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Post by dreamboatcruise on Jan 10, 2018 16:42:07 GMT -5
That Dexcom sensor can send the info to a smartphone and from there, automatically send the data to Verily. Every 5 minutes, patient Doe sends their glucose reading. Smartphone has accelerometer to track activity. Smartphone can be loaded with apps the help coach the patient. Healthcoach and txt patient to set up time to speak and patient can talk to health coach , dietician, CNP with a diabetes specialty about anything that impacts patient Doe's diabetes. Follow up as well. Wanna see a hospital that has no patient beds? www.mercyvirtual.netMy understanding of HIPAA is that the data could not be sent to third party even with identity stripped unless consent is given. There are real concerns about the ability to identify individuals even when their nominal identity (name or social security number) has been stripped. Onduo, which is a spin off of Verily, is one of those companies that provides app and remote coaching. When one consents to use Onduo they are likely consenting to Onduo using the data for analysis and coaching purposes. Though still, that doesn't give Onduo right to share/sell data... likely not even sharing with Sanofi or Verily (its owners).
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Post by dreamboatcruise on Jan 10, 2018 16:26:01 GMT -5
All this talk of Dexcom here sent their stock shooting up today
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Post by dreamboatcruise on Jan 10, 2018 16:06:35 GMT -5
It would be interesting to know from those with what seem very aggressive growth numbers as to what their assumptions are regarding national advertising. Will the growth occur regardless of having a national ad campaign? or when do they think the national ad campaign would need to start to reach their prediction/guess/wish?
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Post by dreamboatcruise on Jan 10, 2018 15:54:22 GMT -5
Are you serious, DBC? Of course, it's guessing and it's just for fun. No one here knows WTF is going to happen, if they did, they probably would have never been in this stock in the first place (or, better yet, would have sold out when we got the approval). Of course he's serious - didn't you notice that his little winky fell of the end of his post? Little? Let's not get personal about my winky... besides, it's normal sized... see Now let me press my over-sized, powerful and working send button.
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Post by dreamboatcruise on Jan 10, 2018 14:42:49 GMT -5
www.yahoo.com/finance/m/3705dde4-f23d-3132-ad70-1d5c50606a38/ss_unitedhealth-taps-into.htmlJAN 10, 2018 @ 08:08 AM 658 The Little Black Book of Billionaire Secrets UnitedHealth Taps Into Emerging Mobile Diabetes Management UnitedHealth Group Inc. signage stands in front of company headquarters in Minnetonka, Minnesota, U.S., on Wednesday, March 9, 2016. Photographer: Mike Bradley/Bloomberg UnitedHealth Group Wednesday said it has partnered with DexCom to launch a glucose monitoring program that uses a wearable device to help older Americans continuously manage their Type 2 diabetes via mobile technology. Initially, the pilot program will involve giving an undisclosed number of enrollees in UnitedHealthcare’s Medicare Advantage plans a device that includes an activity tracker. Health plan enrollees can use the “Dexcom Mobile Continuous Glucose Monitoring System” to track their blood glucose levels around the clock. “Continuous glucose monitoring can be a game changer for people enrolled in our Medicare Advantage plans, as the data can be translated into personalized information that can be acted upon in real time,” Brian Thompson, CEO of UnitedHealthcare’s Medicare and retirement unit said. The business of mobile monitoring technology to manage chronic conditions is becoming more competitive with big names in technology and health insurance developing products, devices and attracting investments. Already in the market with a mobile device and diabetes management program is fast-growing startup Livongo Health. Last year, Livongo attracted more than $50 million in new funding to “accelerate growth in diabetes management , expand to other chronic conditions, and move to international markets,” the company said at the time. In addition, Blue Cross and Blue Shield plans including Anthem have partnered with Alphabet-backed Onduo to monitor glucose levels of patients with diabetes using a wearable device the insurers hope will improve health outcomes. A pilot is beginning this year, the Blue Cross Blue Shield Association has said. The Forbes eBook On Obamacare Inside Obamacare: The Fix For America’s Ailing Health Care System explores the ways the Affordable Care Act will impact your health care. Health plans and technology companies in the space see the costs of diabetes as a significant driver of premium increases with more than 30 million Americans, or 9% of the U.S. population, suffering from diabetes, according to the American Diabetes Association. Another estimated 30 million Americans have diabetes but have yet to have it diagnosed, ADA statistics show. For now, UnitedHealth says its effort with Dexcom is a pilot project for 2018 and decisions have yet to be made on giving the device to all Medicare Advantage enrollees. UnitedHealthcare has more than 4.3 million seniors enrolled in its Medicare Advantage plans . Getting CGMs into the elderly diabetic population cannot happen too soon. Diabetes is linked to dementia and likely in a spiral sort of way... uncontrolled BG causes progression of dementia and dementia contributes to an inability for patients to properly deal with their diabetes leading to deterioration of BG control. Having the ability for healthcare providers and/or family to review CGM data can provide crucial insight and warning. As I've mentioned before, I lost a family member to uncontrolled diabetes who was in a skilled nursing setting, but where the care was obviously nowhere near what it should have been. A CGM could have literally been a lifesaver. Hopefully anyone with a loved one in such a situation will push to get a CGM.
