Seeking a niche
Years ago in what seems like the stone age now patient coaching came from in person face to face interactions. Unlike today text messaging and FaceTime was not widely available. There were no platforms to easily exchange data. It seems hard to believe now but back then an engaged patient actually wrote down their glucose readings in an old-fashioned logbook. Diabetes management back then was also more of a one-size fits all approach, or as we liked to say diabetes management by the numbers.
Thanks to technology diabetes management began to change, researchers discovered that not all patients are the same and diabetes management should not be a one size fits all approach. Just by way of example it used to be that “good” control was defined as having an HbA1c of 7 or below. Studies revealed that seeking this A1c for subgroups of patients was not beneficial and could lead to severe hypoglycemic events. Simply put diabetes management is not a one size fits all approach and what’s right for 25-year-old Type 1 is not necessarily right for a 60-year-old Type 1.
As technology developed further a new view began forming that it would soon be possible to develop an individual diabetes management plan, a plan designed specifically for that individual patient. The many coaching platforms available today are a step in that direction. However most of these platforms still hold to old concepts such as using A1c as measure of control and have not yet adapted to trend management or incorporating Time in Range (TIR) into their definitions of what is and what is not good control.
Just as the definition of what constitutes good control is beginning to change so too is what level of coaching best helps the patient achieve that level of control. Just as diabetes management should not be a one size fits all approach the same goes for level of interaction between the patient and their coach. Since we began writing Diabetic Investor we have always divided patients into three distinct groups.
There are what we like to call Uber users who make up about 10% of the patient population. Simply put these Uber users get it and will do all the heavy lifting required to achieve good control. They are the most engaged using all the way cool whiz bang toys at their disposal. While they may seek help they are self-motivated and really don’t need much coaching.
The exact opposite of Uber users are ostriches, labeled as such because this group which represents 20% of the patient population basically have stuck their heads in the sand. Yes they know they diabetes, but they really don’t care all that much. They are the least engaged not interested in or receptive to any help.
In the middle the largest percentage of the patient population are the moderates. Moderates understand they have diabetes, they know they must do something about it but want their diabetes management to fit into their lives NOT run their lives. They want to live WITH diabetes NOT FOR their diabetes. They are in tune with all the latest gizmos but want coaching on their terms not to be forced upon them.
The key for any of these coaching platforms to be successful over the long term is to evolve beyond the standard definitions of control while incorporating interaction protocols. Just as insulin dosing algorithms get better as they learn so too should the behavioral algorithms used by these companies. One of the common complaints we hear from patients who have used a coaching platform is instead of adapting to their lives they have become somewhat of overbearing, sorry Mom, Jewish Mother.
Rather than engage with the patient on their terms they are like helicopter parents trying to manage every aspect of their child’s life. This tends to turn off the patient who then tunes out. As Momma Kliff used to say; sometimes the problem isn’t the message rather how and when that message is delivered.
Believe it or not we do see reason to be optimistic that these platforms will make this evolution. First and this should be obvious it makes sense from a business standpoint. Right now coaching is in serious danger of becoming a commodity just as drugs and devices have. By providing a true point of deafferentation will be a competitive advantage. Remember in a commodity market it’s all about cost and driving fees lower, not higher.
More from Captain Obvious but there are plenty of patients to go around and unfortunately the patient population continues to grow at epidemic rates. A company could carve out a nice little niche and be very profitable. In fact we see the coaching market evolving much like other markets with companies staking out their territories. Just by way of example it’s quite possible even likely that some company will target seniors with diabetes, while another will target millennials. Just as there are different dating apps for these groups why not different diabetes coaching approaches.
The reality is diabetes coaching is still in its infancy and just as a child grows into a teenager and then an adult so too will these platforms grow and evolve. At the moment everyone is caught up in the digital health revolution and has yet to look beyond what life will be like when the revolution ends. The focus continues to be on way cool whiz bang rather than on the practical application and usage of way cool whiz bang. Being in its infancy this market has yet to experience the inevitable shake out that all market go through as they evolve. Livongo may look like a winner today but who knows what Teladoc/Livongo will look like 5 or 10 years from today.
Most won’t remember this but back when CGM was in its infancy CGM companies made a big deal out CGM usage in an ICU unit, how by using CGM and following the Portland Protocol payors could save huge amounts of money getting patients out of the ICU faster. Back then CGM adoption in the diabetes market was slow as few knew what to do with all the data. As the CGM market evolved, as the technology improved, once people knew what to do with all the data the diabetes market took off like a rocket and has not looked back.
We anticipate the digital health/diabetes coaching market to evolve in similar fashion. Will it take off like a rocket as CGM did, maybe. But it will evolve that is certain.
