1. May 2015
Validating the Nurses
Role in Diabetes Prevention
and ongoing Management
Martyn Molnar
CEO
TupeloLife Corporation
Dr. Eric Hazzard
Global Life Sciences & Research
TupeloLife Corporation.
San Diego, California

2. 2
Synopsis
Based on Existing Research, Program Analytics and Work Streams
• Established intelligence with leading US universities (UC Davis, UCSD, Ca)
• Efficacy, Impact and change– witnessed thru NP engagement within Obesity,
Hypertension, HIV Programs in California and Europe (Germany).
• Visibility of Sustainable returns from Programs executed in the last 12 months
within the Middle East.
• Increased Adherence and Program engagement – due to personalization,
education, monitoring, management and incentives towards agreed outcomes.
• Engagement scale – meeting program participants where they are at allowing
them to “bring their own data” maximizing resources, applying the right cost
to the context of care
• Extending the care continuum – Beyond the Clinic. Programs that impact the
family and go straight to the home.

3. 3
How are we getting this done
Based on Existing Research, Program Analytics and Work Streams
School Programs
Corporates
Tech Research
School Programs
University Research
Clinical Validation
Insurance Community
Nutrition Community
Study Obesity
Technology R&D
Schools Programs

4. 4
How are we getting this done
Based on Existing Research, Program Analytics and Work Streams
The big picture
Efficacy, Impact,
Outcome..
Tunable,
Repeatable..

5. 5
WHAT IS TUPELO?
Tupelo is an integrated,
always-connected
technology ecosystem
enabling scalable,
targeted, and proactive
healthcare management
for patients with
complex, high-cost,
acute and/or chronic
conditions.

6. 6
TUPELO Model vs Other Models
Device
Data Interpreted
Shared
Elaborated
InformationExperienceConsumer
Data
Reactive,
15 % Participation
85 % Drop out Rate
Preventative, Adaptive, Individual, Scalable,
Societal
Engaging (50% - 70%)
TODAY / EMPHASIS TUPELO / EMPHASIS
Insightful, Contextual, Actionable and Relevant Data

7. May 2015
Some clinical feedback
concerning Diabetes care
and management

8. 8
Overcoming ‘Doctor Inertia’, limitations
of ‘Apps’ and Upfront Cost
Need a combination of Self Management and Clinical/Doc Intervention
• TECHNOLOGY – 1000’s Apps focused on Management. Low single digit % utilization.
• SELF MANAGEMENT – Not everyone wants this immediately. TECHNOLOGY serves
to move patients into an uncomfortable space too quickly. Cultural dynamic.
• COSTLY – Costs are bourn upfront and take valuable clinical resource out of budgets.
Limited returns result as a result of #2
• STANDARD PROGRAMS – not meeting the need. Shortage of resources, Doctor
being the bottleneck/point of inertia. ( Clinic AMS : 4 Visits Per Patient Per Year ).
What happens between visits is not being captured.
• 75% – of Checks could be administered by Nursing Staff and should be carried out
more frequently. (Cardio; Bloodwork; Exercise; Weight; Nutrition; Rx feedback)
• Overcome – Increase frequency of interaction, engage Doctor at critical point of
care, keep data always on hand, know when there is a patient disconnect. Migrate
to a Bi Weekly (real time – evidence/data based) engagement setting from quarterly
retrospective.

9. May 2015
Study Proposal
Engaging Nurse Practitioners and
Real time data capture strategies to improve
Diabetic care outcomes

10. 10
Program Attributes
Study Features:
• Patients (n=1,050) randomized into one of three groups
• Nurse Health Coaches (n=30) randomized into one of three groups
• Nurse Health Coaches receive either standard program training or telehealth program
training (there will be no differentiation between telehealth training for unscaled or
scaled)
• 6 months program length
• Outcomes metrics include:
• BMI
• A1c
• Weight
• Waist circumference
• Blood pressure
• Cholesterol
• Physical activity goals
• Nutrition goals
• Satisfaction with Care
• Self-efficacy score
• Knowledge
• Engagement level
• NHC satisfaction and utility rating
• Cost per person
• Estimated cost savings

11. 11
Nurse Practitioner Engagement
Study Design: LifePlatform NP Program vs Standard
Study Aim: does a LifePlatform NP program (unscaled or scaled) outperform a standard
program on the following outcomes?
1. Patient clinical indicators
2. Patient goal achievements (weight loss, physical activity, nutrition)
3. Patient self-efficacy
4. Patient satisfaction,
5. Nurse Tool set satisfaction and usability
6. Cost effectiveness (↑ NP:Patient ratio).
7. Doctors time effectively servicing patients

