1) 6,000 amputations take place in England each year due to diabetes complications costing £600M. The document proposes an intelligent care plan mobile application to help diabetic patients better monitor and control their health. 2) The application would provide daily monitoring of key health risks, education, social support and access to clinical care to help patients bring their diabetes under control to prevent complications like foot ulcers and amputations. 3) Currently treating diabetic patients with severe complications costs tens of times more than non-diabetic patients, ranging from £50,000 to £289,831 per operation. The proposed application aims to provide integrated care for £1480 per patient per year to achieve better outcomes at lower costs

1. Copyright Partnerships for Healthcare Improvement Ltd.
The Lean Start Up - Diabetic Care Plan (intelligent care plan iCP)
1

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Product
Strategy
Vision
6,000 amputations take place in England each
year at a cost of £600M. 80% of patients will
die within 5 years after major amputation. No
diabetic patient should ever suffer an
amputation ever again
Helping people achieve “controlled diabetes” will
prevent damages nerves, muscles, sweat glands and
circulation to feet and legs. Regular foot checks and
control of blood glucose, blood fats, and blood
pressure under control can prevent complications.
80,000 (2.5%) diabetics in England have for ulcers -
getting people to act on information and control their
diabetes we could reduce this to zero.
A patient centric mobile Diabetic Care Plan application
that provides daily monitoring of key risk factors via
wearable devices and gives patients the information,
the social support, motivation factors and access to
integrated clinical care that they need to bring their
diabetes quickly under control and hence prevent risks
of severe complications. So they can live a long
worry free life, free of morbidity and stress.

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DRG Description Total cost for all
hospitals
Cost per patient with
complication
Cases
K01A Operation room procedures for diabetic
complications with catastrophic complication or
co morbidity
£25,138,714 £259,162 97
K60B Diabetes without catastrophic or severe
complications or co morbidity
£3,710,952 £2,072 1791
K60A Diabetes with catastrophic or severe
complications or co morbidity
£1,868,796 £5,106 366
F11A Amputation for circulatory system except upper
limb and toe with catastrophic complications or
comorbidities
£1,751,309 £35,741 49
K01B Operation room procedures for diabetic
complications without catastrophic complication
or comorbidity
£925,912 £8,903 104
F11B Amputation for circulatory system except upper
limb and toe without catastrophic complications
or comorbidities
£501,640 £12,541 40
F13A Upper limb and toe amputation for circulatory
system disorders with catastrophic or severe
complications or co morbidities
£443,556 £11,988 37
F13B Upper limb and toe amputation for circulatory
system disorders without catastrophic or severe
complications or co morbidities
£285,448 £9,208 31
Total £34,626,327 2515
To provide current acute based service on average costs £13,767 per patient in 2010. This is tens times the
cost for non diabetic patient. But average costs mask the massive cost of treating Diabetic patients with
catastrophic conditions.
18 Irish Hospitals: 2011 Treatment Costs for Diabetics w/severe complications

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£50,000 to £289,831/operation
for a patient
with severe complications
£1480/yr/patient
world class integrated care
A new model of care is better and cheaper
Current StateFuture State

5. Copyright Partnerships for Healthcare Improvement Ltd.
Carry out Personal
Health Assessment
Motivate & Support
Patient to follow
care plan
Educate Patient
to make necessary
changes
Create
Personalised
Care Plan
Continuously
Monitor key
health indicators
Identify specific
health risks
Set specific achievable
health goals
Measure Progress &
early warning of worsening conditions
Provide knowledge to
change behaviours
Improve outcomes
and reduce risks
In control of your
health
Improved health
Co-ordinated proactive
care at lower cost

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Using iCP App then no diabetic patient should ever suffer an amputation ever again
Growth HypothesisValue Hypothesis
1
Following a blood test Patient will want information on risk
factors
2
If identified as high risk then they will want to control blood
pressure and blood glucose
3
they will check their readings daily via a tablet to see how
risk factors are being reduced
4
they will want to reduce their weight to meet target via diet
and exercise
5
monitoring activity and exercise will encourage use of the
application
6 Reduce Wait circumference to recommended levels
7 reduce HbA1C to recommend levels
8 reduce total cholesterol to recommended levels
9 reduce blood pressure to recommended levels
10
reduced count and severity of foot ulcers and increased
sensitivity in feet
11 reduced hospital admissions
12 no hospital admissions
1. send invite email to recently diagnosed patient (Xpert
health training attendees) with diet plan
2. send invite to health check patients (Gp Lists) with login
details set up to retrieve blood test results
3. send email to at risk patients from GP list with login
details at next home visit to order BP and BG monitoring
equipment
4. logins
5. Order monitoring devices
6. take out risk assessment
7. Daily visits to view results
8. Try out new feature
9. Add friend to share information
10. Participate in blog
11. Share record with clinical team
12. Buy more devices
13. Pay for tailored care plan
14. Donate data
acquisitionretentionrevenueactivationreferral

