Qualcomm Life Connect 2013 - Jonathan Javitt, M.D., M.P.H

#CONNECT2013

Connecting for Good Loews Coronado Bay Resort, San Diego, California

Jonathan Javitt, M.D., M.P.H. Founder, CEO, Vice Chairman, Telcare, Inc.

Transforming the care of Diabetes through wireless technology

"We will make wider use of electronic records and other health informa5on technology to help control costs and reduce dangerous medical errors." -‐-‐ President George W. Bush, Na?onal Address January 31, 2006

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Transforming care for people with Diabetes, those who care for them and those who care about them

Unless you connect the patient to the system, nothing happens. It’s not the tool itself, it’s what you do with it…

© 2013 Telcare, Inc.

People with Diabetes

6

Spend less than 1 hour/year with their doctor

They leave the encounter confused, perturbed, and frightened They remember liIle of what was said They feel alone and abandoned


Then they spend

7

8759 hours per year attempting to be their doctor

The array of tasks is enough to baffle and demoralize the brightest, most commiIed pa?ent The result is frustra?on, fu?lity, inconsistent adherence, and oNen failure to treat at all


Blood sugar control prevents complications and cost of Diabetes

0

5

10

15

20

25

30

35

80+ 60 -‐ 79 40 -‐ 59 20 -‐ 39 <20

Annu

al Risk of Hospitaliza1

on

Worse Adherence

Risk of Hospitaliza1on

8

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000

80+ 60 -‐ 79 40 -‐ 59 20 -‐ 39 <20 Do

llars

Worse Adherence

Diabetes Expense per Person

Sokol S: Impact of Medica?on Adherence on Hospitaliza?on Risk and Healthcare Cost. Medical Care 2005


§  About 3x the cost of other members in the popula?on

§  Beyond direct spend lies the burden of … absenteeism, increased workers comp risk, decreased produc?vity, and replacement. (ADA es?mate $3000/year)

Non-‐diabe?c Popula?on

Diabe?c Popula?on

Diabetes affects 10% of popula?on, but incurs 30% of costs

Popula'on Healthcare Costs


~15%

R I S K $

High

Low

Tradi?onal Disease Management Has Failed

“High risk” pa?ents (stra?fied based on past claims costs) are the focus of exis1ng care management efforts.

Iden?fying and addressing last year’s high cost pa?ents misses the majority of those who will be next year’s high cost pa?ents


ü  Monitor 100% of the popula?on for: §  Adherence §  Extreme Highs §  Extreme Lows §  Sustained Highs or Lows §  PaIerns

ü  Iden?fy high-‐risk, poten?ally high-‐cost episodes

ü  Intervene with data that enables meaningful and contextual coaching.

ü  Prevent complica?ons, cost, and hospitaliza?on

The Future: Popula?on Monitoring & Management

People with Diabetes Need to care for their disease wherever, whenever …

Unless we issue every pa?ent a 24/7 physician, mobile health is the only solu?on



Building a Network of Care around the pa?ent

•  Family members, diabetes educators, the school nurse, and most importantly, peers.

•  Diabetes is about what you eat, how you exercise, and what medicines you take.

•  People with Diabetes universally express a profound sense of isola?on.

•  Telcare connects people with diabetes to their social network through the cloud using the tool they use the most – their glucose meter

© 2013 Telcare, Inc. 15

Smartphone apps to enhance engagement

Enables carbohydrate, medica?on, exercise data input


Partnering for Increased engagement, Social Networking and Gaming

Bodymedia and Withings for fitness Calorie King for Carbohydrate and nutrition tracking

EA Games and incentives for kids

Rewards and Incentives


Empowering the Caregiver

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Presenting the big picture to identify patients in need of support

And the actionable information needed to drive meaningful improvement


For Employed Popula?ons: A care management layer is cri1cal

•  May be a Telcare partner, Managed Care Organiza?on, or healthcare provider

•  Automated messaging maintains the daily touch

•  Automated messaging must be supplemented by human touch and rela?onship for maximum efficacy

•  Rewards and incen?ves make a difference


0%

10%

20%

30%

40%

50%

60%

70%

80%

Before Telcare

Direct Purchase

HMO Physician Office

Endo + CDE CRO Tradi?onal Insurance

Site of Care

% Adherence with Telcare BGM

Results: Unprecedented Adherence For the pa1ent: improved tes1ng adherence means bePer glucose control

For the caregiver: demonstrated adherence means higher reimbursement


•  Meaningful result seen in all treated pa?ents

•  11% rela?ve difference in A1c in those who engaged >1x per week

Results: Meaningful Clinical Improvement For the pa1ent: 10% reduc1on in A1c means 37% less hospitaliza1on, stroke, heart aPack, amputa1on, vision loss

For the caregiver: demonstrated clinical results drive reimbursement under accountable care


The Most Important Result What do our Pa?ents Say?


The Most Important Result What do Pa?ents Say?


Results for Employers ADA data show that non-‐healthcare costs of diabetes are at least as

high as the direct healthcare costs

Days away from work Decreased produc?vity on the job Accidents and comp claims Worker replacement

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What have we learned? mHealth is a medium that is no more useful without content than radio, television, or cellphones

Now that we have the medium it’s 1me to focus on paths to engagement


Telcare’s Future: A comprehensive Diabetes Solution

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Withings and Bodymedia Integration to the meter Bluetooth

Insulin Pump

Monitored Pancreas

Intelligent Insulin Pen

Bluetooth CGM TBN

V 2.0 Total Diabetes Management


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Telcare: it’s not a sensor – it’s a solution

Health & Medicine

Qualcomm Life Connect 2013 - Jonathan Javitt, M.D., M.P.H