DAPS Health Lines of Business
There are seven lines of business that form the template for national and global Predictive healthcare business.
Lines of business:
A: population based screening program including direct to diabetic consumer
B: payer model inclusive of health care systems, unions, self insured employers
C: consummate care 24/7 continuous oversight utilizing biometric data from home monitoring technology of concurrent co-morbid conditions
D: hospital model
E: dialysis centers
F: large physician network groups focusing on diabetes disease management and distribution of home monitoring technology
G: Life Insurance Companies
First box to be closed
A. Population based screening program
DAP-Health will screen and assess diagnosed diabetics for lower extremity disease including peripheral vascular disease and peripheral neuropathy to determine if there is risk for foot ulcers and amputation and if so, where the patient falls in the natural evolution leading to multiple hospitalizations, surgeries, and ultimately amputation. The linkages between diabetic lower extremity disease and other concurrent co-morbid conditions will be evaluated during the same session. These screening sessions can be held in a mobile site basis as well as in bricks and mortar models. The methodology will be embedded into all lines of business as the core product.
There are 23 million diagnosed diabetics in the United States, and greater than four hundred million world wide. ALL are candidates for the SLSL screening and assessment program. The rationale for inclusion of all individuals with diabetes is based on the assumption that the prevalence of undiagnosed peripheral neuropathy (insensitivity) in the diabetic population is >40% and the prevalence of undiagnosed peripheral vascular disease is >20%. Peripheral neuropathy leads to diabetic foot ulcers, the main cause of amputation; Peripheral vascular disease leads to obstruction and gangrene, also a leading cause of amputation.
NOTE: in previous published reports from my group as well as national presentations to the Center for Disease Control and the American Diabetes Association, we demonstrated that outcomes achieved using the high touch screening methodology along with unique treatment protocols resulted in reductions in amputations and hospitalizations by 70% from clinical baselines in large diabetic cohorts in major health plan populations. These outcomes resulted in a savings to the health plan of approximately $1200-$1600/patient/year. In another study of 16,000 diabetics enrolled in our program, there was a 20% savings in medical expense all causes.
- >40% of those diabetics screened will have undiagnosed peripheral neuropathy/insensitivity
- 20% will have peripheral vascular disease.
- 45% will have gaps in medication management necessary to prevent or control concurrent co-morbid conditions such as heart attacks and strokes, chronic kidney disease, hypertension, and retinopathy.
- For every dollar spent on medication management, there is a 14% reduction in ER visits as well as a significant reduction of in-patient hospitalizations
- Based on historical data, there will be a reduction from clinical baselines of 70% in amputations and hospitalizations, and a 65% reduction in LOS.
B. Payer model
Thru the consulting arm of DAP-Health in partnership with the payer, the firm will develop contracts with payers including e.g. insurance groups; unions; and self insured employers. Through this consulting service, we will advise, train, and develop strategies with the payer on how the impact of a risk stratification or high touch methodology to prediction, prevention, and prevention of recurrence, influences cost savings within major populations; and how linkages of undiagnosed concurrent co-morbid conditions can reduce all costs associated with the disease state while concurrently and dramatically reduce human suffering. A risk stratification model is best utilized and is most effective with this model.
There are two lines of business within the payer model. These lines of business will be based on a risk stratification model for lower extremity disease and can be linked to existing concurrent co-morbid conditions that are known, or will be once the screening and assessment evaluation is performed. The lines of business are based on the clinical rationale of the science of lower extremity disease and the linkages of these conditions to other concurrent diabetic co-morbid conditions.
The two lines of business include:
- Population based approach: whereby the payer will afford the opportunity to all diagnosed diabetics in the plan to be screened for lower extremity disease complications of peripheral neuropathy and peripheral vascular disease, and to other concurrent co-morbid conditions. If one of the complications is diagnosed, then home temperature monitoring technology will be distributed to the client with instructions on how to use the technology. Biometric data streams will be sent on a daily basis to a personal care manager or analyst for evaluation. If there is an indication of pending tissue destruction via temperature trend lines leading to an acute event, the patient will be contacted by the care manager with preventative instructions and further direction on how to “off-load” the extremity.
