Digital diabetes management: With insights at home and abroad, where should today’s business model head?
“Maybe the next time you get a prescription from the doctor, it will be an APP, but no longer just medicine,” noted Statenews, a prominent medical journal, when envisioning the prospect of digital health. The journal also deemed digital therapy a powerful yet provocative new idea in health care, whose software brings precision to therapy and enables personalized treatment. This gives digital therapy a big role to play as we transition to value-based care.
On the heels of a growing integration between AI, big data technology and medical healthcare, digital therapeutics (DTx), designed to treat, manage or prevent diseases by software-driven and evidence-based program, came on our radar. In particular, it is of great value for managing chronic diseases, such as hypertension and diabetes, which strongly correlate with patients’ lifestyles and behaviors.
Across the globe, the number of chronic diseases patients, especially diabetics, is on the upswing annually. Once there is a declining patient compliance in such key parameters as blood glucose monitoring and medication, more complications of diabetes and heavier disease burden will ensue. Digital healthcare’s emergence as a viable solution to diabetes management lies in its low cost, high accessibility and high-frequency intervention in patient’s lifestyles, all of which can strengthen the self-management of patients and increase their compliance. It also speaks of why diabetes digital management has become such a cutthroat market sector for ambitious enterprises. Over the past decade, a great number of leading chronic disease management enterprises, such as WellDoc, Omada, Dnurse, Glooko and Livongo, have come to the fore.
Overseas digital diabetes management enabled by insurance payment model
However, due to the huge differences among overseas markets in healthcare system, stakeholder relationships and patient awareness, the business model exploration of this cutthroat market sector leads to a reality that who is paying party or fee-paying provider depends on different markets.
Finding a paying party first and foremost decides whether a business can fare well in the long term. Take the U.S. as an example. The rate of commercial insurance coverage in the U.S. is up to 80 percent, but 90 percent of the commercial insurance enjoyed by employees is offered by their employers. The employer will have to cover 80 percent of insurance premiums for their insured employees. Aside from covering daily treatment costs, insurers will have to pay more for employees with chronic diseases if they develop complications due to insufficient self-management. Therefore, insurers have ample grounds to make patients accustomed to sustained, sufficient self-management. Livongo and Welldoc, two successful digital diabetes management providers, have come to address this sore point for the U.S. medical system and thus established a business mode with commercial insurance as payment party.
Founded in 2005, WellDoc represents digital diabetes management service at its best. Its core product, the well-known Bluestar Diabetes Health Management APP, based on automated clinical coaching and behavioral algorithms driven by real-time patient data, enables caregivers to extend their care beyond traditional clinics via mobile phones and the Internet. With the nods given by the U.S. Food and Drug Administration, Bluestar is the only FDA-certified diabetes management software in America and has been endorsed by commercial insurers with its reports on clinical effectiveness and health economics efficiency.
Livongo, established in 2008, has parlayed its diabetes management service into a portfolio of management services for various chronic diseases. Its major business is to connect mobile applications with smart blood glucose meters, smart scales and other instruments and allow patients to beam their health data to smart engine and coaches for customized management solutions. Since its beginning, Livongo, who has sensed the sore point of the U.S. medical system, has dedicated itself to building a business model of “B2B2C”, in which its customers are employers who offer employees health insurance, insurers are those who recommend customers, and insured employees are those who have access to Livongo’s services.
In stark contrast to the U.S. medical system that highly values commercial health insurance, Germany demonstrates a laxity in including digital therapy into statutory health insurance coverage. At present, Germany is the only country with coverage for digital health apps (DiGAs) for patients under statutory health insurance. However, compared with the prevalent payment model in the U.S., the European country’s health insurance reimbursement model has not been widely put to use. Germany’s digital management market for chronic diseases also lays bare a reality that it is impossible for the paying party relying on health insurance to send digital healthcare into rapid expansion as enterprises and commercial insurance do.
China’s homegrown digital diabetes management model
In stark contrast to the U.S. And German paying models, China presents a contrasting business scenario. Could America’s technology and business model be a useful guideline for the Chinese market?
The fundamental difference between Chinese and American health security systems lies in the planning and market attributes of the payment end. China is a country where health insurance occupies the mainstream status. China’s universal medical insurance is marked by compulsoriness, sociality and mutual benefit. Its most basic principle is broad coverage and low level, mainly designed for the most basic medical care. With insufficient health insurance funds, health management has not yet fallen into the category of health reimbursement. However, the rate of domestic commercial health insurance coverage remain low. Given that, commercial health insurance, which has no say in medicare service quality and cost control, is impossible to become the paying party of health management.
There is no imitable model from overseas markets for domestic enterprises, but is there a unexpected, different prospect for them? Can patients, pharmaceutical companies and medical device producers in the chain become paying party or complementary payers? In the exploration of business model, some Chinese diabetes management enterprises have formed their own competitive edges and sustainable business approaches.
Chief among them is Dnurse, a forerunner of digital diabetes management founded in 2013. Digital diabetes management is a typical, specific digital medical application. What has a direct bearing on patient is the output of the software program, and its core technical support is composed of Device, Data and Decision. Dnurse’s world-leading product advantages and industrial resources in IoT devices for diabetes monitoring, such as glucose monitor and insulinK®, have boosted user retention and use frequency. The omni-channel sales of its smart equipment is an important part of Dnurse’s charge to C-terminal patients, and also a collector of massive data. Dnurse’s Intelligent Decision Support System (IDSS), based on big data, automatically provides personalized life behavior guidance and suggestions, medical services and relevent product recommendations for patients with low cost and high accessibility, and enables C-end commercialization while providing services. At the same time, Dnurse’s digital diabetes management solutions also serve up TOP2 insulin producers’ patients, helping pharmaceutical companies increase patients’ understanding in diabetes and compliance with insulin use. In this business scenario, pharmaceutical companies are the paying party.
The localization of digital healthcare business models
The exploration of business models represented in microcosm how a start-up achieves its development. Nowadays, with technology, industry and business marching toward globalization, digital diabetes management has embarked on the path toward localization due to huge disparities in medical systems. We hold a belief that more business models for digital healthcare will arise and make for a better world for us.