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Divya Chhabra

AI in Drug Dosing: Improving Patient Outcomes and Reducing Cost of Care

By | HealthTech

Artificial intelligence (AI) is poised to transform chronic disease management by empowering physicians to personalize drug dosing at scale. Dosis, a personalized dosing platform used by dialysis providers to manage chronically administered drugs, has harnessed the power of artificial intelligence to disrupt traditional one-size-fits all dosing approaches, and has introduced precision dosing that is personalized, based on patients’ actual observed responses to their medication. This personalization significantly improves dosing efficiency–achieving equivalent or improved patient outcomes while reducing the cost of care.

Why is now the right time to use AI for dosing?

There are several developments that have come together to create the conditions necessary for the growth of AI-powered drug dosing. The first is technological advancement – modern-day computing power allows for efficient processing of large, complex datasets, making AI solutions practical to implement.

The second is the general public’s familiarity with artificial intelligence as a tool that can solve complex problems. Public familiarity with a diverse array of AI applications in imaging, consumer electronics, and logistics lend popular credibility to the technology, and allow healthcare providers to be comfortable incorporating such tools in clinical settings.

The third is the availability of reliable data in a clinical setting – electronic medical records codify and standardize data in a manner that is much more ingestible by algorithms than free-form paper medical records. The accessibility of dosing and outcomes data in electronic medical records and the ability to effectively analyze this data has made applying artificial intelligence and control algorithms to dosing much more practical and efficient. As a result, it is now possible to draw on data from millions of drug doses and their associated outcomes, a vast improvement on previously siloed and inaccessible datasets.

The final development that cements the need for more innovative dosing approaches is the fact that drugs are now more complex and have more potential to impact basic physiologic processes than at any point in the past. Drugs that impact multiple physiologic processes and have a narrow therapeutic window – the “sweet spot” between toxicity and ineffective therapy – provide the greatest opportunity for  AI-powered dosing.

Dialysis patients and providers significantly benefit from AI-based drug dosing

There are more than 550,000 dialysis patients with End-Stage Kidney Disease (ESKD) in the United States. Dialysis patients tend to have elevated risk for adverse outcomes, and are often on multiple medications. Almost 90% of dialysis patients experience chronic anemia and are treated with Erythropoiesis Stimulating Agents (ESAs). However, exposure to high doses of ESAs is associated with an increase in serious adverse cardiovascular events, like heart attacks and strokes, so the primary clinical intent is to use the minimum amount of medication necessary to prevent patients from requiring blood transfusions.

Dosis’s flagship tool, Strategic Anemia Advisor (SAA), offers dialysis providers clinically validated decision support, empowering them to make optimal dose adjustments based on individual patients’ needs and deliver patient-centered care. It allows clinicians to maintain or improve their hemoglobin outcomes while significantly reducing patients’ exposure to ESAs. This has benefits for both patients and providers: patients are exposed to 25% less drug on average, which means a lower likelihood of serious adverse events like heart attacks or strokes, while providers lower their drug utilization, saving an average $1250 per patient per year.

 The Future – Chronic Dosing To Be AI-Powered

Dosis has proven that precision dosing at scale is possible, and has established a path to success for future applications of AI within the kidney space, including precision dosing for mineral bone disorder (MBD), expansion of value-based chronic kidney disease (CKD) models, and more.

Over the next decade, partially as a result of Dosis’s innovations, AI-driven dosing models will likely be the standard of care across the chronic care spectrum. In addition, as more tools are developed and more opportunities to use those tools are identified, there will be exponential growth in the use of AI to drive innovative therapies.

Analyzing the Healthcare Industry’s Approach to Innovative Technology

By | HealthTech

Originally used as a metric to characterize the treatment of hypertension, therapeutic inertia is a concept that’s recently been reappropriated to describe the healthcare industry’s often slower-than-expected uptake of new tools and technologies. Often described as “the measurement of initiating or changing therapy in a timely manner according to evidence-based clinical guidelines,” therapeutic inertia is a useful lens through which to view innovation in healthcare.

Using Therapeutic Inertia As a Barometer for Innovating Care

As a treatment metric, therapeutic inertia is now standardly used to analyze physicians’ behavior during treatment courses for hypertension, diabetes, and hyperlipidemia. Typically calculated as the percentage of provider visits that resulted in a change in the treatment course, a higher percentage indicates a slow treatment of a condition by a healthcare provider, while a low percentage showing a quick response in providing a new treatment for a medical condition.

Studies have shown that reducing therapeutic inertia number results in improved patient outcomes and better-managed care, and we can see this measurement of treatment being applied to all chronic conditions as a whole. In fact, studies have found that reducing therapeutic inertia is crucial in order to more effectively control hypertension in over 50% of patients. This also is observed to be a significant issue in treating type 2 diabetes. However, this aversion to changing therapies and trying new medicines or treatments is broader than the metabolic conditions in which it has been directly studied.

