1. Wireless Monitoring and Care:Transforming the care of Diabetes Mellitususing mHealth technologyJonathan C. Javitt, M.D., M.P.H.Founder and CEO, TelcareAdj. Prof., Johns Hopkins Medicine
2. "We will make wider use ofelectronic records and otherhealth information technologyto help control costs and reducedangerous medical errors."--President George W. Bush, NationalAddress January 31, 2006
3. 2002 2007 2034E$375$300$225$150$75$0Diabetes is a paradigm just the tip of the iceberg$inbillions$336$174$132Chronic Disease Consumes 70% ofHealthcare SpendingSame for pulmonary disease, heart failure, hypertension
4. A SimpleSolutionA TragicWaste
5. About 3x the cost of other members in the population Beyond direct spend lies the burden of … absenteeism, increased workers comp risk, decreasedproductivity, and replacement. (ADA estimate $3000/year)Non-diabeticPopulationDiabetic PopulationDiabetes affects 10% of population,but incurs 30% of costsMembers Healthcare Costs
6. Example from an actual state employee population The cost trend threatens theviability of every healthinsurance program, nomatter how it is funded. A disproportionate numberof the highest claims havediabetes as a primary orcomorbid condition A new approach toManagement of thispopulation is the only hope
7. ~15%RISK$HighLowTraditional Disease Management Has Failed“High risk” patients (stratified based onpast claims costs) are the focus of existingcare management efforts.Identifying and addressinglast year’s high costpatients misses themajority of those who willbe next year’s high costpatients
8. RISK$HighLow Monitor 100% of the population. Data monitoring for: Adherence Extreme Highs Extreme Lows Sustained Highs or Lows Patterns Identifying those that are notadhering to best self-managementpractices. Early identification of high-risk, potentially high-cost episodes Intervene with data that enablesmeaningful and contextualcoaching.The Future: Diabetes Health Monitoring & Management
9. That’s where mHealth becomes indispensableAn FDA/CE-cleared Continua-compliant server and portal thatcollects wireless data from TelcareBGM, enables display of data andcaregiver messaging.510(k) cleared for both home use andprofessional use.The Telcare BGM – a cellularenabled wireless glucose meter.510(k) clearedFDA/CE-compliant Smartphone Apps that communicate withthe server and enable parents and peers to create a networkof support for the patient.
10. FDA/CE Class II+ medical device Qualcomm IEM technology Global partnerships with 2NetVerizon and Telenor Two-way messaging capability Automatic supply reordering Positive reception from patients,parents, physicians, DME’s, andmedia.Core technology:a wireless-enabled BGM
11. Empowering the Patient:Diabetes is Social• A patient spends 2 hours or less a yeartalking to the doctor• Daily caregivers include nurses, diabeteseducators, family, maybe the school nurse,and most importantly, peers.• Diabetes is about what you eat, how youexercise, and what medicines you take.• People with Diabetes universally express aprofound sense of isolation.• Telcare is the first company to connectpeople with diabetes to their socialnetwork through the cloud using the toolthey use the most – their glucose meter
12. OutcomesWhat have we learned so far?mHealth alone is not a solution. It’s a powerfullplatform for engagement.
13. • “Light touch” intervention• Meaningful result seen in alltreated patients• 11% relative difference inA1c in those who engaged>1x per week• Telcare’s technologyeliminates the need to “doanything” in order totransmit and receive
14. 0%10%20%30%40%50%60%70%80%90%Expected DirectPurchaseHMO Endo Endo + CDE ContractResearch Org.ManagedCare% Adherence to testing by site of CareAdherence: varies by degree of professional engagement
15. Measure Pre-treatment Post-treatment GoalA1C 13.7 5.5 <7Weight 303 261 225Blood pressure 130/100 110/78 130/80Depression 11 5 <5Anxiety 19 5 <5LDL cholesterol 150 98 <100Using the Telcare Platform in aPatient-Centered Medical Home• Poorly controlled diabetes• High blood pressure• High cholesterol• Obese• Moderately depressed
16. Telcare Apps: Our laboratory for engagementand rapid prototypingDiabetes Pal• Readings taken on Telcare BGMare automatically stored in theApp.• Patients and family members cansetup alerts, analyze data, andcreate support networks.• Caregivers, including pharmacistscan canned messages that getdelivered automatically
17. TOP RATED DIABETES APP IN THE iTUNES STORE!
18. What’s Next: Social Networking andGaming• Expansion of existingTelcare apps to includeNutrition and LifestyleFeatures• Madden Football forkids• Badgeville for grownups
19. Key Challenges• No reimbursement for physicianreview of mHealth data• No reimbursement for remotepatient engagement except inunusual circumstances• Drastic change in reimbursement ofglucose monitoring• Government payers need to beempowered to deploy mHealthsolutions on a broad scale
20. Towards a SolutionThe Other Side ofthe Chasm:Patient Engagement