Last week, Omada Health, a San Francisco digital health startup, announced that it is partnering with the American Medical Association and Intermountain Healthcare, the Salt Lake City, Utah-based health system, to prevent the onset of diabetes in adult patients.
It marks the first time that the American Medical Association has announced a formal partnership with a digital health company, a development that was news in itself.
But it’s also important to review why Intermountain Healthcare, the largest private employer in the state of Utah, chose to go the digital route in preventing its prediabetes patients from developing full-blown type 2 diabetes.
A phone interview with Elizabeth Joy, medical director for community health and clinical nutrition at Intermountain Healthcare, offered some clues.
The very first reason that Joy pointed to was convenience for the patients.
“The traditional diabetes prevention programs are 16-week face-to-face educational programs where somebody has to get in their car, drive to a place, sit there for 60-120 min, potentially find a babysitter and that ends up being a barrier to a lot of people participating in the program,” Joy said. “Whereas a digital strategy allows for asynchronous learning and they can access the material pretty much anytime, anywhere since it’s been optimized for different platforms whether it’s a mobile phone, iPad or tablet or laptop or desktop.”
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
And yet, Omada is not the only company offering a digital panacea to a what may become a chronic and expensive problem. Why not go with Noom Health or Canary Health (formerly DPS Health) for instance, who like Omada Health received pending recognition status from the Centers for Disease Control for effectively delivering the agency’s National Diabetes Prevention Program using digital tools?
Without naming competitors, Joy pointed to the fact that Omada won out largely because it led the category.
“There could have been a number of partners that we could have hooked up with for this pilot,” Joy said. “Omada was the first into this space and they caught our attention. They have had a great deal of investment that has made their program stand out in terms of how it integrates wellness coaches or diabetes prevention coaches with the social networking, with the integration of technology like physical activity trackers and the bluetooth scale.”
Joy noted that that Omada’s pay-for-performance model was also “intriguing” as was the company’s two-year results that were published in a peer reviewed journal.
“It was very intentional on our part to get involved with a company that was evidence-based and had published results in peer-reviewed journals,” Joy said.
Striving for evidence-based therapies is part of four key principles that shapes Omada, wrote Sean Duffy, the startup’s CEO in an email. Those principles are:
- Start with Science, and Build a Clinical Evidence Base
- Demonstrate Effectiveness — Through Peer-Review, and in the Real World through real-time data
- Work to Integate into Clinical Workflows
- Align Financial Incentives with Clinical Outcomes
Intermountain aims to enroll roughly 250 patients in the pilot program.
Previously, a query on Intermountain’s enterprise data warehouse would be run based on patients’ lab test values to determine who may be most at risk. Then the list of patients would be sent to relevant providers and care teams to ensure that the correct patients were identified and not those whose lab test results were out of whack for some easily explainable reason.
“They can scan that list and determine whether or not that patient actually has prediabetes or perhaps they had an elevated fasting blood glucose because they were taking steroids for their asthma or for some other condition,” Joy explained.
Thereafter, those patients would be asked to come into the clinic to discuss diabetes prevention options and be invited to the face-face diabetes prevention program if deemed necessary.
Now with Omada’s digital intervention on hand, the workflow will alter a little.
“For our pilot project with Omada, our operational workflows are going to change slightly in that we have provided a list of eligible patients to clinical care managers, the majority of whom are nurses” Joy said. “They will be reaching out by phone to those patients and offering participation in the Omada program.”
Given that it is a pilot and because Intermountain is about to transition to a new electronic health records system, the Omada program is not being integrated into the EHR.
“What we are doing through the pilot is sending a message through our intranet within the EHR to providers that say, ‘Mrs Jones enrolled in the Omada diabetes prevention program’ so that [care teams] know that Mrs. Jones is in the program so if Mrs Jones has to come in for a check up of her blood pressure or a sinus infection or lower back pain, that her doctor knows to say, ‘Hey how’s that Omada program going?’ and just provide some encouragement for continue participation,” she said.
If Omada is successful in preventing the onset of diabetes in adult patients at Intermountain, the economic benefits can be significant.
“We’ve estimated that based on our own internal data that an adult patient with diabetes costs on average about $8,000 more per patient per year compared to an adult patient without diabetes,” Joy said. “I always preface any comments about economics of diabetes prevention with a statement, ‘I am not a healthcare economist’ but it makes sense financially that if we are spending on average $450 to prevent diabetes or to delay diabetes, even if we delay it in one person for two years, the potential cost savings on the low end are about $6,000 …. If you can delay it for 10 years, that’s a huge cost savings relative to the amount of money that you invested in diabetes prevention.”
That’s the message that Joy intends to take to Intermountain’s payers: that investment in diabetes prevention programs – if they work – is money well spent.
