Smart monitoring to help families care for a loved one with dementia at home

# of interviews this week: 11# of interviews: 126

George Netscher

Lauren DeVos

Anna Stolyarova

Pulkit Agrawal

Our Team

George Netscher

PhD in EECS

Signal processing

Anna Stolyarova

MBA/MPH

Healthcare consulting

Lauren DeVos

MBA/MPH

Digital health

Pulkit Agrawal

PhD in EECS

Computer vision

Nick Boyd

PhD in Stats

Optimization

Dan Greening

PhD, Certified Scrum Coach

LLP team Engineering team

Julien Jacquemot

MS in CS

Software engineering

Alex Bayen

PhD, EECS Professor

Mentors and advisors

2

PatientsIndependence

CliniciansPrognosis

CaregiversSupport

Week 0: The needs seemed clear and universal

3

NestSense - Week 0

AD caregivers (family or hired)

need to keep patients safe

AD clinicians are liable for best

possible diagnosis and

prognosis

AD patients want to keep

independence

Insurance providers want

reduced medical claims and longevity estimates

Detect acute events, monitor

symptoms, report

progressive changes

The primary costs in

dementia care are emergencies,

24/7 assisted living, and inaccurate

medical assessment

With computer vision, we can

facilitate independent

care by detecting acute events and

monitoring functional status

Partners: UCSF Memory and Aging Center, Alzheimer’s

Services of the East Bay

Suppliers: Simplicam,

Google

Off-the-shelf hardware, Direct marketing to physicians and

insurance providers, medical validation

Caregivers pay for increased patient safety and independence

Physicians and insurance providers pay for reduced ER use and in-patient

visits

Direct sales, web presence,

medical publications

Engineering talent, patient

pop. for medical validation, direct sales

channels, off-the-shelf hardware

Caregivers and patients online

/through clinicians

Clinicians and insurance

providers via direct contact /

medical journals

4

We built MVPs to test value propositions

Family caregivers need to...

… detect safety-critical events … understand disease progression

5

We expanded MVPs to test new value propositions

Family caregivers need to...… detect safety-critical events

… understand the disease progression

… stay connected with their loved ones

… find personalized solutions

… monitor hired caregiver negligence

6

Week 6: We were overwhelmed by unmet needs

7

Week 7: We reviewed what we learned from 56 need-finding interviews

8

We focused in on our customer segment

Patient disease state- too severe need 24/7 care- too mild value privacy over security

Caregiver income level

- high income can afford

hands-on at all times

- low income supported by

Medicaid

Caregiver age- over 65 less likely to be familiar with technology or

have home internet

350+ thousandmiddle incomeunder 65 y/ocaring for mild moderate stage

9

We developed our customer archetype

Far away or busy family member who wants to check in more oftenSara, the concerned daughter

Who is Sara?● The son or daughter of an Alzheimer’s patient● Mid 30s to early 60s

What does she do?● Spends her days worrying about her sick parent● Works a busy job and can’t leave work to check in● Comes to visit, but often less frequently than she’d

like

What would she like? Something that would...● Help her stay connected with her parents● Allow her to know if anything is wrong or needs

urgent attention● Make her parents happy

10

“The current system waits for the tipping point - e.g. major fall - and then places patient to an institution.”

Decision support

Disease progression

Caregiver watch

Comorbidity monitoring

Social connection

Self-neglect monitoring

Accident monitoring

0% 80%

In-home family caregivers PhysicianRemote caregivers

Time

Looking back, we found that safety alerts were key

Unmet Needs Testing

11

Industry experts confirmed that safety monitoring strengthens customer relationships at all stages

"There is not a lot of purchasing intent for a purely monitoring product"

"Emergency response function lowers churn… you’d want to keep being protected"

"Caregivers often start looking for technologies after a major safety related event" 12

Week 8: We created initial revenue model hypotheses

Medicare

Clinicians

Caregivers Hypothesis: Will pay out of pocket

Hypothesis:Will pay for system-wide savings

Hypothesis:Will bill for viewing data

13

Centers will refer clinicians to NestSense

We found that indirect referrals and payment streams make the universe more complex

Medicare

KOLs at Major Alzheimer’s

CentersClinicians

Caregivers

Associations (e.g. AARP), HHAs, support groups

Cut ($) of referrals

CliniciansClinicians

Clinicians

Referrals

~$100/mo subscription fee

CPT codes: 99490, 99091Up to $100 per remote evaluation

Possibility for a monthly fee from each practice to NestSense

Accountable Care Orgs

NestSense

14

We learned that remote monitoring is a new space and there is a need for data

Out of pocket

CPT codesfor remote monitoring

Improved efficiency for home

health agency

Savings to health care

system

Validating evidence required

Potential for

revenueTrialsTrialsTrials

15

Week 12: We ended up with a partial picture

● Clear value proposition, but high customer acquisition costs● Current hypothesis - greatest value in partnering with home care org.

