Mobile Care for Chronic Conditions Presentation to: Wireless Future of Health IT G-106, Dirksen Senate Office Building March 23, 2009 BeWell Mobile Technology, Inc.

BeWell Mobile Technology, Inc. March Agenda BeWell Mobile Overview Mobile Disease Management Platform Mobile Disease Management Case Examples Asthma Diabetes Economic Possibilities

BeWell Mobile Technology, Inc. March History - BeWell Mobile Incorporated in 2004 Healthcare, software, behavioral science and telecom experience Disease management, wellness & research applications Winner of Industry Awards 2008 Agency for Healthcare Research and Quality Innovation Award 2007 Wireless Reach Award by Qualcomm 2006 ABBY Award for Innovation in Healthcare

BeWell Mobile Technology, Inc. March BeWell Mobile Delivers Value BeWells health management applications increase patient compliance and adherence to therapeutic regimen leading to improved health outcomes and reduced costs of care.

BeWell Mobile Technology, Inc. March Focus on Chronic Disease and Wellness Chronic Disease Management Asthma Diabetes Hypertension Heart Disease Chronic Obstructive Pulmonary Disease (COPD) Depression Wellness Applications Smoking Cessation Weight Management

BeWell Mobile Technology, Inc. March Chronic Disease Prevalence and Costs Share of $1Tr US Health Care Spend Prevalence of Chronic Disease Johns Hopkins

BeWell Mobile Technology, Inc. March Patient Non-Adherence Increases Costs 1/3 of patients take all their medications Drugs dont work in patients who dont take them. – C. Everett Koop, MD 1/3 take some 1/3 may not even fill their prescription Researchers estimate that non-adherence to prescribed medical regimen costs the US health care system about $100 Bn annually

BeWell Mobile Technology, Inc. March BeWell Mobile – Focus on Adherence Real-time feedback Motivation Easy-to-use tools Social support Medically relevant information Behavioral skills Behavioral change

BeWell Mobile Technology, Inc. March Patient is prompted to follow regimen 4. Patient uploads data BeWell DM Platform 3. Instant Reports and automated feedback 5. Provider/Case Manager reviews Results / Reports BeWell Patient Experience Patient Interface Records relevant health data Educates patient Improves self management Provider Interface Real time access to actionable health information Fine tune care plan between clinic visits 6. Secure Patient Feedback & Communication 2. Patient records data

BeWell Mobile Technology, Inc. March BeWell Diabetes Diary - Patient Interface Example 3 Follow Up Question 2 Provide Instant Feedback 1 Record Outcomes 4 Automated Instant Coaching

BeWell Mobile Technology, Inc. March Mobile Disease Management Case Studies Asthma Diabetes

BeWell Mobile Technology, Inc. March Asthma – Prevalence and Treatment Asthma Prevalence: Most common chronic disease among children (NCHS, 2006) 12% of children are diagnosed with Asthma (NCHS, 2006) Asthma is Treatable: Anti-inflammatory medications (inhaled corticosteroids, leukotriene inhibitors) Bronchodilators (methylxanthines, long-acting beta-agonists) Rescue treatments (systemic steroids, short-acting beta-agonists) Asthma goes Untreated in Children: 74% of children with moderate to severe asthma in a national sample did not receive adequate treatment (Halterman et al., 2001) Minority children are less likely to receive adequate treatment (AAFA, 2005) Cell Phone Penetration: 85% of individuals aged 7 to 26 in the US already have cell phones

BeWell Mobile Technology, Inc. March Mobile Asthma Management in Urban Youth CustomerSan Mateo Medical Center ProgramMobile Asthma Management Background Patient ProfileAged years old, urban, uninsured Diagnosis criteriaSevere and persistent asthma Time period2 years Average Duration8.2 months per patient Application languagesEnglish and Spanish Results Adherence to regimen95% Loss of school days due to asthma0 Mobile phone usability95% Patient satisfaction rate95% No current mechanism for Medicaid Reimbursement

BeWell Mobile Technology, Inc. March Diabetes – Prevalence and Costs Diabetes Prevalence : 5.6% of all Americans are diagnosed with Diabetes (ADA) 20% of people 65 have Type 2 Diabetes (CDC) Diabetes Costs of Care : $11,744/patient per year in 2007 (ADA) Nearly 20% of US Health Care Costs Blood Sugar Control and Medication Adherence Reduces Cost of Care : Medical Care Charges increase significantly for every 1% increase above HbA1c of 7% (T. Gilmer; Diabetes Care, Dec 1997) Every 10% increase in Medication Possession Ratio accounts for a 8.6% % reduction in annual care costs among Type 2 diabetics (R. Balkrishnan, et. al., Clinical Therapeutics, 2003) Diabetes Self Management : Expert agree that diabetes is a disease for which 95% of the care lies with the patient (S. McLaughlin, DQIP, Diabetes Spectrum, 1997) Only 2% of Diabetics strongly adhere to treatment regimen including testing, medication and diet (Beckles GL, et al.) US Cell Phone Penetration: 87%

BeWell Mobile Technology, Inc. March Mobile Diabetes Management No current mechanism for Medicare Reimbursement ClientLarge Medical Center ProgramMobile Diabetes Management Background Patient Profile Aged 17 – 75 years with Type 1 or Type 2 diabetes Diagnosis criteriaPoorly controlled blood sugar levels Application languagesEnglish and Spanish Duration21 Months (average of 6 months per individual) Results Overall resultsImproved blood sugar control Quicker intervention Real-time medication/insulin adjustments AdherencePatient participation rate = 83% Utilization rate = 2.1 blood glucose outcomes recorded per day Outcome resultsLowered HbA1c by 0.91 points for patients with starting HbA1c between 8% and 9% Lowered HbA1c by 2.22 points for patients with starting HbA1c 9% Reduced blood sugar range (low to high) by 50 mg/dl between first month of service and the last month of service Patient satisfaction rateThe program received a patient satisfaction score of 3.8 out of 4

BeWell Mobile Technology, Inc. March Cost Savings Example – Diabetes Improved blood sugar control leads to lower costs of care (Gilmer et al.) Average care costs for Diabetics in 2007: $11,744/patient/year Predicted impact of a 1 percentage point reduction in HbA1c % of costs associated with 1 point change in HbA1c: 10% Predicted annual reduction in cost of care: Program participants with HbA1c 9% Lowered HbA1c levels by 2.22 percentage points % of costs associated with change: 22.2% Predicted annual reduction in cost of care: Program participants with HbA1c between 8% - 9% Lowered HbA1c levels by.91 percentage points % of costs associated with change:9.1% Predicted annual reduction in cost of care:

BeWell Mobile Technology, Inc. March Costs of Care Estimated annual costs of care for diabetics with HbA1c 9% per 1 Million population

BeWell Mobile Technology, Inc. March Improved Health Outcomes Predict Reduced Costs Potential annual costs savings for diabetics with HbA1c 9% per 1 Million population

BeWell Mobile Technology, Inc. March BeWell Mobile Disease Management - Summary Demonstrated Results Adherence Health Outcomes Promising Economic Benefits Support from Medicare & Medicaid could help translate this potential into sustainable long term health and economic benefits