Merck Heritage Provider Network Innovation Contest 5 Questions with Fit4D

5 Questions with…Fit4D

This post is part of a special “5 Questions with…” series, featuring Q&As with the semi-finalists in the Merck | Heritage Provider Network Innovation Challenge.

David Weingard - Fit4D. Semi-finalist in the Merck | Heritage provider network innovation challenge

David Weingardis the CEO and Founder of Fit4D – a personalized program that synthesizes workflow, data capture, device integration, and reporting-enabling personalized service delivery via coaches within its network. He has experienced first-hand the complexities of living life with diabetes and its challenges. Fit4D is one of five semi-finalists in the Merck | Heritage Provider Network Innovation Challenge competing for a $100,000 award. Learn more about Fit4D by tuning in to Demo Day on January 23rd.

 1.  What is your concept? Tell us about it in two sentences or less.

Fit4D solves for patients with poorly managed diabetes.  We use technology to make a personal diabetes educator (CDE) coach scalable and affordable.

2.  How did you hear about the Challenge and what prompted you to enter?

We learned about the challenge through Luminary Labs and appreciate the ‘real world’ approach they take to healthcare.  We entered as part of our mission to improve the lives of people with diabetes — it is our passion and reason for being.

3.  What have been your biggest successes and challenges in the last year?

Fit4D started with telephonic coaching, similar to a call center model.  We learned quickly that this method doesn’t scale.   We began to search for alternate ways to help patients including mobile or web-based apps.  Although there are some very cutting-edge apps we found that they worked for the motivated patients, though they are not the problem    It is important to use a real person to help motivate people, by building a therapeutic alliance, especially for those people who are not motivated or feeling very overwhelmed by their diabetes.

This is where the personal CDE coach comes in!   On to the amazing part; technology is at a point where we use it to scale our CDEs and reach more people   And, we communicate in the way patients want to communicate – across mediums such as email, text, online support groups, webinars, phone, Skype and our web platform.  This optimized mix of human and electronic touch points enable us to engage patients (the motivated and the unmotivated) and improve their health.

In the past year we’ve improved the way we measure results by integrating the data from payers/PBMs (e.g. for medication adherence) and medical devices (e.g. A1C kits, blood glucose meters).   Robust tracking and reporting on this data ensures that we deliver on key performance metrics and provides immediate validation.  It’s a true comprehensive patient support program.

4.  What is the main problem you are looking to solve with your solution?

We are solving for those having the biggest challenges with diabetes self-care, and giving them a helping hand when they need motivation or hit a bump in the road.  Ultimately giving a patient a much needed ‘high five’ when they stay on that path or providing personalized support that motivates them to overcome challenges.  (e.g. taking their medication).  Diabetes is hard; it’s an everyday thing, everyday!  Everyone with diabetes is different; not only coming from different social-economic and cultural backgrounds but also facing different hurdles – so the interventions must be personalized.

In addition to supporting patients getting healthier, we’re reducing healthcare costs, improving patient / provider communication, increasing medication adherence and overall improving the lives of those living with diabetes.  40% of the cost of diabetes is associated with those patents with A1C values above 9.   These high A1Cs put a patient at higher risk for heart attacks, strokes, kidney disease, neuropathy and circulation problems. All expensive to treat complications.

5.  Your team has entered into the Virtual Accelerator period, which includes a design, prototyping, and business modeling Boot Camp. What is the biggest insight you uncovered during Boot Camp?

The boot camp, especially the focus groups, reinforced how everyone with diabetes is different and that personal interventions will provide an immediate impact on the patient.  The virtual accelerator has helped us recognize our individual assets as a team and how to leverage them in many ways.

Make sure to register for Demo Day, taking place on January 23rd in New York City.  Click here for your free tickets!




Questions you always wanted to ask your pharmacist….but didn’t!

Fit4D Pharmacist, Sara Wortman, Pharm D, CDE, give answers and tips on getting refills, generic drugs, and more!


Why does it take so long for the pharmacist to fill my prescription?
Pharmacies operate on first come first serve basis.  Pretend 10 other people come before you, one of whom may have had 15 prescriptions to fill.  Even though yours may be something that seems easy and doesn’t need to be counted out and just needs a label, like a nasal spray, you still need to wait.

Example:  You wouldn’t go to McDonalds and get to jump to the front of the line because you want a chocolate shake and the person in front of you ordered food for 15 people.

