Ueda2015 tupelo.nurses role in dm prevention dr.martyn molnar

May 2015

Validating the Nurses

Role in Diabetes Prevention

and ongoing Management

Martyn MolnarCEO

TupeloLife Corporation

Dr. Eric HazzardGlobal Life Sciences & Research

TupeloLife Corporation.

San Diego, California

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Synopsis

Based on Existing Research, Program Analytics and Work Streams

• Established intelligence with leading US universities (UC Davis, UCSD, Ca)

• Efficacy, Impact and change– witnessed thru NP engagement within Obesity, Hypertension, HIV Programs in California and Europe (Germany).

• Visibility of Sustainable returns from Programs executed in the last 12 months within the Middle East.

• Increased Adherence and Program engagement – due to personalization, education, monitoring, management and incentives towards agreed outcomes.

• Engagement scale – meeting program participants where they are at allowing them to “bring their own data” maximizing resources, applying the right cost to the context of care

• Extending the care continuum – Beyond the Clinic. Programs that impact the family and go straight to the home.

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How are we getting this done

Based on Existing Research, Program Analytics and Work Streams

School ProgramsCorporates

Tech Research

School ProgramsUniversity ResearchClinical Validation

Insurance CommunityNutrition Community

Study ObesityTechnology R&D

Schools Programs

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How are we getting this done

Based on Existing Research, Program Analytics and Work Streams

The big pictureEfficacy, Impact,Outcome..

Tunable,Repeatable..

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WHAT IS TUPELO?

Tupelo is an integrated, always-connected technology ecosystem enabling scalable, targeted, and proactive healthcare management for patients with complex, high-cost, acute and/or chronic conditions.

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TUPELO Model vs Other Models

Device

Data Interpreted

Shared

Elaborated

InformationExperienceConsumer

Data

Reactive, 15 % Participation

85 % Drop out Rate

Preventative, Adaptive, Individual, Scalable,Societal

Engaging (50% - 70%)

TODAY / EMPHASIS TUPELO / EMPHASIS

Insightful, Contextual, Actionable and Relevant Data

May 2015

Some clinical feedback

concerning Diabetes care

and management

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Overcoming ‘Doctor Inertia’, limitations of ‘Apps’ and Upfront Cost

Need a combination of Self Management and Clinical/Doc Intervention

• TECHNOLOGY – 1000’s Apps focused on Management. Low single digit % utilization.

• SELF MANAGEMENT – Not everyone wants this immediately. TECHNOLOGY serves to move patients into an uncomfortable space too quickly. Cultural dynamic.

• COSTLY – Costs are bourn upfront and take valuable clinical resource out of budgets. Limited returns result as a result of #2

• STANDARD PROGRAMS – not meeting the need. Shortage of resources, Doctor being the bottleneck/point of inertia. ( Clinic AMS : 4 Visits Per Patient Per Year ). What happens between visits is not being captured.

• 75% – of Checks could be administered by Nursing Staff and should be carried out more frequently. (Cardio; Bloodwork; Exercise; Weight; Nutrition; Rx feedback)

• Overcome – Increase frequency of interaction, engage Doctor at critical point of care, keep data always on hand, know when there is a patient disconnect. Migrate to a Bi Weekly (real time – evidence/data based) engagement setting from quarterly retrospective.

May 2015

Study Proposal

Engaging Nurse Practitioners and

Real time data capture strategies to improve

Diabetic care outcomes

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Program Attributes

Study Features:

• Patients (n=1,050) randomized into one of three groups

• Nurse Health Coaches (n=30) randomized into one of three groups

• Nurse Health Coaches receive either standard program training or telehealth program training (there will be no differentiation between telehealth training for unscaled or scaled)

• 6 months program length

• Outcomes metrics include:

• BMI• A1c• Weight• Waist circumference• Blood pressure• Cholesterol • Physical activity goals• Nutrition goals

• Satisfaction with Care• Self-efficacy score• Knowledge• Engagement level• NHC satisfaction and utility rating• Cost per person• Estimated cost savings

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Nurse Practitioner EngagementStudy Design: LifePlatform NP Program vs Standard

Study Aim: does a LifePlatform NP program (unscaled or scaled) outperform a standard program on the following outcomes?