○ Adult child becomes key influencer○ Sutter private care interested in partnering for pilot study ○ VA Palo Alto has invited for vendor demo

KP KA VPDetect key safety concerns- falls- wandering- stove misuse- faucet misuse

CR Dr., AARP referrals

CSAdult child- parent with moderate AD- middle income- <65 yo

KR CH

CS RM $100/mo subscription

16

Going forward: near-term

Incorporation

Addition of part-time home nurse

Seeking co-founder w/ experience in med. device

Focus groups with OLLI Pilot study

(n=15)

UCSF clinical

trial (n=100)

NIH SBIR

NSF SBIR

Beta for pilot

Nov Dec Jan Feb Mar Apr May Jan

2015 2016

Funding

Product

testing

Business Dev

Technical dev

17

Thank you to everyone who helped!

Questions?

18

Appendix

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Week 7: Privacy concerns could be overcome

“We have lots of people that use nanny cams or video cams all the time. That kind of information can be extremely valuable.”

20

Agin

g in

Pla

ceSt

artu

ps

Entrenched Health Tech

Hom

e Monitoring

Consum

er Tech

Resea

rch

Groups

Remote Health

Monitoring

Competitor Leaf Diagram

21

TAM

SAM

Target

• 5.3 million people in the US and 47 million worldwide living with Alzheimer’s dementia

• The cost of caring for Alzheimer’s patients in the US is estimated to be $226 billion in 2015

• ~1.13 million mild-moderate diagnosed~2.5 million people in the US with mild-moderate Alzheimer’s

dementia~45% diagnosis rate

• ~362 thousand households would consider buying~90% live at home~54% are middle class ~66% of caregivers are under 65 yo

• ~$435 million yearly revenue potentialbased on $100/month subscription service

Re-evaluating Market Size

22

Associations & agencies hold the power; direct marketing to caregivers is not enough

Partnerships ...with clinical advocates Physicians, caregivers, local clinics, daycare centers

...with associations AARP, PatientsLikeMe

Social / OnlineFacebook, Twitter, SEO, Email marketing, bloggers

Channel Strategy to engage

● Personal sell● Ask if would prescribe

by demo-ing product

● Nurture relationship● Cross-promotion● Shared revenue

● Traditional social / SEO techniques

23

Our financial results are highly influenced by customer acquisition costs, adoption rate, and customer attrition

$100...500 per customerCAC

Adoption

AttritionOR

5-10% 50%

●physicians have most influence on adoption rates

●up to 75% adoption based on interview

● expert estimates as low as 10% in rural areas, even if recommended by a physician)

24

Alzheimer’s disease in brief

Stage Mild Moderate Severe

Symptoms - Memory loss- Language problems- Mood and personality changes- Diminished judgement

- Behavioral, personality changes- Unable to learn or recall new information- Long-term memory affected- Wandering, agitation, aggression, and confusion- Require assistance with activities of daily living (ADLs)

- Unstable gait- Incontinence- Motor disturbances- Bedridden- Dysphagia- Mute- Poor/No ADLs- Vacant- Common placement in long-term care

Expected length of time from diagnosis

0 - 2 years 2 - 6 years 6 - 9 years

25

3-year revenue forecast

26

Hardware costs

Purpose Hardware Expected Costs

Monitoring falls CC night-vision camera $40 for 4 rooms

Stove unattended Zigbee carbon monoxide + temperature sensor $5 for 1 stove

Bath/Sink overflowing Zigbee water detector $15 for 3 faucets

Leaving house alone CC night-vision camera $20 for 2 exits

Computational Detection Local processing unit $150 for 1 home

Total: $230 for 1 nest

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Week 1-2: Wasted time with too much functionality

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Week 3: Unclear customer segments led to seemingly contradictory information

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