Digitizing the Diabetes Prevention Program

Omada Health has successfully digitized a clinically proven lifestyle intervention program that could prevent 86M Americans from developing Type 2 diabetes.

In 2002, the NEJM published the results of a 16-week Diabetes Prevention Program (DPP) demonstrating prediabetics who achieved a weight loss of 5-7% could reduce their risk of developing Type 2 diabetes by 58%[i]. CDC estimates there are 86 million prediabetics in the US.

Why this matters

If there is no medical or lifestyle intervention, 15% to 30% prediabetics will develop Type 2 diabetes within 5 years[ii]. Type 2 diabetes is a chronic condition that is currently irreversible. The body decreases insulin production and becomes insulin resistant, which results in glucose buildup. It gets worse – diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness[iii]. Additionally, diabetics are 2-4 times more likely to die from comorbidities such as cardiovascular disease. Despite only about 18 million people diagnosed with diabetes, diabetic patients account for more than 20% of healthcare spending[iv]. The good news is that the DPP is an effective lifestyle intervention program that can help curb this trend. Medicare estimates each enrollee can help the healthcare system save on average $2,650 over a 15-month period[v].

Going digital

Traditional programs are administered through community centers like YMCA, but as of September 2016, only 48,269 individuals have participated in at least one of sixteen sessions[vi]. This brick-and-mortar approach to distributing DPP is clearly not efficient or scalable.

Omada Health has digitized the DPP, delivering the 16-week program through online and mobile mediums. By using technology to broaden reach, Omada Health has already worked with over 45,000 individuals in under 5 years[vii].  Their program has proven clinical efficacy with participants losing nearly double the weight of those using in-person DPPs[viii].

Value-based payment models

What makes Omada Health unique is that they have adopted a value-based business model only making money when individual participants successfully complete the 16-week program and achieve at least 5% weight loss. In other words, payors, including Medicare, only reimburse Omada Health based on achievement milestones (e.g., enrolling, completing the program, achieving 5% weight loss).

This beautifully aligns incentives of all stakeholders: payors and self-insured employers are happy to work with Omada Health to enroll member lives because there’s no downside risk; individual participants with insurance coverage don’t have to pay out-of-pocket; and Omada Health is motivated to ensure that participants achieve that weight loss goal. The key to the business model is the ability to deliver results, and Omada Health has constructed an operating model to reflect this goal.

Operating to execute

Behavior change is at the core of this lifestyle intervention program, which makes continuous engagement key to the defensibility of this business model. Technology has enabled 24/7 connectivity and personalization to facilitate engagement:

  • Online and mobile: Participants are paired with an online coach and a peer support group. They can interact and message coaches and peers anytime, anywhere. This virtual connectivity enables prediabetics to participate without physically driving to a YMCA center. Additionally, health curriculum is distributed online to tailor to individual educational needs.
  • IoT gadgets: Bluetooth connected scales and pedometers are mailed to individuals so that Omada can accurately track progress with little to no extra effort. To monitor food tracking, individuals simply upload photos of their meals to share with their coaches. This data is extremely important as a “source of truth” to help coaches verify rather than just relying on self-reported results.
  • Real-time data analytics: The ability to collect feedback data in real-time to know whether an intervention worked is extremely valuable. For instance, if an online coach sees that someone is taking less than 10,000 steps a day, they can send an extra message to encourage him to exercise more. Omada can then track and see if a particular message type was effective in helping convince the participant to increase physical activity via data from the pedometer.

Moving forward

The digitization of DPP represents an exciting opportunity to not only massively expand accessibility but also improve convenience. Behavior change is personal and what works once may not work again, so it’ll be important to have a constant feedback loop of data and outcomes. To ensure better outcomes, Omada Health could use additional wireless sensors, such as heart rate monitors, to collect more data. With more data, they can continue to iterate their predictive algorithms to understand if there are leading indicators of success and what types of interventions are most effective for specific participant sub-segments. Omada Health has begun to take their “secret sauce” of engagement to other chronic diseases (e.g., chronic heart failure, high blood pressure) where lifestyle interventions are also key to achieving clinically meaningful outcomes and reducing overall healthcare spend.

 

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[i] https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Pages/default.aspx

[ii] https://www.cdc.gov/diabetes/prevention/prediabetes-type2/index.html

[iii] http://www.cdc.gov/chronicdisease/resources/publications/aag/diabetes.htm

[iv] https://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

[v] http://www.commonwealthfund.org/publications/newsletters/washington-health-policy-in-review/2016/mar/march-28-2016/burwell-announces-expansion-of-diabetes-prevention-program

[vi] https://www.ymcapkc.org/programs-classes/healthy-lifestyles/diabetesprevention/

[vii] http://www.mobihealthnews.com/content/medicare-reimburse-diabetes-prevention-program-including-omadas-digital-version

[viii] https://www.omadahealth.com/outcomes

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4 thoughts on “Digitizing the Diabetes Prevention Program

  1. Thanks for sharing this! Omada Health’s work is laudable and inspiring. I’m curious though how they assist patients, especially those that are older or from difficult socio-economic situations, which lack the necessary tools/infrastructure to be digitally connected (i.e., they have no smartphone or internet at home)? I’m also curious if they’ve been able to take a similar preventative approach and apply it to different interventions (e.g., heart disease, mental health, etc.). I agree that taking a preventative approach to many health issues can avoid significant distress for those effected while bringing down costs for governments, employers, and insurance providers. I’m excited to see what best practices emerge in encouraging behavioral change.

  2. I agree with SU – Omada Health has a fascinating model. I like that they’ve been able to align incentives for the company and patients in such a successful way, especially when compared to other companies we’ve explored this semester like Stickk. I’m curious about how they can take that key piece – alignment – into other disease states. For example, cardiovascular health makes sense because there are concrete and specific data points that can be measured and improved to reduce someone’s risk of a heart attack (although we currently aren’t compensating hospitals/doctors for this type of work which might make it harder to get Medicare payments). But I think something like general obesity might be harder to tackle. Not because the incentives are misaligned, but because it’s so broad and associated with so many other co-morbidities, it will be tricky to isolate what you are tracking and focusing on as a patient and therefore who should be paying for the outcomes.

  3. Great article! While I completely agree with the above comments that this technology might not be vital in the prevention and/or management of all disease areas, I think it would be extremely valuable with mental health management. It is my understanding that medication compliance for diseases like schizophrenia is a key challenge and can, for obvious reasons, have a disastrous effect on people’s lives. The ability to track one’s health and be in touch with medical professionals to ensure medication compliance could be game-changing. One concern, however, is data security. Ensuring that PHI is not compromised (and following state and federal regulations) will always be a challenge with new, mobile technologies.

  4. Thanks for the post. The rise of digitally-distributed chronic disease management platforms such as Omada Health has helped revolutionized the way care is delivered in the healthcare system today and has been a key factor in shifting disease management more and more from sites of care such as hospitals and doctor’s offices to the patient’s home, thus taking out significant amounts of medical costs from the system. I think it will be very interesting to see how Omada approaches expanding into other chronic disease categories, such as CHF, which may have less well-defined pathways as compared with diabetes. I wonder how much of their platform could be easily replicated to manage these other diseases? There are some competitors in the market today, such as Vida Health, that have taken the bet that it is relatively easy to target multiple different chronic diseases with the same replicable digital and health coach platform, but I wonder if it is harder in execution than in principle.

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