Why Welkin’s Case Management Software?

Supporting patients can be complex. Their acute or chronic illnesses may need care coordination across services.

In comes the case manager.

Patient case managers connect patients to services and resources to better understand and manage their illness, avoiding unnecessary hospitalizations for improved, cost-effective health outcomes.

Case managers can find and communicate with endocrinologists and ophthalmologists for patients living with diabetes. They work with renal specialists and mental health services on behalf of members suffering lupus. They direct members to disease management programs for education tools, and identify the social and physical determinants derailing patient therapy adherence. Hastening patient speed to therapy, case managers find financial programs for patients who need assistance paying for medication and address reimbursement issues.

Coordinating fragmented services for high-risk members, who may be dealing with multiple complex conditions, can be a lot to manage. So how can case managers effectively support 150 patients, ensuring no one slips through the cracks? Who supports case managers while they support patients?

Why case management software?

To best oversee the patient journeys of a large pool of members, case managers need to rely on good software. Innovative software reduces ambiguity and time waste by creating a rules engine to guide managers through their patient workflow. Configuring software to prompt patient communication, which records all data and interactions for consistent messaging between care teams, case managers know their patients are receiving the steady support they need.

In value-based healthcare, it is necessary to anticipate problems before they happen and take preventative approaches towards case management. In order to do this, case managers must respond to the underlying data in front of them to see the potential problems before they occur.

Traditional case management software is not designed with proactivity (or healthcare) in mind. It equates people to tickets. It doesn’t recognize opportunities for patient intervention, nor alert case managers when specific people need attention. The dashboards reflect some “ticket” data, rather than the scope of the person’s care. The instinct for this software is designed to close tickets over a short period of time rather than proactively manage patients over an extended period. Welkin is different.

Welkin’s solutionWelkin first centralizes all patient data into one place and then puts rules on top of it that govern the when, why, and how of a case managers work with patients. Situations like “if we receive a denial request, then do X, Y, and Z” or “if this patient has an ER visit, then do the following” are the lifeblood of Welkin’s inbox. It is this inbox / rules engine that allows us to encode proactive healthcare into a format that’s doable for case managers. It’s not uncommon to hear quotes from case managers on our platform like:

“Lots of times when I contact a patient from Welkin they say they appreciate us being proactive in our communications and they like being able to reach us when needed.”

“Helps me everyday to provide better service to each patient I speak with by tracking my calls and letting me know when it is time to check in again.”

 “Looking back at previous data has allowed us to focus on when they got relief and circle back to optimize that area.”

After creating the rules that govern a case managers interactions with patients, Welkin is able to centralize all communication and workflow into a single place, often consolidating multiple pieces of cobbled-together tools into one extremely useful piece of software. This patient profile, for example, is the only view that other case management software typically provide, and alone is insufficient to handle the complexities of healthcare.

Unlike traditional case management software, Welkin does not focus on configurability at the user interface level, and instead focuses on configurability at the workflow level. This matters. Given our already best-practice UI, we can cut down on configuration costs dramatically and increase speed to deployment for our customers.

Moreover, the intense level of configuration on workflow and business process allows us to tailor our software to a variety of situations. This is paramount for healthcare organizations using a complex process to ensure that no patient falls through the cracks. The benefits of using software actually designed for healthcare is that their needs have already been considered, like compliance support, and implementation specialists who are experts in domain-specific workflow design.

Welkin understands the complexity of patient management, and the need for a software solution that meets these intricacies so that case managers can focus on what matters most- patient care.

Patient Assistance Programs: Getting Medications in the Hands of Patients Who Need Them, Part Two

Last week, we examined Patient Assistance Programs (PAPs) and the need for financial relief for people buying prescriptions. This week we conclude our two part exploration of PAPs by identifying resources for patients.

Assistance identifying PAPs

One reason patients do not utilize pharmaceutical assistance is because they simply don’t know that it’s an option. Patients are reluctant to discuss their fiscal constraints with their doctors, missing an opportunity to learn about financial relief programs for medications. If patients don’t know such programs exist, they don’t apply for them.

There are nonprofit organizations whose sole purpose is to connect patients with medication that is otherwise unaffordable. They vet medication assistance programs for which the patient may qualify, and find cost-abating resources to relieve some or all of the prescription price tag.These organizations help patients beyond the cost-burden of their chronic disease; they guide patients through a very stressful, confusing time in which individuals and families may have to choose between their bills and their health.

These organizations include:

• The Patient Advocate Foundation– the PAF hosts a National Financial Resource Directory for patients struggling with medication costs, as well as the other social determinants which cause financial insecurity for patients, such as housing, transportation, food, etc. The PAF isolates financial assistance for insured patients with out of reach deductibles and copays, as well as grants for certain medical procedures and treatments and the nonmedical expenses related to them.
• NeedyMeds– a clearinghouse for patient assistance programs and medication information, they also offer a free drug discount card. Their website assists users in finding information on PAPs and healthcare costs.
• RxAssist– “The Web’s most current and comprehensive directory of Patient Assistance Programs”, their database also keeps information on medication discount cards.
• Partnership for Prescription Assistance– PPA is an industry-sponsored nonprofit which assists uninsured or underinsured patients in finding prescription drug subsidy programs, as well as low or no cost health clinics.

 

Copay cards and coupons

In addition to PAPs, there are other resources for patients. Some drug companies also disperse copay cards to lower out-of-pocket costs for financially insecure, commercially insured patients with high-deductibles, or expensive coinsurance. Copay cards come in fixed amounts which patients pay towards the prescription. Sometimes companies change the fixed amount their copay card covers, a possible financial shock which patients may not have planned for. A case manager or patient services advocate managing the patient’s prescription assistance might be able to anticipate the new cost-burden for the patient.

