The document summarizes the findings from an investigation into developing a smart home monitoring system to help families care for loved ones with dementia. Over 12 weeks, the team conducted interviews and built prototypes to understand customer needs. They initially focused on too many use cases, but learned safety monitoring was key. The team identified the target customer as adult children caring for mildly moderate stage parents from a distance. Moving forward, the team plans pilot studies and partnerships to validate the product and business model.
1. Smart monitoring to help families care for a loved one with dementia at home
# of interviews this week: 11
# of interviews: 126
George
Netscher
Lauren
DeVos
Anna
Stolyarova
Pulkit
Agrawal
2. Our Team
George Netscher
PhD in EECS
Signal processing
Anna Stolyarova
MBA/MPH
Healthcare
consulting
Lauren DeVos
MBA/MPH
Digital health
Pulkit Agrawal
PhD in EECS
Computer vision
Nick Boyd
PhD in Stats
Optimization
Dan Greening
PhD, Certified
Scrum Coach
LLP team Engineering team
Julien Jacquemot
MS in CS
Software
engineering
Alex Bayen
PhD, EECS
Professor
Mentors and advisors
2
4. NestSense - Week 0
AD caregivers
(family or hired)
need to keep
patients safe
AD clinicians are
liable for best
possible diagnosis
and prognosis
AD patients want to
keep independence
Insurance providers
want reduced
medical claims and
longevity estimates
Detect acute
events, monitor
symptoms, report
progressive
changes
The primary costs
in dementia care
are emergencies,
24/7 assisted living,
and inaccurate
medical
assessment
With computer
vision, we can
facilitate
independent care
by detecting acute
events and
monitoring
functional status
Partners: UCSF
Memory and
Aging Center,
Alzheimer’s
Services of the
East Bay
Suppliers:
Simplicam,
Google
Off-the-shelf hardware,
Direct marketing to physicians and
insurance providers, medical validation
Caregivers pay for increased patient safety
and independence
Physicians and insurance providers pay for
reduced ER use and in-patient visits
Direct sales, web
presence, medical
publications
Engineering talent,
patient pop. for
medical validation,
direct sales
channels, off-the-
shelf hardware
Caregivers and
patients online
/through clinicians
Clinicians and
insurance providers
via direct contact /
medical journals
4
5. We built MVPs to test value propositions
Family caregivers need to...
… detect safety-critical events … understand disease progression
5
6. We expanded MVPs to test new value propositions
Family caregivers need to...
… detect safety-
critical events
… understand the
disease progression
… stay connected
with their loved ones
… find personalized
solutions
… monitor hired
caregiver negligence
6
8. Week 7: We reviewed what we learned from 56 need-
finding interviews
8
9. We focused in on our customer segment
Patient
disease state
- too severe
need 24/7 care
- too mild value
privacy over
security
Caregiver
income level
- high income
can afford
hands-on at all
times
- low income
supported by
Medicaid
Caregiver age
- over 65 less likely to be
familiar with technology or
have home internet
350+ thousand
middle income
under 65 y/o
caring for mild
moderate stage
9
10. We developed our customer archetype
Far away or busy family member who wants to check in more often
Sara, the concerned daughter
Who is Sara?
● The son or daughter of an Alzheimer’s patient
● Mid 30s to early 60s
What does she do?
● Spends her days worrying about her sick parent
● Works a busy job and can’t leave work to check in
● Comes to visit, but often less frequently than she’d
like
What would she like? Something that would...
● Help her stay connected with her parents
● Allow her to know if anything is wrong or needs
urgent attention
● Make her parents happy
10
11. “The current system waits for
the tipping point - e.g. major
fall - and then places patient
to an institution.”
0% 80%
Decision support
Disease progression
Caregiver watch
Comorbidity monitoring
Social connection
Self-neglect monitoring
Accident monitoring
In-home family caregivers Physician
Remote caregivers
Time
Looking back, we found that safety alerts were key
Unmet Needs Testing
11
12. Industry experts confirmed that safety monitoring
strengthens customer relationships at all stages
"There is not a lot of purchasing intent for a
purely monitoring product"
"Emergency response
function lowers churn…
you’d want to keep
being protected"
"Caregivers often start
looking for
technologies after a
major safety related
event" 12
13. Week 8: We created initial revenue model hypotheses
Medicare
Clinicians
Caregivers
Hypothesis:
Will pay out of
pocket
Hypothesis:
Will pay for
system-wide
savings
Hypothesis:
Will bill for
viewing data
13
14. Centers will
refer clinicians
to NestSense
We found that indirect referrals and payment
streams make the universe more complex
Medicare
KOLs at Major
Alzheimer’s
Centers
Clinicians
Caregivers
Associations (e.g.
