No faith in the patient

No faith in the patient

This being the first time attending the mHealth Summit in our nation’s capital Diabetic Investor was expecting big things. Given that each day we are moving closer to interconnected diabetes management (IDM) one would think this would be the epicenter of innovation. Yet what’s becoming more obvious is that so far no one has gotten the memo that it’s not just about data collection, that for IDM to really work and become the standard of care it’s about turning this data into actionable information.

Another issue larger undiscussed but essential to this conversation is something that Diabetic Investor brought up long ago; whose going to pay for all this. Talking with several of the exhibitors the most prevalent school of thought is that insurers will pay. The general consensus is that armed with all this data payors can more closely monitor their patients with diabetes, identify which are in danger of experiencing a costly complication or adverse event, i.e. a trip to the hospital emergency room and through some sort of intervention will avoid this cost. As one vendor put it; “Better to pay us a few hundred dollars per year than to pay for a visit to the emergency room.”

One problem with this approach is the fact that payors are transferring a greater share of the cost, through higher co-payments, to the patient. In addition many payors are adopting reimbursement policies which are modeled on how Medicare reimburses for test strips. According to Medicare:

“Part B covers the same type of blood sugar testing supplies for people with diabetes whether or not they use insulin. However, the amount of supplies that are covered varies. If you use insulin, you may be able to get up to 300 test strips and 300 lancets every 3 months.

If you don’t use insulin, you may be able to get 100 test strips and 100 lancets every 3 months.”

Doing some simple math that means an insulin using patient is limited to 3 glucose tests per day and that non-insulin patients a useless 1 test per day. These reimbursement policies which are being widely adopted by private payors fly in the face of what the majority of experts see as the proper level of testing.

So on the one hand payors want patients to test enough so they can identify possible issues and prevent costly adverse events, yet at the same time they are actively discouraging testing by transferring a greater share of this cost to the patient through higher co-payments while at the same time limiting how many test strips they will reimburse for. Only in the wacky world of diabetes can they get away this convoluted logic.

Worse still is how little faith everyone has in the patient. When Diabetic Investor asked companies whether they offered any patient education with all this whiz bang data collection we typically received two responses; either a blank stare (or what we like to call the deer in the headlights look) or some form that’s not our job that’s what the doctor is supposed to do. It was almost as if these companies believe patients are too stupid to actually combine data with education. That patients aren’t interested in education and must be told by some higher authority what to do. That these same patients cannot think for themselves and cannot properly manage their diabetes without help.

This attitude is not just condescending, it’s downright demeaning to the millions of patients who are able to manage their diabetes effectively without constantly being told what to do. Is it any wonder that so few patients actually use the very systems that are supposed to help them better manage their diabetes. Isn’t it about time that these companies recognize that patients aren’t stupid, do want education and don’t need big brother watching every damn move they make.

This is what worries Diabetic Investor most, not just who will pay for this whiz bang technology but the equally disturbing fact that for IDM to evolve it must be more than just sending data to the cloud. It must allow the patient to participate in their own care, that it’s not necessary that each time an issue comes up there needs to be an intervention. There is a very old saying that says if you give a man fish you feed him for a day, if you teach this man to fish you feed him for a lifetime. Well as it stands today IDM is giving away a lot of fish and not too many fishing poles.

Getting back to who will pay for all this whiz bang way cool cloud based technology, that too must evolve beyond the typical reimbursement for products. That new payment models must come to the forefront and be system NOT product based. That these systems include not just the products that patients use, but include things like patient education and motivation.

This is what most companies fail to grasp as they just can’t break from the past. They talk a good game when it comes to outcomes based reimbursement but they can’t seem to break away from the conventional fee for service model. They fail to comprehend that patients not only want education, that patients will embrace it when it’s presented in an easy to understand non-clinical matter. That patients don’t need an obsessive amount of education to impact outcomes.

The fact is going forward the companies who will be successful will the ones who have faith in the patient. Companies who are willing to break from the past and come up with not just innovative technologies but equally innovative revenue models where reimbursement isn’t central to success. Now at this point there are many who are saying Diabetic Investor has lost it, we’ve gone off our rocker and the elevator just isn’t making it all the way to the top floors. These are likely the same people who are still using a rotary phone, watching television shows with commercials and think the internet is a passing fade.

IDM will become the standard of care, that much is given. Just who will be the winners here is an open question. Years ago the late Steve Jobs proved that design matters, that consumers would adopt technology that made their lives easier. Mr. Jobs literally changed the world by thinking out of the box, breaking from the past and seeing where things were going not where they have been. Let’s see if the diabetes field has any innovators with the courage and tenacity to change how patients manage their diabetes.