As of August 9th, New York became the first state to offer a copay program for all insured residents (including Medicare and Medicaid) for Naloxone regardless of prescriptions, in an effort to combat the deadly opioid crisis. The state provides up to $40 copay assistance for the medication which reverses overdose effects. The average copay is $10, but most people pay $0 for the drug. New York City police officers began carrying Naloxone in 2014, trained to auto-inject the medication in cases of emergency. Since that time, the NYPD has administered the drug to over 3,100 citizens, saving 90% of them. Now that New York state has made it easier to get the drug in hands of the people who need it, that number should grow.

Many pharmaceuticals have coupons or rebates (usually for brand-name drugs) to ease the financial strain of consistent medication. Using database’s like NeedyMed can help find offers by searching the prescription. Most consumer drug spend is based on the list price, not the reduced price an insurer or pharmacy may pay. Using the copay coupon can reduce this fiscal burden because of the fixed amount. Consumers can use sites like GoodRx to compare pharmacy costs of medication and find coupons to choose the most strategic place to purchase. If covered by Medicare, Medicaid, or other federal or state insurance programs, patients are ineligible for coupons.

Conclusion

Brands who help their patients obtain the medication they need, diffuse the stress that often accompanies this process, and who find economical solutions, create lasting relationships with their consumers. Companies, patient advocates, and consumers can all agree,getting necessary medication to patients who need it, without creating a monetary strain which would prevent them from adhering to their prescribed regimen, is most important.

Patient Assistance Programs: Getting Medications in the Hands of Patients Who Need Them, Part One

This week, we explore the importance of Patient Assistance Programs (PAPs) in the first of a two part blog series identifying financial resources for patients, and the reasons they need them.

The patient journey can be a long and frustrating one, particularly for those with rare diseases who can wait an average of 7 years for a diagnosis. But for some, prescriptions are not the conclusion of their hardships, but the beginning. Where can patients with diseases and their families turn when their prescribed medications are beyond their means?

Patient Assistance Programs

Run as charities by pharmaceutical companies, Patient Assistance Programs (PAPs) offer free or discounted medications, usually for one year, to uninsured or underinsured US citizen who can demonstrate physical and financial need. Programs vary, but generally,  a household income which lingers between 250% and 400% at or below the federal poverty line is eligible. Once approved, the medication relief usually lasts one year. Depending on the pharmaceutical brand, each drug under the company’s umbrella may have their own PAP eligibility and application requirements, which can feel daunting to a patient in need. Each program differs in regard to Medicare enrollees, though many will at least accept patients enrolled in Medicare Part D. Eligibility requirements per drug can be found on Medicare’s website. However, enrollees of Medicaid and Veterans Administration Benefits are ineligible for assistance.

Many major pharmaceutical companies have developed patient assistance charities to get their therapies in the hands of people who otherwise couldn’t afford them. The brands “donate” medications to the nonprofits, who then dispense the treatments to the approved patients who’ve been accepted to receive it. Unfortunately, these programs do have a finite patient membership for whom they can grant medication. Notable PAPs include Lily Cares Foundation, a charity which distributes medications by Eli Lilly and Company; the Johnson & Johnson Patient Assistance Foundation, which provides patients and hospitals with free therapies from Johnson & Johnson operating companies; and the Merck Patient Assistance Program gives free prescription drugs to patients who qualify.

The cost-burden of disease medications

In the 2016 report “The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey”, 52% of the 1,200 people surveyed report struggling to pay for prescriptions. The report reveals that 43% of insured policy holders unable to afford their medical bills “say there was a time in the past year when they or a family member did not get a recommended medical test or treatment because of the cost” and 41% of the insured participants with medical debt opted not to fill a prescription in the last year because the cost was too high, resulting in therapy nonadherence.

Even when medication is cost-effective, patients may still face high deductibles, expensive copays, and coinsurance which keep therapies out of reach. Nearly half of American workers had high-deductible plans last year, whereas 10 years ago that number was under 10%. Policyholders paid an average deductible of $2,241, and families an average of $4,343 before their insurance would cover health costs, not including copays.

Another reason for the payer cost-burden is the rise in medication pricing—prescription drugs have gotten increasingly expensive in recent years. Prescription spend for Americans younger than 65 years is expected to increase by 11.6 % in 2017, and by almost 10% for Americans aged 65 years or older. Drug costs for Americans younger than 65 years are expected to go up by 11.6 % in 2017, and by almost 10% for those aged 65 years or older.

Specialty drug cost spend in 2017 will increase to 35%, despite representing only 1% of medications, a 10% increase from 2015. The 2017 Segel Health Plan Cost Trend Survey reported “Between 2013 and 2014, actual drug cost trend nearly doubled from 5.5 percent to 10.7 percent, primarily because of the launch of new specialty drug options and brand-name drug price inflation. This was the largest single-year increase in actual prescription drug cost trend ever reported by the Segel Health Plan Cost Trend Survey.”

Patient support for improved adherence

Complications along the patient’s journey can impact therapy adherence. Average adherence rates for patients suffering rare diseases hover between 58-65%. When medications are too much of a financial strain, patients are sometimes forced to choose between their therapy and the other costs of living, or even bankruptcy. This can result in poor adherence and medication hoarding. According to a 2016 Quintiles/IMS report, patients who haven’t reached the deductible for their health plan “abandoned about one in four of their brand prescriptions.”

