Today, hundreds of millions of patients globally suffer from chronic diseases and their comorbidities and millions are at risk. Tackling on a scalable level and cost-efficiently the gaps in care and offering a personalized one-stop user experience addressing all patient’s needs and meeting them where they are, can be a game changer for people and health systems. Together with Anand Iyer, Chief Strategy Officer at Welldoc we explore how the company transitioned from a top solution for diabetes to proactively transforming chronic care delivery with its powerful innovative AI-driven platform supporting the most complex chronic conditions, acting as a health monitor, personalized real-time coach and lifestyle advisor, and a medication master.
Millions of patients worldwide suffer from more than one chronic condition and are in need for a service that meaningfully and easily supports and improves their daily lives. Novel health software solutions based on AI and machine learning, chatbots, predictive diagnostics offer significant digital health personalized quality care with the right tailored actionable insights to empower patients to take charge of their health and help caregivers in managing better population health outcomes.
A closer look at the market also demonstrates that increasingly established chronic care players with strong and relevant offerings in one condition have in the past few years actively expanded into new chronic conditions and added new types of services, thus creating integrated digital multi-conditional chronic care platforms to better meet all their users’ chronic needs.
Just a few examples beyond Welldoc, our guest company, DarioHealth expanded its digital chronic-disease-management business beyond diabetes and introduced hypertension care. Recently in Jan 2021, the company acquired Upright Technologies, a musculoskeletal (MSK) health company. Livongo Health now part of Teladoc, added to its prediabetes and diabetes care ecosystem hypertension, weight management, behaviour health. Omada Health expanded beyond prediabetes behaviour change programs to address also diabetes and hypertension adding a muscle and joint pain module to its platform after acquiring Physera in May 2020. One Drop developed one of the first direct-to-customer diabetes service offerings and was among pioneers of app-based digital diabetes coaching services. Today the company supports people in the management of prediabetes, high blood pressure, high cholesterol and any combination of these conditions and with Bayer’s financing and commitments of nearly $100M, One Drop plans to expand to areas such as cardiology, oncology and women’s health. Kaia Health, one of the biggest MSK platform globally introduced digital treatment for pulmonary rehabilitation therapy targeting at COPD and later a new app tackling knee and hip osteoarthritis.
To dive deeper into the topic and the digital therapeutics industry, we talked to Anand Iyer, Chief Strategy Officer at Welldoc, a trailblazer in the digital health space, revolutionizing the management of multiple chronic conditions such as diabetes, hypertension, heart failure, and behavioural health, about the company’s business model and key drivers for success in this market, as well as how Welldoc’s value proposition differs from other market players and company’s future plans.
Enjoy the interview!
Research2Guidance: Welldoc is a pioneer of the industry. Can you please share some of the major milestones of Welldoc’s path until now?
Anand Iyer: Welldoc is considered by many market players as a trailblazer in the digital health space, revolutionizing chronic condition management to help transform lives.
In a nutshell, the problem we are trying to solve is how to support both the patient and the provider to better manage chronic conditions and their associated health and economic outcomes. And if we look at this problem statement, our key milestones and their relevance are fairly clear.
Milestone #1: Demonstrated health outcomes
The gold standard in the medical device and pharmaceutical space is to demonstrate efficacy in a randomized control study. We took the same rigorous approach to demonstrate health outcomes of a digital health solution. In our history, we have 3 randomized control studies published in peer-reviewed medical journals, and over 50 peer-reviewed publications citing real world evidence and data. To illustrate, in the RCT study comparing usual care to BlueStar® plus usual care, there was an average 1.9 percentage point A1C reduction over 12 months in the BlueStar cohort. (Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011 Sep;34(9):1934-42. Erratum in: Diabetes Care. 2013 Nov;36(11):3850.). We have seen similar kinds of results in many real-world environments with marquee enterprise customers.
Milestone #2: Regulatory clearance
Another important milestone for us was our first 510(k) clearance by the FDA which was achieved about a decade ago in 2010. Since then, we have received several more 510(k) clearances, and we just recently submitted our 9th 510(k).
Our flagship product, BlueStar®, is an all AI-driven software-as-a-medical-device (SaMD) solution for diabetes that is cleared as a class II medical device in the USA. We have 18 patents on our AI engine. We are also licensed as a class II device in Canada, and we are pursuing authorizations and clearances in Europe and Asia.