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Post by dreamboatcruise on Jan 10, 2018 14:19:55 GMT -5
I agree the current environment is not going to last. This is an excellent thread describing the giant paradigm shift that's currently underway. A close relative with a doctorate specializing in drug interaction for geriatrics explains the entire current system for diabetes management is ALL based on the (antiquated) A1c measurement. That's all they've had to go on until now. This means FDA testing, protocols, insurance, incentives, relationships, and basically the entire system of diabetes management all sit on a foundation that is just now starting to crumble. 2018 should be a big year that the new players drive the shift to time-in-range management. Every step in this direction will be good for the future of Afrezza. The current players who profit immensely off the old system aren't going away easily but new data plus the new economic environment now favors takeovers and mergers that should accelerate the shift. Seems like things will not change until ADA changes their guidelines (which are used by most practitioners) to add time in range or fully replace A1c. Another change would be when FDA starts requiring clinical trials for diabetes drugs to include measure of time in range. I don't think there is any indication of either of these yet being in the works. It may be overestimating the speed at which medicine changes to assume these will happen within 2018. It certainly is good the discussions are happening, but the real tipping point won't come without institutional changes such as the two I mention. spiro... totally agree. Too many docs remain on cruise control, doing what they feel comfortable with.
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Post by dreamboatcruise on Jan 10, 2018 14:13:57 GMT -5
DBC, your post has much validity in the current environment. I don't think the current environment is going to last. The DXCM relationship with Verily gives Dex the first $1B in data proceeds and as I understand it, Verily views that amount as pocket change because the upside value of the data is so massive. Assuming they (Verily) acts in their own self interest, I would suspect they would take these big amounts of data, redact patient identifiers and make the information well known to the right entities to demonstrate who does and does not produce proper outcomes. Once this happens, it puts pressure on all interested parties to measure patient compliance in a new manner (not A1c). There are some people with diabetes who no matter what they do, struggle to control glucose levels and these people have been dealt a very very challenging hand. For many PWD, diet and exercise would make a monumental difference to their health, quality of life and cost reductions for their healthcare. As previously stated, the financial trajectory we are on is not sustainable and diabetes, due to prevalence and massive costs due to health complications can bankrupt the healthcare system. Its going to change and some entrenched entities will not benefit financially from the changes, as such, they will not go willingly. Can you provide a link to the info about this data sharing arrangement with regard to the $1B. I've read a lot about the cooperation in development of miniturized sensors but seen nothing about this $1B arrangement. Due to HIPAA a patient would absolutely have to consent to have data used in a particular way or shared with a third party. Does Dexcom currently seek consent to share data with Verily? and do patients typically do that? As for figuring out "what works" you have to consider that a Dexcom often isn't aware of everything that effects a person with diabetes. It isn't tracking caloric intake, activity level, other medications (sometimes not even insulin), etc. Personally I think the companies working on artificial pancreas are where the figuring out "what works" is occurring, as they are actually using metabolic modeling. Perhaps Verily is working on that sort of thing but figuring out how bodies metabolize sugars is not very similar to figuring out that if you searched for Prada shoes you might respond to an advert for a Jag. There might be some uses for "big data" analysis in healthcare, but figuring out how to dose insulin isn't one of them.
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Post by dreamboatcruise on Jan 10, 2018 13:38:51 GMT -5
babaoriley... So what's your guess? I'd assume you'd want to participate given that it is fun to do so Though I think you might be surprised at how many people will put some faith into things that appear to be a consensus here, even when the people stating things might personally consider it no more than a WAG or fun wishful thinking... of course that is just a guess on my part
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Post by dreamboatcruise on Jan 10, 2018 13:03:10 GMT -5
Predictions I would say should be based on some sort of analysis. At this point we really don't have information to base predictions on. It seems there are two or three very crucial things we don't know. First is what have the results been in the regions where advertising is being done... i.e. how commercially response are scripts vs money spent on advertising. One might be able to substitute script growth results from another drug with similar insurance coverage vs amount of money spent on advertising (if one was privy to that sort of data for other drugs). Of course we also don't know when we'll see meaningful increase in insurance coverage (it seems some payers only update once a year so for those we'd know that change isn't happening within the 2018 window). I'm assuming that at least first half of 2018 insurance coverage will basically be what it is now. Finally we don't know how much money MNKD will be able to devote to advertising.