The best way brands and patient advocates can ensure positive patient outcomes is to champion them at the earliest possible stage. It’s proven that support systems improve activation, adherence, and benefit patient outcomes. Patient services can be a major part of this support  by providing disease education and therapy information to patients, as well as investigating and removing roadblocks to therapy, such as finding solutions for cost-prohibitive prescriptions tao ensure adherence. Some healthcare professionals are even receiving training to advocate for patients and help them through complicated financial challenges related to treatments. Guiding patients to medication assistance drives both patient and commercial success.

Stay tuned…

Next week we conclude our two-part exploration of patient assistance programs as we delve into PAP resources for people in need.

 

 

 

 

 

 

 

 

 

 

Partner Spotlight: Community Health Center Network Expands Accessible Healthcare to At-Risk Populations in the East Bay with their Care Neighborhood Program

Welkin Health partnered with Community Health Center Network (CHCN) last September, but the Community Health Center Network has been making an impact on communities long before that.

CHCN is a “Medi-Cal managed care organization” which contracts in the interest of eight satellite health centers. These centers merged together as a network in 1996 to create a solution to the problem of limited healthcare access affecting underserved populations in the East Bay.

Located in Alameda County, CA, CHCN identifies at-risk candidates in vulnerable communities, assesses their needs and limitations, and provides quality health services for these populations. In tandem with their sister organization, the Alameda Health Consortium, CHCN provides physical, behavioral, dental, and preventive health services to more than 130,000 people in over 90 locations. Each of the eight centers is sensitive to linguistic and cultural differences and barriers to care and services, and helps patients access affordable health insurance and publically-funded medical programs.

A new partnership

CHCN and Welkin Health’s partnership was announced at last year’s Health 2.0’s conference in Santa Clara. CHCN was one of four 2016 finalists for Technology for Health Communities, a program which helps underserved communities utilize technology to improve health outcomes. Technology for Health Communities pairs groups serving vulnerable people with digital health organizations, which then initiates pilot programs to target population health risks and establish lasting “commercial models” for improved health outcomes across that community.

The partnership, which was initially incorporated into three or the eight CHCN health centers, has expanded across the entirety of their network. Integrating Welkin’s configurable case management platform into their Care Neighborhood program, CHCN maximizes patient outreach and care coordination in the East Bay, guiding at-risk populations to the right medical and community resources.

Sustaining meaningful connections with patients

Poor health outcomes are not necessarily predetermined; they can arise from a confluence of resource insecurities. In the press release announcing the partnership, Welkin Health CEO and co-founder Chase Hensel explains that “‘CHCN serves patients whose needs are complex. These individuals are among those facing the most risk due to social determinants beyond their control…Our platform will create more pathways of communication between CHWs and patients, help to streamline workflow and provide the ability to capture critical data about this population in the hopes of improving the health outcomes in these communities for the long-term.’”

Welkin’s software helps CHWs in their Care Neighborhood initiative create and sustain meaningful connections with patients. They follow the platform’s workflow to remotely connect with patients and help them manage the factors which affect their health, including medication adherence, food and transportation insecurity, nutrition and lifestyle. The steadfast CHWs work to make every resource accessible to vulnerable patients, to collaborate with peers embedded in other health centers and find solutions which make cost-effective healthcare within reach, for a measurably improved quality of life.

Care Neighborhood is a case management and care coordination program for high-risk populations to empower patients to better manage their chronic conditions, while reducing healthcare costs and bettering patient outcomes.

Their services include provider relations management, claims, and patient reviews- all of which can be captured in the case management platform. Their health centers share resources and data, amassing collaborative patient information. This data aggregate helps CHCN identify gaps in care and better patients services, thereby improved patient health.

Iteration and optimization fosters scalability

On Thursday, 7/27, CHCN graciously allowed a small contingent from Welkin to attend their new feature request rollout and training. Customer Success team member Allison Mateo gave a detailed features demo to their community health workers (CHWs), answering questions and guiding them through the software updates configured to meet their complex but specific case management needs. Following the training, the Welkin group enjoyed the opportunity of observing the CHWs run through an actual (PHI-protected) case using Welkin’s software, to witness first hand how their platform is making an impact on CHCN’s Care Neighborhood program.

Looking towards the future

Next month marks the one year anniversary of the partnership between Welkin Health and CHCN. As CHCN expands their outreach, fostering a healthier, better informed community through their network resources, Welkin will continue to support their complex needs so they can focus on what’s really important- their patients.

Dispatches from the 4th Annual Patient Support Services and HUB Design Summit

This week, World Congress’ 4th Annual Patient Support Services and HUB Design Summit convened in Philadelphia. The Patient Support Services and HUB Design Summit explores the benefits and strategies of integrating value-added hub and support services in an erratic era of healthcare.

The summit spanned two days, hosting more than 30 speakers to discuss a variety of the facets involved in patient-centric care and hub performance in our current healthcare climate.

Welkin Health’s CEO Chase Hensel attended the conference to participate on a panel entitled “Leverage Patient Centered Solutions Through Value-Added Services Which Engage Patients and Enhance ROI”. Chase was joined by Jennifer Doyle of Horizon Pharma, Kristen Magee from AssistRX, and Chad Woods of Sandoz, moderated by Cardinal Health’s Jesica Freeman.

Chase spoke on the opportunities for drug manufacturers to work with software companies to integrate their third party providers to create a unified experience for all stakeholders, as well as common pitfalls to avoid when implementing and running patient services programs.

