digital health: clinical evidence and patient impact · 2018-10-08 · *current a1c distribution...

ANDHealth and Novartis Present

Digital Health:

Clinical Evidence and Patient Impact

ANDHealth Members::

#ANDHealthSummit |@ANDHealthAU | @Novartis

KEYNOTE

Disrupting Diabetes!

Hitting the “Sweet Spot” with AI and

Machine Learning in the Treatment of

Chronic Disease

ANAND IYER

MS, PhD, MBA, CO-FOUNDER & CHIEF STRATEGY

OFFICER, WELLDOC

©2018 WellDoc, Inc. Intellectual Property. All rights reserved

Disrupting Diabetes!Hitting the “Sweet Spot” with

AI and Machine Learning in

the Treatment of Chronic

Disease

Anand K. Iyer, PhD, MBA

Chief Strategy Officer, WellDoc

Sydney, Australia

May 3, 2018

©2009-18 WellDoc, Inc. Intellectual Property. All rights reserved. Proprietary and Confidential. Not permitted to be duplicated or reproduced without the express written consent of WellDoc, Inc. WellDoc and the logos associated therewith and all other WellDoc marks contained herein are trademarks of

WellDoc. All other marks contained herein are the property of their respective owners.

2000

1988-2000

% of patients A1C <7% of patients A1C <7

Source: Casagrande SS et al. The prevalence of meeting A1C, blood pressure, and LDL goals among people

with diabetes, 1988-2010. Diabetes Care. http://care.diabetesjournals.org/content/early/2013/02/07/dc12-2258.full.pdf

2005 2007-2009 2010-2012 2013 2014 2015

44%2000-2005

44.1%2005-2010

57%2010-2015

52.3%



1Picture courtesy of Chris Crockford and Erik Johanssen


12

Enter Stage Left: Digital Health

©2018 WellDoc, Inc. All rights reserved

• Solutions that use digital technology in the attempt to improve patient engagement and therefore, health outcomes and/or costs

• Encompass a wide variety of tools, ranging from wearable sensors and portable diagnostic equipment to data-driven software platforms, telemedicine tools, and mobile health care apps

• Empower individuals to track, diagnose, manage, and improve overall health and well-being, including how to choose and access health care services

Confusion

314 Wearables available worldwide

60% of apps are just general wellness

Patie

nt C

hurn

200 new apps each day20% of large health systems have full-scale digital health programs

Source: IQVIA 2017 Report “The Growing Value of Digital Health”

SVB Analytics, “Consumer Digital Health: How Market Shift is Leading to New Opportunities”, 2016

15

Enter Stage Right: Digital Therapeutics (DTx)


DTx: A subset of digital health, but that:

• Are SaMD: Software as a Medical Device as defined by IMDRF

• Have demonstrated outcomes and efficacy as evidenced in multiple RCTs, conducted by independent third parties, published in peer-reviewed journals

• Are cleared by the regulatory authorities for patient safety and GMP

• Adhere to the latest cybersecurity guidelines and best practices

• Leverage AI and MI as their “mechanisms of action”

• Deliver value that’s integrated into mainstream healthcare delivery

Source: Digital Therapeutics Alliance www.dtxalliance.org

http://www.dtxalliance.org/

16

Digital Therapeutics Have the Potential to Help Healthcare Systems Achieve 5 Important Goals


1. Helping patients become more engaged in their own care

2. Closing communication gaps

3. Identifying patients’ needs and tailoring services to meet them

4. Enabling consumers to get care in convenient, cost-effective ways

5. Improving decision-making by consumers and providers

What We Built: BlueStar®: Engaging Patients and Their Healthcare Providers



▪ Clinical Parameters: BG (manual & connected), BP, Lipids, Labs, etc.

▪ Medications: All medications, vitamins, herbal supplements, etc.

▪ Activity: Direct and through IoT sensors

▪ Food: Direct and through restaurant locators

▪ Symptoms: Notes and context around entries

▪ Psycho-social: Behavior modification support

How: Supporting Patients and Care TeamsWhat: Managing the “360o” of Diabetes

BlueStar®: What it Does and How It Works

▪ Journey: Guided, BlueStar-U or “at-will”

▪ Patented Real-time Feedback Engine: Precise, Personalized, Contextual, On or Off-line

▪ Insights: Weekly summaries and “why’s”

▪ Care Team: SmartVisit report, Population reports

▪ Device Integration: Meters, IoT Sensors, Others



Data Capture Frequency

DataCapture Source

Patient

Non-Patient (e.g., Provider, 3rd party,

EMR, Labs, etc.)

