Going after the big fish

Yesterday Onduo issued a press release which stated;

“Today, Onduo announced its first peer-reviewed publication of clinical outcomes in JDST1. The company published real-world evidence demonstrating significant clinical benefit for people living with type 2 diabetes who participated in its behavior-change program and accessed its virtual diabetes clinic. The article presents data on 740 Onduo participants located in 21 states in the U.S., with 30% living in rural communities. Most notably, the results show that 92% of Onduo participants with the highest initial HbA1c improved their glycemic control, with an average decrease in HbA1c of 2.3%, from 10.7% to 8.3% (p<0.001).”

What struck us while reading was not the results rather the target patient population, patients with Type 2 diabetes. Of particular interest only 31% of the patient population was using insulin. Yet according to the release – “The article details results for the 740 participants, including data on nearly half of whom were remotely prescribed and shipped CGMs to during their participation.” So stop and think about this just for a moment as many if not most will fail to grasp the significance of these two items.

First Onduo is targeting the largest group of patients, Type 2’s who do not use insulin. Second, they are in their own way proving what we have been saying all along that CGM will be used by all patients regardless of how they treat their diabetes. Third and this is also significant unlike their competitors, Livongo being the most well-known, they are using virtual not human interventions which simply means they can manage a greater group of patients at a much lower cost per patient.

It’s this last point which should concern Livongo as it opens the door for Onduo to go 100% at risk and only get paid for producing verifiable improvements in outcomes. Keep in mind Onduo is backed by Verily, a unit of Google and Sanofi two well healed companies who can afford to go 100% at risk. Although this partnerships continues to be contentious and could fall apart, we are looking beyond who is doing this focusing instead on what is being done.

Keep in mind Google is not the only high-tech cash rich company swimming in the diabetes pool. Apple and Amazon are also splashing around as are others. Each in their own way poses a unique threat to Livongo and not just because they have gobs of money. All along we have been stating that what Livongo does is hardly unique and is easily replicated. Folks for all the way cool whiz bang there are only so many things a coach can say and honestly this is not rocket science.

The real key here is you guessed it – money. As we have stated all along Livongo only gets paid when a patient enrolls and stays enrolled in their programs. Think of what happens when Onduo or someone else comes in and says we’re only going to get paid for producing verifiable results. That their program is FREE to the employer and all the risk is born by the provider.

The facts are these – first the key to this market is targeting non-insulin using patients with Type 2 diabetes. Thanks to smart insulin pumps and Tyler insulin using patients really won’t need coaching as their insulin system will do all the work. Nor will patients using a GLP-1 need much coaching given how a GLP-1 works. That leaves patients on oral therapies alone as the largest yet most difficult group of patients to penetrate. This data from Onduo shows it’s possible to crack this tough nut and should send a warning to anyone who believes Livongo has open field running ahead of them.