12. 12
Pursued Outcomes
Study Design: Combined NP and RT Programs/Devices LifePlatform vs Standard
Analysis-
• Standard inferential statistical analyses will used to compare differences between and
within groups
• Cost effectiveness will include predicted and actual cost savings based outcomes
Standard NP Model Un-scaled NP Model Scaled
Clinical Outcomes
↑
↑↑↑ ↑↑↑
Patient Goal
Achievement
- ↑↑↑
↑↑↑
Patient Self-Efficacy - ↑↑ ↑↑
Patient Satisfaction ↑ ↑↑ ↑↑
Nurse Health Coach
Satisfaction and Usability
Rating
↑ ↑↑↑ ↑↑↑
Cost effectiveness* ↑ ↑↑ ↑↑↑
Physician Servicing ↑(50%) ↑↑(20%) ↑↑↑(20%)
*NP scaled model will be 50% more cost-effective than NP unscaled
Predicted Results -

13. 13
Nurse Practitioner : Validation
Study Design: LifePlatform vs Standard
Study Design: Patient and NP, Three-arm Randomized Controlled Trial
Type 2 Patients
Standard
Program
(1:30)
LifePlatform NP
Program (1:30)
LifePlatform NP
Program Scaled
(1:45)
Randomized
Nurse Practitioners
Randomized

14. 14
Program Structural Differences
Study Design: LifePlatform vs Standard
Standard Program VS.
• Periodic Check in (Dr)
• Goal Setting (non incentivized)
• Periodic vitals capture
• Advice line and possibly email (Dr/NP)
• Website / Generic Content access
• Structured In-person education classes
• Generic Information for the masses
• Low structure and Information search and
relevance for Doctors to make an assessment
• Administration intensive
• No Tech
LifePlatform NP Program
• Weekly Call/Video call with NP (billable in India)
• Goal Setting (incentivized outcomes) enhanced by
health platform and devices
 Badges, Social media, outcome tracking
• Real time information
• 24/7 advice line and email (NP)
• Customized education content and tracking of
engagement (NP)
 Automated by health status or program
• Personalized messaging, alerts, and notifications (NP)
• Nurse portal and analytics to manage and monitor
caseload efficiently and effectively
• Highly Structured information and patient relevance –
timely presented
• Administration limited
• Technology (Home tablet, mymo activity tracker, BIA
weigh scale, Smart phone app, web portal, SMS )

15. 15
Nurse Coaching
Nurse Coaching Programs
Specific Roles of Nurse Practitioner (NP):
1. Providing self-management support – NPs will:
1. provide information,
2. teach disease-specific skills,
3. promote healthy behaviors,
4. impart problem-solving skills,
5. assist with the emotional impact of chronic illness,
6. provide regular follow up, and
7. encourage people to be active participants in their care.
2. Bridging the gap between physician and patient – NPs can bridge gaps by following
up with patients, asking about needs and obstacles, and addressing health literacy,
cultural issues and social-class barriers.
3. Helping patients navigate the health care system – NPs can help coordinate care and
advocate for their patients.
4. Offering emotional support: – As trust and familiarity grow, NPs can offer emotional
support and help patients cope with their illnesses.
5. Serving as a continuity figure:– NPs connect with patients not only at office visits but
also between visits, creating familiarity and continuity.

16. May 2015
Study Proposal
Technology Framework : Facilitation

17. 17
Technology Ecosystem
TupeloLife Platform Overview
Features:
• Personalized Tech System for each Patient based on Treatment Plan
• Integrated real time data collection from Devices (incl. 3rd party) to allow
for Meaningful Remote Monitoring
• Easy-to-use, Useful, and Engaging NP and Patient Portals to Communicate
and Manage Information
• Remote/Virtual consultation options (Video Call, etc.) – Real time msgs
• Non Smartphone dependent
• Automated Reminders and Alerts to promote Compliance, Adherence, and
Increase Effectiveness and Efficiency of Patient Management – Incentive
rich to encourage rather than enforce Adherence
• Nurse as an Educator and content distributor
• Powerful and Practical Analytics Geared at Outcomes
• Timely, relevant information flow for engaging Physicians
NP Tupelo Health
Cloud and
Software
Patient,
Devices, &
Portal

18. May 2015
Thank you