Transforming Diabetes Management 3
This post was originally published in LinkedIn.
This is the 3rd in my series of articles about transforming diabetes care. In my last article, I described the launch of SugoSure – a diabetes management system which I designed and developed, aiming to fundamentally transform diabetes care delivery.
Its launch in Singapore has not achieved this goal (yet). Today’s article tries to distil lessons learnt from our experience with SugoSure.
Thinking Big
I started my journey by examining diabetes care as a process and identifying ways to improve it. This took time since diabetes is complex: a fully-described patient journey covers a very large map.
We tried to re-engineer many steps in this journey, mapping out ideal management for each step to build a best-practice approach to diabetes, guided by the clinical literature.
This is a trusted approach taken by the medical community, which often aims to lift standards of care by mapping disease management pathways, incentivising clinicians to follow guidelines and measuring outcomes.
The value SugoSure provides is its protocols and alerts - encouraging adherence to these pathways while incorporating telemedicine and remote monitoring into a complete and comprehensive disease management platform.
Too Much for a Startup to Transform Alone
As mentioned in my previous article, implementing care pathways – especially if they include new telemedicine channels – often faces resistance from clinicians.
This was not something a small startup like SugoSure could push through – our attempts to showcase a group of early adopter physicians gained limited traction in Singapore. Doctors – even those who had advised us on SugoSure’s design – were unwilling to change the way they interacted with patients.
And without physician use and endorsement of SugoSure, its adoption and value were diminished. Patients are interested in SugoSure but are reluctant to subscribe unless it is recommended by their doctor – whose involvement is needed for full benefits to be achieved.
Partners need to share the vision
What would have helped SugoSure get off the ground with doctors? The answer to me is clear: supportive partners who share our vision. We haven’t found these in Singapore – not for lack of trying.
Consider the types of partner who have power to encourage adoption of innovations such as SugoSure. The following is specific to Singapore’s healthcare system, although I believe lessons learnt can be generalised to almost any country.
Regulators
The Ministry of Health in many countries serves a dual purpose of delivering healthcare (through publicly-funded facilities) and regulating it. Regulation sets an overall framework to ensure high quality care, delivered efficiently and cost-effectively, particularly where public funds are involved.
Through its declared War on Diabetes, Singapore’s focus appears to be more on building public awareness and prevention of diabetes than on improving how the condition is treated. Perhaps this is easier and, at this point in time, may be a more effective approach to the diabetes epidemic.
But the way diabetes is managed also needs improvement and technology offers new ways to do this. We’re not talking about sophisticated and expensive approaches to continuous glucose monitoring or the latest pharmaceutical innovations (which have their place, although may potentially even add cost to the system). Instead, we should consider how to help the many people with sub-optimally controlled type 2 diabetes. This group can benefit substantially from tech-enabled ways to better self-manage and interact with clinicians.
If this objective is prioritised by regulators, change can and will happen. Outcomes can and will improve and (in the long term) costs can and will be reduced. Programmes must be carefully planned to pilot then roll out technologies. Careful change management programmes will need to be implemented to secure adoption.
My plea to regulators around the world: work with the private sector to harness its innovations and help worthy startups to overcome adoption barriers which otherwise prevent innovations from seeing the light of day.
Public Sector Delivery Organisations
Singapore has a mixed public-private system, with probably the majority of care for patients with diabetes delivered through public hospital diabetes centres and polyclinics.
It is hard for a startup tech company to penetrate this system. Like many large organisations, Singapore’s public healthcare clusters have their own silos of innovation. But one major obstacle to startup tech companies gaining a presence in the public sector is its data standards.
In a tech-enabled future healthcare world, systems will need to talk to each other using data defined in standard ways. These standards are not yet open to private sector players in Singapore – resulting in the dominant part of the market for diabetes systems being unavailable to private startups.
Private Sector Delivery Organisations
Singapore’s private healthcare sector is large and comprises both private GPs/primary care chains and hospitals housing private specialists.
However, the private sector here is typically not an early adopter of technology, which is fundamentally evaluated based on short or medium term return-on-investment. Diabetes management is a case in point.
Having spent much of my career involved with private sector healthcare delivery, I knew this and adjusted my expectations of private sector partnership possibilities in Singapore.
However in other countries this may be less of a limitation. In the US, for example, HMOs such as Kaiser Permanente, lead the way in care pathway transformation. So the private sector can and should look seriously at transformative technologies. Properly implemented, it can indeed be commercially viabl
Healthcare Payers
The US HMO model has some merits, although is not universally-loved. The reason why HMOs have a commercial rationale and ability to transform care is because they integrate healthcare provider and payer. This illustrates the key role which organisations which pay for healthcare can play in transforming how it is delivered.
Public health systems are by definition integrated: the state both pays for and delivers care. Like US HMOs, they therefore they have both rationale and ability to drive care transformation as discussed in my comments about Regulators above.
Many countries (Singapore included) also have a significant private health insurance market, separate from healthcare providers. These large insurers should naturally be concerned about their long-term loss ratios and the health status of their insured populations.
So I make a second plea – this time to the insurance industry: collaborate with health tech innovators, embrace new approaches and seed pilots in partnership with startups. Then innovate in product development and marketing to positively impact the health of your insured populations.
Too many insurers I have spoken with in recent years failed to understand the opportunity to break out from an unattractive and (often) loss-making traditional health insurance business. Imagine how this can be transformed through partnerships into a highly differentiated offering with unique advantages enabled by technology.
There are certainly barriers here to be overcome – not least of which is the age-old resistance by doctors to payer-driven changes in clinical practice. But ultimately it should be a win-win situation for all: patient, doctor and society.
Pharma and Med Device Companies
Any analysis of stakeholders in health tech adoption would, of course, be incomplete without mentioning pharma and medical device companies. These are usually multinationals who are expert innovators themselves with the reach and muscle to bring their innovations to market.
Many of them are doing a fine job for the benefit of patients worldwide, occasionally in partnership with innovative start-ups where there is a commercial rationale.
Lessons Learnt
How to transform (or not to transform) a complex condition like diabetes? Lessons learnt should be pretty clear from the previous discussion.
It’s a complicated ecosystem (ugly healthcare) but one which has enormous potential to benefit from tech transformation (promising healthcare).
The path to transformed state will be a rocky one, differing from country to country depending on the structure of legacy healthcare delivery systems.
But in all markets, regulators and payers for healthcare must play a carefully thought-out and strategic role with a focus on chronic disease (where there is greatest need and opportunity).
Recognise private sector innovation and nurture collaborations with worthy startups.
And learn from past mistakes: that’s what we are doing with SugoSure. The odds were stacked against us in Singapore. But I believe we have a solid product so we are scouring the world for other more supportive markets. And we welcome discussion with partners who share our vision.
