Beyond Diabetes Devices - Weaving Coaching Into D-Tools

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Thankfully, companies aren"t just making straight-up gadgets anymore for helping us manage our diabetes. They"re increasingly realizing that adding health coaches, clinical advisors and educator insights as part of the package make all the difference.

After all, it"s no secret that we PWDs (people with diabetes) spend most of our time managing diabetes on our own, outside of doctor"s office, and D-Businesses are finally starting to see that as an opportunity.

This trend has been slowly gaining steam for a while now, with small innovative D-tech companies like Telcare and Livongo focusing on services to go with their devices, as well as big players like Medtronic making noise about helping customers "get actionable insight" from their devices. Today, we take a look at a few interesting new approaches on this front...

Welkin and Clevertar - Virtual Care

You may have heard the name Welkin Health, a company based in San Francisco that offers an app and online platform for people with any type of diabetes. They aim to help "bridge the gap between physician office visits" by allowing care teams to virtually monitor BG levels, determine if followups are needed and help navigate any necessary medicaton, diet or support changes.

They provide a combination of mobile, web, and telephone-based (SMS) coaching programs and are now working with Humana"s Innovation Group on a system that will "allow coaches and patients to communicate fluidly throughout the patient"s day."

“It’s better to have frequent collaboration versus one, hour-long assessment every three months,” says Penny Mach, a Certified Diabetes Educator, in this MobiHealth story. “The app allows for little bits of coaching more frequently.”

In this case, they"re especially enthusiastic about the opportunity to help elderly PWDs or any of us who aren"t geographically mobile.

Meanwhile, new on the scene is Australia-based Clevertar, which offers a virtual health coach service called My Diabetes Coach, currently only available in Australia but with aspirations to expand into the U.S. What"s unique about this system is a virtual health advisor named "Laura" -- like the Siri of diabetes -- who coaches people recently diagnosed with type 2 using an iOS or Android app. Laura offers interactive info on BG monitoring, medication adherence, nutrition, exercise, and foot care, as well as analyzing glucose readings and sending alerts to a human case manager if need be. Laura is animated and looks pretty good on a tablet, we must say.

There"s a related program called Anna Cares being rolled out in hospitals with the help of Clevertar that is already in clinical trials in the U.S., but it"s not clear whether the program will be launched here commercially anytime soon.

Yep, this virtual help is becoming the way of the world in diabetes management. While we"re all so concerned about what insurers will actually pay for these days, it"s going to be fascinating to see how these companies approach the reimbursement issue.

Hygieia and the D-Nav Package

Another approach to offering "coaching" is making smarter tools that can actually recommend what a PWD should do next. Remember the Michigan-based startup known as Hygieia that we wrote about several years ago? The one developing a device called the D-Nav that"s described as a first-of-its-kind "Diabetes Insulin Guidance System," or DIGS, that works like a nav system for your car?

It looks like a cross between a small Etch-a-Sketch and an insulin pump, but in fact it has no insulin delivery capability (nor can you draw with it). It"s actually an integrated glucose meter and insulin dosing calculator that uses its own test strips and then shows a blood sugar reading after five seconds. The device calculates how much insulin you’d need based on the reading, plus any food or correction bolus required. Right now, to use it you need a connector cable to upload data to a computer.

Hygieia is aiming largely at type 2 patients, although D-Nav can be used by anyone with diabetes – and btw it"s already approved and in use overseas.

This little company"s also been making headlines for bringing on some well-known names in the diabetes industry:

• Mary Austin - longtime Michigan diabetes educator and dietician and past president of the American Diabetes Association, who became the clinical services manager on June 1 and will supervise the team of clinicians for Hygieia.
• David Conn - an industry exec who"s worked at JnJ Lifescan, AgaMatrix, Facet Technologies and HypoGuard in the past and joined Hygieia in September 2015 as head of the U.S. business.

And surpise... what"s changed in 2016 is Hygieia"s new aim to address the "full-service picture of diabetes management between doctor appointments" with its D-Nav as the focal point.

"We have moved away from being about developing a medical device, and instead we"re focused on the delivery of diabetes care management," says Hygieia CEO and Co-Founder Eran Bashan. "If you look at data of people not managing their diabetes well, 99.5% of cases involve issues with insulin management. From this business point of view, that"s where we see ourselves making a difference."

D-Nav users will be offered regular coaching services with a nurse or clinical representative, trained by Hygieia to coach PWDs on what they might need to do differently based on the D-Nav data. Bashan tells us those support folks would not necessarily be Hygieia employees, but an outsourced service, performed at a local CVS Minute Clinic, or even weaved into a clinical practice if preferred. Obviously, they"re still working out the details.

And surprise again... this is where the payers come into play.

In March, news broke that Hygieia had partnered with Blue Care Network of Michigan (the HMO that covers me!) for a one-year pilot study of the D-Nav in 1,000 local PWDs living with T2. A special clinical support office is slated to open by Fall, when the pilot will begin.

According to Bashan, they could save health insurers approximately $100 million a year if every T2 in the state of Michigan began using the D-Nav service. Bashan says that"s because 50 to 75% of the insurance costs for PWDs is in healthcare delivery, not medical devices. Using the D-Nav platform with related coaching services, he believes those costs can come down 25% per month.

Of course, we have to have a thorough look at the base device itself, to gauge whether PWDs IRL (in real life) will like it and want to continue using it.

And the costs to users in the U.S. is still not clear. In the UK, the system runs roughly $220 per month for the package: the D-Nav device and paired coaching services, plus unlimited test strips (which is a deal right there!) Yep, unlimited strips... Bashan says insurers actually don"t care how many strips you use, as it"s all about the end-dollar amount they have to shell out per patient. So if the whole D-Nav package is cost-effective, then Hygieia is willing to include as many strips as you might need because that doesn"t change the insurer"s bottom line.

Huh. Seems like a productive approach...

But then, we learned something a bit concerning: Hygieia has a setup where it can cut a user off from its technology and services if they aren"t doing what the clinical nurses recommend. So for example, if a user is ignoring advice about testing more often or changing insulin doses, they can be taken off the D-Nav system. Wow, punitive! Talk about carrot and the stick...

But Bashan adamantly insists that will be rare, as most people will continue to use the D-Nav and Hygieia services efficiently. As evidence, he points to some who"ve been using it for years both in the UK and in clinical studies here in the States. About 25% voluntarily drop off the system, he says.

Let"s be clear that the D-Nav device is not yet FDA approved, but the company hopes to submit in the coming year.

We think it still looks a bit clunky for a D-device in this day and age, but that"s apparently also being addressed by Hygieia -- as Bashan says they"re developing a next-gen model that will contain a Bluetooth chip and sport an improved screen display that looks more like a smartphone.

They"re also planning a release later this year of a patient portal that allows users to view your their glucose and insulin data, as they currently only have a provider data portal (Wait, what? How have they not addressed the patient data side yet?).

Still, it the D-Nav + coaching is intriguing concept, and could prove to be at the forefront of a trend among health insurers to support tools that include patient-help services.

Although at this juncture, with insurers making exclusive deals based on discounts from leading device makers that limit patient choice -- it"s hard to see their concern over patient well-being. We sure hope it"s in there somewhere.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn"t adhere to Healthline"s editorial guidelines. For more information about Healthline"s partnership with Diabetes Mine, please click here.

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