You may not see all the people in front of you in line, often people drop off their prescriptions and walk away to shop or find something else they need to purchase.  Pharmacies also have physicians calling in to talk to the pharmacist, patients wanting to talk to the pharmacist, and prescriptions being faxed and e-scribed in that also need to be processed, all with various levels of priority.   While it may seem like there is often an army of people working behind the pharmacy counter, there are usually only one or two pharmacists.  Everything that goes out of the pharmacy needs to be verified, checked for accuracy, and checked against your other prescriptions for interactions, all things only a pharmacist can do.  If you think about it, there is a lot that happens between the time you drop off your prescription and when you pick it up, even when there are no problems.

Quick Tip:  To avoid long waits, going to the pharmacy at off hours is a good plan.  Off hours are generally early morning, late afternoon, and late evening hours, depending on the pharmacy’s hours of operation.


Say I forget to call my doctor to get a refill and  run out of my medication.  Why can you give me an emergency supply for some medications but not others?
If it’s a maintenance drug (like a pill for diabetes) that is considered necessary and stopping it abruptly could be detrimental to you, pharmacists will often dispense a 3 to 4 day supply to avoid interrupting treatment  and causing a worsening in your health condition.  It’s considered a good faith fill. Typically this happens for (but not limited to) medications taken for diabetes, cholesterol control, heart disease/high blood pressure, and other chronic disease states.  There are certain medications that pharmacists won’t be able to give an emergency supply like controlled substances such as pain medications. Keep in mind, when you fill your prescription, it will be less the days the pharmacist kindly filled in good faith.

Example:  Your doctor may call in a 30 day supply, if the pharmacist good faith filled 3 days, you will only get 27 days when you pick up the prescription for this month.

Quick tips:

  • Mark your calendar 5 days in advance of when you need to call your doctor to fill your script so you make sure you have it in time.
  • You must regularly get your prescriptions filled at a pharmacy to be provided a good faith fill.


Why am I allowed to fill my prescription with my local pharmacy and then, out of nowhere, I have to utilize a mail order pharmacy?
This is an insurance company policy.  Typically, this is for maintenance medications for a long-term condition or something like birth control.  It’s cheaper for the insurance company for you to get 3 months at a time at a mail order pharmacy.  In the long run, it’s often cheaper for you too!

When this happens, keep in mind, the pharmacy can’t just send the prescription to your insurance company.  You must have the doctor send it in the method appropriate for your state. Your local pharmacy can transfer prescriptions from mail order but never to a mail order pharmacy.  They require new prescriptions directly from your doctor.  If you transfer to a local pharmacy from mail order, the 90 days supply prescription is now “broken” and will require a new prescription sent or faxed to from your doctor.

Quick tip:  Have your doctor write 2 prescriptions.  One for one month and one for mail order.  This way your physician can send in the prescription to the mail order for processing and you can take the other one month prescription to your local pharmacy to have filled right away.  This way you have your medication while you are waiting for the mail order to arrive.


Why do you need my address?
Generally it’s because they need it to verify demographic information.  It isn’t being used in any other way than to make sure pharmacies are doing things right.  It’s not that they are selling your info but might send you targeted info from the pharmacy.

Example:  Let’s say your pharmacy only has a partial month’s supply for your diabetes pills and you don’t return to pick up the remainder of your medication once it is ready.  Your insurance already paid for it, and the pharmacy has no right to keep it.  Therefore, they might mail it to you so that it doesn’t sit on their shelves for too long.*


Why do you need my ID?
Not every prescription requires ID to be filled or picked up.  It depends on the state in which you live, whether the pharmacy knows you by name as a regular customer, and what kind of medication is being filled.  In general, an ID is used to verify that you are the correct person, especially if it’s a controlled substance (like pain medication).  This decreases amount of fraud and theft, and is actually meant to protect both you and the pharmacy.

What must be on the prescription?
This varies by state.  Typically, your name, date, the doctor’s signature, drug name, quantity, and directions. This can vary for controlled substances as well.

To know exactly what must be on the prescription you should check with your state rules and regulations.  For controlled substances and in many states it is required to have a diagnosis code written as well.  The diagnosis is often written as a number.  For example, 250.00 is one of the diagnosis codes for diabetes.

Quick Tips:

  • This is important to remember if you are traveling out of state and haven’t filled your prescription.  The state you travel to may have different laws about what must be on the prescription.  It is definitely best to get everything you will need filled BEFORE you travel.
  • It’s always best to double check with your doctor to ensure  that everything that is necessary to fill the prescription is written before you leave your healthcare providers office.

