Weight loss and reversing Type 2 diabetes eHealth coaching€¦ · Weight loss and reversing Type 2...
Transcript of Weight loss and reversing Type 2 diabetes eHealth coaching€¦ · Weight loss and reversing Type 2...
Weight loss and reversing Type 2 diabetes cost-effectively through eHealth coaching
Dr Carl J. Brandt, PhD, GP, Co-founder
2
Rune Bech, co-founder,Director
Co-founded NetDoctor, SlankeDoktor and SundhedsDoktor .
Former digital officer of Danish broadcaster TV 2 and Saxo Bank
Master in Broadcast Journalism, Danish School of Journalism.
Dr. Carl Brandt, PhD
GP, co-founder
Co-founded NetDoctor.com, SundhedsDoktor and SlankeDoktor
Practising general practitioner and science/research personality within healthcare and lifestyle interventional programs
1998: NetDoktor.se
B2C. Health information portal with a leading market position in UK, Germany, Denmark and Sweden.
Founded NetDoktor.se in 1998 – in 2015 Liva Healthcare
2015: livahealthcare.comB2B. A personal lifestyle coach
in the pocket of the patient.
Leading market position in Denmark and UK
Digital Individualized and Collaborative Treatment of TD2 in General Practice Based on Decision Aid
By Prof. PhD GP Jens Søndergaard, Prof. PhD Michael Hecht Olsen, PhD Jens Steen Nielsen, PhD GP Carl J. Brandt, Prof. PhD GP Jette Kolding Kristensen, PhD Peter Gæde, PhD Camilla Sortsø, PhD Sonja Wehberg, Prof. PhD GP Dorte Ejg Jarbøl, Prof. PhD Jesper Bo Nielsen.
Supported by the Steno Collaborative Grant
Scientific team
DICTA
The Liva platform at a glance
Participant appA personal coach in the pocket
Coach dashboardScalable personal e-coaching
Outcomes dashboardReal time/world outcomes data
Users Weightloss Staytime Staytime
Usersinintervention
KG Staytimeactiveusers
Staytimeallusers
Newusersmonthbymonth
Disease Gender Agegroups Education
1 2 3
Particpants Health Coaches Commissioner
The Liva platform makes personal empathic coaching scalable, and payor executives can track outcomes and ROI in real time.
Confidential
The Platform Evidence Key Customers
Users maintained 7 kg of weight loss after 20 months1
€2,000+ saved in societal costs per year per diabetic2
3-500 patients managed per health professional3
Liva’s platform combines personal healthcare
professionals with an advanced tech platform, promoting stronger user
engagement and healthier individuals
1. Brandt et al., “Sustained Weight Loss during 20 months using a personalized interactive internet based dietician advice program”, International Journal on Advances in Life Sciences, 20112. Institute of Applied Economics and Health Research, “Liva Healthcare Cost Effective Analysis”, 20173. Liva Healthcare, “Best Practice Guidelines”, 2017
TechnologyRelationship
Liva’s mission: To drive outcomes via lifestyle coaching
6
1 Slowing the progression of lifestyle diseases
or…
2 Stopping the progression
or even better…
3 Reversing the diseases when possible
Confidential
Danish health authorities with Liva in operation
7
Confidential
NHS England works with Liva on diabetes prevention
+
1
2
Pilot (pre-diabetes prevention)Began December 2017 for 18 months5,000 pre-diabetic patients5 provider selected
Full scale nationwide diabetes prevention• Begins July 2019• 200,000 pre-diabetic patients per year• 5 providers selected
Confidential
Pilot: NHS England selected Liva from 87 providers
9
87 30 14 LIVA+4
Pre-qualification 1st selection 2nd selection Winner Feb. 2017 May 2017 Aug. 2017 Nov. 2017
Confidential
200,000 pre-diabetic patients a year in new NHS programme
10
NHS Diabetes Prevention Programme• 200,000 pre-diabetics per year• 20% will be pure-play digital initially• Full nationwide roll out from July 2019• NHS success criteria: 4-6% reversal
(HbA1c below 42)• 5 providers selected (Liva + 4)
Confidential
Gävleborg Region first to implement Liva in Sweden
11
Diabetes gets expensive if the patient ignores lifestyle
1. Sortsø et al., “Societal Costs of Diabetes Mellitus in Denmark”, Modern Economy, 2015
€0
€5 000
€10 000
€15 000
€20 000
€25 000
€30 000
€35 000
Diabetes patients without complications Diabetes patients with minor complications Diabetes patients with severe complications
Soci
etal
Co
sts
per
Pat
ien
t
Healthcare incl. pharmaceuticals and nursing services Productivity loss Additional costs
€6,197
€32,232
€14,080
55%
20%
25%
Share of patients:
• A diabetes patient with severe complications costs €32,000 per year
Confidential
56,40%
14,70%
17,10%
11,70%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Lifestyle intervention Standard treatment
Discontinue medication
Reduce medication
Diabetes can be reversed for 56% of patients via lifestyle change
56% of diabetics can be
reversed
Authors: Mette Yun Johansen, MSc; Christopher Scott MacDonald, MSc; Katrine Bagge Hansen, MD, PhD; Kristian Karstoft, MD, PhD; Robin Christensen, PhD; Maria Pedersen, MD, PhD; Louise Seier Hansen, MSc; Morten Zacho, MSc; Anne-SophieWedell-Neergaard, MD; Signe Tellerup Nielsen, MD, PhD; Ulrik Wining Iepsen, MD, PhD; Henning Langberg, DMSc; Allan Arthur Vaag, DMSc; Bente Klarlund Pedersen, DMSc; Mathias Ried-Larsen, PhD
Source: JAMA. 2017;318(7):637-646. doi:10.1001/jama.2017.10169
• A study in Journal of The American Medical Association (JAMA) by Professor Bente Klarlund Pedersen from the University Hospital of Copenhagen showed that type-2 diabetes can be rolled back through lifestyle intervention for 56% of patients.