The Risk May Be in Sticking with the Status Quo

The healthcare industry is risk-averse for understandable reasons: when patient health is at stake, the risks of new tools, treatments, and operating workflows can seem to outweigh the benefits. However, many new tools are aimed at reducing medical error, which is currently listed as the third leading cause of death in the United States, just behind heart disease and cancer. Death due to a medical error can be caused by simple mistakes, errors in judgment, or system defects, including computer breakdowns. With medical errors causing up to 440,000 deaths per year, technical innovations are needed to help limit human and system errors that could be fatal.

Using Technology for Early Intervention

It’s known that earlier intervention and advancements are better for patients’ overall outcomes. And, while healthcare practitioners naturally turn to their own clinical experience to make decisions on how to treat their patients, turning to artificial intelligence-based technology that synthesizes a broader pool of experience to help them in their work has proven to be quite effective.

A recent study presented at the 2019 ASCO Annual Meeting showed that physicians changed their treatment decisions in 13.6% of cases after being presented treatment recommendations from IBM’s Watson for Oncology tool. Diving deeper, of those that changed their decisions, more than half did so because the innovative technology provided more up-to-date, evidence-based information on newer treatments compared to their own individual knowledge. Having artificial intelligence to help reduce healthcare practitioners’ errors in judgment leads them to perform their duties to the best of their abilities. This is a game-changer in treating all types of ailments effectively and efficiently.

Preparing for Value-Based Care

Investment in innovative technologies gives modern healthcare organizations an edge as they prepare for value-based care models. Although most clinics run on a pay-per-visit model currently, the transition to value-based care will require maximum efficiency and effectiveness.

Tracking and working to reduce therapeutic inertia will also push healthcare providers to adapt faster and make iterative improvements to patients’ treatments plan.

With the stakes so high, providers have a good reason to be risk-averse. However, if this risk aversion is taken too far, it can impede innovation, ultimately resulting in harm to the patients that healthcare providers are trying to protect.

Why Kidney Care Will Finally Get the Innovation and Attention It Deserves in 2019

By | Kidney Care

For over two decades, healthcare has been a popular innovation and disruption target for researchers, policymakers, investors, and entrepreneurs. However, most of the disruption and innovation we’ve seen has conspicuously missed nephrology and instead focused on fields such as cancer, diabetes and heart disease.

That said, 2019 could well be a breakthrough year for getting needed attention and innovation within the kidney care field. Here are three major factors driving a surge of interest in disrupting nephrology.

Chronic Kidney Disease is a Growing Problem

Chronic kidney disease (CKD) is a worldwide health crisis. In the United States alone, forty million Americans are living with kidney diseases and 700,000 have kidney failure. Moreover, 90% of people with CKD are unaware they have the disease. By 2030, the prevalence of CKD is expected to 17% for patients over 30.

With no cure for End-Stage Renal Disease (ESRD), 13 Americans die each day as they wait for kidney transplants. 500,000 patients are currently undergoing dialysis treatment and experiencing negative side effects, such as chronic anemia, bone disease, and depression.

Aside from the human impact, treating kidney disease is extremely expensive. As a Medicare patient progresses from without CKD to ESRD, the cost of care increases over tenfold, from $8,000 to $87,000 per year. ESRD alone costs Medicare $34B annually, which amounts to 7% of all Medicare expenditures. while making up only 1% of the Medicare patient population.

It’s clear that the US healthcare system cannot sustain both the medical and financial burden of kidney disease, and there is a critical need for both improvements in care and reduction in cost.

Innovation Through Care Delivery and Technology

We’ve long known that investors see the massive potential to disrupt the healthcare industry as a whole. Venture capitalists invested $2.6 billion into healthcare startups in January 2019 alone — a 37% increase from the $1.9 billion raised during the same month in 2018, and the highest amount raised in January on record.

Now, we’re beginning to see venture capital take interest in the kidney space. In 2018, there were several major investments in kidney care startups. Strive Health, Cricket Health and Somatus raised $77.5 million, $24 million and $11 million respectively, to expand their care delivery platforms, which aim to slow the progression of kidney disease and offer more holistic treatment plans for patients with kidney disease. Lastly, CVS Health announced its plans to enter the dialysis space, focusing on home dialysis.

On the technology side, Outset Medical raised $132 million to expand the labeled indication of its simplified and user-friendly dialysis machine, Tablo, to home dialysis. AI startup RenalytixAI raised $29 million to commercialize their diagnostic tool that aids in early detection of kidney disease. In February 2019, raised $18 million for their at-home urinalysis kit for early detection of chronic kidney disease.

We’re seeing this excitement to disrupt the kidney space reflected in the public sector as well.

The Department of Health and Human Services (HHS) recently announced that it is partnering with the American Society of Nephrology to launch KidneyX, the accelerator focused on driving innovation in the prevention and treatment of kidney disease.

Fueled by massive capital injections from VCs and support from HHS, startups and entrepreneurs will continue to develop new ways to tackle the kidney disease epidemic head-on and shape the future of nephrology.

The Shift Toward Value-Based Care Continues

As value-based care increases in popularity, kidney care stands out as a trailblazer in the payment model. In 2011, the Centers for Medicare and Medicaid Services (CMS) implemented a bundled payment model for all dialysis treatments paid for by CMS. Since then, dialysis clinics have received a single predetermined fee for all dialysis services. This was introduced alongside a Quality Initiative Program (QIP), also maintained by CMS, that lists a set of quality metrics a clinic must meet in order to receive full reimbursement.

