Physician entrepreneurship and app development: business model lessons. First given at Medicine 2.0 Meeting at Harvard Medical School September 15, 2012.
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Dyer Medicine 2.0 (2012)
1. Physician Entrepreneurship and App
Development:
How Did I Do It?
Medicine 2.0, September 15th 2012
Jennifer Shine Dyer MD, MPH
Physician, Mobile Health Entrepreneur
Duet Health LLC
EndoGoddess LLC
Columbus, Ohio
2. • Pediatric
Endocrinologist
• Health Behavioralist
(MPH)
• Problem-solving
technology
entrepreneur
• Social media
enthusiast
(@EndoGoddess)
28. Nationwide Children’s Hospital, 2009
80% of hospitalizations
due to insulin non-adherence
(140 total)
$10,000 each hospitalization
$1.4 million total cost
30. Fifth Third Bank: Diabetes
21,000 employees
30 kids with type 1 diabetes
420 adults with diabetes on insulin
$450,000/year extra annual costs
due to non-adherence
Adults with insulin-dependent diabetes (2% of total population)
Kids with type 1 diabetes (0.15% of total population)
10% of those on insulin therapy will have hospitalization ($10000 each) due to non-adherence
Sources: CDC, NIH, Fifth Third Annual Report
48. Competitive Analysis (US)
AgaMatri iGlucose Glooko Telcare WellDoc EndoGoal
x
Data
Management X X X X X X
Device
Connectivity X X X X
Guidance X X
Corporate
Wellness X X
Adherence X
Rewards X
I’m going to share the lessons that I have learned about entrepreneurship and app development with respect to business models.
This is PJ, a fantastic kid who I diagnosed with type 1 diabetes at 15mo and was lucky enough to get to see him every 3 months for his checkups as his endocrinology doctor. Who am I? 30-something physician first, behavioralist 2 nd , and mobile health entrepreneur.
I have long been concerned about how I can better motivate my patients. These life saving medications do not work unless patients take them. And fear, about death, does not always work to motivate, especially teenagers.
To motivate teens, I began texting them weekly. It worked to improve their diabetes care but solution not scalable and effect wore off…they needed more, they needed actual rewards. So I left medical practice to build the solution.
This is the first app that I made. Automated personalized SMS texting conversation by doctor to teen.
Building upon the lessons learned from the first app, I build a self entry glucose journal with itunes rewards and motivation quotes.
Recently, I build further upon the lessons learned with EndoGoddess App and released the EndoGoal app with the same foundation but new rewards and a new gamification digital pet feature.
Before starting the talk I’d like to clarify a few definitions. B to C business model and B to B business model.
I’d also like to clarify 4 ways to make money in the app business. First, one can make revenue by charging consumers for the app purchase in the app store.
Secondly, when the app is free for the baseline features, one can make money by charging a subscription model for customized app features.
Thirdly, when an app is free in the app store, one can make significant revenue when the baseline features are available for functionality but desired higher-level features require an in-app purchase. This is a popular source of revenue currently for many apps.
Finally, once a critical base of users is established, traditional internet advertising banners can be bought for display…particularly when the app is free. This, however, is not a popular choice when the app is purchased in the app store as users expect to not be exposed to multiple advertisers.
As mentioned earlier, to motivate teens, I began texting them weekly. It worked to improve their diabetes care but solution not scalable and effect wore off…they needed more, they needed actual rewards. So I left medical practice to build the solution.
A medical student and I created our first app together that automated the texting protocol that I initially used.
However, the effects wore off as I continued texting the teens. They needed more than once a week reminders, they needed more motivation, and they needed more support…they felt like their parents and friends really didn’t support them because they didn’t know how much work diabetes is everyday.
Motivation, Ability, Trigger….engagement theory for sustained behavior change with chronic diseases
Startup lifestyle
EndoGoddess App, released September 2011: more scalable and more motivating with points game and iTunes rewards
We followed the money and changed customer then focused on addressing business pain point with our solution. Let me explain.
