this could do several things. One, it may lead to a more powerful statement of medical necessity based on a collection of relevant inputs vs. individualized arguments, which could result in a higher chance for approval. Second, it creates the potential for cost synergies by optimizing the overall set of products and services an individual requires. For example, reducing the need for home modifications with mobility equipment designed to create more accessibility and functionality. Lastly, it is likely to ignite innovation to streamline processes and technology compatibility. The impact of this to the overall customer experience in terms of reducing frustrations and improving communications would be transformative. What you can do to help: • Look “upstream” and “downstream” from your processes to identify points of integration outside your normal purview to better serve the customer • Embrace more progressive models that deliver consistency and standardization in data collection and processes and enable connected outcomes

5. Apply and Leverage Contemporary Technology

There is no shortage of innovation when it comes to developing mobility equipment and accessories. Improvements have been made in performance, ease of use, access and adaptability. Modern engineering and technology are advancing at an aggressive rate, and we’re seeing the benefits in standing devices, all-terrain chairs, advanced control systems in CRT and much more. Many established companies, as well as start-ups, are investing to build better functioning products and services. We’re also seeing innovation in areas like the “internet of things” (IOT). Chairs are being instrumented to gather more movement data — including recline frequency, geo-tracking to gauge overall mobility and cushion instrumentation to understand patterns in wear, positioning and weight shifting. Apple has recognized the potential of this market — building functionality into their Apple Watch with heart-rate monitors, and optimizing the Activity app for wheelchair users, taking into account different pushing techniques for varying speeds and terrain. Eventually this will lead to even greater data and insight for outcome studies and for even more targeted investment and improvement for our customers. While we need this progress to continue and accelerate, there are other aspects of our industry that could also benefit from increased innovation. Interoperability Healthcare in general is challenged with horizontal and vertical system integration. A hospital system should theoretically be able to pass information to/from its stakeholders (customers, insurance providers, equipment providers, service entities) via simple “handshakes.” Systems from all stakeholders should be able to easily get data, coordinate appointments, and significantly shorten the cycle time to complete a transaction. The technology is available to make CRT a seamless, and fairly short transaction within the system. By integrating all parties, the entire ecosystem would be better, faster, and much more customer-focused. Data and Analytics Technological advances in predictive analytics are making marked improvements in industries worldwide. Bots and artificial intelligence are applied to large data sources looking for trends, correlation, and causation … and finding them! This is available technology, but we need for the data to be somewhat consistent and with some level of standardization. In our industry, improved efficiency-based data analytics would result in much shorter wait times, less re-work in document processing, streamlined billing and simply a better overall customer experience. On the clinical side, having access to equipment performance data regarding precisely how someone is using (or not using) a mobility device would provide tremendous insight to shape the clinical analysis and associated recommendations. While instincts and experience go a long way in a clinical setting, nobody has ever said they would turn away data and information if it will help to make better decisions. We can, and should, aggressively mine that data and invest in getting results for our customers. While this future with sensor data and collaboration will take some time to build-out, we can still do something now. Data on order history, parts failures and payment detail is increasingly available today. By harnessing and aggregating it, we can spot trends that can inform our operational decision making, as well as how we interact on an individual basis with a given customer. The customer experience will benefit greatly — this is starting to happen now! Mobile Tools Mobile apps are ubiquitous in so many aspects of life today and provide tremendous functionality, yet we don’t seem to be applying this same drive for innovation and use of contemporary technology in the CRT space. Apps for things like tracking an equipment order, scheduling appointments, paying bills and tracking medications are not yet prevalent in our industry, but need to be. What you can do to help: • Be more forward thinking and invest in modernized IT capabilities and infrastructure • Push your partners and suppliers to do the same


We are an industry dedicated to serving individuals living with disabilities by providing resources that assist them in living their lives more fully and actively. I know we are up for the challenge of using the tools of today, and tomorrow, to achieve better outcomes and experiences. We have a solid foundation from which to build. We have people across the industry who demonstrate a compassionate and caring approach that would be hard to match in any other industry. Now is the time to raise the bar to benefit those we serve. Knowing the passion and dedication of so many of you in this industry, this is not a dream, it will become a reality. But I am not naïve enough to believe that any of this will be easy or come quickly. This is a journey which has already begun in some areas and will take additional focus, resources, dedication and investment to advance further. At Numotion, we have been and will continue to drive this agenda forward. As the CEO I am fully vested in focusing on the points I have raised here, as well as other ideas that will contribute to the fulfillment of our collective mission and I welcome the collaboration required to make it possible. I am confident that collectively we will fully accomplish the things necessary to transform the CRT industry from within. Please share with me your feedback and/or additional ideas on how we can transform the CRT industry from within. Send your comments to: [email protected]. RM Mike Swinford is Chief Executive Officer (CEO) of Numotion, headquartered in Brentwood, Tenn. Prior to joining Numotion in 2014, Swinford spent 22 years at the General Electric Company (GE), where he led various businesses in the healthcare services sector as President and CEO of GE Healthcare Services. He was also Vice President and General Manager of Diagnostic Imaging and Asset Management Services. For more information contact [email protected].