As a result, the dialysis industry has had eight years of experience with a true value-based care system, where the pressures to reduce cost are carefully balanced with the pressures to maintain quality. The successful link between patient outcomes and profit that ESRD care already highlights has set an example for other healthcare areas.

Recently, Cigna transitioned to a value-based model as well, which resulted in cost savings of more than $600 million. It surpassed its goal of having 50% of its Medicare and commercial health reimbursements tied to value-based care models in top markets by the end of 2018.  Another payor, Humana, announced its plan to bring value-based care to independent practices in Louisiana, West Virginia, and Pennsylvania through a partnership with Accountable Care Organization Aledade.

While nephrology has taken a back seat to other specialties for decades, the recent confluence of innovation and the shift toward a more patient-focused care promise to bring it to the forefront in 2019 and beyond.

National Siblings Day: Running a Brother & Sister Business Two Years In

By | Dosis News

Starting a business always has its ups and downs, but forming one with a sibling is on a whole other level. Dosis CEO Shiv and COO Divya Chhabra co-founded the company together two years ago, and have learned various life lessons on how to thrive in business while maintaining a good personal relationship.

To celebrate National Siblings Day, they’re sharing their thoughts and experiences on what led them to work together and what it’s like being sibling co-founders on a day-to-day basis.

Founding Dosis

Since they were kids, Shiv and Divya have always made a great team. They have complementary skills that caused them to want to start a company together one day.

Divya entered the healthcare space as an entrepreneur in 2017 after receiving her B.S. in Biological Engineering from MIT and serving as Product Manager at athenahealth for several years. Shiv, on the other hand, was already pursuing his own entrepreneurial endeavor as president of a pressure pump manufacturer after receiving his B.S. in Chemical Engineering from Columbia.

Both Shiv and Divya wanted to form a company that really affected the lives of millions of people. Divya’s experience in the healthcare industry and Shiv’s entrepreneurial experience made this a great gateway to form Dosis and make their vision come to life.

Business Views

Outside of sharing a last name, Divya and Shiv have a lot in common, particularly with regards to their business views. Both believe employers should care deeply about employees and culture, while still promoting a high standard of work.

However, it’s their difference in business interests that really make them a complementary pair. Shiv leans toward finances and sales, while Divya is more interested in product and operations. Although their work still overlaps in certain areas, they can focus on their own job and trust each other’s knowledge, making them a tremendously well-suited co-founder team.

Keeping Business Separate From Family

Bringing work home is a common issue for any professional, but that is amplified when it comes to sibling co-founders. Divya and Shiv try to keep business as separate as possible from their personal relationship, down to using Slack to discuss work matters and text to talk about non-work related things.

Keeping work out of family affairs is a big part of this as well. Work isn’t allowed to come home with Shiv and Divya for the holidays. They ensure disagreements are resolved quickly amongst themselves, and other members of the family are left out of it. Conflicts are resolved by being frank and honest with each other, always remembering that they have each other’s best interests at heart, and that they’re always on the same side because they both want success for the business and each other.

That being said, no matter how hard one may try, work can get personal. Disagreements are bound to happen and it can be difficult to not let it affect personal relationships. Remembering to not bring family members into the affair is another obstacle as well. Typical end-of-day conversations with family can unintentionally make business matters personal, so finding other ways to de-stress and quickly resolve disagreements are crucial.

The Perks of a Sibling-Run Business

Being siblings, Shiv and Divya have unconditional trust in one another’s intentions, truly taking off some of the burdens of running a business. Trust is one of the most important things to have when starting a company, and it’s a big relief for Shiv and Divya that they don’t have to worry about each other’s honesty and integrity.

Since they’ve grown up with each other, niceties are also thrown out the window. They can be as frank with one another as they like, allowing business matters to move much faster. Decisions are quickly made, with all opinions on the table and little left unsaid.

Another component that helps speed up business decisions is that Shiv and Divya know each other extremely well, including their strengths and weaknesses. Work is divided up to cater to each other’s strengths so the best quality of work is produced.

Growing Dosis

While Shiv and Divya have the occasional business disagreement, they know that they’re always there for each other and are focusing on Dosis’ growth. With their company, they’re truly fulfilling their childhood dream of truly impacting people’s lives for the better.

Chronic drug dosing is fundamentally difficult for humans to do well, and Dosis is here to help perfect the process. All patients are uniquely responsive to a drug, and this responsiveness is determined by any number of factors that can change over time. Meanwhile, therapeutic target ranges tend to be narrow and difficult to hit, making it difficult to find the optimal dose of a drug to give patients. When patients are on specific drugs for months and years, this can lead to poor outcomes for the patients, greater likelihood of complications, and unnecessarily high costs.

With Shiv’s entrepreneurial background and Divya’s healthcare expertise, Dosis is scaling rapidly. It recently surpassed 5,000 patients on its platform at more than 50 clinics nationwide and is continuing to spread its footprint. Divya and Shiv are achieving their goal of truly making a difference in people’s lives and are excited to see what the future holds.