August 2011

Using Mobility for the Treatment of Chronic

Disease

Jonathan C. Javitt, M.D., M.P.H.

CEO, TelcareSenior Fellow, Potomac Institute

for Policy StudiesFormer Chair, PITAC Health Subcommittee

Chronic Disease Consumes 70% ofHealthcare Spending

2002 2007 2034E

$375

$300

$225

$150

$75

$0

Diabetes is just the tip of the iceberg

$ in

bill

ions

$336

$174$132

A flawed process

Take reading Record results Discuss results

Episodic treatment … for a disease one lives each day

1 2 3

A Terrible Waste

On average, non-compliance increases per-patient costs $3,400 annually

Source: CalPERS HCDSS 2007 based on methodology from Sokol MC, Medical Care June 2005 | Volume 43 | Issue 6 | pp: 521-530

CompliantNon-Compliant % Difference

Medical Costs PMPM 583$ 937$ 61%Rx Costs PMPM 236$ 164$ -31%

Total Costs PMPM 819$ 1,101$ 34%

Annual Cost DifferenceAnnualized Costs Per Patient 9,828$ 13,212$

3,384$

Mobility creates a consumer-centric paradigm for care

Cellular-enabled glucose meter

Realtime analytics

On-device text messaging

One-click ordering

On-device messaging is key to building compliance

Guidance must be delivered at the moment it is needed to matter

Telcare delivers its messages at a critical teaching moment…

Most Telcare messages are generated based on Telserve’s rules engine, established by the patient’s health professional and tailored to the patient’s circumstances. Telserve chooses from a broad catalog of messages including:

- Immediate feedback on current clinical circumstances with guidance for treatment

- Reminders for eye exams, foot exams, A1c testing or annual physician appointments

- Coaching on compliance

- Re-ordering of supplies

Authorized caregivers may also send medically directive messages and content right to the meter at the time of testing

Healthcare takes a village

Family members

Health plan workers

Peers on social networks

Caregivers

We need to build healthcare into the mobile experience

Harnessing Mobility createsUnimagined Opportunity

Clinical trials Monitored Pancreas

Analytics Caring for one another

Social Networking and Gaming

The patient is no longer alone

There is a community of people facing the same challenges

Team-building

Compliance contests

If Farmville can do it,so can we

Clinical Trials

600 Clinical trials per year where BG is measured

Mobility solution eliminates the burden of manual Case Report Forms and automatically enters data into CFR 820.3-compliant database

Immediate identification of failure to test and other protocol violations at an actionable moment

Decrease in study cost

Data can be paired with CGM and other data streams

Monitored Assisted Pancreas

1. Glucose monitor. May be on-body or implantable

2. Insulin dispensing device. May be off body, on body, or implantable. May dispense rescue drug as well (e.g. glucagon)

3. Communication hub linked by nearfieldradio to #1 and #2. Linked to server by cellular radio communication

4. Remote computer and monitoring stationOptional additional inputs

5. Accelerometer/activity monitor. May be contained in #3 or worn separately

6. Geolocation device, may be contained in #3 or worn separately

7. Medical Record input8. Food intake input

Medical Record

Food Intake

Geolocation

Activity Monitor

Basal InsulinInsulin Bolus Guide

Emergency Shutdown

1. CGM 2. Pump

3.

4

5

6 6

7

Pharmacoanalytics

Interaction of insulin and other diabetes drugs with metabolism known to be highly variable

Effects of activity, specific dietary intake, other drugs, and genomic influence are profound and unknown

Data have never been available to track these variables in real time and associate them with blood sugar results

Capture of these data and multivariate analysis will lead to personalized medicine solutions and a whole new understanding of diabetes.

What’s the next Frontier?

M2M solutions for Asthma

Heart Disease

Obesity

Hypertension

Cholesterol

Addressing diseases that consume 7 of 10 Healthcare dollars today