Where is the Biggest Opportunity?Let‟s use the Pareto Principle to find The Problem… In the case of the U.S. healthcare system, approximately 80% of all costs are from 20% of the those with chronic illnesses Concerning the 80% chronic illness costs, what is the main contributor to these high costs? Answer: Those who have multiple chronic illnesses! $13,000 $12,699 $12,000 Average Per Capita Health $11,000 $10,000 ~20% Costs Care Spending $9,000 $8,518 $8,000 $7,000 $6,000 $6,178 $5,000 $4,000 $4,256 ~80% $3,000 $2,000 $2,241 $1,000 $850 $0 0 1 2 3 4 5+ Number of Chronic Conditions Source: Johns Hopkins Medical Expenditure Panel Survey, 2001.
What are the Failure Modes to Fix?Treatment Testing: – Lack of studies or poor experimental design – Comparing new drugs to the placebo – Extrapolating data from results on animals – Extrapolating from group to group i.e. adult data to childrenTreatment Planning: – One-at-a-time approach – Weak patient involvement – Doctor bias or improper framingTreatment Measures: – Fragmented provider delivery – Delayed monitoring of status – Subjective measures Smart Treatment Planning Addresses These Common Problems!
Solution Overview Natural Remedies? International Remedies? Over the Counter? Prescription Drugs? Diet & Nutrients?• Target: persons with (multiple) chronic illnesses• Improve wellness through structured treatment planning• Through an advanced method of testing and documenting over many weeks, or a Smart Test Plan Solution: Optimal Treatment = Lower Costs = Best Quality of Life
A Case Study Customer: 45 year old male named “Frank” Chronic Conditions: Two Specifics: Parkinson‟s (rigidity and bradykinesia or slowness of movement) & Sleep Apnea: (very low oxygen levels due to snoring) Problem: “Very tired” at his day job Problem Duration: 1 YearNo. of Rx: 1 2 4 5 STOP! Frank complains he Frank complains he Frank continues to cannot sleep Dr. C is tired at work be tired during the Sleep Study day Prescribes Dr. A Dr. A Confirms Dr. B CPAP Prescribes Prescribes Apnea Prescribes Provolonia Trazodone Mirapex & Amantadine
A Test Plan is Developed• Frank works with his doctor(s) to see if there are other treatments: he chose to test a Mandibular Advancement Brace.• After discussion, Frank‟s doctor prescribes a new medicine to control the Parkinson‟s – Selegiline• Taking into consideration his overall situation, a combined Smart Test Plan was developed: Selegiline Mandibular 5MG Tab Amantadine Parkinsons Cpap Advancement (AM, AM & 100MG Cap, No. of finger Tiredness Stiffness Week 10psi Brace Noon) (AM, Noon, PM) taps/60sec Rating (1-10) Rating (1-10) 1 0 1 5 100 2 1 0 5 100 3 0 1 5 300 4 1 0 Doctors here) 5 (Checkpoint with 300 5 0 1 10 100 6 1 0 10 100 7 0 1 10 300 8 1 0 10 300 Key: 1 = Use, 0 = Do Not Use
Case Study Conclusion• On the last week of documenting, the Treatment Planner shows Frank his report• The best regiment is suggested to be:1. Use the Brace, and2. Use Selegine at level 10, and3. Use Amantatine at level 300 Optimal [ ]:Cpap [ ]:MDAB Selegili Amantadi D High 1.0 1.0 10.0 300.0 Cur 0.94183 Low [0.0] 0.0 [1.0] 0.0 [10.0] 5.0 [300.0] 100.0 <= Optimum Levels in RED Composite Desirability 0.94183 No. of F Maximum Effect of change as you y = 122.750 d = 1.0000 move from High to Low Tirednes Maximum y = 9.8750 d = 0.98611 Stiffnes Maximum y = 8.6250 d = 0.84722 Now Frank feels great and takes less treatments!
How is this Technology Better? 30% of Older Adults Value GapFrank’s Case New Process Source: www.itl.nist.gov/div898/handbook/pri/section3/pri3.htm
A Case Study with SoftwareCustomer: 18 year old female named “McKayla”Chronic Conditions: OneSpecifics: AcneProblem: “OMG so totally annoying”Problem Duration: Years McKayla chooses the treatments to use in her Test Plan.
Software Session (Cont.) McKayla documents the Treatment results
Software Session Conclusion McKayla Receivesher Personal Report!
Software Session – Review1. The conventional number of combinations to try would normally be 8 (or 3 2 ). We require only a fraction (½ or ¼) of this time. This saves weeks or months of time! 2. Sometimes, the recommended combination was not included in the original test plan. There is no need to test every combination! 3. The recommended combination rating is better than those tried in all the plan steps. This leads to optimum comfort.
Software Session - Safety Drugs include only those that have been already Safety checks for dualapproved by the therapy FDA Safety checks for adverse reactions on-line!
