Here we go yet again
This morning Senseonics announced they have hooked up with Glooko allowing Eversense data to be shared with Glooko’s data management technology. This is just the latest in series of announcements as everyone with a CGM, connected pen or pump now has some form of data management software/app. That poor dead cat can’t be swung today without it hitting a data analytics deal.
It seems as though everyone has awakened to the fact that getting the data is just step one and helping patients analyze all this data is a very important step two. However, what none of these deals have done and really can’t do is get the patient to act on the recommendations made by the software/app which is the critical third step. As we keep saying providing the patient with how to manage their diabetes is the easy part. The hard part the most elusive step is and has always been the action step.
Thanks to insulin dosing algorithms, CGM technology, connected pens and connected pumps insulin using patients have a plethora of options that can help them dose their insulin more effectively. This as Momma Kliff likes to say is the good news. However, as Mom used to say when everyone has the same thing a promising market opportunity quickly transforms into a commodity market. And with commodization comes price contraction.
Way back in the day this happened with old fashioned BGM. It has also happened with insulin pumps and is now happening with CGM and connected pens. Think about this just for moment from a patient perspective. Let’s assume just for this moment that reimbursement is taken out of the equation that it is a true level playing field. Hearing about all this way cool whiz bang technology the patient decides ok it’s time to start playing with these way cool toys.
Naturally their first step will be to Google these technologies, to understand how they work. With a little investigation they will learn that while there are some minor differences between these toys, they all do about the same thing the same way. They collect data from a CGM, connected pen or insulin pump analyze all this data and spit out recommendations. They all can share this data and produce lots of pretty charts and graphs.
Just as likely they will check out other forms of social media to get some feedback from patients who have played with these toys. What they will find is some patients love it, others hate it and still others have no real strong feelings one way or another. Therefore, it seems logical they would choose the cheapest toy to start with figuring since all these toys do about the same thing the same way why pay more for one you over another.
It also seems logical that should all the toys be priced competitively they will seek out a brand they trust.
Given that we do not live in a world where it is a level playing field, a world where reimbursement does matter this choice really isn’t much of a choice at all as 9 times out of 10 the patient will use the system dictated by their health care provider. Yes, there are a minority of patients who will pay more to use the system they want but the majority won’t. Yep this is all about money – who spends it, who saves it and who makes it.
The only way we see this changing would be for someone, heck anyone to think out of the box and give these patients some real skin in the game. To change the paradigm and make it not about the toy rather about what the patient gets for playing with the toy. To focus not on “outcomes’ but achievements. To provide tangible rewards for these achievements something the patient can see touch and feel. Rewards that matter to the patient.
See what no one gets here is that by giving patients skin in the game better outcomes will come. They just can’t get out of the clinic and into the real world. They are so used to talking about outcomes they have forgotten that outcomes are an esoteric concept to patients. A patient cannot see feel or touch outcomes.
Let’s be very clear here we strongly believe in these toys as when used as designed they will have a positive impact, no question about that. However, we also understand patients and what motivates them. We understand that even with these toys the patient still must do some heavy lifting. Yes, all the complex calculations will be done for them, but they still must act.
For the past 20 years or so we have witnessed some notable improvements in drugs and devices. What we have not seen is any improvement in outcomes. What we haven’t seen is the drug and device makers taking that final step out of the clinic or toy factory and into the real world. They are so focused on the how to they have forgotten about the want to.
We have seen this dynamic play out over and over. Someone introduces a way cool drug or device. Their market research indicates patients wants this toy. Then they sit around befuddled when after launching this new toy it’s not commercially successful. Why they wonder when all their research indicated patients wanted this toy aren’t, they playing with it. Was poor formulary placement, a bad marketing plan, what the hell went wrong.
The reality is nothing went wrong except for the fact these companies who say they understand patients really don’t. They remain clueless as to what motivates a patient, how these patients feel about their diabetes and most importantly what really matters to the patient. Diabetes is more than a chronic disease, it’s a lifestyle that carries with it not just physiological but also psychological burdens. Sure, the drug and device companies understand what diabetes is and what it can do but they don’t understand living with diabetes.
This is why this cycle continues. This is why outcomes haven’t changed much over the past twenty years. This why these latest toys will only help a handful. Providing the how to manage diabetes has never been the problem, transforming data into action, the want to manage diabetes has been and continues to be the problem.