Following the money: where is it all going? Hospitalizations
And the consequences of non-adherence to diabetes medications are expensive. Let me explain with actual data:
Non-adherence is expensive and businesses and families are the ones who are paying most of that cost.
Remember, that companies and private insurance are shouldering this cost, here is an example.
The Benfield Group LLC. Rememberitnow email reminder employee wellness program which started in 2010 may work for conditions where forgetfulness is a primary reason for nonadherence but this doesn’t work for diabetes. Employers motivated to decrease healthcare costs thus explains large increase in wellness programs over past several years. Sources: http://insight.milliman.com/article.php?cntid=7628?&utm_campaign=Milliman%20Homepage&utm_source=milliman&utm_medium=web&utm_term=home%20banner&utm_content=MMI http://www.huffingtonpost.com/2012/06/25/employee-health-incentive-benefit-survey-society-for-human-resource-management_n_1625978.html
Glucose checks alone correlate with good diabetes control (and insulin adherence). Glucose checks mean engagement. Given that glucose checks are a strong predictor for insulin non-adherence, improving this rate by X% is the core of the business model and we believe this will reduce hospital visits and reduce health care costs by Y%. The value of SMBG in insulin-treated patients with type 2 diabetes is unknown. Most observational studies and randomized trials have focused on patients treated with oral agents and have led to conflicting results ( 4 – 15 ). Despite the absence of consistent data, the American Diabetes Association recommends SMBG for “all insulin-treated patients with diabetes” ( 27 ). We conducted one of the few longitudinal studies that prospectively measured HbA 1c at different times after starting an intensified protocol, precisely ascertained compliance, and controlled for the effect of other variables affecting glycemic control. Our results support the American Diabetes Association monitoring recommendation because we found that intensified blood glucose monitoring resulted in significant and sustained reductions in HbA 1c in stable, insulin-treated subjects. This change was remarkable because study investigators did not provide subjects with any self-care recommendations, referrals, or treatment modifications. In fact, parallel changes were detected in prelunch and bedtime blood glucose readings even before subjects returned to download data from their blood glucose meters and first received summary time-of-day readings and interpretations.
We provide an effective solution designed by a doctor and behavioral research who knows diabetes and the importance of glucose checks: turnkey apple/android mobile insulin adherence/glucose checking engagement and rewards program specific for adults or children.
Maintaining BJ’s health behavior model principles but improving rewards to health savings accounts.
We provide an effective solution designed by a doctor and behavioral research who knows diabetes and the importance of glucose checks: turnkey apple/android mobile insulin adherence/glucose checking engagement and rewards program specific for adults or children.
Real rewards. Not only do you feed yourself but you feed Cooper too. Cooper is along for the journey. Your diabetes dog. Everytime you take of yourself you take care of Cooper. Engagement.
Nationwide would pay initiation fee then monthly user fee based on the number of users. They would also offer health savings account payment based on user engagement and adherence.
Long term focus for exit strategy: with revenues, crowdfunding, and angel investment we are planning to complete clinical trial testing of the app to prove beyond pilot studies that apps provide excellent platforms for behavior change that should be part of the healthcare ecosystem: both by doctor prescription and by insurance cost containment strategies. The only way to enter this arena is with evidence.
Growth: advertising
Growth: in app pharma purchases
Growth: increasing platforms with smart apps on dumb phones
Integration beyond web-based software.
Based on past experience with EndoGoddess App, developed EndoGoal. We provide an effective solution designed by a doctor and behavioral research who knows diabetes and the importance of glucose checks: turnkey apple/android mobile insulin adherence/glucose checking engagement and rewards program specific for adults or children.
Being a 30 something technology entrepreneur, I never went to school specifically for app making but find myself here solving human problems with human methods just by watching how technology integrates into mine and my patients lives…and you can and should do it too!