1. Patient clinical indicators

2. Patient goal achievements (weight loss, physical activity, nutrition)

3. Patient self-efficacy

4. Patient satisfaction,

5. Nurse Tool set satisfaction and usability

6. Cost effectiveness (↑ NP:Patient ratio).

7. Doctors time effectively servicing patients

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Pursued OutcomesStudy Design: Combined NP and RT Programs/Devices LifePlatform vs Standard

Analysis-

• Standard inferential statistical analyses will used to compare differences between and within groups

• Cost effectiveness will include predicted and actual cost savings based outcomes

Standard NP Model Un-scaled NP Model Scaled

Clinical Outcomes↑

↑↑↑ ↑↑↑

Patient Goal Achievement

- ↑↑↑↑↑↑

Patient Self-Efficacy - ↑↑ ↑↑

Patient Satisfaction ↑ ↑↑ ↑↑

Nurse Health Coach Satisfaction and Usability Rating

↑ ↑↑↑ ↑↑↑

Cost effectiveness* ↑ ↑↑ ↑↑↑

Physician Servicing ↑(50%) ↑↑(20%) ↑↑↑(20%)

*NP scaled model will be 50% more cost-effective than NP unscaled

Predicted Results -

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Nurse Practitioner : ValidationStudy Design: LifePlatform vs Standard

Study Design: Patient and NP, Three-arm Randomized Controlled Trial

Type 2 Patients

Standard

Program

(1:30)

LifePlatform NP

Program (1:30)

LifePlatform NP

Program Scaled

(1:45)

Ra

nd

om

ize

d

Nurse PractitionersRando

miz

ed

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Program Structural Differences Study Design: LifePlatform vs Standard

Standard Program VS.

• Periodic Check in (Dr)

• Goal Setting (non incentivized)

• Periodic vitals capture

• Advice line and possibly email (Dr/NP)

• Website / Generic Content access

• Structured In-person education classes

• Generic Information for the masses

• Low structure and Information search and relevance for Doctors to make an assessment

• Administration intensive

• No Tech

LifePlatform NP Program

• Weekly Call/Video call with NP (billable in India)

• Goal Setting (incentivized outcomes) enhanced by health platform and devices

Badges, Social media, outcome tracking

• Real time information

• 24/7 advice line and email (NP)

• Customized education content and tracking of engagement (NP)

Automated by health status or program

• Personalized messaging, alerts, and notifications (NP)

• Nurse portal and analytics to manage and monitor caseload efficiently and effectively

• Highly Structured information and patient relevance –timely presented

• Administration limited

• Technology (Home tablet, mymo activity tracker, BIA weigh scale, Smart phone app, web portal, SMS )

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Nurse CoachingNurse Coaching Programs

Specific Roles of Nurse Practitioner (NP):

1. Providing self-management support – NPs will:1. provide information, 2. teach disease-specific skills, 3. promote healthy behaviors, 4. impart problem-solving skills, 5. assist with the emotional impact of chronic illness, 6. provide regular follow up, and 7. encourage people to be active participants in their care.

2. Bridging the gap between physician and patient – NPs can bridge gaps by following up with patients, asking about needs and obstacles, and addressing health literacy, cultural issues and social-class barriers.

3. Helping patients navigate the health care system – NPs can help coordinate care and advocate for their patients.

4. Offering emotional support: – As trust and familiarity grow, NPs can offer emotional support and help patients cope with their illnesses.

5. Serving as a continuity figure:– NPs connect with patients not only at office visits but also between visits, creating familiarity and continuity.

May 2015

Study Proposal

Technology Framework : Facilitation

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Technology EcosystemTupeloLife Platform Overview

Features:

• Personalized Tech System for each Patient based on Treatment Plan

• Integrated real time data collection from Devices (incl. 3rd party) to allow for Meaningful Remote Monitoring

• Easy-to-use, Useful, and Engaging NP and Patient Portals to Communicate and Manage Information

• Remote/Virtual consultation options (Video Call, etc.) – Real time msgs

• Non Smartphone dependent

• Automated Reminders and Alerts to promote Compliance, Adherence, and Increase Effectiveness and Efficiency of Patient Management – Incentive rich to encourage rather than enforce Adherence

• Nurse as an Educator and content distributor

• Powerful and Practical Analytics Geared at Outcomes

• Timely, relevant information flow for engaging Physicians

NP Tupelo Health Cloud and Software

Patient, Devices, &

Portal

May 2015

Thank you