Mobile Care for Chronic Conditions
Presentation to: Wireless Future of Health ITG-106, Dirksen Senate Office Building
March 23, 2009BeWell Mobile Technology, Inc.
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Agenda
BeWell Mobile Overview
Mobile Disease Management Platform
Mobile Disease Management Case Examples Asthma
Diabetes
Economic Possibilities
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History - BeWell Mobile
Incorporated in 2004
Healthcare, software, behavioral science and telecom experience
Disease management, wellness & research applications
Winner of Industry Awards 2008 Agency for Healthcare Research and Quality Innovation Award 2007 Wireless Reach Award by Qualcomm 2006 ABBY Award for Innovation in Healthcare
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BeWell Mobile Delivers Value
BeWell’s health management applications increase patient
compliance and adherence to therapeutic regimen leading to
improved health outcomes and reduced costs of care.
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Focus on Chronic Disease and Wellness
Chronic Disease Management Asthma Diabetes Hypertension Heart Disease Chronic Obstructive Pulmonary
Disease (COPD) Depression
Wellness Applications Smoking Cessation Weight Management
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Chronic Disease Prevalence and Costs
Share of $1Tr US Health Care SpendPrevalence of Chronic Disease
Johns Hopkins
With Chronic Disease
48%
Without Chronic Disease
52% With Chronic Disease
83%
Without Chronic Disease
17%
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Patient Non-Adherence Increases Costs
1/3 of patients take all their medications
Drugs don’t work in patients who don’t take them.
– C. Everett Koop, MD
1/3 take some
1/3 may not even fill their prescription
Researchers estimate that non-adherence to prescribed medical regimen costs the US health care system about $100 Bn annually
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BeWell Mobile – Focus on Adherence
Real-timefeedback
Motivation
Easy-to-use tools
Social support
Medically relevantinformation
Behavioralskills
Behavioralchange
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1. Patient is promptedto follow regimen
4. Patient uploads data
BeWellDM
Platform
3. Instant Reports and automated
feedback 5. Provider/Case Manager reviews Results / Reports
BeWell Patient Experience
Patient Interface Records relevant health data Educates patient Improves self management
Provider Interface Real time access to actionable health
information Fine tune care plan between clinic visits
6. Secure Patient Feedback & Communication
2. Patient records data
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BeWell Diabetes Diary - Patient Interface Example
3
Follow UpQuestion
2
Provide Instant Feedback
1
Record Outcomes
4
AutomatedInstant
Coaching
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Mobile Disease Management Case Studies
Asthma
Diabetes
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Asthma – Prevalence and Treatment
Asthma Prevalence: Most common chronic disease among children (NCHS, 2006) 12% of children are diagnosed with Asthma (NCHS, 2006)
Asthma is Treatable: Anti-inflammatory medications (inhaled corticosteroids, leukotriene inhibitors) Bronchodilators (methylxanthines, long-acting beta-agonists) Rescue treatments (systemic steroids, short-acting beta-agonists)
Asthma goes Untreated in Children: 74% of children with moderate to severe asthma in a national sample did not
receive adequate treatment (Halterman et al., 2001) Minority children are less likely to receive adequate treatment (AAFA, 2005)
Cell Phone Penetration: 85% of individuals aged 7 to 26 in the US already have cell phones
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Mobile Asthma Management in Urban Youth
Customer San Mateo Medical Center
Program Mobile Asthma Management
Background
Patient Profile Aged 12-21 years old, urban, uninsured
Diagnosis criteria Severe and persistent asthma
Time period 2 years
Average Duration 8.2 months per patient
Application languages English and Spanish
Results
Adherence to regimen 95%
Loss of school days due to asthma 0
Mobile phone usability 95%
Patient satisfaction rate 95%
No current mechanism for Medicaid Reimbursement
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Diabetes – Prevalence and Costs
Diabetes Prevalence: 5.6% of all Americans are diagnosed with Diabetes (ADA) 20% of people ≥ 65 have Type 2 Diabetes (CDC)
Diabetes Costs of Care: $11,744/patient per year in 2007 (ADA) Nearly 20% of US Health Care Costs
Blood Sugar Control and Medication Adherence Reduces Cost of Care: Medical Care Charges increase significantly for every 1% increase above HbA1c of 7% (T. Gilmer;
Diabetes Care, Dec 1997) Every 10% increase in Medication Possession Ratio accounts for a 8.6% - 28.6% reduction in
annual care costs among Type 2 diabetics (R. Balkrishnan, et. al., Clinical Therapeutics, 2003)
Diabetes Self Management: Expert agree that diabetes is a disease for which 95% of the care lies with the patient (S.
