THE	  FUTURE	  OF	  OPEN	  MODELS	  	  FOR	  DIABETES	  CARE	  2012	  DiabetesMine	  Innova1on	  Summit	  Ikhlaq	  Sidhu,	...
Macro	  Market	  Forces	  in	  Healthcare	  	         •  Healthcare	  Spending:	                                          ...
Total Health Expenditure per Capita,                                                                U.S. and Selected Coun...
Macro	  Trend	  #2:	                                   A	  Larger	  Market	  but	  with	  Lower	  Margins	                ...
Outline	  •  The	  current	  state	  of	  diabetes	  data	  and	     soiware	  	  •  Why	  this	  is	  a	  problem	  •  Wh...
Diabetes	  Data	  and	  Soiware	  Today	                •    Ver1cal	                •    Closed	                •    Prop...
Diabetes	  Data	  and	  Soiware	  Today	  Source:	  	  Timothy	  Bailey,	  Journal	  of	  Diabetes	  Science	  &	  Technol...
WHY	  IS	  THIS	  A	  PROBLEM?	  
SMBG	  data	  downloading	  	           •  45%	  of	  907	  type	  1s	  never	  download	  their	              meter	     ...
Pa1ents	  Don’t	  Download!	  	           •  Data	  from	  the	  T1D	  Exchange	  –	  25,000	  pa1ents	              with	...
…but	  there	  is	  a	  shortage	  of	  providers	            •  New	  York:	  1.8	  million	  people	  with	  diabetes,	 ...
…and	  providers	  have	  li{le	  1me	  with	                                      pa1ents!	           •  In	  a	  study	 ...
SOFTWARE	  CAN	  HELP	  BRIDGE	  THE	  GAP,	  BUT…	  
HOW	  DO	  YOU	  GET	  MORE	  PATIENTS	  TO	  USE	  IT?	  
What	  we	  can	  learn	  from	  •  1.	  Characteris1cs	  of	  other	  commercially	     successful	  diabetes	  therapies...
1.	  Where	  is	  industry	  growth	  coming	                          from?	                   Share	  of	  Overall	  Dia...
1.	  Why	  are	  DPP-­‐4s	  so	  successful?	  •  Easy	  for	  pa1ents	  –	  once	  per	  day	  pill	  •  Li{le	  thinking...
2.	  What	  can	  we	  learn	  from	  IT?	                                                        1980s:	  IBM	  was	  lat...
Takeaways	  from	  the	  IT	  Case	  1.  Open	  standards	  modularity:	  It	  will	  happen.	  (Usually	      demanded	  ...
What	  are	  the	  parallels	  to	  diabetes	  healthcare?	                                                               ...
Recent	  Progress	  
Recent	  Progress	  
The	  Future?	                     •  A	  single	  standardized	                        report	  Automa1c	         •  Acce...
Key	  Ques1ons	  •  Could	  open	  standards	  improve	  diabetes	  care?	  •  What	  is	  preven1ng	  more	  open	  stand...
Master of                                                                                           EngineeringFung	  InsD...
Open models healthcare v5 7
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Open models healthcare v5 7

  1. 1. THE  FUTURE  OF  OPEN  MODELS    FOR  DIABETES  CARE  2012  DiabetesMine  Innova1on  Summit  Ikhlaq  Sidhu,  Megha  Raghavan    UC  Berkeley   Fung Institute for Engineering Leadership UC Berkeley
  2. 2. Macro  Market  Forces  in  Healthcare     •  Healthcare  Spending:   Total  NaDonal     $2.2T  in  US$6.6T  Globally   25% $5 Health  Expenditures   2019:  $4.6T   •  Growing  Need:  Baby   $4 Boomer  +  Diabesity   20% 2011:  $2.7T   $3 •  18%  of  the  US  economy!   15% $2 $1 •  Price  Pressure  and   Declining  Margins   10% $0 2000 2005 2010 2015 2020 •  Chaos!   Year  Source:  Centers  for  Medicare  &  Medicaid  Services,  Office  of  the  Actuary:  Data  from  the  Na1onal  Sta1s1cs  Group,  October  2010   2  
  3. 3. Total Health Expenditure per Capita, U.S. and Selected Countries, 2008 $8,000 $7,538 $7,000 $6,000Per Capita Spending - PPP Adjusted $5,003 $5,000 $4,627 $3,970 $4,063 $4,079 $4,000 $3,677 $3,696 $3,737 $3,353 $3,470 $3,129 $2,870 $2,902 $3,000 $2,729 $2,000 $1,000 $0 Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.
