How digital health coaching drives behaviour change and better patients’ outcomes – Interview with Jonas Hjortshøj, CCO of Liva Healthcare

With hundreds of millions of patients globally suffering from chronic diseases and millions being at risk, digital health coaching programmes arise as an essential part in driving better population health outcomes. Jonas Hjortshøj, CCO of Liva Healthcare shares with us what are the key success drivers to their digital lifestyle modification coaching and chronic disease management programmes that help patients lead healthier and better lives, as well as the company’s international growth plans to further drive and disrupt the digital health coaching space.

Digital health coaching has emerged as a key piece in addressing global population health. Personalized innovative digital chronic disease management and prevention programmes facilitate behaviour change and transform patient experience. App supported coaching services are more and more seen as the missing bridge between digital health start-ups and healthcare incumbents.(Discover the six building blocks of best in class digital health coaching services). Some payer organizations and pharma companies revamp or expand their digital service offerings via partnerships with novel health tech companies to address the increasingly costly chronic diseases burden.

To dive deeper into the digital health coaching and digital behaviour change programmes, we talked to Jonas Hjortshøj, CCO of Liva Healthcare, an innovative health tech company headquartered in Copenhagen and London. Jonas will shed some light onto how Liva’s personal health programmes empower patients living with chronic conditions and lifestyle-related challenges such as Type 2 diabetes, obesity and heart disease, the company’s business model and key drivers for success in this market, as well as how they respond to the corona pandemic.

Enjoy the interview!

Research2Guidance: As a short introduction, could you please share Liva Healthcare’s story

Jonas Hjortshøj: Liva Healthcare was founded in 2015 by 3 pioneers and serial entrepreneurs behind the e-health success NetDoctor.com. The founders are a medic, journalist and physio therapist by education. Since 2002 they have been working in this space of delivering very strong applied science digitally.

Liva Healthcare improves lives through digital lifestyle modification coaching. The heart of our value proposition is rooted in creating a personalized and personal relationship with the coach. The unique combination of scientific guidance and empathetic support from our coaches results in the patient embracing new habits and lifestyle changes that are lasting. There is a lot of psychology involved in “how to achieve that!”.

A lot of companies offer various forms of coaching and tracking features, but the difficult part is “how do you really make people change what they are doing?” People need to be accountable to someone and that is the whole premise of what we are trying to do – we create personal relationships that make people want to actually achieve the goals and changes they have agreed with their coach.

Research2Guidance: What is your business model?

Jonas Hjortshøj: Our business model is B2B. Our clients are primarily in the Pharma and Insurance’s sector, but we also provide our services to national healthcare systems such as NHS England.

We primarily offer a full-service solution consisting of coaching and our technology platform, but also have experience providing our platform as a SaaS solution (Software as a Service).

To give you an example, we have a client, a global health insurance company that have bought our solution for their 50 coaches to use it. We have signed another contract with an Australian insurance company for them to use the software as a service.

For our Pharma clients we offer a full-service programs. This allows us to monitor the outcomes and enables us to control the process more and at the end to reach better results. Here some of the end-points we can demonstrate is ongoing engagement (retention) of ~65% of users after 12 months use – and sustained weight loss of 7 kg after 20 months.

At present, some of the most impressive results we have seen is the work we have done with NHS. Together we built a comprehensive and innovative service for pre-diabetic / Type 2 diabetes patients across the UK.

When we talk to Pharma companies and Payers and we show them our data, they are pretty astonished. With our technology and human / empathetic approach, we bring the lifestyle changes so needed for a person to be better, to feel better and have long lasting results.

Research2Guidance: Your results are fantastic. Can you elaborate a bit more on your service offering? How does it work?

Jonas Hjortshøj: We have created a scalable and personal health programmes for lifestyle and chronic disease management. In a nutshell, all the things we offer as a service, could happen in the physical world – one-on-one coaching, group therapy, dietary plans, exercise plans etc. For example, some clinics that treat diabetes patients have one-on-one coaching in person. At Liva Healthcare, we are simply taking this experience, making it digital and making it scalable through the use of technology.

When we onboard a person / patient (For example, a Pharma company brings a patient on to their product and they also are looking to create a lifestyle modification for this patient), the first thing is to set up a video call with one of our coaches. During this one-hour consultation a personal connection is established, the user builds rapport and he / she is able with the help of the coach to figure out “What is that I want to achieve?”.

At Liva Healthcare we use various psychology techniques, one of them is “acceptance and commitment-based therapy” (ACT) a part of cognitive behaviour therapy that creates more lasting lifestyle modifications. The coach is trying to understand what kind of values the person has, what matters to them and what can be done differently today for them to be able to achieve their goals.