McLaughlin, DQIP, Diabetes Spectrum, 1997) Only 2% of Diabetics strongly adhere to treatment regimen including testing, medication and diet
(Beckles GL, et al.)
US Cell Phone Penetration: 87%
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Mobile Diabetes Management
No current mechanism for Medicare Reimbursement
Client Large Medical Center
Program Mobile Diabetes Management
Background
Patient Profile Aged 17 – 75 years with Type 1 or Type 2 diabetes
Diagnosis criteria Poorly controlled blood sugar levels
Application languages English and Spanish
Duration 21 Months (average of 6 months per individual)
Results
Overall results Improved blood sugar controlQuicker intervention Real-time medication/insulin adjustments
Adherence Patient participation rate = 83% Utilization rate = 2.1 blood glucose outcomes recorded per day
Outcome results Lowered HbA1c by 0.91 points for patients with starting HbA1c between 8% and 9%Lowered HbA1c by 2.22 points for patients with starting HbA1c ≥9%Reduced blood sugar range (low to high) by 50 mg/dl between first month of service and the last month of service
Patient satisfaction rate The program received a patient satisfaction score of 3.8 out of 4
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Cost Savings Example – Diabetes
Improved blood sugar control leads to lower costs of care (Gilmer et al.)
Average care costs for Diabetics in 2007: $11,744/patient/year
Predicted impact of a 1 percentage point reduction in HbA1c % of costs associated with 1 point change in HbA1c: 10% Predicted annual reduction in cost of care: <$1,174>
Program participants with HbA1c ≥ 9% Lowered HbA1c levels by 2.22 percentage points % of costs associated with change: 22.2% Predicted annual reduction in cost of care: <$2,607>
Program participants with HbA1c between 8% - 9% Lowered HbA1c levels by .91 percentage points % of costs associated with change: 9.1% Predicted annual reduction in cost of care: <$1,069>
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Example HMOGeneral membership 1,000,000 Incidence rate for diabetes (ADA) 5.6%HMO estimated diabetes population 56,000 % of diabetics with HbA1c ≥ 9% (est.) 20%Target Population - Diabetic HMO Members with HbA1c ≥ 9% 11,200
2007 US cost of care per diabetic (ADA) ($11,744)
Estimated Annual Costs for Target Population ($131,532,800)
US Population 300,000,000 Extrapolated Annual Costs for US Population ($39,459,840,000)
Costs of Care
Estimated annual costs of care for diabetics with HbA1c ≥ 9% per 1 Million population
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BeWell Mobile Diabetes Program Predicted Reduction in Costs of CareTarget population - Diabetic HMO Members with HbA1c ≥ 9% 11,200 Estimated annual cost of care for target population ($131,532,800)
Adherence estimate (BWM) 83%Estimated adherent diabetic population with HbA1c ≥ 9% 9,296
Demonstrated reduction in HbA1c (BWM) 2.22Predicted savings based on health outcome (Gilmer, et.al.) 22.2%Estimated cost reduction per adherent member / year ($2,607)
Predicted Potential Annual Reductions in Costs of Care* 20,582,906$
US Population 300,000,000Extrapolated Potential Annual Reductions in Costs of Care* 6,174,871,718$ *net of estimated licensing fees and program costs
Improved Health Outcomes Predict Reduced Costs
Potential annual costs savings for diabetics with HbA1c ≥ 9% per 1 Million population
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BeWell Mobile Disease Management - Summary
Demonstrated Results Adherence Health Outcomes
Promising Economic Benefits
Support from Medicare & Medicaid could help translate this potential into sustainable long term health and economic benefits