Carrot, stick or both

Carrot, stick or both

Ask any primary care physician what’s the biggest reason why their patients with diabetes aren’t achieving better outcomes and more than likely they will put medication adherence on the top of the list. Keep in mind that primary care providers treat nearly 80% of the diabetes population, so it’s fair to say they know what they’re talking about. Yes they will list other reasons but by far medication adherence is top on the list.

This issue of medication adherence is the focus of a new report published by CVS Health Research Institute which was released yesterday. The full report can be seen at While the report is somewhat biased towards CVS, imagine that, it does provide a solid picture of the battle fought by millions of patients with diabetes.

Not to be outdone yesterday Walgreens announced they had teamed up with WebMD on a new health and wellness initiative.  According to an article posted on the Drug Store News web site:

“Among the features and services Walgreens and WebMD will offer consumers in the coming months are:

Walgreens will incorporate into its digital experience and stores select WebMD content in various topic areas, including: allergy, healthy eating, skincare, fitness, healthy aging, emotional health, heart health, cold and flu, sleep and oral health. In addition, WebMD will make Walgreens’ online prescription refill and transfer services and Healthcare Clinic appointment scheduling available across WebMD’s desktop and mobile offerings;

Walgreens will offer its customers access to WebMD’s virtual wellness-coaching programs that help individuals maintain and improve their health through positive lifestyle choices and healthy behavior change. Participants will be able to enroll in programs that help with smoking cessation, weight management, nutrition, exercise, stress management and emotional health, as well as in programs for managing conditions such as diabetes and heart disease; and

The companies plan to incorporate Walgreens’ Balance Rewards for healthy choices program into the WebMD virtual-wellness coaching programs offered through Walgreens to incent members to participate in health-related activities. Walgreens’ Balance Rewards for healthy choices helps people adopt healthy behaviors by earning Walgreens Balance Rewards loyalty program points through participation in health-related programs and tracking progress toward a goal.”

The Walgreens program is just further evidence that the paradigm is slowly shifting and companies are beginning to understand what Diabetic Investor has been saying for years; patient education is good for business. That educated patients test their glucose levels on a regular basis and take their medications as prescribed. Most importantly educated patients achieve better outcomes while avoiding many of the costly complications associated with poorly controlled diabetes.

Walgreens is also adopting another strategy outlined by Diabetic Investor long ago; the use of incentives. Now Walgreens is not alone here as diabetes companies Johnson and Johnson (NYSE:JNJ), Novo Nordisk (NYSE:NVO) and TelCare are just some companies who have used or experimented with the use of incentives.

Now Diabetic Investor won’t get on our high horse and once again say we knew this was coming but what the heck. The fact is while we doubt the old guard in diabetes sees what’s going on here; some worlds are beginning to collide- namely interconnected diabetes management (IDM), patient education and the use of incentives.  Let’s face facts diabetes is the poster child for combining IDM, patient education and the use of incentives as there is near universal agreement on what defines good control and this information is easily verifiable.

The question becomes how patients will adopt to this paradigm shift, especially in an environment where data breaches happen almost daily. Yes the use of incentives may help but then again just how much a patient wants Big Brother in their lives. As Diabetic Investor has noted on numerous occasions the vast majority of patients want to live their lives WITH their diabetes and NOT FOR their diabetes. These patients understand that diabetes is a serious condition that requires their attention, yet they don’t want managing their diabetes to dominate their already busy lives.

Diabetic Investor suspects as these worlds colliding newcomers to the wacky world of diabetes stand a better chance at success than the old guard. Basically there are two key reasons for this; the old guard can’t break from the past, they lack the technological savvy and they don’t understand that patients with diabetes are consumers not patients. (Ok that’s three reasons) Apple, Google and the like also have boatloads of cash to fund their efforts.  Diabetic Investor also suspects that some smaller less well-known companies will emerge to become leaders in the field or at minimum attractive acquisition targets.

Quite frankly it’s no longer a question of if the diabetes world will be turned upside down but when it will happen. Over the next few weeks we will once again here the old guard explain away poor quarterly results, how competitive bidding is just killing their business and how it’s going to be a very rough road ahead. Some will try and convince investors that new whiz bang technology is the answer, that way cool whiz bang technology will magically turn things around. The reality is this is more of the same old, same old and just further evidence they just don’t get it.

One major concern as this changing of the guard takes place is will these newcomers as smart and cash rich as they are fall into the same trap as the old guard. We’ve seen some evidence of this with Google and their way cool whiz bang contact lenses that are supposed to measure glucose.  Given the issues with the new Apple operating system and their health app we’re also learning that as innovative as these companies can be they are not immune to making mistakes. And let’s not forget that a new guard in diabetes will still have to deal with the FDA, an agency that knows it needs to change yet can’t seem to change.

As we transition from the old to new guard Diabetic Investor is reminded of something said by Anatole France back in 1890; “All changes, even the most longed for, have their melancholy; for what we leave behind us is a part of ourselves; we must die to one life before we can enter into another!”