2. 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.
3. 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 children
Treatment Planning:
– One-at-a-time approach
– Weak patient involvement
– Doctor bias or improper framing
Treatment Measures:
– Fragmented provider delivery
– Delayed monitoring of status
– Subjective measures
Smart Treatment Planning Addresses These Common Problems!
4. 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
5. 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 Year
No. 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
6. 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
8. •Practices will be held on Tuesday and Thursdays at Bayside (same field) 5:30 to 7:00
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, and
2. Use Selegine at level 10, and
3. 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 fewer treatments!
9. How is this Technology Better?
30% of
Older
Adults
Value
Gap
Frank’s
Case
New
Process
Source: www.itl.nist.gov/div898/handbook/pri/section3/pri3.htm
10. A Case Study with Software
Customer: 18 year old female named “McKayla”
Chronic Conditions: One
Specifics: Acne
Problem: “OMG so totally annoying”
Problem Duration: Years
McKayla chooses
the treatments to
use in her Test
Plan.
13. Software Session – Review
1. 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.
14. Software Session - Safety
Drugs include
only
those that have
been already
Safety checks for dual
approved by the
therapy
FDA
Safety checks for
adverse reactions
on-line!
15. Solution System Process
Current 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 treatment
New Smart Treatment Process:
Get the
Choose a Use
Chronic Log Best
Condition Treatment Test Results Med
Done
Test Plan Plan Mix
16. 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
17. Why Optimization?
Traditional approaches On-target Smart
Developing the
miss the mark, often Treatment Planning
Smart Test Plan
resulting in: will result in:
is finding where
• Pain • Comfort
your target is,
• Increased clinic visits • Reduced clinic visits
and taking aim • Poor quality of life • Quality of life
• Loss of work • High functioning
• Lower Costs!
18. 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
Parkinson's 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.
19. 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:
– 25% of U.S adults who are internet users “often” look for information online
about health topics (Harris Interactive‟s Healthcare News, Volume 8, Issue 8,
August 2008)
• 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
20. Market Opportunity - Segmentation
TARGET SEGMENT 1 TARGET SEGMENT 2
Who Are They: Empowered patients with a Wellness providers' who seek
chronic illnesses care for their client
Descriptive Traits: •Mid to high income •M.D. in a clinic
•Internet user •Wellness nurse providing
personal case management
Behavior Base: •Persistent – wants the best •Open mind to new tool or
treatment approach
•Tolerant of collecting and
recording data
Customer Analysis: •Dissatisfied with circumstances •Clinic Management
or quality •Insurer Management
Competitor Analysis: •Information sites (WebMD) •Provider apathy
Environmental •Strong disclaimer •Controls & safety checks
Analysis: •Controls & safety checks
This Tool is the Key to a Successful Disease Management Program!
21. 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
22. 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!
23. A Competitor Compared
Web Portal Smart Treatment
Area
i.e. WebMD® Planning
General –Assumes Individual – Provides
Information 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 effects
Treatment Includes herbal and
Biased to Western Rx
Options alternative
Minimal effort in
Process Effort involved in logging
information gathering,
data means greater effort,
& Results but results are
but results are actionable.
generalized
24. 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
26. 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 with
Average 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.
