The holiday season just past was a feast for the senses—decorations, scented candles, fresh-cut evergreens, and the happy faces of visitors. But all the household cleaning and holiday decorating can also set off an asthma attack, as some sufferers from the disease may have learned over the last month if they’ve been keeping careful daily records of their symptoms.
Many people, however, fail to scrupulously note down each time they reach for their rescue inhalers, if it means pulling out the pen-and-paper diaries traditionally recommended by doctors. That lack of data was frustrating to David Van Sickle, a former epidemiology service officer with the Centers for Disease Control and Prevention, and former academic researcher. Van Sickle knew that patients who understand what triggers their attacks—plants, dusty ornaments, cleaning products, exercise, workplace chemicals—could avoid emergency room visits and hospitalizations,
“You should basically live symptom-free, with current medications,” Van Sickle says.
While still a post-doctoral student at the University of Wisconsin School of Medicine and Public Health, Van Sickle started working on a project to harness digital technology that would make symptom diaries easier for patients to keep. In 2010, he and two experienced IT entrepreneurs co-founded the Madison, WI-based company they originally called Asthmapolis, and recently renamed Propeller Health. The company’s mobile-connected recordkeeping service now covers both asthma and chronic obstructive pulmonary disease (COPD), which are often treated with the same medications.
The core of the Propeller Health platform is a data-collecting device that snaps onto one end of a medication inhaler. The Propeller sensor takes note every time the user takes a dose of medicine from the inhaler. It stores the time-stamped information, and wirelessly transmits it either to the user’s smart phone or to a Qualcomm base station plugged into the wall at home. When a smart phone is near enough to get the data immediately, its GPS sensor adds the location where the dose was needed. The Propeller platform then searches online sources such as the Weather Channel for possible environmental triggers in the neighborhood, Van Sickle says.
Patients receive individualized messages from Propeller Health, through their own online page, e-mails, text messages, or even snail-mail letters, to help them understand the patterns behind their daily symptoms and use of medications. The system might issue alerts when a patient enters a place where it would be advisable to take a preventive dose of rescue medication, for example.
Users can also opt to share the Propeller data with their doctors and family members. Doctors receive messages when the data suggest that a patient’s illness isn’t well controlled by their current drug regimen. The goal is to make sure patients have the prescriptions they need, and to remind them if they miss a dose. The company’s inhaler device and patient support platform received FDA clearance in July 2012.
The consequences can be severe when asthma is not well managed with medications, or when patients don’t ask for a doctor’s help in time.
“There can be a fatal outcome,” Van Sickle says. In COPD, a progressive disorder, any acute attack hastens the loss of lung function, he says.
Beyond the toll on individuals, the US healthcare system spends about $50 billion a year on each of the two respiratory illnesses. That cost could be reduced by avoiding preventable hospital admissions and emergency room visits, Van Sickle says. But at this point, more than 60 percent of the 25 million US asthma patients have inadequate control of their illness, Propeller Health estimates.
The financial burden increasingly falls on health care providers, because of cost-cutting incentives imposed by payers and federal health care reform. For example, by 2015, the Centers for Medicare and Medicaid Services may not compensate a hospital if a COPD patient is re-admitted within 30 days after they complete a previous hospital stay. Such financial pressures create a business opening for preventive care services.
“Propeller Health’s target customers are the entities at financial risk,” Van Sickle says. The potential customer base includes hospitals, health insurance plans, integrated health care systems, and physician provider groups that are paid fixed rates per capita for caring for their patients.
The startup’s business prospects looked good to The Social+Capital Partnership, a Palo Alto, CA venture firm, which invested $5 million in a Series A round for Propeller Health earlier this year. The startup had already raised over $2 million from Kapor Capital and other angel investors; the California HealthCare Foundation; and drug retailer Walgreen’s, says Ted Maidenberg, a general partner at Social+Capital. Maidenberg says the time is ripe for Propeller Health because its services save money.
“Every health system is strapped for cash,” says Maidenberg, a member of Propeller Health’s board of directors. “All of them should be looking for solutions that give them a good return on capital.”
Propeller Health now has 10 active programs with clients, including Dignity Health in California and the Wyckoff Heights Medical Center in New York.
Customers pay a monthly charge of about $15 to $25 to sign up their patients or members, depending on the additional services Propeller Health is asked to provide. For example, some doctors arrange for the company’s own asthma educators to reach out to patients who need help managing their illness. Interim results from an ongoing clinical study showed trends toward reduced emergency room visits and lower health care costs for patients using the Propeller Health device and company feedback.
Patients themselves don’t pay any fee for the Propeller Health service. But users may still benefit financially if they can avoid going to the hospital or emergency room by using the digital record-keeping system, Van Sickle says. Patients could end up bearing part of the cost of any expensive hospital visits, because many health plans are raising the deductible amounts that members must pay before insurance coverage kicks in.
“This trend toward higher deductibles, without a doubt, will draw more attention to these self-management technologies, and could have financial benefits to consumers,” Van Sickle says.
Out-of-pocket consumer costs, including prescription drug co-pays, may be one of the many reasons why asthma and COPD are not well controlled by medications, Van Sickle says. Other possibilities include poor technique in the use of inhalers, and a tendency of patients to discount the severity of their symptoms even while they miss work days or forego social events. The majority of asthma patients need an additional drug called a “controller” medication as well as a rescue inhaler, Van Sickle says. But only 40 percent or fewer receive those maintenance drugs, he says.
“Controller therapy is chronically underprescribed in the US,” Van Sickle says.
But prescribing doctors may be flying blind when their patients keep spotty records, lose their symptom diaries, or inaccurately reconstruct their health histories during their occasional office visits, Van Sickle says. Propeller Health hopes to improve those interactions between patients and doctors, he says.
Propeller Health is planning changes that will make its platform useful to a wider range of patients. The program, which now works for English and Spanish speakers, will be adapted for other languages. The sensor device, which now fits on most meter-dosed inhalers, will be adapted to work with dry powder inhalers later thist year, Van Sickle says. While the sensor captures medication use, patients can also enter their own notes about their symptoms, and other observations, on their personalized online records. The company is also making improvements that will allow the Propeller system to integrate with online patient engagement platforms used by various health care organizations.
While asthma patients can find other asthma symptom-tracking apps through sources like the iTunes App Store, Propeller Health’s chief marketing officer Erica St. Angel says the company has the only commercially sold system combining a digital device, a mobile app, online patient support, and analytics. Propeller Health is aiming to reach profitability by the second quarter of 2015.
As Propeller Health’s user base grows, so will the value of the aggregate data it collects, says Social+Capital partner Maidenberg. Stripped of individual patient names, the cumulative incidents of rescue inhaler use can reveal airborne hazards such as toxic releases within a metropolitan area, he says. Warnings can not only be shared with all Propeller Health users, but may also bolster public health initiatives in municipalities such as the City of Louisville, one of the company’s early partners.
“In 10 years should there be any inhaled medicine that’s not instrumented (to collect data)?” Maidenberg asks. “The answer to that, to me, is no.”