This just got more interesting

This just got more interesting

Well earlier today we wrote about Walgreens deeper push into interconnected diabetes management (IDM) with expanded access to MDLIVE and their new app which collects and incentivizes glucose readings. Later today we learned that Express Scripts has aligned with BGM newcomer Livongo as they too dig deeper into IDM.

According to a company issued press release;

“Livongo Health announced today that Express Scripts has selected Livongo to provide clients and members access to better tools to manage diabetes, a chronic condition affecting nearly 10% of the U.S. population and growing rapidly.1 Through this partnership, Livongo’s innovative, cloud-based diabetes management program will be available to Express Scripts’ more than 3,000 clients, which represent more than 85 million people in the U.S., including some 8 million people with diabetes.

“We are excited by the opportunity to partner with Livongo, an innovative company that will accelerate our ability to improve the care of people with diabetes,” said Glen Stettin, Senior Vice President and Chief Innovation Officer at Express Scripts. “Our expert diabetes pharmacists, high-touch Therapeutic Resource Center care model and innovative solutions help us practice pharmacy smarter for millions of people with diabetes, ensuring better, more cost-effective care.”

Express Scripts clients will have seamless access to Livongo’s diabetes management program, Livongo for Diabetes, which offers three key components:

  • A connected glucose meter that transmits data and messaging in real-time
  • A smart analytics platform that provides personalized insights
  • A human touch through remote coaching from Certified Diabetes Educators

This innovative approach encourages more frequent blood glucose checks, provides targeted outreach from Certified Diabetes Educators, and automates the often cumbersome task of ordering supplies and manually tracking blood glucose readings. Most importantly, participants receive personalized, real-time information that enables more confident self-management and can improve glycemic control.”

It seems the only piece missing from the Livongo/Express Scripts partnership is incentivization something that could be easily added.

What these two announcements, ironically which came on the same day, tell Diabetic Investor besides what we already mentioned today, is that;

  1. The IDM market is just as competitive as the conventional BGM market.
  2. What will happen to companies like TelCare, another company which has a meter which transmits readings to the cloud, allows for patient messaging and connects patients with CDE’s.
  3. While the old guard still has greater market share, for the moment, are these moves which don’t include the big boys just one more nail in their coffins.
  4. Have we reached the tipping point when it comes to BGM, will non-cloud enabled systems go the way of the dinosaur?
  5. And what about a company like Glooko which does not have a meter itself but does convert conventional metes into cloud enabled, what does this say about the future for their platform?

These two moves should also further confirm something we’ve been stating regularly, that it no longer a question of if we’re moving towards outcomes based reimbursement rather when this transformation will become commonplace.

Diabetic Investor suspects the next iteration in this saga will be someone coming out with an agnostic platform. That rather than force a patient to use a Walgreens co-branded, iHealth or Livongo meter develop a system perhaps using the Glooko platform. The key isn’t the meter a used by the patient, the key remains what to do with this data once it’s in the cloud. Transforming data into patient relevant, actionable information which hopefully translates into better patient outcomes.

As we noted earlier today for the vast majority of patient’s diabetes management isn’t overly complex. Ask almost any primary care provider, endocrinologist or CDE and they will state consistently that if patients would be therapy compliant they would achieve better outcomes. That truth be told the hidden purpose behind data collection and transmission is to see not just if the patient’s therapy regimen is working but if they are actually taking their meds as prescribed. While glucose readings don’t tell the whole story they do provide valuable insight.

One also has to wonder whether payors will get into this field too as they have as much, if not more, at stake than Walgreens or Express Scripts. Think of what it would mean to a payor who could demonstrate to an employer real savings realized from IDM.

We also wonder how physicians will react to this after all they are the ones writing the scripts so these meters can be covered by the patient’s insurance. Frankly Diabetic Investor does not see these physicians being eager to write scripts for system which could end up taking away their patient. Would it not be a good idea for a payor or perhaps a BGM company to deploy a system which is platform agnostic allowing the physician to maintain control of the patient. Would it not make sense that physicians would write scripts for the company that gave them this system?

As with most things in this wacky world this about money, who spends it, who makes it and who saves it. The reimbursement pie may be changing but it’s still a mighty big pie and everyone wants a slice and no one wants the crumbs left behind. Every diabetes device and drug company has a vested interest in protecting their piece of the pie. So does every payor, self-insured employer and big box retailer- let’s not forget about a small retailer named Wal Mart. We further suspect that CVS in attempt not to lose out to Walgreens will follow suit and come up with an IDM program of their own.

This change to diabetes management, this move towards IDM should shock no one. Yet it’s astonishing how the old guard companies are now left scrambling and the newer smaller nimbler companies like Livongo and iHealth are stealing their thunder. The game is not over by any means as the old guard still has the scale and resources to compete IF they decide to. This of course would mean they would have to break from past practices and actually do more than have countless senseless meetings which decide what color toilet paper should be in the executive restrooms. Should they be unable to break from past traditions their once thriving franchises won’t be worth that pretty toilet paper that’s hanging in the executive restroom.