DiabetesManagement mHIseminar.Peeples


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Disease Management with Cell Phones by Malinda Peeples, Well Doc, Inc.

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DiabetesManagement mHIseminar.Peeples

  1. 1. Diabetes Management and Emerging Wireless Solutions: Changing the Rules of the Game mHealth Initiative March 31, 2009 March 2009 | © 2008 WellDoc Communications
  2. 2. Agenda Chronic Disease Solution overview Case study CONFIDENTIAL 2 March 2009 | © 2008 WellDoc Communications
  3. 3. “Traditional” Healthcare Levers Many disparate efforts; One growing problem Disease Management Pharmaceutical Innovation Static Education New Compounds Nurse Call Centers CRM Strategies “Three’s a Crowd” Generics and Supply Chain Management $2.3T US Annual Spend 80%+ on Chronic Disease WWDC Service Offerings Growing Care Gap Click Click Device Innovation Healthcare Plan Design “Better, Faster” Historical Actuarial Models Wire-free Data Transfer Specialist-Friendly Policy Basic Software Support Distributed Reach: Minute Clinics CONFIDENTIAL 3 March 2009 | © 2008 WellDoc Communications
  4. 4. Emerging Innovation Levers Information-enablement will harness “convergence” of disparate efforts Disease Health and Pharmaceutical Pharmacokinetic Wellness Management Innovation 360-degree View Cause and Effect Preventive, Acute, Simulation Maintenance Data, Information, Patient-centered Real-time Information Knowledge Distributed Care Networks Behavior Change Automated Systems Device Solution Healthcare Plan Value Innovation Chain Design User-driven Applications Incent Change: New CPT Codes Multi-purpose Devices “P4P”: Rewarding Personalized Therapy and Practice-based Feedback Improvement Wireless is Critical to Productivity: Reduction in This Convergence! Non-Billable Efforts CONFIDENTIAL 4 March 2009 | © 2008 WellDoc Communications
  5. 5. How WellDoc Tackles These Pain Points Information visibility, accuracy, relevance, context – Anytime, Anywhere 3rd Party Wireless Service Enablement • Presence Servers (E.g., Peer-to-peer applications) Virtual Coach • Geo-location-based Servers • Testing & Medication Reminders • All-IP Network Translators • BG Target Ranges • Physician Instructions • Hypo & Hyper Glycemic Algorithms • Caregiver Alerts • Cell Phone and Network Agnostic WWDC Service Provider Support Tools Click Offerings Click • Suggested Physician Action Plans - • Total Diabetes Management Medical Records • Predictive Modeling Management Systems • Evidence Based Guidelines • Partner Formulary Integration WWDC Service Longitudinal Behavior System Click Offerings Click … • Stages of Change Behavior Modification • Expert System – Event/Alert Tracking • Patient Behavior Monitoring WWDC Service • Integration into DM call center (case Offerings Future Click Case Manager Diabetes Clinician Click management) Stakeholders (DM) Educator (e.g. Physician) • Patient stratification and prioritization Secure Information Access CONFIDENTIAL 5 • Contextual information and messages sent from DM case worker March 2009 | © 2008 WellDoc Communications
  6. 6. Demonstrated Initial Health Outcomes WellDoc’s early trial confirmed merit for further investigation July 2008 2 study arms Diabetes Technology & Therapeutics – Control: 15 patients – Intervention: 15 patients Average Age: 54 (control), 50 (intervention) Disease State: Type 2 for > 7.5 years Average Demographic – GED/High-School equivalent – Non-tech savvy – 60% African-American Key Outcomes – 2.03-point drop in HbA1c (p < 0.003) in intervention – 100% physician satisfaction – Physicians 5X more likely to titrate/add drugs CONFIDENTIAL 6 March 2009 | © 2008 WellDoc Communications
  7. 7. Proven Health Outcomes WellDoc’s clinical trials have anchored executive and clinical attention Data Tracking 2008-2009 Randomized Control Trial Patient BG testing Inspiring Engagement. Delivering Outcomes. Patient med adherence Patient med usage Patient acceptance and usage Patient healthcare utilization Very strong interim glucose management results Patient healthcare costs Primary Aim – A1C Decrease Patient outcomes Secondary Aims Physician prescribing behavior – Healthcare utilization Physician acceptance and usage – Patient provider usability Physician adherence to evidence – Patient adherence – Provider prescribing behavior CONFIDENTIAL 7 March 2009 | © 2008 WellDoc Communications
  8. 8. A Case Study Carl Registers on the System and Is Trained Demographics – 64 year old male – Skilled laborer; less than high school education Health history – – Type 2 diabetes – Hypertension Treatment Regimen – Glucovance 500mg 1 pill at breakfast – Januvia 100mg 1 pill at breakfast – Lantus Insulin 10 units bedtime – Lisonpril 10mg 1 pill at breakfast Healthcare Team – PCP & Diabetes Educator System Preferences – No medication reminders – Chooses phone and web portal – Grants PCP web access – Wife is supportive CONFIDENTIAL 8 March 2009 | © 2008 WellDoc Communications
