Disease Management with Cell Phones by Malinda Peeples, Well Doc, Inc.

1. Diabetes Management and
Emerging Wireless Solutions:
Changing the Rules of the Game
mHealth Initiative
March 31, 2009
March 2009 | © 2008 WellDoc Communications

2. Agenda
Chronic Disease
Solution overview
Case study
CONFIDENTIAL 2
March 2009 | © 2008 WellDoc Communications

3. “Traditional” Healthcare Levers
Many disparate efforts; One growing problem
Disease Management Pharmaceutical
Innovation
Static Education
New Compounds
Nurse Call Centers
CRM Strategies
“Three’s a Crowd”
Generics and Supply
Chain Management
$2.3T US Annual Spend
80%+ on Chronic Disease WWDC Service
Offerings
Growing Care Gap Click
Click
Device Innovation Healthcare Plan Design
“Better, Faster” Historical Actuarial Models
Wire-free Data Transfer Specialist-Friendly Policy
Basic Software Support Distributed Reach: Minute
Clinics
CONFIDENTIAL 3
March 2009 | © 2008 WellDoc Communications

4. Emerging Innovation Levers
Information-enablement will harness “convergence” of disparate efforts
Disease Health and Pharmaceutical
Pharmacokinetic
Wellness Management
Innovation
360-degree View
Cause and Effect
Preventive, Acute,
Simulation
Maintenance
Data, Information,
Patient-centered
Real-time Information Knowledge
Distributed Care Networks Behavior Change
Automated Systems
Device Solution Healthcare Plan Value
Innovation Chain Design
User-driven Applications Incent Change: New CPT
Codes
Multi-purpose Devices
“P4P”: Rewarding
Personalized Therapy and
Practice-based
Feedback
Improvement
Wireless is Critical to
Productivity: Reduction in
This Convergence!
Non-Billable Efforts
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March 2009 | © 2008 WellDoc Communications

5. How WellDoc Tackles These Pain Points
Information visibility, accuracy, relevance, context – Anytime, Anywhere
3rd Party Wireless Service Enablement
• Presence Servers (E.g., Peer-to-peer
applications)
Virtual Coach • Geo-location-based Servers
• Testing & Medication Reminders • All-IP Network Translators
• BG Target Ranges
• Physician Instructions
• Hypo & Hyper Glycemic Algorithms
• Caregiver Alerts
• Cell Phone and Network Agnostic
WWDC Service
Provider Support Tools Click Offerings
Click
• Suggested Physician Action Plans -
• Total Diabetes Management
Medical Records
• Predictive Modeling
Management Systems
• Evidence Based Guidelines
• Partner Formulary Integration
WWDC Service
Longitudinal Behavior System Click
Offerings
Click
…
• Stages of Change Behavior Modification
• Expert System – Event/Alert Tracking
• Patient Behavior Monitoring
WWDC Service
• Integration into DM call center (case Offerings
Future
Click Case Manager Diabetes Clinician
Click
management) Stakeholders
(DM) Educator (e.g. Physician)
• Patient stratification and prioritization
Secure Information Access
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• Contextual information and messages sent
from DM case worker
March 2009 | © 2008 WellDoc Communications

6. Demonstrated Initial Health Outcomes
WellDoc’s early trial confirmed merit for further investigation
July 2008 2 study arms
Diabetes Technology & Therapeutics – Control: 15 patients
– Intervention: 15 patients
Average Age: 54 (control), 50
(intervention)
Disease State: Type 2 for > 7.5 years
Average Demographic
– GED/High-School equivalent
– Non-tech savvy
– 60% African-American
Key Outcomes
– 2.03-point drop in HbA1c (p < 0.003) in
intervention
– 100% physician satisfaction
– Physicians 5X more likely to titrate/add
drugs
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March 2009 | © 2008 WellDoc Communications

7. Proven Health Outcomes
WellDoc’s clinical trials have anchored executive and clinical attention
Data Tracking
2008-2009 Randomized Control Trial
Patient BG testing
Inspiring Engagement.
Delivering Outcomes.
Patient med adherence
Patient med usage
Patient acceptance and usage
Patient healthcare utilization
Very strong interim glucose
management results
Patient healthcare costs
Primary Aim – A1C Decrease
Patient outcomes
Secondary Aims
Physician prescribing behavior
– Healthcare utilization
Physician acceptance and usage
– Patient provider usability
Physician adherence to evidence
– Patient adherence
– Provider prescribing behavior
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March 2009 | © 2008 WellDoc Communications

8. A Case Study
Carl Registers on the System and Is Trained
Demographics
– 64 year old male
– Skilled laborer; less than high school
education
Health history –
– Type 2 diabetes
– Hypertension
Treatment Regimen
– Glucovance 500mg 1 pill at breakfast
– Januvia 100mg 1 pill at breakfast
– Lantus Insulin 10 units bedtime
– Lisonpril 10mg 1 pill at breakfast
Healthcare Team
– PCP & Diabetes Educator
System Preferences
– No medication reminders
– Chooses phone and web portal
– Grants PCP web access
– Wife is supportive
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March 2009 | © 2008 WellDoc Communications