“It is possible to provide seamless transitions for the patient as they navigate their access journey. By integrating data and systems you can dramatically increase speed to therapy and improve your understanding of what’s happening with patients,” Chase remarked.

“The name of the game”

“It is very clear that patient-centric services is the name of the game and stakeholders are positioning themselves to provide optimal patient experiences,” Chase said about the Summit. “There is a clear priority on streamlining the patient experience.”

Many of the panel discussions at the Summit paid special attention to the patient journey as critical to understanding the initiation of therapy and finding the gaps in care to optimize services, improving access, and speed to therapy. One panel heard patients’ testimony on their journeys involving specialty drugs and pharmacies, and descriptions of their hub concerns.

Others explored the new shift to patient-centric care- the increased cost-burden to patients, education and advocacy, and the patient perspective in terms of value-based care. Patient services using a customizable case management platform can smoothly guide patients past channel and access roadblocks to obtain therapies and empower them to best manage their diseases.

The “Leverage Patient Centered Solutions Through Value-Added Services Which Engage Patients and Enhance ROI” discussion examined how manufacturers can wield value-added services to engage patient populations on their journeys to optimize outcomes, both for patients and manufacturers’ ROI.

In the Keynote Stakeholder Roundtable discussion “Internal Big Picture: Explore Strategies Used to  Ensure Patient Centricity Through Hub Design Channel Optimization, Compliance, and Distribution”, Eric Baim of Shire, Donna Gilbert of AmerisourceBergen, and Christopher Grant of Quest Diagnostics debated patient service compliance, supply chain and network design and channel optimizations, and patient services perspective, respectively. Their conversation revolved around Hub design for integrated market access which stays patient-centric while respecting compliance and maximize channel efficiency.

Strategic data

When asked about stakeholders’ priorities, Chase responded “it appears that having access and insight into all of the data around hub services is everyone’s primary concern.”

Some Summit panels considered data planning, such as Tuesday’s “Uncover Data Strategies and Best Practices Behind Successful Hubs”. Maria Bucceri Kirsch of Novartis and Maureen Espensen Formerly with Marathon Pharmaceuticals discussed strategic hub design and performance expectations for optimal outcomes.

The “Data Driven Service Design: Improving Hub Services and Outcomes Through Emerging Analytics” discussion delved into hub patient analytics as tools to better understanding their consumers, and how brands can use these insights to better patient engagement and experience.

As political and market forces influence healthcare, manufacturers will need patient data to demonstrate their value and ensure relevant products and services. Integrating an elegant software solution which manages complex workflows, the aggregation and centralization of data, and guides patients through a potentially arduous journey positions brands for success when the market  is uncertain. An agile patient support and case management platform unsnarls the tangle of complicated healthcare intricacies, and offers seamless transitions onto therapy.

This time next year

Successful patients hubs have proven to be an effective platform for increased therapy access and bettered patient outcomes, as well an opportunity to collect actionable data for manufacturers to take back and hopefully execute on. Healthcare might look different this time next year, but a 5th Annual Patient Support Services and HUB Design Summit seems inevitable.

The Need for New Medical Technologies to Create a Reimbursement Roadmap

The ACA remains viable this week, after the latest effort to repeal and replace Obamacare was thwarted by the Senate. The rejection of the most recent ACA replacement iteration was met with relief by many for myriad reasons (resulting in an abysmal CBO score), some of which include increasing the amount of uninsured Americans by 22 million, the gutting of Medicaid by $772 billion over the next ten years, and an undersized budget for contending with America’s opioid epidemic.

During these partisan healthcare reform efforts, medical device therapies face uncertainties and hardships when introducing products to market. Payment and reimbursements for new devices are bound by rigorous process restraints, which could stall utilization if coverage becomes limited and cost-sharing becomes too great a burden for payers.

To position their product for universal adoption and commercial success, brands must create a thoughtful blueprint aligning FDA approval, clinical data, and plans for timely payment very early on in their device’s inception, and implement the three-pronged requirements of reimbursement. Establishing a commercialization roadmap for a new or improved medical technology which includes payment and reimbursement design jockeys brands for quicker approval, adoption, and sales growth.

The necessity of strategy

Despite what some companies might mistakenly assume, creating an effective and innovative therapy approved by the FDA isn’t the starting point for widespread utilization; strategic reimbursement planning should be rooted before FDA approval. In doing so, medical devices can immediately initiate sales following the conclusion of the regulatory approval process, or in some cases guarantee a higher level of reimbursement than comparable therapies in the marketplace.

Delaying reimbursement consideration can result in negative consequences, such as prolonged remittance and stunted utilization. Therapy efficacy alone is not enough to ensure reimbursement; a new technology is not necessarily reimbursed for a greater amount, or sometimes even covered at all by private insurers and Medicare. A successfully executed reimbursement pathway can take as long as years, so manufacturers need to draft a game plan for payments sooner rather than later.

After working with the FDA to craft use phrasing for coverage, device manufacturers address the concerns of policymakers and payers. In concert with reimbursement planning, evidence of positive outcomes should be accepted from the medical community to ensure coverage, proper coding must be assigned, and payment design mapped out.

This is the three-pronged attack of reimbursement strategy: 1) coverage 2) coding 3) payments. Supported by clinical outcome data, these considerations must comprise the critical planning for medical device market success.

Coverage challenges

Depending on the therapy, coverage challenges can look a bit different but the goal is the same: universal coverage. “Coverage” applies to the terms in which private payers and the Centers for Medicare & Medicaid Services (CMS) will remit payment for devices.