Milestone #3: Commercial operational module
In many ways, conquering this point is perhaps one of the most difficult milestones to achieve. How do you profitably scale your solution? The answer lies in flexibility associated with the commercial model. At Welldoc, we’ve taken a multi-prong strategy:
Milestone #4: Economic value proposition
At Welldoc, we were able to validate the potential of our digital health solution, BlueStar®, to significantly reduce healthcare costs by working together with IBM Watson Health, formerly Truven Health Analytics. We were able to marry our clinical outcomes with their MarketScan datasets that fully integrate de-identified, patient-level health data and claims from over 230M patients in the United States. Their data and analysis demonstrated that BlueStar® can save on average $3150 per user per year for those patients who start their BlueStar® journey with an elevated A1C over 8%.
This finding is very important because it cements the pathway forward, allowing health plans and other enterprises to see the value in digital health solutions for population health management.
Milestone #5: Scalability
The challenge in healthcare delivery is providing a personalized (i.e., “n=1”), quality care solution, but to large (n=very large) patient populations at an affordable price. It’s kind of the tension in the string, but armed with AI-driven SaMD, it’s almost like having your cake and eating it too. With a digital first approach, we are able to reach more people with our AI-driven software to bend the outcomes curve while offering a more scalable and affordable solution.
This distinction is important as the cost of human care is very high, and it is not scalable. A software solution is inherently cost-effective and scalable. And if you get the software to deliver the same, if not better health outcomes than humans, then you get both the outcomes as well as the cost savings. This is the way we think about our landscape.
The Key Point: The market needs a solution that is scalable without disintermediating the existing healthcare team. We have taken both an innovative and scientific approach in parallel, and this distinguishes Welldoc as a trailblazer in the market, with our hallmark digital first strategy that is also backed by science.
Research2Guidance: Now looking back at your journey, you have started with a focus on Diabetes and knowing how market is at present, how important in your view will it be for a company to offer a service – multi chronic conditions solution instead of concentrating on just one condition?
Anand Iyer: Chronic conditions represent an overwhelming burden for healthcare ecosystems. The lack of true, consistent engagement of chronically ill patients with their therapy pathway leads to continued increases in cost. The Welldoc platform addresses the burden of multiple chronic conditions such as diabetes, hypertension, heart failure, and behavioral health. Our solution has multiple mechanisms that are needed to positively engage patients and meet them where they are in their unique health journeys, adapting to how they live. We have created an innovative model for care delivery that can be a virtual coach, lifestyle advisor, health monitor, and medication master at the same time.
Research2Guidance: What is Welldoc’s business model and reimbursement strategy?
Anand Iyer: Our business model is best characterized as a Business to Business to Consumer (B2B2C) model. Our direct customer is the healthcare enterprise.
Our payment model is flexible to meet the needs of our customers and can include typical PMPM models, licensing, and code-based reimbursement. Our model embraces Value-Based arrangements, by increasing the quality of care at an affordable cost and delivering a positive ROI.
Research2Guidance: What is your value proposition/service offering today?
Anand Iyer: Our Welldoc platform is a comprehensive software solution that delivers personalized, real-time coaching and feedback, longitudinal pattern insights and educational tools that are actionable and individualized. It also uniquely delivers evidence-based clinical decision support to healthcare providers, to give them an accurate view into what is really happening with their patients, thereby allowing them to rapidly optimize the right therapy pathway for the patient. In addition, the platform provides coaching over time on patterns that the system has observed based on the data inputs from the patient.
A patient does not just see “your glucose level was X and Y this week,” but “your glucose was X and Y this week because of your med adherence or because of the food you ate, etc.” This value-added engagement is all AI-driven inside the product itself.
All of these data analyses are beneficial for providers and care teams. Through intelligent personalized reports, the provider receives recommendations on appropriate course of action and areas that need to be addressed with the patient. What is fascinating is that in our clinical studies, doctors who received such reports were 2 to 4 times more likely to make a medication change and help patients live better lives with their chronic condition(s).
Finally, a key value proposition of our platform is its device and system-agnostic approach. We connect with over 300 different medical devices, consumer wearables, labs, pharmacies and EMRs. This connectivity allows for “less friction” for both engagement and access to data that can help to further personalize each patient’s journey.
Research2Guidance: Today we see brands like Amazon, Walmart taking a consumer approach to health. What do you think about consumer-driven care? Do you see it as an interesting opportunity for Welldoc?
Anand Iyer: Traditional healthcare is slowly blurring the lines between the healthcare we know versus the consumer-centric model that is emerging. I think in the future these two worlds will converge expanding access to care at a lower cost. Indeed, different retailers and well-known brands are venturing into the healthcare space with a B2C model. These market players are using their assets and strengths to enter the market and serve the consumer.
We believe there is a great opportunity to partner with retail to help support patients in managing their chronic conditions while providing valuable insights and reporting to the providers. We believe this will be done in conjunction with taking on Value-Based risk for patient care, which incentivizes improvement in patient health outcomes and a reduction in the total cost of care.