9. Carl Starts to Use the System
Measure..Analyze..Manage
MEASURE: (using the phone)
– Enters blood glucose & gets
feedback
– Enters carbohydrates & gets
feedback
– Does not enter Meds
– Adds notes (“ate more than
usual”)
– Populates the logbook
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March 2009 | © 2008 WellDoc Communications

10. The System looks at Carl’s Data
Measure..Analyze..Manage
Alert education
ANALYZE (using proprietary analytics)
– Feedback
• Just-in-time
• Trending
– Education
• Problem-solving
• Treatment specific
– Smart testing
Smart Testing
• “Pairs”
• Effective testing
CONFIDENTIAL 10
March 2009 | © 2008 WellDoc Communications

11. Managing Diabetes: A Collaborative Effort
Measure..Analyze..Manage
Clinical Support • I have a prescription plan through Aetna Medicare.
• I take my medication daily on a regular bases and no
Self-management Support • I don't skip taking it and no i do not have side effects
•I try to exercise at least four or five time's a week
Peer & community Support • but I'm having a problem with my hips on my last visit
• to the doctors he gave me a prescription for celebrex
so I'm in hopes that this will help.
MANAGE (patient-centered & provider • As for counting carbs i try to keep this in mind when
eating but I’m finding that there are many contributing
connected)
•factors at work here
HCP can send message to Carl or a •I’m getting ready to shampoo the carpets and do some
painting- dose this count as exercise
group of patients
HCP can administer surveys WELLDOC COMMUNICATIONS | DIABETES MANAGER 1.0 DESIGN WIREFRAMES | JULY, 2008
READ MESSAGE FROM INBOX
Carl can message his HCP through the ^Previous Message Next Message v
Button 1 Anytime anywhere a
user selects a
REPLY
“catastrophic action”
Message SAVE MESSAGE
DELETE FORWARD REPLY ALL (ex. “DELETE”) A
Center
phone and or web
popup confirmation
dialogue Is fired.
Inbox Subject: Counting isn’t just for KIDS!!
From: Joanna Smith, CDE
Drafts
CC: Dr. Clough
Recieved: Mon 6/30/08, 4:30pm
Sent Items
Saved Items How2Count.pdf
Hey John,
Button 2
Content in this box
scrolls if too long.
Have you ever given any thought to the amount of carbohydrates in your
Button 3 Buttons at bottom
meal? stay within screen
height.
I’ve noticed that you’ve never entered a carb number in any of your
readings. Double‐click on the attachment above to check out some really
good reading material.
If you have any questions about anything, give me a call!
Sincerely,
Joanna Smith, CDE
1.800.HLTHWYS
Read Message: Patient
PAGE 17
MESSAGE CENTER 1.0
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March 2009 | © 2008 WellDoc Communications

12. Carl Learns Self-Management
Measure..Analyze..Manage
Phone Education
Web Education
CONFIDENTIAL 12
March 2009 | © 2008 WellDoc Communications

13. Managing Diabetes: A Collaborative Effort
Measure..Analyze..Manage
Clinical Support
Self-management Support
Patient Action Plan
Peer & community Support
WWDC Service
Click
Offerings
Click
MANAGE (patient-centered & provider
PCP Action Plan
connected)
WWDC Service
Click
Offerings
After 3 months on the system: Click
Patient Action Plan sent to Carl:
Outcomes
PCP Action Plan sent to health care
•A1c 9.2% improved to 6.7%
provider
•Weight lost 16 #
Preparation for MD visit done by Carl •No change in therapy
•Following medication regimen (self-
report)
CONFIDENTIAL 13
March 2009 | © 2008 WellDoc Communications

14. Why are We Doing all this
…and what’s next?
Engaging and empowering patients: “Thank you all so much for helping me get
my diabetes under control. I understand it better and know how to eat better. I
think when I started the study my a1C was 9.2% and now it is 7.2%! The program
was an eye opener and gave me good habits to keep up the good work! I'm a little
nervous being back out there on my own but all good things come to an end some
time. ….. Carl”
Supporting clinicians: “Last week I received HgbA1C results on one of my
toughest to control diabetics. Over the past five years I have attempted a
combination of encouragement, fear, threats, family conferences, and multiple
specialist referrals with little effect on his motivation. He and I are happy and
grateful to report his HgbA1C is down from an average of 11-13, to 7.5 after just a
couple of months in the study. I know I had mentioned in the past my skepticism
that a poorly compliant patient would not get much benefit, or sustain use of your
application, however, I must say I have only compliments from my experience so
far.” Dr.P
Improving Care through connecting clinical support, patient self-management, and
peer and community support
CONFIDENTIAL 14
March 2009 | © 2008 WellDoc Communications

15. Thanks!
Malinda Peeples, RN, MS, CDE
Vice President for Health Care Integration
mpeeples@welldocinc.com
443-692-3104
March 2009 | © 2008 WellDoc Communications