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April 22, 2022

Sprint: Virtual Care for T2-Diabetes and Obesity

Commentary
HealthXL Team & HealthXL Community
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In our two-part HealthXL Sprint meetings, we connect senior leaders across our community to solve health challenges. 

In our most recent sprint, we discussed virtual care for type-2 diabetes and obesity, here are  key takeaways. 

Experts included: Armin Furtwaengler (Global Medical Lead Innovation Scouting, Corporate Division Medicine at Boehringer Ingelheim), Cathy Zaremba (Director of Product Marketing at BrightInsight), Chris Wasden (Head of Pharma Speciality Solutions & Corporate Strategy at Happify Health), Daphne Petrich (Senior Business Development Manager at HelloBetter), Fredrik Debong (Co-founder and CPO at hi.health), Jim Howard (CEO at Readout Health), Kasparas Aleknavičius (Head of Medical Affairs at Kilo Health), Kathleen Wright (Founder at Second Brain Healthcare), Lee Shapiro (Managing Partner at 7wire Ventures), Meaghan Schedel (Consultant at HealthXL),  Mike Pace (CEO and founder at PalmHealth.co), Naomi Parrella (Medical Director, Rush Center for Weight Loss and Lifestyle Medicine at Rush University Medical Center), Piotr Sokolowski (Chief MedTech Strategist at S3 Connected Health), Stephen Egan (Director at Redicare), Thomas Foley (Chief Growth Officer at GenieMD)

*All opinions are participants’ own and do not reflect the stance of their respective employers.

5 Key Recommendations: 

Diabetes prevention needs to be personalized and should start earlier: Even with increased community education efforts about diet, exercise, and prevention, there is a growth in the rate of type 2 diabetes. Diabetes is multi-faceted and prevention programs need to be personalized for disease states and demographics. A radical transformation of behaviors is a long journey and starts with the rejection of factors such as a carbohydrate rich diet, sedentary lifestyle, and poor sleep. For many people, that transformation is about building an awareness of the body’s signals and knowledge of how to respond in effective ways, earlier. Solutions need to contribute to an environment where better behavior is easy. There needs to be reminders of the progress being made that make the solution rewarding and engaging rather than intrusive. 

Solutions must interrupt the cycle of poor habits: Anxiety and depression may contribute to the underlying reasons behind poor eating habits that lead to obesity. However, while obesity is often exacerbated by mood disorders and their treatments, it is also a marker of an imbalance in the body and depression and anxiety can be another manifestation of the “lack of health”. The hypothalamic-pituitary-adrenal (HPA) axis is off balance. This presents a chicken and egg scenario between the two factors and can create a damaging cycle. The key is to interrupt that cycle. While the importance of mental health is clear, we may also want to consider focusing on ways to effectively begin treatment in order to reverse the course. One great start is working on beliefs, understanding, and mindset. Obesity, T2-Diabetes, and mental health are all connected, but treating mental health will not necessarily allow the cardiometabolic dysfunction to resolve on its own. 

The pharma route to market is challenging for diabetes solutions: When an independent  solution gets acquired by a pharma/medtech company, as in the case of mySugr by Roche, the risk is that other manufacturers then stop working with the group. Internists don’t want to have a different platform for each product, yet the patients are first and foremost individuals and need choice. Patients want a digital therapeutic (DTx) that is drug agnostic and can work across all medications within a therapeutic area as they will likely change their therapy over their disease journey. Solution adoption needs to become easier and more streamlined, a unified data stream made available and easily integrated into existing management platforms. Pharma companies are also deprioritizing diabetes from their portfolios. Multiple generic drugs on the market make the space less profitable for pharma. The willingness to invest in digital therapies that address this space is not a high priority or part of a long-term strategy unless aligned with a specific initiative like a digital biomarker to drug development. A more productive route to market may be through partnering with medical device companies that are concentrating their efforts on easing the measurement of blood glucose levels (e.g., Dexcom and Abbott).

Consumers will pay for diabetes remission programs if they have good clinical outcomes for “reasonable effort”: The Direct-to-consumer (D2C) model empowers people who want to be empowered as opposed to being influenced by a pharma company or a health system they don’t frequently visit. Yet in countries with a public healthcare system, a patient paying for a solution is remarkable. D2C is scalable when it comes to growth, but that does not necessarily equate to financial sustainability. D2C can be a stepping stone to other routes to market. If a solution can build a focus on wellness and behavior change that people stick with, that could build the foundation for a solution to enter into partnerships and platform plays with healthcare systems. The solutions can’t be too daunting or seem impossible to stick with. Consumers need to believe it’s possible and worth it to justify the effort and cost. The cost of patient acquisition through social media can easily be $200 or more. If the price point of a D2C solution is $600, companies are spending as much as a third on the cost of acquisition. D2C solutions might need to start at a higher price point or be pursued in parallel with other paths to market.  

Providers and health systems can provide credibility for your solution: Word of mouth can help a company scale rapidly. A physician referral can build trust and belief in a solution. Paying consumers are interested in changing behaviors, but don’t know what they want or need to get there. But mainly the drive to adopt a solution lies in looking for a simpler way to get a good outcome, not necessarily the best outcome. Patients and providers need the right language to have conversations efficiently and in a way that doesn't burden the provider. Adoption needs to be simple for the clinician and if a solution can quickly deliver results the provider could become an advocate. For T2-diabetes, providers will also be more interested in solutions with actual personalized data (biomarkers) vs. those that are behavior-heavy, personalized light. Health systems with a long term relationship with a consumer can create better outcomes by focusing on prevention - this includes reduction in the risk of T2-diabetes. For countries where there is a national health system, these efforts may take hold more quickly than in a fragmented system like the US. 

Want to join the conversation? Check out our website for upcoming meetings and events. 

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