Mobile Care for Chronic Conditions Presentation to: Wireless Future of Health IT G-106, Dirksen Senate Office Building March 23, 2009 BeWell Mobile Technology,

Mobile Care for Chronic Conditions

Presentation to: Wireless Future of Health ITG-106, Dirksen Senate Office Building

March 23, 2009BeWell Mobile Technology, Inc.

BeWell Mobile Technology, Inc. March 2009 2

Agenda

BeWell Mobile Overview

Mobile Disease Management Platform

Mobile Disease Management Case Examples Asthma

Diabetes

Economic Possibilities


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


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.


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


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%


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


BeWell Mobile – Focus on Adherence

Real-timefeedback

Motivation

Easy-to-use tools

Social support

Medically relevantinformation

Behavioralskills

Behavioralchange


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


BeWell Diabetes Diary - Patient Interface Example

3

Follow UpQuestion

2

Provide Instant Feedback

1

Record Outcomes

4

AutomatedInstant

Coaching


Mobile Disease Management Case Studies

Asthma

Diabetes


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


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


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%


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


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>


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


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


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

Documents

Mobile Care for Chronic Conditions Presentation to: Wireless Future of Health IT G-106, Dirksen Senate Office Building March 23, 2009 BeWell Mobile Technology,