Without analysis I think it's guessing. I'll wait to see what guidance management gives and how closely they came to meeting 2017 guidance... then I'll make my prediction for 2018.
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Post by dreamboatcruise on Jan 10, 2018 12:51:14 GMT -5
After the approval of Afrezza Mannkind reached a valuation of $4billion with ~350Million shares Sanofi came in and later dumped us, pushing us to the corner, giving by the same time voice to nosayers predicting by the end of 2016 we are out of business. Thanks to the financial engineering of Matt we had the best year ever on balance sheet. He brought Mike in for the commercialization to increase and sustain the revenue. We tried with external outsourcing, Internal outsourcing, lately insourcing which finally gave us the best result. Following the scripts numbers from 2015 till 2017 we draw a "V" curve and my prediction is 2018 should help us sketch a "golf stick" in numbers we will reach an average of 2175 per week -> 2175*52=113100With 140 Million shares available at an average pps of $2 and quarterly expenditure of less than $35 Million without being at full production capacitiy, because it could be cheaper. $200 million is enough to aggressively go out there to conquer Diabete-America taking $MNKD to break-even Shares can be authorized ad infinitum, so from that perspective there is unlimited money available... though in practice availability of shares doesn't guarantee any certain amount of money, or money at all.
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Post by dreamboatcruise on Jan 9, 2018 20:57:53 GMT -5
dreamboatcruise "I wouldn't count out possibility that MNKD will offer to convert at a discount to wherever the price is then trading even if in low $2s range. Nothing prevents them from doing that." I am hoping MannKind has some kind of positive news before handing over approximately 5 million shares to settle the note. Either way we should be reading about it by Friday. If we do get good news I think the most likely would be some new "punt" agreement with Deerfield buying more time, though nothing from them doesn't come with a price... I would expect at least some of the debt paid in cash or discounted shares, with Deerfield ending up with an aggregate amount of more than the $10M due in recognition of their kind patience
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Post by dreamboatcruise on Jan 9, 2018 20:44:51 GMT -5
@scotta ... do you have some info on what fraction of diabetes patients are currently on some form of fee for outcome. That certainly would be encouraging if the shift is meaningful. Though there would also be the question of what "outcome" they are measuring. If it is only A1c, and they are using ADA type guideline, that is still suboptimal and not being measured in a way that would most encourage use of Afrezza. I still don't believe CGM companies would be interested in marketing in such a way that might imply their product is mainly useful only with one particular insulin, especially when it is an insulin that hardly any patients are aware of. Realistically speaking how long do you think it will be before ADA adopts time in range for their treatment guidelines? And majority of patients covered by insurance that pays for this outcome... and thus necessarily pays for CGMs for both T1 and T2 patients? Will be great when it does happen, but change in healthcare seems to come very slowly. The great push to make healthcare records electronic and easily transportable started 20 years ago and yet I still have to get my PCP to take a paper copy of a lab report from my folder and fax it to a specialist (yes many health organizations have made progress but it's been very slow) Good Question re: fee for outcomes. My dartboard guess is as of right now, very few but its going to ramp. Most diabetes are poorly controlled and CGMs would demonstrate how glaringly poor the entire population is doing in terms of time in range. Its the big swings in blood glucose levels that cause the most long term damage and as such, the expensive treatments associated with the debilitation outcomes of poor control, ie laser treatments for retinopathy, wounds that cannot heal and subsequent amputation, CV issues. With all the crazy stuff floating around these days, try this one on for size. Amazon is getting into the Rx business. They are also going to have their own PBM (run I believe on an existing outsourced platform but dont quote me for sure on that one). Amazon has already proved it can run their business successfully on a much lower margin than competitors so even if the PBM ran at 1/4 the profit that the big guys do, Amazon would probably still make money or still stay in the game so they could dominate the space. You realize you don't need a prescription to buy insulin. You do need an Rx to get your insurance company to pay for insulin. Amazon has a pretty good web services operation. They could figure out how to collect and aggregate CGM data. What happens if they can get paid a fee for good outcomes and have a system and tools to produce unprecedented results? The cost of the Rx products is chump change compared to the savings insurance companies reap from a massive patient population that has a poorly controlled disease whose costs could bankrupt the US healthcare system. All speculation on my part but given our nations debt, aging population, pension fund liabilities, poor wage growth... you get the idea, what we have now in our healthcare