It’s not about the damn toys!

So, let’s see if we’ve got this straight Wal Mart is splitting from CVS over pricing, while Walgreens and Microsoft are hooking up on yet another digital health initiative. Oh, and we forgot to mention that yesterday the House, which is open for business, began hearings to investigate the high cost of prescription medications. Yep just another bright and sunny day in the wacky world.

Of the three events the Walgreens Microsoft deal has the most direct impact on diabetes. Per a press release;

“Walgreens Boots Alliance Inc. (WBA) and Microsoft Corp. have joined forces to develop new health care delivery models, technology and retail innovations to advance and improve the future of health care. The companies will combine the power of Microsoft Azure, Microsoft’s cloud and AI platform, health care investments, and new retail solutions with WBA’s customer reach, convenient locations, outpatient health care services and industry expertise to make health care delivery more personal, affordable and accessible for people around the world.”

Does any of this sound familiar –

“The companies will focus on connecting WBA stores and health information systems to people wherever they are through their digital devices. This will allow people to access health care services, such as virtual care — when, where and how they need it.

The integration of information will enable valuable insights based on data science and artificial intelligence (AI) that can allow for fundamental improvements such as supporting the transition of health care data into more community-based locations and sustainable transformation in health care delivery.

Working with patients’ health care providers, the companies will proactively engage their patients to improve medication adherence, reduce emergency room visits and decrease hospital readmissions. Core to this model is data privacy, security and consent, which will be fundamental design principles, underscored by Microsoft’s investments in building a trusted cloud platform.

By better connecting people, providers and the systems in which they work, the industry will be able to provide better quality patient care.”

Now we don’t say we’ve seen this movie before, but we have. As we’ve been stating for years it’s not a question of whether interconnected diabetes management (IDM) becomes the norm but when it becomes the norm. The problem isn’t, never has been nor will be the technology to make IDM possible. There are plenty of interconnected toys in toy chest.

The problem has been and continues to be engaging the patient, so they play with all the toys. Each effort we have seen or looked at in IDM all do the same thing just with different toys. They all collect data, analyze data and attempt to help the patient manage their diabetes more effectively. Each claims they can drive cost out of the system without adversely impacting patient care. Yet so far anyway none of them have proved anything more than they can write a great press release.

Speaking of that we’re curious how Verily feels about this deal as didn’t they just also sign a deal with Walgreens . Wasn’t that deal supposed to help patients with diabetes. See if this sounds familiar;

“In a push to leverage technology to improve patient outcomes and lower health care costs, Walgreens and a sister company of Google are teaming up to do things like getting patients to stay on their meds and develop devices with sensors that can “help prevent, manage, screen and diagnose disease.”

Under a deal announced today, Walgreens Boots Alliance of Deerfield will be the “first-choice retail pharmacy development and commercialization partner” of Verily, the life-sciences unit of Alphabet, the tech holding company based in Mountain View, Calif.” Crain’s Chicago Business December 19. 2018

As we noted last week during JPM every and yes, we mean every healthcare company is scared of the Death Star more commonly known as Amazon. Also, as we noted after JPM Walgreens isn’t sitting around waiting for Amazon to eat them for lunch, they are proactively doing everything they can to protect their turf, hence all the deals. Walgreens understands that healthcare is changing rapidly and while they may not know exactly what Amazon will do, they aren’t waiting to find out.

With more than 100 million Prime members Amazon has the potential to be as disruptive in healthcare as they have been in retailing. There isn’t one thing used by a patient with diabetes, drug or device, that Amazon cannot deliver to the patient. As we have noted more than once it’s only a matter of time before snarky Alexa not only orders more Tide but also becomes a diabetes coach. Just as Walgreens wants to all the toys to talk to the cloud so too does Amazon.

The reality here is that we are in the midst of one the greatest battles ever. A battle not for the weak kneed or faint of heart. Again, not to be redundant but diabetes is the perfect platform for Walgreens, Amazon and all the others. It’s growing patient population, there is no cure in sight and patients with diabetes play with lots of toys and take lots of drugs, not just diabetes drugs. Throw in the fact that patients with poorly controlled diabetes create tons of cost for the healthcare system anyone who can get these patients under control stands to make billions.

IDM has awesome potential but so far that’s all it has. There is a ton of evidence that shows IDM works, that has never been in dispute. Yet, so far anyway, no one has been able to successfully scale IDM. This is what makes these deals so intriguing as they are ultimately attempting to bring scale to IDM. Yet our gut and many gray hairs tell us none of these efforts will succeed until they fully appreciate the person who is supposed to play with all these toys. So far anyway all these efforts have focused on not the patient but the providers of healthcare, the companies that pay for the patients’ healthcare. Each effort at its core wants to drive cost out of the system a noble goal that unfortunately cannot happen if the patient doesn’t do their part.

Until the patient has a vested interest in better outcomes nothing will change. Until the patient has skin in the game the results will not differ. Everyone in this process to drive cost out of the system is incentivized in some way, everyone that is except the patient. All these efforts at getting the patient to do all the heavy lifting of managing their diabetes do so without giving the patient anything immediate or tangible for their hard work. They expect the patient to do all this stuff on the misguided belief that a patients actually cares about outcomes or will feel better.

We will not go into our normal rant here about how the majority of patients have a chronic disease they don’t understand, do not want which requires tons of work to manage properly. That these people want to live their lives WITH and NOT FOR diabetes. Even worse when they do a good job what do they get, nothing nada zilch – their co-payments don’t get lower, their deductibles stay the same. Is it any wonder that with the billions spent we are still at the point where nearly two-thirds of patients are NOT under good control.

So here we are with more money being thrown at the problem for this after all is battle over money – who makes it – who saves it and who spends it. Walgreens can make all the deals they want. Amazon can spend all they want but ultimately nothing will change until the patient has skin in the game, until the patient gets more than new toys to play with. This isn’t, never has been nor will it be about the toys in the toy’s chest. This is all about getting patients to become engaged with their diabetes management. Something that won’t happen until the patient gets more than a pat on the back, but even a pat on the back would be a nice start.