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Healthcare Innovation: Creating Pathways for Better Health

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Bushra Singh presented her business Mindful Living Club which offers a Diabetes Prevention Program for anyone who needs it. She presented to the Chicago Technology For Value-Based Healthcare (https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup) on September 25, 2018

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Healthcare Innovation: Creating Pathways for Better Health

  1. 1. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Diabetes Prevention Program Healthcare Innovation: Creating Pathways for Better Health
  2. 2. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. 1. Diabetes Epidemic in US & Reasons 2. What are Diabetes Prevention Programs (DPP) 3. Components of DPP: Technical, Social, Clinical, Operations, Regulatory 4. DPP Business Model 5. Mindful Living Club – DPP Offering & Challenges 6. DPP Market review Meetup Agenda
  3. 3. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Problem/Gap Obesity and Unhealthy lifestyle leading to Diabetes Epidemic ▪Evidence based lifestyle change programs: For people with high risk Diabetes or with Pre-Diabetes ▪There is a evidence that Lifestyle Change program have been successful in preventing Diabetes. A program that guides people about their nutrition physical activity needs, keep them engaged and motivated till their individual health goals are met. LOOSING WEIGHT 5-7% can reduce the risk of diabetes to 58% More than 29 million US adults have diabetes, and 25% of them don’t know it. About 86 million US adults— more than a third—have pre-diabetes, and 90% of them don’t know it. Without intervention, many people with pre-diabetes could develop type 2 diabetes within 5 years. If you have pre-diabetes, getting type 2 diabetes doesn’t have to be a sure thing. In fact, pre-diabetes can often be reversed. Approximately 5 million more people per year in US will be diagnosed with Diabetes. If current trends continue, 1 in 3 people will have diabetes by 2050 Diabetes costs health system $13,500/patient/year to payers Solution
  4. 4. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Problem Assessment: Why Diabetes Epidemic ? • Lack of awareness • Risk factors for getting diabetes & how to prevent it • Lifestyle changes prevent diabetes • Social structure and support can help • Scattered, disjoint and limited opportunities for prevention initiatives • Confusing & hard to follow nutrition and diet guidelines • Poor Attitude towards eating
  5. 5. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. What is National DPP/MDPP CDC-Lifestyle change programs: • A support group of people with similar goals and challenges. - Together sharing ideas, celebrate successes, and work to overcome obstacles. - Staying in touch with each other during their journey. • CDC-Approved curriculum • A Lifestyle Coach.
  6. 6. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. What’s Different about DPP • New Healthcare Paradigm /Rethinking current healthcare landscape • Bringing attention to Prevention • Creating Providers outside the Clinical Settings • Importance of Community as a driver of health solutions
  7. 7. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Who can be a supplier of DPP • Anyone with resources to facilitate coaching sessions with people and motivate them to change the lifestyle Help facilitate loosing 5-7 % body weight over the duration of 6 month and keeping it off for 12 months. Components of the program • Coordinator • A set of 16 class room sessions (Virtual, In-person or Hybrid) • Reimbursement based on Attendance & Weight loss. (Value based) • Coach – CDC curriculum-DPP Coach Certification.
  8. 8. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Business Model $$ DPP Supplier $ Patient/Member Community Center/Library $ Incentives (Choices) Collaboration Profit (Admin fee)
  9. 9. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Member Engagement for DPP Through Physician office, Community Centers, Library, Church. No formal Physician referral is required. Eligibility: People with High Risk of Diabetes & with Pre-Diabetes: Type II Risk Assessment Survey: Data Points DPP Program Eligibility • Weight/Obese • Age • Gender • Gestational history • Family History • Blood Pressure • Physical activity level
  10. 10. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Medicare Eligibility • Enrolled in Medicare Part B • Body Mass Index (BMI) of at least 25 if not self-identified as Asian, or a BMI of at least 23 if self-identified as Asian • A hemoglobin A1c test with a value between 5.7 and 6.4 percent, a fasting plasma glucose of 110-125 mg/dL, or a 2-hour plasma glucose of 140-199 mg/dL (oral glucose tolerance test) • No previous diagnosis of type 1 or type 2 diabetes (other than gestational) • Do not have end-stage renal disease (ESRD)
  11. 11. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Technology component • Risk assessment Quiz • Promotion & Awareness • Member Enrollment • Data Collection & Monitoring (IOTs) • Sharing Data with CDC & CMS • Privacy Notifications, Consent & Waivers • Member Engagement: Communication /Texting emailing, Webinars, Video chats • Claim Processing /Third Party or use CMS Interface
  12. 12. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Clinical Components • Patient Data: Weight, Class Attendance, Blood Glucose levels • Meal Journal • Exercise Routines /Weekly Activity Level
  13. 13. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Social Aspect Social Support & Keeping the patients engaged Incentive to keep motivation Commitment to health/program Partnering with local vendors : • Grocery Stores • Restaurants • Local gyms, Health Clubs & Yoga Studios • Libraries/Part District & Health Departments
  14. 14. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Medicare Reimbursement Healthcare Common Procedure Coding System (HCPCS) G-codes that MDPP suppliers will use to submit claims for payment when all the requirements for billing the codes have been met. Performance Goal Performance Payment Per Beneficiary (with the required minimum weight loss) Performance Payment Per Beneficiary (without the required min loss) Performance Goal Performance Payment Per Beneficiary (with the required minimum weight loss) Performance Payment Per Beneficiary 1st core session attended $25 $25 4 total core sessions attended $50 $50 9 total core sessions attended $90 $90 2 sessions attended in first core maintenance session interval (months 7-9 of the MDPP core services period) *$60 $15 2 sessions attended in second core maintenance session interval (months 10-12 of the MDPP core services period) *$60 $15