Medicare addresses coverage using a National Coverage Decision (NCD). An NCD will only cover a small population of new technologies which are not currently defined by regulations but have amassed a large amount of clinical data. In the absences of an NCD, Medicare contractors can opt for Local Coverage Decision (LCD) considerations for devices which do not fit into established regulations.

The importance of coding

Coding is the universal language spoken by CMS, payers, physicians, and facilities. A therapy’s code denotes payment, and without it payment and reimbursements cannot be rendered for the device. Codes are alphanumeric and generated to indicate services for claim forms. Ideally, new devices can use an existing code for claims, but sometimes they will have to obtain a new one.  

Payments

Value-based reimbursements and patient-centered care are changing the healthcare landscape, including therapy pricing internalizations. Devices must prove effectiveness, in conjunction with medical procedures that are covered by a single payment to the facility for a procedure. Facility and physician practice payments for devices determine product sales.

The CMS services (the largest third-party payer) limits technology coverage to what is deemed “reasonable and necessary” for treatment. Devices included in the bundled-payment system can circumvent “full reimbursement” challenges, even if a new technology.

But being a bifurcated approval system, FDA clearance does not guarantee Medicare bundled-payment approval, or reimbursement requirements. It can take much longer to get CMS coverage approval than it did to obtain FDA clearance. To avoid device adoption roadblocks, some small device and wearable manufacturers choose to bill directly to consumer post-prescription, rather than rely on providers to aggressively seek reimbursement. Operational direct-to-consumer (DTC) billing gives brands the ability to drive their pricing, claims, and billing processes. Additionally, managing their own supply and payment process gives companies real-time data into sales performance.

Leveraging data

Clinical data is imperative to obtaining reimbursements and gaining the approval from the medical community to drive sales for a new device. Coverage clearance is contingent on the evidence of successful outcomes from clinical trials, which must be published and prove “added value” over existing technologies. This data must be provided well before CMS vets the new device, or commercialization will be postponed.

Not just clinical data is required; in February, 2013, Medicare passed the Sunshine Act for Medical Device Companies. This act requires all device therapies submit annual reports to CMS which detail spending on device education and physician payments to obtain reimbursement for their product.

Conclusion

Coding, coverage, and payments must all be drafted in a strategic reimbursement plan in the early phases of device adoption and growth projection. Brands will need to demonstrate clinical outcomes which prove both medical necessity of the product, as well as the added value compared to similar existing technologies. The more carefully planned and supported the roadmap toward reimbursements before FDA clearance, the quicker the device is ready for sales opportunity and revenue generation for manufacturer.

 

No More Sleepless Nights: The Relationship Between Innovative Therapies for Parents of Children with Type 1 Diabetes

Managing one’s own chronic disease can be tricky. Coordinating therapies with everyday life takes a lot of practice, as does symptom control, dealing with side effects, and contending with coverage and providers.

Type 1 diabetes (T1D) is especially challenging in this way. Daily, patients with T1 diabetes have to carefully reconcile diet, bolus and basal insulin doses, physical activity, other illnesses, and even emotions to achieve “controlled” blood sugars, and avoid dangerous hypoglycemic and hyperglycemic events. High and low blood sugars are not only immediately disruptive, and physically and intellectually taxing on patients, but a continuous roller coaster of glucose measurements (“uncontrolled”) have lasting, longform consequences including kidney, eye, nerve, and heart diseases.

So imagine the difficulty in having to orchestrate these factors and convey the ramifications when the patient is your child. Previously referred to as “juvenile diabetes”, T1D largely emerges during childhood, leaving the disease’s management in the hands of the patient’s adult parents and guardians. They learn about the disease, the many factors which must work in concert for stable blood sugar levels, and serve as the advocates for their loved one with healthcare and insurance providers. They send their children into the world trusting that they, their teachers, nurses, and other parents are all prepared with the right information to avoid dangerous low or high glucose episodes. This kind of intense attention to care, and often abrupt change of lifestyle, revolves around the child’s disease, but is profoundly felt by their parents.

People managing chronic diseases – their own or their child’s – benefit from support. Thankfully, organizations like Children with Diabetes offer parents and their children living with diabetes resources and anecdotal wisdom to help each other. This week, Children with Diabetes is hosting their annual conference in Orlando which unites children and families with type 1 diabetes, as well as clinicians for Friends for Life. Friends for Life is a week-long conference in which patients, families, and healthcare professionals convene to share information and make lasting relationships with others with type 1 diabetes.The Friends for Life community helps families build supportive networks, empowering parents to make informed choices on behalf of their child.

Technology, too, is finally developing to allay parents’ fears, the improvements providing support systems for caregivers. Some of these cutting-edge strides originated from the parents of children with T1D who created their own solutions when troubled by conventional care. The advent of data sharing and treatment innovation in this new generation of diabetes devices drives peace of mind for caretakers.

Innovative T1D monitoring

Technology is ramping up to improve diabetes management. Dexcom’s continuous glucose monitor (CGM) created headlines again last month, when Apple announced their Watch’s new bluetooth API, which connects directly to the Dexcom sensor, displaying glucose results on the Apple Watch. Rather than downloading the phone app or carrying the receiver, both of which can suffer gaps in data when connectivity is an issue, the Dexcom CGM sensor can now communicate directly with the Apple Watch. Dexcom’s continuous glucose monitor works by transmitting blood sugar readings every 5 minutes from a transmitter planted in a minimally invasive sensor, to the mobile phone app and/or Apple Watch. CGM results and alerts can be shared, so loved ones with access to the patient’s Dexcom account can have near real-time insights into the glucose data. As “followers”, parents and guardians need only glance at their phone to see where their child’s blood sugar is sitting, read trend graphs, and receive notifications and alerts.