  4. 4. Macro  Trend  #2:   A  Larger  Market  but  with  Lower  Margins   Annual  Revenue  Growth   Approximate  Breakdown   •  Services  =  80%   20% •  Devices  /  equipment  =  8%   16% •  Pharma  =  12%   12% Predic1on:   8% •  Target  across  sectors   4% •  Volume  Business   0% 2004 2006 2008 2010Source:    2011  free  cash  flow  and  revenue  growth  projected  by  JPMorgan  for  12  large  medtech  companies:  ABT,  BCR,  BAX,  BSX,  COV,  EW,  ISRG,  JNJ,  MDT,  STJ,  SYK,  ZMH.       4  
  5. 5. Outline  •  The  current  state  of  diabetes  data  and   soiware    •  Why  this  is  a  problem  •  What  we  can  learn  from  other  diabetes   therapies  and  open  standards  in  IT  •  Recent  Progress  •  Key  ques1ons  
  6. 6. Diabetes  Data  and  Soiware  Today   •  Ver1cal   •  Closed   •  Proprietary   •  Not   Standardized  
  7. 7. Diabetes  Data  and  Soiware  Today  Source:    Timothy  Bailey,  Journal  of  Diabetes  Science  &  Technology  2007;  photo  provided  by  Dr.  Bruce  Buckingham      
  8. 8. WHY  IS  THIS  A  PROBLEM?  
  9. 9. SMBG  data  downloading     •  45%  of  907  type  1s  never  download  their   meter   •  75%  of  1,165  type  2s  never  download  their   meter   •  Only  37%  of  type  1s  are  sa1sfied  with   downloading  Source:    dQ&A  pa1ent  panel,  3Q2010.  Self  Monitoring  of  Blood  Glucose  Data  from  dQ&A  
  10. 10. Pa1ents  Don’t  Download!     •  Data  from  the  T1D  Exchange  –  25,000  pa1ents   with  type  1  diabetes  at  69  leading  clinical   centers  across  the  US.   •  Blood  glucose  meter  downloading:     –  68%  never  download   –  21%  download  less  than  once  a  month     •  CGM  downloading:     Burden  on  doctors     –  43%  never  download   to  see  and     analyze  data   –  35%  download  less  than  once  a  month  Source:    n=25,000  pa1ents  in  the  Helmsley  Charitable  Trust  T1D  Exchange  
  11. 11. …but  there  is  a  shortage  of  providers   •  New  York:  1.8  million  people  with  diabetes,   only  600  diabetes  educators  (2nd  highest  #  in   US)   •  “Overall,  there  appear  to  be  only  one-­‐half  the   endocrinologists  required  to  the  fill  the   needed  posi1ons  in  the  U.S.”   –  ~4,000  endocrinologists  to  care  for  the  ~25-­‐100   million  pa1ents  who  could  poten1ally  be  seen    Source:    D  Jornsay,  AADE  2012  Annual  Mee1ng,  Las  Vegas;  A  Stewart,    J  Clin  Endocrin  Metab  2008        
  12. 12. …and  providers  have  li{le  1me  with   pa1ents!   •  In  a  study  of  pa1ents  with  type  2  diabetes,   medical  residents  spent  an  average  of  only  five   minutes  during  visits  discussing  diabetes!   •  Average  primary  care  visit  length  in  2005:  21   minutes   •  Best  case:  Four  hours  per  year  with  an   endocrinologist  vs.  8,756  hours  of  self-­‐ management      Source:  Barnes  et  al.,  Diabetes  Educ  2004;  Chen  et  al.,  Archives  of  Internal  Medicine  2009  
  13. 13. SOFTWARE  CAN  HELP  BRIDGE  THE  GAP,  BUT…  
  14. 14. HOW  DO  YOU  GET  MORE  PATIENTS  TO  USE  IT?  
