better MD , Inc.

1. NAASO 2003 Annual Scientific Meeting betterMD.net, Inc. OBJECTIVES TREATMENT OPTIONS • Low Calorie Diet PLUS weight loss medications. • Very Low Calorie Diet FOLLOWED by weight loss medications. • RNY Weight Loss Surgery referral for patients who have failed other physician-supervised effort. • All options include diet, exercise and lifestyle education with regular follow-up and Internet support. • Treatment is continued over a five year period. • WEA Trust, a group insurance provider for 78% of Wisconsin school districts and 155,000 members currently doesn’t cover obesity care. • WEA sought a Comprehensive Weight Management solution for their members statewide. • Over five years WEA seeks to show cost and care effectiveness in order to add this benefit for their members. SUBJECTS OUTCOMES • The WEA Trust -- betterMD.net Obesity Management Study is open to WEA insureds with a BMI of 30 or more. • In the first 24 months 70 of a possible 220 subjects have enrolled. • Currently 84 patients have enrolled in 36 months: • Average age is 46 (range 27 - 61), • 66% female : 34% male • Average baseline BMI is 44.1 (30.8 - 66.4) • 7 patients have withdrawn – 2 patients were dropped due to changes in insurance coverage – 1 patient was dropped due to pregnancy • Each participant MUST sign a Study agreement with WEA and pay an “up-front” fee based, in part, on the expected costs of treatment. • The “up-front” fee for the LCD+meds arm is $1,500, the VLCD followed by meds arm is $2,000 and $5,000 for the RNY weight loss surgery arm. • 50% of fee reimbursed at the end of five years based on compliance (number of visits, lab tests, and follow-up surveys.) *Note – Additional data has been sorted and analyzed since the deadline for abstract submission. These outcomes reflect actual measurements through September 1, 2003 METHODS • Enrollment at web site: www.betterMD.net/WEA • On-line Treatment Planner generates plans • Plans reviewed and selected by patient and provider • Treatment option approved & returned to betterMD.net • Medications and nutritional supplements distributed by betterMD.net based on treatment protocol • Referral to surgery and other providers per Study protocol • Web-based Plan Preferences and Goal Setting support • Exercise and Food Diaries online • Weekly Checklist Reports submitted via web site (reviewed by staff) • Secure web messaging platform (vScribe) accessed through secure web portal • Weekly eNewsletter (Health-e-Thoughts) • Order, Visit, and Compliance Monitoring • Individual follow-up, and extended support via phone, fax and e-mail CONCLUSIONS / DISCUSSION These second year results demonstrate the success of an insurance company program for weight loss treatment through an interactive Internet disease management website. The majority of patients achieved, and maintained more than a 10% weight loss over the first 24 months of the five year study. They also show the comparability of non-surgical options to gastric by-pass surgery at substantially lower costs. Non-surgical options were one seventh as expensive as gastric bypass surgery ($3,000 vs. $21,000) over the first two years of the study. This research supports incorporating obesity care using an interactive Internet disease management website into traditional insurance benefits. CONTACT INFORAMTION David C. Murdy, M.D. Chief Medical Officer office: 608-754-7339 betterMD.net, Inc. toll free: 877-578-1067 Janesville, WI 53546 e-Mail: david.murdy@betterMD.net October 11 - 15, 2003 Ft. Lauderdale, Florida Second Year Outcomes and Cumulative Costs for an Internet-supported Insurance Company Comprehensive Weight Management Program David C. Murdy, M.D. Second Year Outcomes and Cumulative Costs for an Internet-supported Insurance Company Comprehensive Weight Management Program David C Murdy, M.D., Janesville, WI, United States. The WEA Trust - betterMD.net Obesity Management Study is a five-year study of the cost-effectiveness of Internet-directed weight management care. The WEA Trust is a group insurance provider to 78% of all school districts and over 155,000 members statewide. The WEA Trust seeks to develop a cost and care effective comprehensive weight management solution for its members statewide. The Study is open to WEA-insured members with a BMI over 30 throughout Wisconsin. In the first 24 months 70 have enrolled. Patients enroll on the website, complete an on-line history and establish a preferred treatment plan. After an exam and approval by their personal physician they begin either a low-calorie diet plus medication, a very-low calorie diet followed by medication, or bariatric surgery. Patients are followed via an interactive website, providing education and clinical support. Of 70 enrolled patients, 69 patients have completed at least one month of treatment. For patients enrolled between 30 and 180 day the average weight loss for the LCD+meds, VLCD, and bariatric surgery arms are 41 lbs., 46 lbs., and 55 lbs respectively. For patient enrolled between 181 and 365 days the average weight loss for the LCD+meds, VLCD, and bariatric surgery arms are 45 lbs., 47 lbs., and 78 lbs. respectively. For patients enrolled for 366 days or more the average weight loss for the LCD+meds, VLCD, and bariatric surgery arms are 44 lbs., 51 lbs., and 97 lbs. respectively. Those reaching at least a 10% weight loss at 180 days are 83% for LCD+meds, 78% for VLCD, and 71% for surgery. Those reaching at least a 20% weight loss at 180 days are 17% for LCD+meds, 38% for VLCD, and 43% for surgery. Average cumulative costs of study-related weight management care for those who have participated more than 180 days were $2,600 for the LCD+meds, $3,400 for the VLCD and $20,700 for the bariatric surgery arms. These second year results demonstrate the success of an insurance company program for weight loss treatment through an interactive Internet disease management website. They also show the comparability of non-surgical options to gastric by-pass surgery at substantially lower costs. Results for Patients at 12 to 24 months Low Calorie Diet + medications: Average initial weight 238#, Average loss 34#, Range 2 to 66 pounds. (n=5) 80% reached a 10% weight loss, 40% reached a 20% weight loss Very Low Calorie Diet(followed by medications): Average initial weight 269#, Average loss 43#, Range -20 to 209 pounds. (n=52) 57% reached a 10% weight loss, 36% reached a 20% weight loss Surgery(followed by medications): Average initial weight 313#, Average loss 83#, Range 28 to 151 pounds. (n=10) 68% reached a 10% weight loss, 50% reached a 20% weight loss Comments: Due to the relatively small sample size of the LCD+Medication arm, one very successful patient has substantially improved the Mean Weight Loss for that arm of the study.