Among all the semi-finalists for Sanofi’s Data Design Diabetes Demo Day, we think N4A Diabetes Care Center was the most unexpected and confusing. N4A dates back to 1960’s legislation on aging, and is a loose affiliation of state agencies around aging. N4A literally stands for Advocacy, Actions, and Answers on Aging.
As Sandra Mark Woods explained in her presentation, they’re not an app, not software, nor offering live streaming, but they are a data-driven organization and “high-touch” in diabetes management. N4A is a Title VI organization that has been providing services in communities for decades. They are involved in Meals-on-Wheels, depression counseling, transport of patients to providers, and chronic disease management services. Millions use it, they have 800 million patient records and a diabetes index with 30 million maps.
They note that 80% of diabetics live in just 8000 zip codes (out of 38,000). They also note that most diabetics under-consume healthcare resources, then have a big, bad event (at sadly predictable rates) and end up over-consuming resources. They aim to stop this progression from under to over consumption. It’s a death march.
The uncontrolled diabetic is living at about a 18% risk of hospitalization (per year?) representing a 2000% increase in healthcare costs when he or she lands in a hospital. Noncompliance and underutilization is not cost-effective, when the reason is lack of transportation, or a fear of needles.
N4A will be culturally sensitive, locally tailored to patient needs. They already know in each zip code how many diabetics will end up in ED, how many will end up as inpatients, and know how many diabetics are at risk and not doing enough to stop it.
For all this time, N4A has lived off grants, but now with Diabetes Care Center they’re moving into business. Their plan is fee for service, insurer contracts, and value-sharing by avoiding acute events. They figure if they spend $1000 per enrollee (netting about $360 profit) to save on a $35k event, everyone will win. And others can’t compete with their data and reach. When someone in the audience asked, who pays the $1000 per enrollee (since they’re not employer based) the N4A folks answered: the insurer, or a sponsor, or an ACO. Each payer will see ROI.
The question that got to the heart of our confusion was: aren’t they already doing this work, as a nonprofit? Well, it turns out: No… Their nonprofit side collects data, the new for-profit side targets the individuals and tries to prevent hospitalizations.
It’s a brave new world, where a 40+ year-old bureaucracy with reams of patient data can compete in a startup innovator challenge. But if that’s what it takes to improve diabetes care, we’ll endorse it.
Oddly, however, there’s not too much at N4Ax.