• Liva has built the digital platform to do just that!
14
Personal relationships are key to succeeding with a lifestyle change
Ongoing personal e-coaching Asynchronous via app by text and video
Personal lifestyle planEach plan is tailored to the
individual participant’s needs
Easy lifestyle and goal trackingAutomatic tracking (e.g., steps) or easy manual tracking (e.g. meal photos)
Personalised contentMotivational material and other content is carefully targeted and timed
“A real personal coach in your pocket”Relationship based: Behaviour
psychology agreements and commitments
Health coach Participant
Support communityof fellow participants(peer-2-peer)
Scalable asynchronous e-coaching Data makes the intervention more
personal and the health coach bettersupported by AI and machine learning
Liva’s 9 months NDPP lifestyle intervention pathway
15
Q1 Q2 Q3
●●●●●●●●●● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
Weekly coaching Bi-weekly Monthly
Step 1: Relationship building
+Initial meeting with allocated personal coach• One hour one-2-one session• Live video or physical meeting• Relationship building and goal setting
Step 2: 26 Online coaching interventions via app
Coach Patient
Confidential
The Liva app - as seen from the patient
A personal coach in the pocketAsynchronous coaching
via app by text and video
Charts + tracking of vitalsTracking of up to 14 vitals
Health coach Patient
Support communityof peers (mentoring)
1 2 3
17
Liva participant app allows you to set and track relevant goals
18
Participant overview
Asynchronous video and text communication tools
Live video tool for ongoing interventions
Patient vitals and charts
Group mentoring tools
The Liva coach dashboard – tools to handle 3-500 patients per FTE
Content library (build as you go) for efficient
recycling
Liva in one slide: Scalable empathic digital health coaching
19
One health coach can manage 3-500 patients
Patient follows programme via app
Weekly advice from personal coach
Trackprogress
Peer supportgroup
Liva outcomes with pre-diabetic patients - real time/real world
38%pre-diabetics reversed
after 6 months*
Real world Liva data.
4,3 kgaverage weight loss after 6
months
Trend. Real worldLiva data
67%reduced HbA1c
after 6 months
Real world Liva data.
LIVA retention rates:• 3 months: 69%• 9 months: 63% *Blood sugar levels (HbA1c) driven below 42
Liva outcomes with 103 Type 2 Diabetes patients
6,8 kgAverage weight loss
after months
Real world Liva data*
2.667€saved per patient per year
Trend. Real worldLiva data*
4,8 kgAverage weight loss
in 7,4 months
Real world Liva data*
*Komkova A, Brandt CJ, Hansen Pedersen D, Emneus M, Sortsø C, Electronic Health Lifestyle Coaching Among Diabetes Patients in a Real-Life Municipality Setting: Observational Study, JMIR Diabetes 2019;4(1):e12140, DOI: 10.2196/12140, PMID: 30860486
LIVA Healthcare A/SRainmaking LoftDanneskiold-Samsøes Allé 41DK-1434 Copenhagen KDENMARKwww.livahealthcare.com
LIVA Healthcare UK LtdInternational House1 St Katharine's Way, London E1W 1UNUNITED KINGDOMwww.livahealthcare.co.uk
Thank you for your attention
Appendix
23
Monitoring
Peer to peer support
Patient
Personal health coaches1. SDCO basedNurse/Dietician/Physiotherapist2. GP based Nurse (optional)
Individualgoals and plans
Procedural knowledge
1. Individual digital coaching
Monitoring
Peer to peer support
Patient
1. Personal health coaches• SDCO based Nurse/Dietician/Physiotherapist• GP based Nurse (optional)
Individualgoals and plans
Procedural knowledge
1. Individual digital coaching
2. General practice• GPs dashboard integration of patient registered outcome measurements• Overview of patient registered outcome measurements
2. GP dashboard integration, (one click summary in EPJ)2. Integration into GP platform
Monitoring
Peer to peer support
Patient
1. Personal health coaches1. SDCO based Nurse/Dietician/Physiotherapist2. GP based Nurse (optional)
Individualgoals and plans
Procedural knowledge
3. Hospital hypertension and diabetes specialist
• Decision support by specialist recommendations
• Recommendations for treatment in accordance with algorithm
• Automatically delivered
1. Individual digital coaching
2. General practice• GPs dashboard integration of patient registered outcome measurements• Overview of patient registered outcome measurements• Decision-support by specialist
3. Specialist decision support to GPs
• Patient data is fed from the patient, the health coach and the GP summary page into an algorithm
• Based on the in entered data the GP will be given advice about optimal medication
• The GP then decides medication for the patient
Specialist anbefaling:T2D: LADA Metformin v
BT 165/98 Amlodipin v
LDL/HDL Simvastatin v
3. Specialist decision support
Liva offers two options: Full service or SaaS
Full service: Liva supplies coaching
Full-service: IT platform and coaching
SaaS: Use your own staff
Software-as-a-service, SaaS
Platform licenseCoaching included
Platform license only
White label/ownbrand
Disease agnosticStaff training
included3-500 patients per
FTE