From this in-depth video conversation a plan or commitment is created in an agreement. This is the foundation to build upon and a reference later to check “How one is doing, how can we help further, etc.” From that moment on, the life coaching is transitioned into having a dialogue with the coach both by text messaging, but also via small bits of a video that is sent back and forth with insightful content.

There is some automation on the backend; however, we try to make the “interventions” as personalized as possible for every case. Our service offering is taking all the things that coach will do in real life and just scaling it digitally.

Research2Guidance: How long does it take to complete your programmes?

Jonas Hjortshøj: Our programmes are 9 month or 12 month, but can be configured to different length depending on the objective and client.

The first month, after the initial hour session with the coach the patient meets with him / her on a weekly basis. For the next 4 months, these meetings transition to every second week. The final months the patient meets with the coach once a month. These are regular scheduled interventions in which the coach provides a feedback on the patient behaviour patterns, what can be further improved or adjusted in the program to better meet the goals.

We are looking for ways to create better outcomes, increasing scalability and lowering marginal costs so in near future there might be different approaches and time milestones.

Research2Guidance: Do you interfere if you see that the patient is not so active and is not following his / her coach’s suggestions?

Jonas Hjortshøj: Yes. Our plans are tailored to patients needs and the core of our business is the establishment of this personal relationship. Most patients need an ongoing motivation and support to create new healthier habits and to reshape their lifestyle in a long-term. Our technology allows us to deliver both empathy and expertise based on the data we see.

It is important also to note that our coaches are motivated to be there for their patients and to care about their health outcomes. We incentive them accordingly. The engagement that they have with the patient and the personal relationship that it builds is essential to the outcomes that our programs drive.

Research2Guidance: How many coaches do you have?

Jonas Hjortshøj: We have 50 to 70 coaches and across the external service around 100.

Research2Guidance: At Liva Healthcare you offer different programmes, like diabetes, weight loss, mental health, etc. Which one is more successful for you? How many users do you have?

Jonas Hjortshøj: We offer 8 dynamic programmes addressing different lifestyle diseases or designed to prevent such, like in the case of “prediabetes”.

On the surface you see unique programmes and there are differences in the professional /educational background of the coaches depending on which programme they are assigned to. To take care of a certain disease data some programmes need a healthcare professional. However, the basic lifestyle intervention is very similar whether you are person with diabetes or a person with obesity. The methodology is the same in terms of creating a personalized and powerful psychological relationship between the coach and the patient that enables the latter to do the changes he / she wants and needs to do to reach the goals. Our coaches’ approach in terms of being there for their patients, sharing insights and showing empathy is the same in every single program.

As we are B2B business which programme is more sought for really depends on clients’ needs, pain points and members / patients base. For example, we are working with NHS England is focusing on the services towards pre-diabetes, while a large pharmaceutical company we work with is primarily interested in the obesity programme. This year we are launching in 5 markets pilot obesity programmes together with them. We will onboard about 500 patients in each of those markets.

Research2Guidance: How many users do you have via your clients?

Jonas Hjortshøj: Since 2002, the founder team has had more than 140.000 people/patients through various digital health and coaching programs. In the most recent version of the technology, Liva Healthcare, we have had over 10.000 patients enrolled with tremendous outcomes; for example two general findings across programs have been that 44% of people with pre-diabetes experienced reversal of the condition and the share of people with diabetes in control (HbA1C<7) grew from 22% to 46%.

Research2Guidance: How do you differentiate your service offering from other market players? What is Liva Healthcare’s USP?

Jonas Hjortshøj: One unique selling point is our clinical results. If one looks across the market even in North America one struggles to see the clinical data and the outcomes that we have generated.

Often, we are asked “How did you do that?” The core of our success lies on being able to build personal relationships between real coaches and patients, along with having a cutting-edge technology to make it scalable. As I mentioned above, psychology is part of our programmes and we use it smartly “against” people themselves to help them reclaim their health and lives.

We help our Pharma clients to create strong adherence and achieve better outcomes for their patients by combining medicine with lifestyle interventions. Health Insurance companies can deploy our robust technology with their own health team.

Based on our results we are confident to say, “You will have XXX lower healthcare cost for this patient / member via this intervention and we are willing to go at risk with you on this”.

Research2Guidance: Which markets are you active on? Which ones are of interest to you?

Jonas Hjortshøj: At present Liva Healthcare is in Denmark, UK and during 2020 we will be in Finland, the Netherlands, Belgium, Australia and Canada. Growth is accelerating rapidly. We are closing a lot of contracts.

The German market is a fascinating market. I think the new law (red. DVG) surprised a lot of market players. Our company has German investors and we are assessing the market potential. It is interesting that there are so many companies even outside the healthcare space that believe that they can create an app and get reimbursed, but the truth is that a lot of them have no idea what they are getting into or what are the basic requirements.