  15. 15. What  we  can  learn  from  •  1.  Characteris1cs  of  other  commercially   successful  diabetes  therapies  •  2.  Open  standards  in  informa1on  technology  
  16. 16. 1.  Where  is  industry  growth  coming   from?   Share  of  Overall  Diabetes  Industry  Growth     Insulin  pumps   CGM   Others     GLP-­‐1s     Insulin   DPP-­‐4s    
  17. 17. 1.  Why  are  DPP-­‐4s  so  successful?  •  Easy  for  pa1ents  –  once  per  day  pill  •  Li{le  thinking/educa1on  required  •  Low  HCP  hassle  –  no  training  needed,  not  1me   consuming  •  Low  adherence  barriers  for  pa1ents  •  Standardized  –  all  DPP-­‐4s  are  pre{y  much  the   same  
  18. 18. 2.  What  can  we  learn  from  IT?   1980s:  IBM  was  late  so  they  offered  an  open   architecture  (5150)   1970’s:  Ver1cal,   • Higher  volume  proprietary,  closed   • Best  in  class  components   • Horizontal   Late  70s   1990s:  IBM  tries  to  go   Perfect  storm:  Chaos  +   back  to  proprietary  OS   growing  market     and  loses  market  share   And,  who  made  the  money?    
  19. 19. Takeaways  from  the  IT  Case  1.  Open  standards  modularity:  It  will  happen.  (Usually   demanded  by  customers.)  2.  It  only  takes  one  single  player  (to  change  the   landscape  of  the  industry)  3.  Change  is  irreversible  once  it  happens  –  IBM   example  in  the  PC  market  
  20. 20. What  are  the  parallels  to  diabetes  healthcare?   Millions   US  PC  Sales  Units   of  Units   US  PC  Sales  Units  10   150   8   6   100   4   50   2   0   0   1975   1980   1985   1990   1995   2000   2005   2010   2015   1975   1980   1985   1990   Introduc1on  of     Interconnec1vity       Mobile   Open  Standards   &  Networks   Data  In  personal  compu1ng,  the  drivers  of  mass  adop1on  were:   –  Ver1cal  closed  to  open  standard  (1980)   –  Giving  power  to  user  (1980  to  1990)   –  Widespread  Network  Connec1vity  (1995-­‐2000)   –  Mobile  compu1ng  and  mobile  data  (2005+)   Source:  ETForecasts  
  21. 21. Recent  Progress  
  22. 22. Recent  Progress  
  23. 23. The  Future?   •  A  single  standardized   report  Automa1c   •  Accessible  on  any  Wireless   device  Transmission   •  Ac1onable  insights     •  Data  analy1cs  
  24. 24. Key  Ques1ons  •  Could  open  standards  improve  diabetes  care?  •  What  is  preven1ng  more  open  standards  in   diabetes  care?  •  Why  don’t  more  pa1ents  use  soiware  and   download  data?  How  can  this  be  addressed?  •  ____  is  the  biggest  problem  with  obtaining/ interpre1ng  diabetes  data.  It  could  be  solved   by  ____  
  25. 25. Master of EngineeringFung  InsDtute  for  Engineering  Leadership   Ikhlaq  Sidhu      Chief  Scien1st  and  Founder,  Fung  Ins1tute   Faculty  Director,  Center  for  Entrepreneurship  &  Technology   Academic  Director,  Engineering  Leadership  Professional  Program   2009  Emerging  Area  Professor  Award   sidhu@berkeley.edu  

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