  9. 9. Carl Starts to Use the System Measure..Analyze..Manage MEASURE: (using the phone) – Enters blood glucose & gets feedback – Enters carbohydrates & gets feedback – Does not enter Meds – Adds notes (“ate more than usual”) – Populates the logbook CONFIDENTIAL 9 March 2009 | © 2008 WellDoc Communications
  10. 10. The System looks at Carl’s Data Measure..Analyze..Manage Alert education ANALYZE (using proprietary analytics) – Feedback • Just-in-time • Trending – Education • Problem-solving • Treatment specific – Smart testing Smart Testing • “Pairs” • Effective testing CONFIDENTIAL 10 March 2009 | © 2008 WellDoc Communications
  11. 11. Managing Diabetes: A Collaborative Effort Measure..Analyze..Manage Clinical Support • I have a prescription plan through Aetna Medicare. • I take my medication daily on a regular bases and no Self-management Support • I don't skip taking it and no i do not have side effects •I try to exercise at least four or five time's a week Peer & community Support • but I'm having a problem with my hips on my last visit • to the doctors he gave me a prescription for celebrex so I'm in hopes that this will help. MANAGE (patient-centered & provider • As for counting carbs i try to keep this in mind when eating but I’m finding that there are many contributing connected) •factors at work here HCP can send message to Carl or a •I’m getting ready to shampoo the carpets and do some painting- dose this count as exercise group of patients HCP can administer surveys WELLDOC COMMUNICATIONS | DIABETES MANAGER 1.0 DESIGN WIREFRAMES | JULY, 2008 READ MESSAGE FROM INBOX Carl can message his HCP through the ^Previous Message Next Message v Button 1 Anytime anywhere a user selects a REPLY “catastrophic action” Message SAVE MESSAGE DELETE FORWARD REPLY ALL (ex. “DELETE”) A Center phone and or web popup confirmation dialogue Is fired. Inbox Subject: Counting isn’t just for KIDS!! From: Joanna Smith, CDE Drafts CC: Dr. Clough Recieved: Mon 6/30/08, 4:30pm Sent Items Saved Items How2Count.pdf Hey John, Button 2 Content in this box scrolls if too long. Have you ever given any thought to the amount of carbohydrates in your  Button 3 Buttons at bottom meal? stay within screen height. I’ve noticed that you’ve never entered a carb number in any of your  readings. Double‐click on the attachment above to check out some really  good reading material. If you have any questions about anything, give me a call! Sincerely, Joanna Smith, CDE 1.800.HLTHWYS Read Message: Patient PAGE 17 MESSAGE CENTER 1.0 CONFIDENTIAL 11 March 2009 | © 2008 WellDoc Communications
  12. 12. Carl Learns Self-Management Measure..Analyze..Manage Phone Education Web Education CONFIDENTIAL 12 March 2009 | © 2008 WellDoc Communications
  13. 13. Managing Diabetes: A Collaborative Effort Measure..Analyze..Manage Clinical Support Self-management Support Patient Action Plan Peer & community Support WWDC Service Click Offerings Click MANAGE (patient-centered & provider PCP Action Plan connected) WWDC Service Click Offerings After 3 months on the system: Click Patient Action Plan sent to Carl: Outcomes PCP Action Plan sent to health care •A1c 9.2% improved to 6.7% provider •Weight lost 16 # Preparation for MD visit done by Carl •No change in therapy •Following medication regimen (self- report) CONFIDENTIAL 13 March 2009 | © 2008 WellDoc Communications
  14. 14. Why are We Doing all this …and what’s next? Engaging and empowering patients: “Thank you all so much for helping me get my diabetes under control. I understand it better and know how to eat better. I think when I started the study my a1C was 9.2% and now it is 7.2%! The program was an eye opener and gave me good habits to keep up the good work! I'm a little nervous being back out there on my own but all good things come to an end some time. ….. Carl” Supporting clinicians: “Last week I received HgbA1C results on one of my toughest to control diabetics. Over the past five years I have attempted a combination of encouragement, fear, threats, family conferences, and multiple specialist referrals with little effect on his motivation. He and I are happy and grateful to report his HgbA1C is down from an average of 11-13, to 7.5 after just a couple of months in the study. I know I had mentioned in the past my skepticism that a poorly compliant patient would not get much benefit, or sustain use of your application, however, I must say I have only compliments from my experience so far.” Dr.P Improving Care through connecting clinical support, patient self-management, and peer and community support CONFIDENTIAL 14 March 2009 | © 2008 WellDoc Communications
  15. 15. Thanks! Malinda Peeples, RN, MS, CDE Vice President for Health Care Integration mpeeples@welldocinc.com 443-692-3104 March 2009 | © 2008 WellDoc Communications