At Liva we are well positioned in the sense that we can check mark all the basic requirements, but the devil is in the details. All the legal processes and then questions like how you are going to get the physicians to prescribe the product, can you afford to have a sales force big and strong enough to go around and educate the healthcare stakeholders, etc. are making us be more careful and analyse the market possibilities in more depth. For sure this move from the German government has created some very interesting conversations globally.

Research2Guidance: How do you choose the markets? Are you going only where your partners are, or you have a strategy set that you follow?

Jonas Hjortshøj: It is both. In a way there should be a balance between strategy and opportunity. In the past a lot was based on opportunity arising. At present, our plans are to be a market leader in Europe and this goal is driving our strategy / efforts.

Canada, for example, was led by a very large corporation that really liked our solution and we saw big opportunity of working with them. In Australia was a similar case.

Research2Guidance: Today, COVID-19 has changed the world around us. A lot of companies are adjusting their solutions / services or are creating a new one to help their users better deal with the situation. How do you respond to the corona pandemic?

Jonas Hjortshøj: COVID-19 will massively accelerate the adoption of digital health into traditional healthcare systems. From where Liva is positioned, there is tremendous demand and interest for remote health services that enables patients to be receive care remotely. We have had a surge of leads and customers contact us to start up or accelerate a deployment of our solution.

More concretely, we have taken the following steps:
1) Liva Healthcare is offering its digital health platform free to all public healthcare organisations in Denmark for the next 6 months – this is to help people living with chronic conditions such as diabetes, heart disease, obesity who normally have regular face to face meetings with nurses, dietitians, coaches or other healthcare professionals. Right now, due to COVID-19, thousands of patients are left alone to manage their condition by themselves and are asked not to visit their doctor.

2) In dialogue with a pharmaceutical company to expand our service offering by repurposing our technology platform to become a link between HCP and patients – in order to enable healthcare delivery during COVID-19 restrictions

3) Responded to NHS England request for information on our ability to significantly increase patient enrolment figures in the UK.

Research2Guidance: Last year we published a whitepaper with the results from R2G’s global survey on “Partnerships In Digital Health – Breaking Points And Success Factors”. What we saw is that only one infour partnerships is considered to be successful by the industry market players. In your opinion, what are the breaking points and how to build a successful digital health partnership?

Jonas Hjortshøj: To have a successful partnership it is important to be honest about what are you trying to achieve and what do you want from this partnership, what is your incentive. For example, let’s take a Pharma company “Am I trying to use the digital service to create outcomes for patients or am I trying to sell this service to physicians or payors and thereby creating more of an access and traction for my Pharma product.”

It is also important to be on the same page when it comes to data / facts. If you take obesity. It is a chronic condition. A lot of companies in the weight loss space see it as people are obese because of what they eat, because they don’t exercise, etc. Those factors are partly true. What is missing is that there is a lot of physiology and biology involved when it comes to obesity. So, both parties need to align facts / definitions to move on together, otherwise there will be different approaches, which may lead to unmet expectations and outcomes.

Last but not least, create evidence and prove that what you are doing is valuable. And this will be the driver to expand the partnership.

Research2Guidance: What is next for Liva Healthcare? Where do you see the company in the near future?

Jonas Hjortshøj: My vision is that Liva Healthcare will be the biggest lifestyle digital modification company in Europe. We will be also present in some parts of Asia Pacific and Middle East. We are very well positioned to take a big market share in the European market, which is a lot more scattered than the US market. To be successful in Europe you need to take into consideration the different cultures and embrace the fact that what works for one market may not work in another market.

At present in North America, especially in the US, there are so many companies trying to do variations of what we are doing and many of them are very good. However, I believe they will struggle to be successful in Europe because of the cultural nuances. And we have seen that already with some big US players that can’t scale their business in Europe.

Research2Guidance: Jonas, thank you very much for your thoughts and insights.

About Liva Healthcare

Liva Healthcare is an innovative health tech company headquartered in Copenhagen and London. Liva offers scalable digital health coaching for patients living with chronic conditions and lifestyle-related challenges such as Type 2 diabetes, obesity and heart disease. Liva is growing rapidly with operations across Europe, Asia-Pacific and Canada and was founded in 2015 by the team behind the popular health information portal NetDoctor.com.

Liva’s award-winning app is used by primary healthcare, pharmaceutical companies, insurance companies and public and private healthcare organisations such as NHS England and AXA PPP healthcare. Liva is a partner to NHS England on its ambitious National Diabetes Prevention Programme (NDPP).

Through Liva’s app, patients have access to a personal health coach who provides professional guidance, support and empathy through an ongoing relationship to build long-lasting behaviour changes. Participants can track their progress real-time via the Liva app, and engage with a support group of peers to keep them motivated. Liva has been proven to work efficiently across all socio-economic backgrounds and is capable of engaging groups normally hard to reach. For more information, please visit:  www.livahealthcare.com