This document discusses how mHealth technology can transform diabetes care by wirelessly monitoring patients and providing remote care. It notes that diabetes accounts for a disproportionate amount of healthcare costs and that traditional disease management has failed. The document advocates for monitoring 100% of diabetic patients using wireless glucose meters and smartphone apps to identify issues early and intervene through data-driven coaching. Clinical examples show improved outcomes through increased patient engagement using these mHealth solutions. Challenges to broader adoption include lack of reimbursement for remote care and data review.

1. Wireless Monitoring and Care:
Transforming the care of Diabetes Mellitus
using mHealth technology
Jonathan C. Javitt, M.D., M.P.H.
Founder and CEO, Telcare
Adj. Prof., Johns Hopkins Medicine

2. "We will make wider use of
electronic records and other
health information technology
to help control costs and reduce
dangerous medical errors."
--
President George W. Bush, National
Address January 31, 2006

4. 2002 2007 2034E
$375
$300
$225
$150
$75
$0
Diabetes is a paradigm just the tip of the iceberg
$inbillions
$336
$174
$132
Chronic Disease Consumes 70% of
Healthcare Spending
Same for pulmonary disease, heart failure, hypertension

5. A Simple
Solution
A Tragic
Waste

6.  About 3x the cost of other members in the population
 Beyond direct spend lies the burden of … absenteeism, increased workers comp risk, decreased
productivity, and replacement. (ADA estimate $3000/year)
Non-diabetic
Population
Diabetic Population
Diabetes affects 10% of population,
but incurs 30% of costs
Members Healthcare Costs

7. Example from an actual state employee population
 The cost trend threatens the
viability of every health
insurance program, no
matter how it is funded.
 A disproportionate number
of the highest claims have
diabetes as a primary or
comorbid condition
 A new approach to
Management of this
population is the only hope

8. ~15%
R
I
S
K
$
High
Low
Traditional Disease Management Has Failed
“High risk” patients (stratified based on
past claims costs) are the focus of existing
care management efforts.
Identifying and addressing
last year’s high cost
patients misses the
majority of those who will
be next year’s high cost
patients

9. R
I
S
K
$
High
Low
 Monitor 100% of the population.
 Data monitoring for:
 Adherence
 Extreme Highs
 Extreme Lows
 Sustained Highs or Lows
 Patterns
 Identifying those that are not
adhering to best self-management
practices.
 Early identification of high-
risk, potentially high-cost episodes
 Intervene with data that enables
meaningful and contextual
coaching.
The Future: Diabetes Health Monitoring & Management

10. That’s where mHealth becomes indispensable
An FDA/CE-cleared Continua-
compliant server and portal that
collects wireless data from Telcare
BGM, enables display of data and
caregiver messaging.
510(k) cleared for both home use and
professional use.
The Telcare BGM – a cellular
enabled wireless glucose meter.
510(k) cleared
FDA/CE-compliant Smartphone Apps that communicate with
the server and enable parents and peers to create a network
of support for the patient.

11.  FDA/CE Class II+ medical device
 Qualcomm IEM technology
 Global partnerships with 2Net
Verizon and Telenor
 Two-way messaging capability
 Automatic supply reordering
 Positive reception from patients,
parents, physicians, DME’s, and
media.
Core technology:
a wireless-enabled BGM

15. Empowering the Patient:
Diabetes is Social
• A patient spends 2 hours or less a year
talking to the doctor
• Daily caregivers include nurses, diabetes
educators, family, maybe the school nurse,
and most importantly, peers.
• Diabetes is about what you eat, how you
exercise, and what medicines you take.
• People with Diabetes universally express a
profound sense of isolation.
• Telcare is the first company to connect
people with diabetes to their social
network through the cloud using the tool
they use the most – their glucose meter

17. Outcomes
What have we learned so far?
mHealth alone is not a solution. It’s a powerfull
platform for engagement.

18. • “Light touch” intervention
• Meaningful result seen in all
treated patients
• 11% relative difference in
A1c in those who engaged
>1x per week
• Telcare’s technology
eliminates the need to “do
anything” in order to
transmit and receive

19. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Expected Direct
Purchase
HMO Endo Endo + CDE Contract
Research Org.
Managed
Care
% Adherence to testing by site of Care
Adherence: varies by degree of professional engagement

20. Measure Pre-treatment Post-treatment Goal
A1C 13.7 5.5 <7
Weight 303 261 225
Blood pressure 130/100 110/78 130/80
Depression 11 5 <5
Anxiety 19 5 <5
LDL cholesterol 150 98 <100
Using the Telcare Platform in a
Patient-Centered Medical Home
• Poorly controlled diabetes
• High blood pressure
• High cholesterol
• Obese
• Moderately depressed

21. Telcare Apps: Our laboratory for engagement
and rapid prototyping
Diabetes Pal
• Readings taken on Telcare BGM
are automatically stored in the
App.
• Patients and family members can
setup alerts, analyze data, and
create support networks.
• Caregivers, including pharmacists
can canned messages that get
delivered automatically

22. TOP RATED DIABETES APP IN THE iTUNES STORE!

23. What’s Next: Social Networking and
Gaming
• Expansion of existing
Telcare apps to include
Nutrition and Lifestyle
Features
• Madden Football for
kids
• Badgeville for grownups

24. Key Challenges
• No reimbursement for physician
review of mHealth data
• No reimbursement for remote
patient engagement except in
unusual circumstances
• Drastic change in reimbursement of
glucose monitoring
• Government payers need to be
empowered to deploy mHealth
solutions on a broad scale

25. Towards a Solution
The Other Side of
the Chasm:
Patient Engagement