Low(~Static)

High(~Dynamic)

• System-generated KPI’s, alerts, trends

• System and feature-level utilization data

• Absence of data

• Physiologic data • Symptom data• Lifestyle data• Medication data

• Registration data (e.g., demographics, medication history, daily regimen, etc.)

• Psycho-social data (health literacy, cultural, social, etc.)

• Labs and screenings• Evidence-based

guidelines• Medication regimen• Metabolic targets and

ranges• Clinical rules• Physician instructions

Increasing Variety, Volume, Veracity and Velocity of Data



Discover: Using known data to draw insights• Pattern recognition• Discriminant

functions (SDF, LDF)• Clustering• Behavioral patterns• “Why”

Inform: Presenting primary analyses of the data• Engagement or usage

data• Clinical value data• Population data• “What”

Extrapolate: Using existing data to model patterns and predict future occurrences• Bayesian, Markov• Machine learning

based models• “When”

Data Status

Analysis Intent

“Don’t Know What I’m

Looking For”

“Know What I’m Looking

For”

“Have Data” “Don’t Have Data”

Adapt: Using learning techniques to provide new insights and choices for optimizing outcomes • Dynamic feature and

service configuration• “How”

IDEA!

Sweetening the Value Proposition: An IDEA!



John:

Basal Insulin

Mary:

MDI

Same BG of

226 mg/dL

Informative: Key to Precision and Personalization“What happened?”



Summary and Insights for:

BG Meds

Carb Summary & Insight

Activity Sleep

Discovery: Multi-variate Correlative Insights“Why did it happen?”



Extrapolative: Human vs. AI Machine“When will it happen?”

Iyer, A; Abstract presented at Chief AI Officer Conference, Corinium, San Francisco November 2017



Phil has a low BG (65)

in the morning

Phil takes his BG later (92);

indicates before exercise

Reminder to bring a snack along

for exercise due to Phil’s low

earlier in the day, plus current BG

Adaptive: Engaging People“Keeping it from happening”



Adaptive: Engaging People“Making it happen!”



Getting to the “Sweet Spot”:Combining BlueStar’s A1c “Shifting” Effect …



On average, a

2-point drop in A1c

4X what’s required

for a new drug

Top 15 drugs today

average 0.8

… With Average Population “Starting A1c Points”

30%

34%

16%

20%

Current Distribution for Non-Medicare Patients

% with A1c < 7 (In Control) % with A1c 7 to 8 (Elevated)

% with A1c 8 to 9 (High) % with A1c > 9 (Not Controlled)

41%

35%

14%9%

Current Distribution for Medicare Patients

% with A1c < 7 (In Control) % with A1c 7 to 8 (Elevated)

% with A1c 8 to 9 (High) % with A1c > 9 (Not Controlled)

*Current A1c Distribution Source: MarketScan database, a product of Truven Health Analytics, an IBM Company. The MarketScan database contains employer-based healthcare claim information for more than 122 million patients in the US represented by more than 130 unique carriers, and includes laboratory test results for over 1.67 million patients.

… With Real, Adjudicated US Claims Data

In both populations, average cost in each A1c band increases as a step function as A1c increases

*Source: Truven MarketScan Database: Annual Cost Per Patient is average amount paid for any healthcare claim within 365 days for: 1) patients with at least two lab results within the same A1c range ; and 2) patients with four lab results within the same A1c range. Percentage in Band Today is based on national attrition levels in Truven database.

Converting AI into Economic Return: Sweet!



WellDoc Validates Potential of Its Digital Therapeutic, BlueStar®, to Significantly Reduce Healthcare Costs.

Cost savings based on reductions in acute medical incidents, supplies and medications, and co-morbid conditions.

3-5XAverage ROI Average Savings/User/Month

$254-$271

www.welldoc.com

Thank You!

Anand K. Iyer, PhD, MBAChief Strategy Officer

[email protected]

@DrAKIyer@WellDoc@BlueStar

mailto:[email protected]

digital health: clinical evidence and patient impact · 2018-10-08 · *current a1c distribution...

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