Why do I have to bring the actual written prescription for some drugs but not others?
It depends on the drug.  Any highly controlled substance (level C-II) must be given to the pharmacist in its originally written format from your healthcare provider.  It cannot be called, faxed, or e-scribed.

Why can’t I have name brand drugs if I want them?
Insurance companies want to save the you money.  They have a set list of medications called a formulary that they use to keep costs down.  Part of the cost of brand name drugs is due to the years and years of research and development for approval and the marketing that it takes to get the drug to market.  When the generic comes out, drug is cheaper because they didn’t put the same time and money into it the original manufacturer did.  The generic has the same therapeutic affect as the brand name medication, it legally has to.

Note:  Many patients say they are allergic to the generic drug.  It’s not that one is allergic to the generic drug itself but could be allergic to its other properties, such as the time release factor or the coating.  These things don’t have to be the same as the name brand.  Be assured the active ingredient must always be exactly the same.

Example:  Ever tried a generic Tums?  Many are awful and chalky.  They have the same affect but their taste make up is much different!


*The pharmacy will only mail medications in certain cases.  Do not expect your pharmacy to mail your medication unless you set up a process to do so.  This is not something a pharmacy is required to do.

Diabetes Technology: Friend or Foe?

Today I finished the Philadelphia Marathon, proud at “toughing it out” and running the whole time – though slower than expected and with way more diabetes challenges than necessary.

In the last 14 years of my life with type 1 diabetes, and as a runner/triathlete, I have learned that “winging it” with diabetes usually doesn’t work.  To have a great race, it’s always better to be prepared for all the crazy moments diabetes can toss into the mix.

I’ve found that simulating the race day environment beforehand with the same clothes, food and insulin teaches me what will work best.  Diabetes doesn’t always work logically though these training efforts illustrate patterns that I can adjust and retest before race today.  This strategy has enabled me to successfully finish numerous marathons and Ironman triathlons – even getting faster despite aging.

Well, I’m a crazy busy person (like everyone, right?)… and this time I didn’t use the discipline to do what had served me so well in the past.  Additionally, I realized that I had become dependent on my Dexcom CGM.   Well, if it is moving in the wrong direction, I can fix it, can’t I????


Before today’s race, I took more carbs in than normal through an electrolyte drink and too little insulin.   I spiked to 365 by race start and it took me 7 miles to get it down into the low 200s.  By then, the damage was done.  I was out of it, dehydrated and started to slow down.  I stabilized my BG and the next 6 miles were OK.  Then I started going low and averaged a blood sugar of 60 for the last 9 miles of the race.  How could this happen with this great technology?  Here is what I learned today and humbly share with those of you athletes, or family members/friends of athletes with diabetes.

  1. Most athletic events, whether a marathon or after school soccer workouts need to be treated as a big deal, especially with diabetes.  To succeed requires focus, concentration and determination.  With all the things to think about during the event (clothing, weather, hydration, nutrition, logistics, pace, etc.), mental bandwidth is stretched.   There isn’t enough time to continually monitor every aspect of diabetes with all this other stuff going on.
  2. I forgot to turn on the alert feature of the CGM which may have helped me correct the problems I was having sooner (reference bandwidth problem in #1).
  3. We are responsible for ourselves.  I own my experience today based on what I did.
  4. A CGM, (while a great tool), shows trends.   It is not an accurate representation of what is happening at the actual moment.  By the time the extreme high or low has happened, chances are it has been that way for a while.
  5. While using diabetes technology like a CGM enabled me to not stop and “waste time” testing my blood sugar during a race, it also gave me a false sense of control and bravado about not being as prepared through simulations.
  6. Testing my BG during a race forced me to focus on diabetes completely for that moment rather than glance at a CGM screen and moving on.  In the end my high and low blood sugars cost me more time than stopping to test.
  7. If I want to race the best that I can, I need to take my diabetes planning as seriously as I do my training.  That means, simulations, recording notes in my logbook, fixing, repeat…over and over so I can control it…not let it control me in a race.
  8. And, despite all of these issues, today I finished a marathon while living with diabetes.     Something to be proud of and something to share.

In the spirit of us all being in this together, I hope that sharing my race experiences today will help you in successfully achieving yours.

Written By:

 David Weingard
CEO, Type 1