Hacking for solutions

John Costik intimately understands the need for accessible and transparent results for caretakers of children with diabetes. The Atlantic published the story about his son, Evan, diagnosed with type 1 diabetes when he was 4, whose father’s struggle to manage his disease transformed T1D monitoring. John Costik would sleep on the floor beside Evan to test his glucose every couple hours after harrowing low blood sugar episodes. The Costik’s made the jump to a CGM to better monitor Evan’s sugar levels, but back in 2013 there was no share function for CGM datathey were sent directly to the receiver kept with Evan. Evan’s parents had no way of monitoring him when they were away from his side. Being a programmer for a grocery chain in New York state, John hacked together a fix so they could stay on top of his son’s health. He created an Android app.

Costik’s app was compatible with Dexcom’s G4, and after tweeting a screenshot of the app in use, other parents and caretakers of diabetics followed suit, some even using Costik’s open-source code (which he posted on Github). One father of a T1 diabetic sought a “more user-friendly” interface for Costik’s code, which he passed on to others via Facebook. People shared and improved resources with each other to advance diabetes technology, for better management and insights into the disease.

Parenting diabetes innovation

The Atlantic article likened a (then) phantom closed loop insulin delivery system simulating the functionality of a pancreas to Bigfoot—a conceivable but unconfirmed hirsute man-beast. This analogy inspired Bigfoot Biomedical Inc., formerly SmartLoop Labs. Bryan Mazlish, BigFoot’s CTO, was spurred to action by his family. Both his son and wife are T1 diabetics, and in 2013 Bryan crafted the first automated insulin delivery and adaptive algorithm mechanism for diabetes management.

Remarkably, the leadership across BigFoot shares two defining qualities: a dedication to creating innovative technology to better diabetes insights and outcomes, and parenting children with type 1 diabetes. Other company exectivies also have deeply personal ties to Bigfoot Biomedical’s mission. Lane Desborough, Chief Engineer who co-created Nightscout, an open-source code for CGM remote monitoring, has a son with T1 diabetes. Bigfoot CFO Jon Brilliant’s daughter was diagnosed when she was 9.

Jeffrey Brewer, Bigfoot’s President and CEO, encountered a frustrating disconnect between tech and medical solutions when his 7 year old son was diagnosed in 2002. Through JDRF, Brewer funded advancements to better control the disease which, with additional funded, evolved into their Artificial Pancreas project, in hopes to simulate pancreatic activity with an Artificial Pancreas Delivery (AID) system. Brewer joined JRDF as their CEO in 2011 and, appealing to the Leona M and Harry B Helmsley Charitable Trust, secured a grant to fund the their Artificial Pancreas team. In 2014, Brewer stepped down from JRDF to help co-found Bigfoot Biomedical, and started working on their smartloop AID system. Bigfoot began their clinical trials last summer, securing $35 million in Series A funding, as well as investments from both JDRF and the T1D Exchange towards the development of their closed-loop technology.

Born from Jeffrey Brewer’s dissatisfaction with existent Diabetes technology, JDRF’s Artificial Pancreas initiative is now fully realized with Medtronic’s MiniMed’s 670G system. It is the first “artificial pancreas” on the market, approved by the FDA last summer. This closed-loop system takes glucose readings using their continuous glucose monitor, the Guardian Sensor 3, then analyzes the data and administers bolus doses based on those results. Because the devices talk to each other, far less human intervention is required after calibrating doses and changing infusion sets and insulin reserves. This affords children and guardians peace of mind, and time better spent on other things, in addition to improved outcomes in the short and long term.

A sleep-filled future for parents

Closely monitoring glucose for tight disease management not only mitigates the full scope of complications for children with diabetes, easing parental fears, but it reduces healthcare spending. Well controlled glucose levels from a young age can prevent  the occurrence of comorbid diseases, ketoacidosis, and other potentially avoidable hospitalizations. For every child living with type 1 diabetes, there is a parent or guardian caring for them who also needs support and innovative resources. The fresh class of cutting-edge solutions conceived by intrepid parents and medical devices is restoring sleep to parents who, until recently, slept anxiously by their child’s bed on the floor.

Cutting Edge Therapies for Atrial Fibrillation: In the rising atrial fibrillation market, med device innovates and predicts a healthy return

Allied Market Research published its Atrial Fibrillation Market Report forecasting market growth to 2022. They expect atrial fibrillation (AF) therapies to reap $8,319 million in the next 5 years, yielding a CAGR of 13.0% by 2022. The report found that North America has, and will continue to have (with a CAGR of 12.1%), a stronghold on the market, and that non-surgical devices dominated the space in 2015- catheter ablation generating the highest gains.

There are a variety of factors driving the market boom for AF- a growing geriatric population with an increasing rate of AF, improved access to healthcare and treatments, a better educated patient population, and technical innovation in therapies. Companies are making great strides in developing healthcare solutions which make detecting AF easier, and living with it more manageable. Here, we explore some of the treatments on the forefront, certain to garner the predicted return.