  15. 15. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Fee for Service Vs Value Based Payment Model Fee-For-Service (FFS) •Medical services are unbundled and paid for separately. •Incentivized physicians to provide more treatments or services • Drawbacks: High cost; unnecessary treatments or services or physicians are discouraged from performing procedures, including necessary ones, because they are not paid anything extra for performing them. Value-Based Care (VB) Payments Quality of their service Appropriateness of care, utilization of resources and clinical outcomes Integrated delivery of a variety of services as well as on healthcare outcomes •Care can stretch across multiple venues •Care is delivered under a model that simultaneously considers costs and healthcare outcomes •Healthcare outcomes are meticulously evaluated by measurable metrics •Clinicians not just providers of care, responsible for managing care under new delivery models such as Accountable Care Organizations (ACOs). 15
  16. 16. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. DPP- Mindful Living Club Approach • One stop shopping for all diabetes prevention and management • CDC Guidelines • Metabolism Boosting Diets: • Michael Pollen's Food Rules –What to Eat • Maharishi (Saint) Vagbhad's Ayurvedic philosophy of "Kitchen as your Pharmacy • Plant based Diet / Intermittent fasting/Low Carbohydrates- High Fat • Mindful Elements • Deepak Chopra’s Seven Laws of Spiritual Success • Arkaya Yoga Philosophy • Innovative strategies member engaged • Getting involvement in a hobby/ find a purpose/passion • Getting them socially connected and sharing their journey of weight loss with others • Releasing negative emotions using stress management techniques • Introduce/suggest members various food/food based menu plans that boost the metabolism
  17. 17. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Mindful Living Club: Back to Basics Healthy Lifestyle Tips 1. Eat “Real Food”; freshly prepared whenever possible a. Plan & prepare meals ahead of time weekly, freeze as needed for future b. Don't eat anything your great grandmother wouldn't recognize as food c. Don’t eat anything with more than five ingredients, or ingredients you can't pronounce d. Stay out of the middle of the supermarket; shop on the perimeter of the store e. Don't eat anything that won't eventually rot f. It is not just what you eat but how you eat. Always leave the table a little hungry g. Eat together with people you love & like; around a table and not a TV, at regular meal times 2. Get involved in a hobby to be physically active, something you always wanted or used to totally enjoy 3. Stay socially connected and share your emotions; Join a forum or DPP for lifestyle change 4. Work towards releasing or resolving your negative emotions using stress management techniques; Yoga , Meditation/Mindfulness, Listening to Music, painting, sewing
  18. 18. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Program details Membership based program • Once a week webinar & monthly in person meeting • Class size (min 5 – max 12) Member enrollment channels • Community based locations, Emails, Facebook, Youtube, Meet-ups, local physician practices Member engagement • Webinar, Whatsapp, Email, Scheduled in-person meetings Tools • Myfitness Pal, Fit bit or other trackers, Zoom live meeting, Youtube Live, FB, Whatsapp, shared Google calendars
  19. 19. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Program Statistics • Number of sessions held - 4 - Each session was 3 months long with 12 webinars • Group size of 5-7 people • Participation – Average 75% over 3 months • Attendance - 50% • Average Weight loss was 5-7 lbs in 3 months • 25% of members reduced their dependence on insulin 19
  20. 20. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. 55+ Yrs 50-55 Yrs 40-50 Yrs 57% 35% 20 9% Female/ Male = 74%/ 26% 0 10 20 30 40 Low risk High risk Diabetic Pre-diabetic Percentage Source: Sessions held over 18 months. Data on file. Less than 4lbs 4-6 lbs More than 6lbs 73% 18% 9% ©2017 All rights reserved. Confidential and proprietary information.
  21. 21. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. 21
  22. 22. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Operational Challenges • Extreme Busy Schedules • Lack of motivation/Inertia • Lack of time • Social events & travels • Determining the ideal cost of the program • Diverse food habits and background
  23. 23. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Bottle Necks for Expansion • Operations cost too high • More interest from sick population • Conflicting Health Systems Agendas • Conflicting nutritional guidelines for the prevention, reversal & control • ADA/AHA/CDC guidelines are confusing and lot of new research on plant based and regarding low fat/high carb diets.
  24. 24. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Moving Forward Seeking funding for program expansion Partnering with District/Community Education to promote the awareness
  25. 25. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Face book/YouTube
  26. 26. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Consulting to Build Solutions • Available to consult :How to offer DPP/MDPP • It takes 24 month for them to become certified MDPP supplier • DPP can be started immediately with DPP coach & takes about 12 months for accreditation
  27. 27. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Competitive landscape • Habitnu • Retrofit • Omada Health • YMCAs • Community based • Health systems
  28. 28. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Important Links CDC: https://www.cdc.gov/diabetes/prevention/index.html CMS https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/
  29. 29. Mindful Living Club © 2018 Mindful Living Club. All rights reserved. Confidential and Proprietary information. Bushra Singh Founder & Director of Mindful Living Club https://www.facebook.com/MindfullivingClub/ Care@minfullivingclub.blog Bushrasingh@yahoo.com (847)-271-9741

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