system and other aspects of our country is simply not sustainable. You do need a prescription to buy Afrezza. Reports to the contrary are not accurate. What you say about diabetes complications is certainly true, and even well known throughout the healthcare profession. Problem is that most payers don't have that long a term view. I have a group of friends in healthcare management. Even an organization like Kaiser that is known for being "evidence based" doesn't take a long term view of the cost/benefit... I've been told this. Payers realize that they may not have a patient as their member 5 years down the road after paying more now to keep them healthy. Additionally, in all industries execs are rewarded for short term results, not long term... myopic business planning is rampant in companies everywhere. Thinking about what will save money 10 years down the road simply isn't what exec are incentivized to do. It is true enough that better preventive (and more aggressive diabetes) care would save American consumers and taxpayers huge amounts of money, but the system isn't currently set up where the players actually have incentive to do so. Currently it's actually the opposite. Insurers are required to spend a certain percentage on the actual care, which caps the percentage profit they can make. The way to increase profit when the percentage is capped is to increase the health expenses so that overall premiums go up. It would be nice to think some course correction is coming, but alas, I'd be surprised if things really change in our current atmosphere of dysfunctional politics. BTW, collecting CGM data is pretty trivial from a technology standpoint (if not HIPAA) and is in fact is already a reality. Dexcom, and I presume Abbot, already have the technology built in to upload CGM data. I know Amazon has been rumored to be thinking about PBM business (actually has obtained pharmacy licenses in some states, and already sells drugs in Japan), but it appears big insurers may now be questioning bringing PBMs in house (or the functionally equiv CVS-Aetna merger). Maybe that merger leaves more opportunity for Amazon as an independent PBM, but also perhaps means that the dominance of independent PBMs has peaked and now declining. I'd be hesitant to even guess how all of that may shake out... though it really is the profit incentives that would need to change or else it's just possibly more efficient competitor doing the same thing as the existing ones.
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Post by dreamboatcruise on Jan 9, 2018 17:38:38 GMT -5
Wasn't he reporting in to Mike when he was hired? May have been, that was about same time Mike C. was hired as CMO, under Matt P. Easy to research: Mike C AnnouncementTwo New Hires AnnouncementApparently was unhappy or not getting the job done. Move on. Or he was offered a lot of money to jump ship. In my industry lots and lots of people are enticed away from jobs not because there is a problem but simply that another company decides to throw money at them. A whole spectrum of possibilities and we probably will never know. Unless there becomes a pattern of people leaving now, it is pretty much a non event, IMO.
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Post by dreamboatcruise on Jan 9, 2018 17:28:00 GMT -5
@scotta ... do you have some info on what fraction of diabetes patients are currently on some form of fee for outcome. That certainly would be encouraging if the shift is meaningful. Though there would also be the question of what "outcome" they are measuring. If it is only A1c, and they are using ADA type guideline, that is still suboptimal and not being measured in a way that would most encourage use of Afrezza. I still don't believe CGM companies would be interested in marketing in such a way that might imply their product is mainly useful only with one particular insulin, especially when it is an insulin that hardly any patients are aware of. Realistically speaking how long do you think it will be before ADA adopts time in range for their treatment guidelines? And majority of patients covered by insurance that pays for this outcome... and thus necessarily pays for CGMs for both T1 and T2 patients? Will be great when it does happen, but change in healthcare seems to come very slowly. The great push to make healthcare records electronic and easily transportable started 20 years ago and yet I still have to get my PCP to take a paper copy of a lab report from my folder and fax it to a specialist (yes many health organizations have made progress but it's been very slow)
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Post by dreamboatcruise on Jan 9, 2018 17:11:57 GMT -5
I think that Mike solved the Liquidity issue. On October 1, 2017 MannKind invested 15,000,000 in to Bitcoin when it was trading at $4,404.00 per share. for 3,405.09 Bitcoins.
He didn't sell them on December 16th when they hit $19,187 per coin as he was greedy with MannKind's money. ($65,333,461). He figured they would continue to go up in value and we didn't need the cash until the 2nd quarter.
Today's value is $14,699.00 per Bitcoin or $50,051,417 So should Mike sell MannKind's Bitcoin's or wait for the next run up in value. Since one of their lottery tickets hit the jackpot last week, I think we can hold off on liquidating the bitcoin, though couldn't hurt to take some off the table to be prudent... just in case the lamp Mike just bought doesn't actually contain a genie.
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