Time to leave the clinic

Willie Sutton committed his first bank heist in 1925 in Ozone Park, NY. His life’s work would land him on the FBI’s Most Wanted List, bring him $2 million dollars, put him in prison for 33 years, (which included additional time because he kept escaping), six years in hiding and four years of parole. When asked why he robbed banks, Willie is credited with replying, “because that’s where the money is.”

Well in case no one has noticed when it comes to our wacky world the largest market is not insulin using patients which account for approximately 5 million patients here in the US but the 25 million who don’t use insulin. Put in simply terms if patients with diabetes were a bank the most money can be made targeting the 25 million patients that don’t use insulin. Sure, plenty of money can be made from insulin using patients but more money can be made from non-insulin using patients for as Momma Kliff used to say there are lots more of them.

We mention this given all these deals being made to make interconnected diabetes management (IDM) the standard of care. As we have noted on many occasions most of these efforts so far have targeted insulin using patients as they are the low hanging fruit on the IDM tree. This makes perfect sense as insulin using patients due to the nature of insulin therapy tend to be more engaged with their diabetes management then non-insulin patients.

IDM has the potential to be a major help to insulin patients as the system does all the heavy lifting rather than the patient. In essence Tyler is nothing more than an IDM system. Thanks to CGM technology and insulin dosing algorithms life for insulin using patients is becoming easier and easier. We’ve said it before and will say it again it won’t be long before insulin therapy is pretty damn simple, that is provided the patient uses this way cool whiz bang technology.

IDM also has great potential with non-insulin using patients, but this potential will never be realized until companies take diabetes management out of the clinic. The problem with most IDM systems is they are designed from a clinical perspective NOT A CONSUMER PERSPECTIVE. This is a critical distinction as patients with diabetes are CONSUMERS of healthcare.

Not to be redundant but as we noted yesterday these non-insulin patients have a chronic disease, they do not understand do not want yet requires work to manage. They want to live their lives WITH diabetes and not FOR diabetes. They want diabetes to be part of their lives not to run their lives. Most of all they want diabetes management to be stupid. Something they just do and not have to think about.

Considering that the majority of non-insulin patients only have to take pills what could be dumber than that. Why then if all they have to do is take pills why is therapy compliance the biggest problem in diabetes? Common sense would indicate that better to swallow a few pills everyday then inject insulin. Yet study after study notes that as simple as oral therapies are therapy compliance is the biggest obstacle standing better patients and better outcomes. As physicians tells us all the time everything would be much different if patients would just take their meds as prescribed.

We think all this would change if companies would stop treating these non-insulin patients as patients took diabetes management out of the clinic and started treating these people as CONSUMERS. Again, as we noted previously these consumers have no skin in the game when it comes to achieving better outcomes. They do not pay a lower premium for their health insurance, their co-payments for the drugs they take are not lowered or eliminated nor are their deductibles lowered or eliminated. These consumers are not rewarded or incentivized in any way to achieve better outcomes.

There are many reasons for this but a huge one is that most companies look at diabetes management from a clinical perspective and not a consumer perspective. They believe that these consumers want to “feel” better and care about whether their A1c is 7 or higher when in reality most of these consumers don’t even know what A1c is. They believe these consumers care about things like time in range or the many complications that can happen from poorly controlled diabetes.

Well we hate to break the news to these companies, but these consumers don’t understand time in range and think all the bad things that can happen from poorly controlled diabetes will happen to the other guy. Unlike insulin using patients there are no immediate tangible benefits from better diabetes management.

This flies in the face of everything these consumers are used to doing. A non-smoker pays lower premiums than a smoker. Consumers pay lower auto insurance premiums for better driving habits. Consumers save money on their homeowner’s insurance for installing alarm systems or combining coverages with one insurer. When they shop at the grocery store, they save money by joining the stores frequent shopper program as they are when they join an airlines frequent flyer program.

Yet when it comes to their diabetes management, they are told to do all the heavy lifting because they will “feel” better or because they will avoid complications that may, or MAY NOT happen sometime in the future. To us this is just ridiculous and as the facts show does not work, so of course let’s keep doing something that has proven to be ineffective.

IF these consumers were treated as consumers IF they had skin in the game IF they saved money or were incentivized or rewarded for better outcomes there is the very real possibility they would become more actively engaged with their diabetes management. IDM makes this possible. Think of it this way these consumers may not understand all the reasons why they are being told to do what to do but IF they had skin in the game and saved money from doing it, they just might give it a try.

Think about a smoker. Everyone knows smoking is not a healthy behavior but as every ex-smoker knows quitting isn’t that easy. Yeah, they might feel better after they quit but during the process of quitting the feeling isn’t so great. Besides nicotine withdrawal there is weight gain and let’s be honest smokers like how they feel when they smoke. Yet when a smoker looks at how much money they can save from quitting the process of quitting becomes more bearable. A smoker trying to quit has plenty of options that can help them quit. Besides patches and gums there are drugs which help them quit. Tools they are more likely to use given the reward of quitting is greater than the cost of these tools.

The same goes for diabetes management. The consumer may not like taking all their damn pills, but they would be more likely to do so IF they were rewarded in some way. Thanks to IDM technology the consumer could see the progress they are making and get the help they need all that’s missing is the reward.

IDM companies would also be well advised to redesign their way cool whiz bang cloud enabled toys taking them out of the clinic as well. Rather than show actual glucose levels, a number that these consumers don’t understand anyway, why not display how much time their levels are in the green, yellow or red zone. Listen these consumers may not understand time in range, but any idiot knows the more time in the green zone the better. Why not provide some positive reinforcement when they are spending time in the green zone.

These consumers don’t walk into a room and hear from their friends, family or co-workers how great their A1c is. Yet this same consumer on a weight loss program receives this positive feedback as they make progress to their weight loss goal. Positive feedback which reinforces all the heavy lifting they are putting in to lose the weight. Why should a consumer with diabetes be treated any different?

As we have long stated IDM offers great potential, but that potential will NEVER materialize IF consumers don’t use it. For IDM to really take off and bring about the change we know it can it’s time to take IDM out of the clinic and bring it into the consumer arena. It’s time to give the consumer skin in the game, give them something real something tangible something that can see, feel or touch. It’s time to stop treating them as patients with diabetes but consumers with diabetes.