Understanding atrial fibrillation

Atrial fibrillation is the most common cardiac arrhythmia, which affected between 2.7 and 6.1 million of Americans in 2010. AF is asymptomatic, so many people are not aware that they have it, making it difficult to precisely determine its prevalence. This particular kind of arrhythmia is rapid and erratic, occurring in the left and right atria because of an abnormal electrical signal in the heart. This causes the atria and ventricles to beat out of sync, wherein blood collects in the nether ventricles and blood flow is distributed inconsistently. Untreated, AF can produce a stroke or heart failure.

Catheter ablation therapy

Catheter ablation is the most commercially successful therapy for AF, with an expected CAGR of 13.8%. This growth is due in part to the triumph of advancements in treatment, like AtriCure’s cryForm Cryoablation Probe, a flexible and minimally invasive intervention tool using nitrous oxide to treat arrhythmia. Using catheters, ablation technologies emit energy to scar cardiac tissue, limiting possible irregular electrical signals in the heart. Catheter ablation is an appealing treatment because it is non-surgical and results in minimal recovery time.

In May, Abbott Laboratories received the CE marking for their TactiCath Quartz contact force ablation catheter. The catheter integrates with Abbot’s EnSite Precision cardiac mapping system, a 3D mapping system which aids physicians in applying contact force to create lesions on heart tissue.

Medtronic has created successful AF therapies using radiofrequency thermal ablation systems (the Cool-tip) and microwave ablation (Evident), which is delivered with small probes, or “antennas”.

Other therapy advancements

Last fall, Medtronic announced the FDA’s approval as the first US medical device manufacturer of MRI compatible implanted cardiac devices. As MRI’s are the diagnostic imaging systems of choice, the inability to defer to one in fear of device malfunction due to electromagnetic interaction prevented patients from enjoying the full scope of care. There suite of defibrillators, pacemakers, and cardiac monitors can now be used safely with both 1.5 Tesla and 3T Tesla MRIs. This includes the Visia AF and Visia AF MRI implantable cardioverter defibrillators, which monitor and manage atrial fibrillation. As 15% of patients who suffer strokes also live with AF, it’s imperative for people with implanted devices to be able to access MRIs.

Another innovative tool in the fight to manage AF is cardiac rhythm detecting wearables. Preventice introduced the BodyGuardian Remote Monitoring System, a pocket-sized monitor which tracks arrhythmic activity for AF patients, and transmits its recordings. Formerly CardioNet Inc., BioTelemetry hosts a suite of heart event monitoring devices which detect arrhythmias and offer data reporting, soon to include its MCOT Patch for irregular heartbeat discovery and analysis.

Observing irregular cardiac behavior not only saves lives, but can save in healthcare costs by preventing hospitalizations and preparing for potential comorbidity.

Atrial fibrillation and strokes

This May, Boston Scientific released the results of a year long study which found an 84% reduction (compared to untreated patients) in strokes for nonvalvular atrial fibrillation patients who were treated with their Watchman. The Watchman is an implanted device which closes the left atrium to mitigate strokes in AF patients- the left atrial appendage is where most stroke-inducing blood clots are believed to originate.

The Stroke Prevention Devices Market has experienced a lot of growth because of the increase in geriatric population in the western world. With an expanded geriatric population follows an uptick in AF patients who must stay vigilant in stroke detection (they are 5 times more likely to experience a stroke than people with regular heartbeats), presenting new opportunities for growth and innovation in the marketplace.

The future of AF therapy innovation

Continued monitoring of AF is paramount. Cutting-edge therapies such as catheter ablation, monitoring and detection wearables, and MRI-friendly plantable devices are changing the treatment landscape, reducing healthcare costs and giving patients longer, better quality of life but as AF therapies are predicted to yield a CAGR of 13% in the next 5 years, where can treatments innovate going forward? Where else can they add value for patients?

In addition to revolutionizing stroke risk reduction for AF patients, Boston Scientific has been breaking new ground treating patients for heart failure. They teamed up with a CRM company to monitor patients who’d been hospitalized for heart failure in an effort to reduce hospital readmissions after treatment. Beginning with the patient’s intake, Boston Scientific used technology to capture real-time insights into patient’s self-management efforts. Post-hospitalization, Boston Scientific could make calculated interventions with patients, educating them on their disease state and therapy, continuing relationships with patients throughout their healthcare journey.

Using “pathway analytics” to measure cost-efficiency and patient outcomes, Boston Scientific found 25% of the hospital readmissions for heart failure patients could be avoidable, thereby cutting spending for all parties. It was their assessment that “better care coordination, supported by modern technology and process…can decrease overall costs.”

Offering post-diagnostic patient support services grants stakeholders a place to stay attentive to at-risk populations, and patients peace of mind. Integrating a modular platform with services, coordinates patient and treatment data and ensures patients adhere to event monitoring and therapy. To fully take advantage of the atrial fibrillation market surge, medical devices will have to continue to innovate and distinguish themselves from their competitors.

Welkin Participates in this year’s SF Design Week

This year’s San Francisco Design Week showcased a wide range of products and thought leadership created by designers and entrepreneurs from Silicon Valley companies. Topics ranged from designing products for homes to forging better tools for digital payments to transportation and more. In particular, one session, hosted by Practice Fusion, turned the spotlight onto the role design has in digital health. One of our own, Autumn Leiker, participated on the panel to discuss health behavior change through design, alongside designers from Fitbit, Omada Health, and Lantern Health.

