How many do we need?

So OneDrop goes out and hires two new executives one from Sanofi and the other from ResMed. They note that are expanding beyond diabetes into other chronic disease states. Please stop us if you have heard this before because you have heard this far too many times before. Is this not what Livongo is doing? What about OnDuo? What about Walgreens. CVS? Heck what about Amazon?

Just for grins and giggles let’s say that all this competition for patients with diabetes doesn’t drive prices down. Let’s also say that there are enough coaches to coach all these patients and that this coaching actually works not just for the short term but is sustainable for the long term. Would it not make sense that should this be true we would have seen more evidence than what we have seen today? Real evidence not just more fuzzy math.

The reality, a place we live but many of these companies don’t, is that greater competition will not just drive prices down they will force companies to go 100% at risk. Now we aren’t opposed to seeing these companies only getting paid for real verifiable and sustainable improvements in outcomes. But this is a capital-intensive business and only OnDuo really has the resources to play in the 100% at risk sandbox. If they wanted to and frankly, we can’t understand why they wouldn’t want to, OnDuo could go on offense and force all the less well capitalized companies to play defense.

We just can’t help but wonder when this whole house of cards begins to unravel. When digital diabetes goes into the crapper just as disease management went into the crapper years ago. It sounds so impressive to say these companies are expanding beyond diabetes until you look at those pesky facts which tell you there are more diabetes patients then there are patients with hypertension. It sounds so impressive that all these players have some sort of way cool whiz-bang artificial intelligence (AI) when in fact all they really need is common sense.

The bottom line here is once again everyone is over complicating a simple peanut butter and jelly sandwich. This is and always will be about patient adherence compliance or whatever the politically correct term is for patients taking their meds as they are supposed to. All this way cool whiz bang coaching data analytics texting is designed so patients take their meds as they are supposed to.

The downfall of disease management wasn’t it didn’t work. The downfall of disease management the cost was not worth the benefit for the majority of the patient population. What employers learned and they’ll learn this again with digital diabetes is that the real cost savings comes from keeping their diabetic employees out of the emergency room. They will also learn that short term improvements don’t translate into sustainable long-term improvements. They will one day wake up look at the numbers and say something like why they are paying for this.

Now the digital diabetes players will say they save money and if you believe their convoluted math, which matches their convoluted way they report “revenue”, maybe this is true. However we quite haven’t figured out how anyone can leave out the cost of diabetes medications when looking at cost savings, never quite got that.

Sure there’s lot of flash with all this way cool whiz bang but there isn’t much substance. It sounds good looks good, but it doesn’t pass the smell test. The biggest problem however isn’t that these companies are pulling the wool over everyone’s eyes. No the problem is people aren’t doing their homework, they like everyone else have fallen in love with whiz bang way cool. They are buying into all this fuzzy math because they want to believe.