- Consummate care: this line of business includes elements of (a) above, but will link other concurrent co-morbid conditions crystallized during the screening and assessment session. Then on a continuous 24/7 basis, monitor these complications thru home technology data analysis. The clinical rationale for this approach includes the knowledge that there are multiple concurrent complications all moving in the direction to acute emergent episodes, and these complications leading to acute/emergent events do not occur spontaneously and can be predicted if data trends are analyzed appropriately. Currently the offering may include home monitoring for: Bp; blood glucose levels; temperature (inflammation) trend lines from peripheral neuropathy leading to multiple hospitalizations, surgeries, and ultimately amputation
C. Consummate care
includes 24/7 continuous oversight of existing high risk lower extremity conditions via data stream biometric analysis utilizing home monitoring technology. This model will be targeted to the individual diabetic client who wishes to have a very robust oversight of concurrent co-morbid conditions of diabetes, particularly those complications related to foot ulcers leading to hospitalization, surgery, and amputation.
Assumptions: a diabetic with peripheral neuropathy and/or peripheral vascular disease will have multiple (3 or more) concurrent co-morbid conditions including:
- clinical depression: estimate 30%
- retinopathy (leading cause of blindness)
- heart disease (leading to heart attacks and stroke): > 75%
- kidney disease (leading to end stage renal disease): 50% of dialysis patients are diabetic with associated complications.
The underlying rationale for use of home monitoring of concurrent conditions and analysis of biometric data flows for temperature trending for prediction of foot ulcers is based on the fact that no one complication leading to acute/emergent episodes is spontaneous, and if data trend lines are analyzed on a daily basis, the information will allow the clinician to look at threshold markers to acute episodes and thus are able to lay dormant or reverse the trend lines leading the acute episodes.
In a population based approach where claims are available, the clinical criteria and decision on which potential diabetics to enroll first will be based on a risk stratification strategy:
- existing foot ulcer
- recent discharge from hospital due to ulceration or reconstructive/distil vascular surgery
- history of amputation
- history of foot ulceration
- history of peripheral neuropathy
- history of peripheral vascular disease
- new diagnosis of neuropathy and/or peripheral vascular disease crystallized at the screening and assessment session by DAP-Health clinicians
- diagnosis of diabetes
It is important to note that once a diabetic lower extremity complication develops, the next similar acute/emergent complication will generally occur within one year.
A history of, or current condition of, one of the above (a-g) also is correlated with other concurrent co-morbid conditions, generally multiple in nature including:
- clinical depression
- heart disease
- kidney disease
Thus, these patients will need to have a 24/7 continuous monitoring system in place in order to significantly reduce the incidence of acute episodes associated with these concurrent co-morbid conditions
This model can be used within all populations in the different lines of business.
D. Hospital model
DAP-Health should plan to establish contracts with individual hospitals or hospital systems to establish Centers of Excellence within the hospital’s catchment area. The high touch methodology will result in a reallocation of dollars leading from in-patient losses to out-patient profitability by creating models for heretofore unrealized incremental new revenue streams:
- reducing LOS thus causing higher margins on DRG’s
- allowing for out-patient department billing for technical and professional components
- Triaging patients that have been screened in out-patient hospital facilities to various out-patient services within the hospital thus increasing revenue streams.
This methodology creates a new Center of Excellence for the diabetic population.
E. Dialysis Companies
Individuals on dialysis therapy are at high risk for foot wounds leading to hospitalization and amputation. Approximately 50% of all dialysis patients are diabetic. However dialysis is an independent risk factor for lower extremity complications and thus patients do not need to have diabetes in order to develop complications. It is estimated that 90% of this patient cohort may fall into the high risk category. Home monitoring technology for temperature trend lines is thus necessary to help manage this population effectively.
F. Large physician network groups
These groups can be magnets for major diabetic populations utilizing the unique DAP-Health methodology of prediction and prevention. Along with the disease management protocols all diabetics will be candidates for the home monitoring technology for diabetic lower extremity disease distributed thru the offices of the physicians.
G. Life Insurance Companies
The predictive methodology in the diabetes life insurance arena can be a unique product for the insurance company by offering a predictive methodology for disease management allowing for an increase in lifespan of the patient with resultant fewer complications