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Experiments and Minimum Viable Products
no MVP Test Metric
1
Website with login to obtain test results
and written guidance
registration rate
2
Login in to obtain Personalised Health
score after adding some data
activation rate
3
Buy Blood pressure and blood glucose
monitoring and tablet devices via a long
term lease
registration rate, activation rate, retention rate,
revenue rate
4
Buy Blood pressure and blood glucose
monitoring and tablet devices via a on-
off purchase
registration rate, activation rate, retention rate,
revenue rate
5
Provide limited my charts product to
monitor BP, BG, Weight,
registration rate, activation rate, retention rate,
6
Add medicine tracking for glucose and
BP control, plus activity tracker
registration rate, activation rate, retention rate,
referral rate, revenue, lifetime value
7
Provide Food Carbohydrate counter and
record each meal on nutrient wheel
registration rate, activation rate, retention rate,
referral rate, revenue, lifetime value
8 Record food taken via snapchat
functionality
registration rate, activation rate, retention rate,
referral rate, revenue, lifetime value
9 Add foot pictures and time line with
annotation on sensitive measure
registration rate, activation rate, retention rate,
referral rate, revenue, lifetime value
10 add journal functionality
registration rate, activation rate, retention rate,
referral rate, revenue, lifetime value
11 add social networking
registration rate, activation rate, retention rate,
referral rate,
12 Add moderator to social networking and
advisor
registration rate, activation rate, retention rate,
referral rate
13 add Xpert training videos registration rate, activation rate, retention rate,
referral rate, revenue, lifetime value
14 donate my data
registration rate, activation rate, retention rate,
referral rate, revenue, lifetime value
acquisitionretentionrevenueactivationreferral

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Kanban of work in progress
Backlog / Design In Progress Built Validated
acquisitionretentionrevenueactivationreferral

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Diabetic Retinopathy - all diabetics over the age of 12 years are
offered annual eye screening in the UK, and effective treatment
reduces eye deterioration by 33.33% (2.5 Million people ww have
diabetic caused blindness)
Kidney disease a simple urine test detects early signs and early
treatment prevents risk of developing disease or at least puts off need
for dialysis by 15 to 20 years (incidence is one third of diabetics)
High blood pressure and diabetes increase risk of stroke by 200%.
Effective BP control reduces risk of stroke by 33.33%
50% of diabetics also have CVD, effective treatment reduces chance of
heart attack by 50%
15 to 40 times more likely to suffer lower limb amputation, diabetic
foot examination and treatment of foot ulcers can prevent amputations
Health screening services provide very effective prevention

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Available to all people aged 40-70 years old for Diabetes and
Cardiovascular risk repeated every 5 years
HbA1c test measures the average blood glucose levels over a period of
10 weeks*
When detected early then a 1% reduction in HBA1c levels can translate
into a 30% reduction in number of complications such as eye disease
and nerve damage
16% drop in the number of complications such as heart disease(21, 22)
Advantages of using HBA1c tests are:
Test is conducted on the spot without need for fasting and results are
immediate
It is a highly reliable test with low % of false negatives (that is they test
negative when they have diabetes)
Diabetic Screening a UK success story

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Target Measures
Normal Risk High Risk
BMI 18.5 to 24.9 25 to 29.9 > 30
Waist
Circumference
<94 cms (M), 80
cms (F)
94-102 (M),
80-88 (F)
>102 (M), 88 (F)
Blood Glucose
(mmol/l)
fasting < 6.0
Pre meal below
5.9
2 hours post
meal below 7.8
HbA1c (mmol/
mol) average
blood glucose
20 to 41
(normal|)
42 to 47 (pre
diabetes)
48 and above
(diabetes)
Blood pressure below 130/80 below 140/90 Above 140/90
Total
Cholesterol
(mmol/l)
no current
recommendation

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Screen Shots for Prototype Intelligent Care Plan Application for DMTII

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Risk of amputation (macrovascular complications) is calculated
from 4 significant predictors
1. Waist circumference
2. Systolic Blood Pressure (mmHg)
3. Total Serum Cholesterol (mmol/L)
4. Whole Blood Haemoglobin A1c Level (%)
and we will want to track first sign of foot ulcers and each occurrence
No Development Risk
Very High
Development Risk
Moderate
Development Risk
Low Development Risk
High
Development Risk
Diabetes Complication
Risk Index (DCRI)
Diabetic Type 2 Risk Assessment Model

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