Monitor loved ones with dementia at home
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The document summarizes the findings from an investigation into developing a smart home monitoring system to help families care for loved ones with dementia. Over 12 weeks, the team conducted interviews and built prototypes to understand customer needs. They initially focused on too many use cases, but learned safety monitoring was key. The team identified the target customer as adult children caring for mildly moderate stage parents from a distance. Moving forward, the team plans pilot studies and partnerships to validate the product and business model.
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Monitor loved ones with dementia at home
- 1. 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
- 2. 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
- 3. Patients Independence Clinicians Prognosis Caregivers Support Week 0: The needs seemed clear and universal 3
- 4. 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
- 5. We built MVPs to test value propositions Family caregivers need to... … detect safety-critical events … understand disease progression 5
- 6. 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
- 7. Week 6: We were overwhelmed by unmet needs 7
- 8. Week 7: We reviewed what we learned from 56 need- finding interviews 8
- 9. 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+ thousand middle income under 65 y/o caring for mild moderate stage 9
- 10. We developed our customer archetype Far away or busy family member who wants to check in more often Sara, 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
- 11. “The current system waits for the tipping point - e.g. major fall - and then places patient to an institution.” 0% 80% Decision support Disease progression Caregiver watch Comorbidity monitoring Social connection Self-neglect monitoring Accident monitoring In-home family caregivers Physician Remote caregivers Time Looking back, we found that safety alerts were key Unmet Needs Testing 11
- 12. 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
- 13. 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
- 14. 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 Centers Clinicians Caregivers Associations (e.g. AARP), HHAs, support groups Cut ($) of referrals Clinicians Clinicians Clinicians Referrals ~$100/mo subscription fee CPT codes: 99490, 99091 Up to $100 per remote evaluation Possibility for a monthly fee from each practice to NestSense Accountable Care Orgs Nest Sense 14
- 15. We learned that remote monitoring is a new space and there is a need for data Out of pocket CPT codes for remote monitoring Improved efficiency for home health agency Savings to health care system Validating evidence required Potential for revenue Trials Trials Trials 15
- 16. 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 VP Detect key safety concerns - falls - wandering - stove misuse - faucet misuse CR Dr., AARP referrals CS Adult child - parent with moderate AD - middle income - <65 yo KR CH CS RM $100/mo subscription 16
- 17. 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
- 18. Thank you to everyone who helped! Questions? 18
- 19. Appendix 19
- 20. 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
- 22. 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 potential based on $100/month subscription service Re-evaluating Market Size 22
- 23. 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 / Online Facebook, 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
- 24. Our financial results are highly influenced by customer acquisition costs, adoption rate, and customer attrition $100...500 per customer CAC Adoption Attrition OR 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
- 25. 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
- 27. 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 27
- 28. Week 1-2: Wasted time with too much functionality 28
- 29. Week 3: Unclear customer segments led to seemingly contradictory information 29