AARP), HHAs,
support groups
Cut ($) of referrals
Clinicians
Clinicians
Clinicians
Referrals
~$100/mo
subscription fee
CPT codes: 99490, 99091
Up to $100 per remote evaluation
Possibility for a monthly fee from
each practice to NestSense
Accountable
Care Orgs
Nest
Sense
14
15. We learned that remote monitoring is a new
space and there is a need for data
Out of
pocket
CPT codes
for remote
monitoring
Improved
efficiency
for home
health
agency
Savings to
health care
system
Validating evidence required
Potential
for
revenue
Trials
Trials
Trials
15
16. Week 12: We ended up with a partial picture
● Clear value proposition, but high customer acquisition costs
● Current hypothesis - greatest value in partnering with home care org.
○ Adult child becomes key influencer
○ Sutter private care interested in partnering for pilot study
○ VA Palo Alto has invited for vendor demo
KP KA VP
Detect key
safety concerns
- falls
- wandering
- stove misuse
- faucet misuse
CR
Dr., AARP
referrals
CS
Adult child
- parent with
moderate AD
- middle
income
- <65 yo
KR CH
CS RM $100/mo subscription
16
17. Going forward: near-term
Incorporation
Addition of part-
time home nurse
Seeking co-founder w/
experience in med. device
Focus groups
with OLLI
Pilot study
(n=15)
UCSF
clinical
trial
(n=100)
NIH
SBIR
NSF
SBIR
Beta for pilot
Nov Dec Jan Feb Mar Apr May Jan
2015 2016
Funding
Product
testing
Business
Dev
Technical
dev
17
20. Week 7: Privacy concerns could be overcome
“We have lots of people that use nanny cams or video cams all the time. That kind
of information can be extremely valuable.”
20
22. TAM
SAM
Target
• 5.3 million people in the US and 47 million worldwide living with
Alzheimer’s dementia
• The cost of caring for Alzheimer’s patients in the US is estimated to be
$226 billion in 2015
• ~1.13 million mild-moderate diagnosed
~2.5 million people in the US with mild-moderate Alzheimer’s
dementia
~45% diagnosis rate
• ~362 thousand households would consider buying
~90% live at home
~54% are middle class
~66% of caregivers are under 65 yo
• ~$435 million yearly revenue potential
based on $100/month subscription service
Re-evaluating Market Size
22
23. Associations & agencies hold the power; direct
marketing to caregivers is not enough
Partnerships
...with clinical advocates
Physicians, caregivers, local
clinics, daycare centers
...with associations
AARP, PatientsLikeMe
Social / Online
Facebook, Twitter,
SEO, Email marketing,
bloggers
Channel Strategy to engage
● Personal sell
● Ask if would prescribe
by demo-ing product
● Nurture relationship
● Cross-promotion
● Shared revenue
● Traditional social / SEO
techniques
23
24. Our financial results are highly influenced by customer
acquisition costs, adoption rate, and customer attrition
$100...500 per customer
CAC
Adoption
Attrition
OR
5-10% 50%
●physicians have most influence on adoption rates
●up to 75% adoption based on interview
● expert estimates as low as 10% in rural areas, even if recommended by a
physician)
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25. Alzheimer’s disease in brief
Stage Mild Moderate Severe
Symptoms - Memory loss
- Language
problems
- Mood and
personality changes
- Diminished
judgement
- Behavioral,
personality changes
- Unable to learn or
recall new
information
- Long-term memory
affected
- Wandering,
agitation,
aggression, and
confusion
- Require assistance
with activities of
daily living (ADLs)
- Unstable gait
- Incontinence
- Motor disturbances
- Bedridden
- Dysphagia
- Mute
- Poor/No ADLs
- Vacant
- Common
placement in long-
term care
Expected length of
time from diagnosis
0 - 2 years 2 - 6 years 6 - 9 years
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27. Hardware costs
Purpose Hardware Expected Costs
Monitoring falls CC night-vision camera $40 for 4 rooms
Stove unattended
Zigbee carbon monoxide +
temperature sensor
$5 for 1 stove
Bath/Sink overflowing Zigbee water detector $15 for 3 faucets
Leaving house alone CC night-vision camera $20 for 2 exits
Computational Detection Local processing unit $150 for 1 home
Total: $230 for 1 nest
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