Solution System ProcessCurrent Traditional Process: Chronic Choose a Use OK Y Done Condition Treatment Treatment ? N Multiple “go backs“ cause a waste of This may not be time and additional pain the best treatmentNew Smart Treatment Process: Get the Choose a Use Chronic Log Best Condition Treatment Test Results Med Done Test Plan Plan Mix
This Tool is Not…• meant to replace advice from your Doctor• meant to replace instructions from your Pharmacist• to be a sole source of information to which decisions or diagnoses are made• always accurate – it is as good as your data--and just like the X-ray for example, the results must be read and verified• a tool where you can copy the results and use on another person• an „expert‟ system to cure all• a rationing system Smart Plan + Medical Knowledge = Optimal Comfort
Why Optimization? Traditional approaches On-target SmartDeveloping the miss the mark, often Treatment PlanningSmart Test Plan resulting in: will result in:is finding where • Pain • Comfortyour target is, • Increased clinic visits • Reduced clinic visitsand taking aim • Poor quality of life • Quality of life • Loss of work • High functioning
Market Opportunity - Size• Target customers are the chronically diagnosed who are starting or altering their treatment regiment. They need to know… o what treatment options are effective (Screening)? o If there are treatment levels with better efficacy? o If there is effective natural alternatives? o if there are options which are just as effective but at a lower cost?• Sample Target Community and Market Size: Condition Prevalence in U.S. Customers Risk Factor Unbiased Measure (5=Best) Canker Sore 10,000,000 10,000 1 5 Migraine Headache 23,000,000 23,000 1 2 Prostate Enlargement 15,000,000 15,000 1 3 Acne Rosacea 13,000,000 13,000 1 3 Osteoarthritis 16,000,000 16,000 1 2 Sleep Apnea 16,000,000 16,000 1 2 Acne Vulgaris 4,600,000 4,600 1 5 Peptic Ulcer 20,000,000 20,000 1 1 Psoriasis 4,000,000 4,000 1 5 Epilepsy 2,500,000 2,500 1 4 Parkinsons Disease 1,500,000 1,500 1 5 Glaucoma 3,500,000 3,500 1 2 Gout 2,300,000 2,300 1 3 Source of Quantity: "The Essential Guide to Chronic Illness" by J.W. Long M.D.
Market Opportunity - Trends• According to a survey by the AMA: – 68% of older adults who regularly take at least one prescription drug also use over-the-counter medication, dietary supplements, or both – 30% of older adults use at least 5 prescription drugs – One in 25, or 2.2 million older adults, are taking drug combinations that place them at some level of safety risk. • People want to know more information about their treatments: – The leading site for health information (WebMD) posted $332M in revenue last year! – “Currently, 5.5 million users in the US use the Internet to find health information…” – www.keyfindings.com• Smart Planning – Solution to an Information Problem – A solution for the active and involved patient – Efficient planning, data driven and unbiased – Personal Report leads to comfort
Market Opportunity - Segmentation TARGET SEGMENT 1 TARGET SEGMENT 2Who Are They: Empowered patients with a Wellness providers who seek chronic illnesses care for their clientDescriptive Traits: •Mid to high income •M.D. in a clinic •Internet user •Wellness nurse providing personal case managementBehavior Base: •Persistent – wants the best •Open mind to new tool or treatment approach •Tolerant of collecting and recording dataCustomer Analysis: •Dissatisfied with circumstances •Clinic Management or quality •Insurer ManagementCompetitor Analysis: •Information sites (WebMD) •Provider apathyEnvironmental •Strong disclaimer •Controls & safety checksAnalysis: •Controls & safety checks This Tool is the Key to a Successful Disease Management Program!
Potential Sales Model• Distribution Channels o Individual consumer market – users of internet, active patients seeking better comfort o Physicians, Nurse advocates, and other health care providers interested in getting health care information on their patient and possibly decreasing costs• Sales cycle o The customers will come directly to the website, register, pay online, and use the service for a year o The „subscription fee‟ approach allows for longer steps and better quality results o Returning users will include clients with any changes to their conditions or treatments
Competition Vs. Smart Planning• Competition or Risks: o The current process: visits to physicians offices where one-at-a-time method is de facto o Customer Focus: Smart Test Plans, especially a plan with natural remedies, may take months, requiring data record keeping and recording o Health Information web sites offer symptom checkers: •WebMD.com •Medicinenet.com o Future personalized treatment planning analysis based on individual DNA• Smart Planning: o A personal report on the effects of treatments o Non-biased aggregator of information, include Rx and natural options side- by-side o Only health information site which provides effect of a treatment on an individual o Optimal med mix is found – faster!
A Competitor Compared Web Portal Smart Treatment Area i.e. WebMD® Planning General –Assumes Individual – ProvidesInformation everybody responds specific information unique the same to a drug to you Decision Tree. Mathematical optimization. Engine Based on general Based on your individual static content data effectsTreatment Includes herbal and Biased to Western Rx Options alternative Minimal effort inProcess Effort involved in logging information gathering, data means greater effort,& Results but results are but results are actionable. generalized
Summary• Of all the areas to make an impact, chronic illnesses have the highest overall opportunity• There are currently many different failure modes in the treatment of chronic illnesses – which we fix!• Use of patented software for health treatment planning has a clear technology advantage over the often used one-at-a- time method• The case studies and software prototype indicate that a Smart Treatment Plan App is feasible to develop• Market size and health trends support the idea that this project will see success entering the marketplace• The optimal treatment mix found as the result of a Test Plan, will lower healthcare costs to an individual, and therefore to society as a whole
Back-up Reference • Average per capita spending on people with one or more chronic conditions is more than five times greater than spending on $12,699 people without any chronic $13,000 $12,000 conditions. ($850 for people withAverage Per Capita Health $11,000 no conditions compared to $10,000 $4,398 for people with one or Care Spending $9,000 more conditions.) $8,518 $8,000 • Compared to individuals with $7,000 no chronic conditions: $6,000 $6,178 • Spending is over two and $5,000 a half times greater for $4,000 $4,256 someone with one chronic $3,000 condition. $2,241 • Spending is over seven $2,000 times greater for someone $1,000 $850 with three chronic $0 0 1 2 3 4 5+ conditions. • Spending is almost 15 Number of Chronic Conditions times greater for someone with five or more chronic Johns Hopkins University, Partnership for Solutions conditions. Source: Medical Expenditure Panel Survey, 2001.