As a designer at Welkin Health, Autumn works with our partners to help them adapt to the shift toward value-based healthcare. This starts with a deep understanding of each partner’s individual needs and goals for patient engagement, which can range from behavioral to community health care journeys or through trial to permanent medical device implant procedures. While each care journey is unique, our designers and product teams work on developing tools that can be used and adapted across multiple use cases and roles. Because Welkin’s partners work involves changing patient behavior directly, Welkin’s role is more behind the scenes from the patient perspective. Thus, our design team’s goals are to empower our partners with intuitive tools for effective patient engagement.

As Autumn explained at the panel discussion, her team’s work starts with categorizing the types of tools our partners need, which fall under communication, task tracking and data collection. After understanding how each partner handles these three types of tasks, such as routing incoming/outgoing calls, creating custom patient alerts and integrating this data with other sources, such as electronic health records, Autumn and her team work with partners in person to help design workflows that combines these tools to support their unique program.

Although digital health might seem to be moving slowly when compared to how fast the tech industry can be, there is still a tremendous opportunity in both design and technology to improve people’s health and lower costs. While there may be more public awareness on patient-facing aspects of digital health tools, there is also a need to make better tools for health care providers. People who work in healthcare might be extremely empathetic, highly skilled and knowledgeable on how to best serve their patients, but if they are overwhelmed by spreadsheets, faxes, paper forms, support tickets, sticky notes, etc. they are going to be less effective and efficient. In the end, work is needed to change behavior through design for both patients and healthcare workers.

Ultimately, Autumn’s challenge as a designer at Welkin Health is to grapple with the question of how we can ensure our highly customizable platform to accommodate diverse partners doesn’t become too overloaded and unwieldy with features. She’s turned to user research to help answer that question. It’s clear that there is still a lot more work to be done to help optimize healthcare tools. However, panels like this one by SF Design Week highlight and celebrate the progress that’s been made so far, especially in an industry that needs these improvements. By looking at healthcare workflows with a design perspective, Autumn and the team here at Welkin Health strive to build better tools for patient engagement and positive behavior change.

Creating Holistic Value with Innovative Partnerships

When Apple announced how the Apple Watch’s new bluetooth API can integrate directly with the Dexcom sensor, Dexcom’s stock enjoyed a 6% jump. Because it connects to the sensor and not an app, there is no loss of communication between the continuous glucose monitor and the Apple Watch—unlike the Dexcom app, which in the case of a connectivity issue, loses data, defeating the purpose of continuous monitoring.

This new API makes consistent data tracking possible, which is why the partnership marks an exciting opportunity for Dexcom. Teaming up innovative tech with their medical device optimizes Dexcom’s product by transforming the Apple Watch into a diabetes wearable for patients who require aggressive or automated glucose tracking.

The marriage between Dexcom and Apple is another in emergent partnerships between medical devices and integrative software to unite life-changing products with cutting-edge technology— enabling better patient outcomes using personalized, customizable care.

Partnering for patient success

At the 54th Congress of the European Renal Association and European Dialysis and Transplant Association, Baxter released the results of two studies which mapped the patient and clinical results of coupling SHARESOURCE, its cloud-based patient management platform, with their renal therapy HOMECHOICE CLARIA automated PD system. Baxter used the SHARESOURCE platform to monitor their customers with peritoneal dialysis (PD), capturing and analyzing their patient data for adherence and therapy complications, empowering their clinicians to support patient self-management, and preempt critical incidents.

 “‘Baxter’s SHARESOURCE remote patient management system was designed to support patients’ access to PD, with the confidence to perform home therapy knowing their healthcare providers are remotely managing their care,’ said James Sloand, M.D., senior medical director, Baxter. ‘New data show the technology can help healthcare providers achieve this goal because they have timely access to accurate patient therapy adherence data, allowing them to address pertinent clinical issues earlier.’”

Their studies also revealed that the patient management software afforded PD nurses 35% more time to spend proactively engaging with patients, possibly intervening before critical events, and refining clinical management.

Patients reporting on their disease management can create day-to-day improvements to health, deter adverse events, and even save lives. The greater accumulation and analysis of patient data, the clearer the insights device companies have into patient metrics. This in turn perpetuates better support, and inspires device enhancements, while advancing patient-centered care.

The value of innovative partnerships

Device companies have much to gain from real world evidence generated by patient success. As payers insist that costs be transparent, therapeutic efficacy will be scrutinized and companies will need to provide data-driven evidence of patient success to support their value propositions. Integrating patient services not only catalyzes superior patient outcomes, it aggregates a story, which testifies to the brand’s value.

It will take a concerted effort for device makers to shift to value based care models, but with patient support services readily available, the value of their medical device—abetted by support software—is demonstrable.

The benefit for stakeholders

Boston Scientific teamed up with Accenture to monitor patients suffering heart failure in an effort to reduce hospital readmissions after treatment. Beginning with the patient’s initial hospitalization, Boston Scientific used Accenture’s technology to capture real-time insights into patient’s self-management efforts. Post-hospitalization, Boston Scientific could make calculated interventions with patients, educating them on their disease state and therapy, continuing relationships with patients throughout their healthcare journey. 

Using “pathway analytics” to measure cost-efficiency and patient outcomes, Boston Scientific found 25% of the hospital readmissions for heart failure patients could be avoidable, thereby cutting spending for all parties. It was their assessment that “better care coordination, supported by modern technology and process…can decrease overall costs.”

In addition to improving patients’ lives, their disease management achievements benefit the commercial health of the device. Improved patient outcomes reduces additional complications and hospitalizations, driving ROI for device companies, and cost-efficiency for all stakeholders.

For patients who’ve been aided by med tech partnerships greater quality of life may not be quantifiable, but it is the ultimate testament to the holistic value of the partnership.