Research2Guidance: Who are your main competitors and how do you differentiate?
Anand Iyer: A company should be able to answer what market I am in, what does this market value and want, and how can my solution address this need? The Healthcare Industry wants something that has proven health outcomes, is safe for patients to use, has a delightful user experience, is cyber secure, and seamlessly integrates into the care flow of providers. When one looks at these 5 factors, Welldoc is in a unique position.
When we look at our direct competitors with AI-driven software, there are few, if any, players who offer the types of health outcomes we have achieved.
There is a lot of noise in the market coming from companies using the same buzz phrase “we are a digital health company” and these companies might have new technologies or bundled solutions that are “scotch-taped” onto a human-centric care model. That is not a competitor for us. That is technology-enabled disease management, that comes with a different set of scale and cost limitations due to its human-centric approach. We differentiate ourselves on the outcomes we achieve, and the scalability and cost by which we achieve it.
Research2Guidance: What are the main challenges you are facing now?
Anand Iyer: There are a few challenges that the entire digital health industry faces. One is around patient activation and engagement. How do you get patients to activate their digital health solution and how do you architect the solution to keep them engaged? A part of the answer lies in making the experience as simple and intuitive as possible, with as little required from the end-user as possible. Our device-agnostic and integration approach helps address this issue.
Another challenge is how to focus on the person rather than the disease. A patient with diabetes, hypertension and anxiety will not want to go to three different applications to manage their individual conditions. Thus, the burden of a multi-disease, single UX approach falls on the shoulders of the digital health solution provider. Our platform approach to the broader cardiometabolic space helps us to address this challenge.
Research2Guidance: What are the main drivers of a larger acceptance and adoption of a digital health solution?
Anand Iyer: There are several key factors that must be addressed for a solution to be accepted and used by the market: it must provide value to the patient, provide a delightful user experience, and connect the patient with his/her existing care team, seamlessly within the workflow of the provider.
In the USA, over 60% of adults have at least one chronic condition and many have two or three. For a company to be successful it should offer a single platform that can address multiple conditions and their comorbidities. Driving engagement and maintaining a positive member experience also translates into higher acceptance and satisfaction scores.
Research2Guidance: Welldoc is present in the USA. And you have expanded your partnership with LifeScan to bring new digital innovation to the Canadian healthcare market. Do you have any strategic plans to expand further and which markets are of interest to you?
Anand Iyer: We are definitely expanding in Europe and Asia.
Research2Guidance: What trends do you see in the digital therapeutics industry?
Anand Iyer: 2021 and beyond will really showcase the power of digital solutions in helping people self-manage their conditions. Digital health solutions will be mainstream and will help to encourage self-management behaviors in patients to live not only healthier lives, but will also help health plans, health systems, and care teams to transform personalized data for better models of care.
Research2Guidance: COVID-19 has accelerated the adoption of digital health solutions into the healthcare system. How did the pandemic affect Welldoc?
Anand Iyer: The pandemic has transformed the healthcare system. It has presented a lot of challenges for all the stakeholders involved, but has also created many opportunities. Our real-time data, longitudinal analysis, and intelligent action-driven personalized reports have helped patients make better lifestyle decisions while supporting care teams in personalized treatment modifications based on actual health trends and patterns.
In the times of COVID-19, our user engagement has increased dramatically, with some key features seeing greater than 300% growth since the onset of COVID-19 in early March 2020. Users are reaching out and connecting more with their care teams. We have also developed tools within BlueStar to help people manage some of these new constraints that COVID-19 has brought to all of us.
Research2Guidance: What is next for Welldoc? Where do you see the company in the near future?
Anand Iyer: We will maniacally focus on continuing to deliver superior health outcomes, ROI, and higher quality of care, at scale, across multiple conditions, globally! That’s a mouthful! But, it’s where we see ourselves in the future. And it will be done directly by us and through us by others, where we help enable other key programs with our value proposition.
Research2Guidance: Anand, thank you very much for your interesting thoughts and insights. We wish you and Welldoc’s team to stay safe and healthy.
Welldoc® is revolutionizing chronic condition management to help transform lives with a platform that supports diabetes (type 1 and type 2), prediabetes, hypertension, heart failure, and behavioral health. BlueStar®, Welldoc’s award-winning FDA-cleared digital health solution, guides individuals through the complicated journey of living with diabetes by enabling them to self-manage their conditions and enhancing connections to their healthcare team. Welldoc streamlines the relationships between payers, employers and healthcare systems resources, with the goal of improving population health and reducing the costs of chronic diseases.