Smartphone enabled albumin screening Service proposal

January 2019 We will be able to routinely identify missed elements of pathways of care for individuals and ensure that those gaps are filled ” NHS Long Term Plan

Shift to community setting Healthy.io enables people to self-test in the comfort of their own home Patient safety Prevention Long term conditions Outpatient redesign With 42m urine tests undertaken by the NHS, urinalysis is the second most common diagnostic test. A&E demand reduction Shift to community setting

Smartphone enabled screening Healthy.io makes home albumin testing a clinical reality. Early intervention >1m people with undiagnosed Chronic Kidney Disease (CKD) Reduce health inequalities ACR testing is most often missed in at-risk populations Digital self-management Enable more people to take responsibility of own care Significant population health savings Cost savings of up to £461 per patient in previously untested patients

50% Clear guidance, but low compliance 30% 10% ACR tests reported in at-risk populations 50% Clear guidance, but low compliance of people with diabetes 30% NICE CG 182 and NICE QS05 define testing Albumin:Creatinine Ratio (ACR) in at-risk populations as critical from a clinical and cost point of view. of people with hypertension 11 million people in UK are at risk of CKD 10% of people with other risk factors Source: 2017 CKD Audit

‘Adherence as a service’: shifting testing from the clinic to the home Fully integrated digital ACR testing pathway GP practice just needs to provide a list of patients Includes app sent by SMS message and testing kit Interoperability and integration with EHR and clinical systems supporting HL7 & FHIR message types Already integrated to SystmOne and emis Onboarding, fulfilment and delivery services available

72% 11% 89% Improved adherence to testing Of consented patients completed the test 11% Of patients with new albuminuria detected Trialed across 10 Modality GP practices in Hull CCG and Airedale, Wharfedale & Craven CCG. Patients who had no previous ACR measurement reported in the last 12 months were given an option to receive a home albumin test. Test results were directly sent through SystmOne and reviewed by a clinician. 89% Of patients avoided a visit or lab testing

“ We have been able to identify cases of early stage CKD which may otherwise have gone undetected. Patients find the kits easy to use and welcome the convenience of home testing.” Dr. Ros Davies, Executive Partner, Hull Division

Reaching 30% of untested patients can yield £209m in cost savings over 5 years Results over 5 years for UK population (assuming 30% consent rate) Using Healthy.io's ACR home testing (previously untested population) Savings per patient £461 New CKD diagnosed 22,946 ESRD cases avoided 3,463 Deaths avoided 523 Total Costs Saved £209,445,072 Yorkshire and Humber AHSN commissioned York Health Economics Consortium (YHEC) to develop an economic evaluation cost-effectiveness model comparing Healthy.io’s albumin-to-creatinine ratio (ACR) self-screening test against standard care (SC) for the detection of albuminuria in people with diabetes or hypertension in the English National Health Service (NHS). The model uses data from the Modality Evaluation undertaken in GP practices in Hull and Airedale, Wharfedale and Craven CCGs.

Total Net Savings Cost and Savings of albumin service per CCG COST Avg. registered patients with DM (2018 National Diabetes Audit) 16,193 Avg. % uncompliant 34% Avg. # people eligible for home testing 5,506 % receiving enrolled in service (based on Modality evaluation) 32% # of people receiving home test 1,762 Cost per service delivery (incl. test, shipment and patient engagement) £12 Total cost per CCG £21,141 NET SAVINGS Year 1 Total Net Savings £26,427 Per Patient £15 ROI 125% Year 5 £812,179 £461 3,842%

Home based ACR testing solution for people with diabetes Enables self-testing to support self-care Improves access to preventative services  Promotes compliance with NICE guidelines Improves convenience and satisfaction for patients