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Evidence-Based Diabetes Management September 2017

Omada's Paul Chew, MD: From Treating Chronic Disease to Prevention

Mary Caffrey
The chief medical officer of Omada Health discusses a transition from one of the world's largest pharmaceutical companies to a digital health provider, and from treating chronic disease to preventing it.
  CHEW: The most important concept we must realize is that diabetes prevention is more than just weight loss. It’s a change in your lifestyle in terms of healthy eating, exercise, and a change in mind-set. It’s not a cosmetic approach but an approach that will internalize the benefits of these interventions to reduce your risk of chronic disease—not only of diabetes but the risk of cardiovascular disease as well.

  EBDM™: One of the big obstacles for digital health has been integrating into the physician and care team workflows. How has Omada approached this problem?

  CHEW: Integration into the medical workflow is very important. Working as we have at Omada through optimizing the patient portal, [mediating] between the patient and the physician so they can communicate more effectively is one way. We also work with the electronic health record—these are initiatives we have under way.

EBDM™: What specific roadblocks have you seen within managed care settings?

  CHEW: Managed care settings have so many competing priorities nowadays that we must be very clear that the coming tsunami is one of the biggest ones they must address—and that is chronic disease. More money is spent on chronic disease than infectious disease. As the population ages, the cost of chronic disease will be even greater. Diabetes prevention can reduce the cost of cardiovascular disease, kidney disease, and neurologic disease, and it’s something that can be seen—with the publications that we have, we’ve modeled the [return on investment] to be within a couple of years.10,11 It’s a clear and present danger. And we believe it’s a clear and present return on investment. 

EBDM™: Where have managed care organizations “gotten it right” when it comes to digital health adoption?

  CHEW: It’s a very early area, so it’s hard to say there’s a successful digital adoption [in managed care]. The ability to make an appointment through a patient portal or to get refills—those are rudimentary digital approaches to healthcare. We have found, for example, that wearable devices, though helpful, need to be supported by intensive behavioral change. That’s why we believe Omada—with its publications, approaches, and 120,000 participants to date—is one solution that should be considered when it comes to diabetes prevention and cardiovascular disease prevention.

  Implementing the Medicare Diabetes Prevention Program

  EBDM™: As you know, CMS has proposed delaying full participation of digital health providers in the Medicare DPP when it launches in April 2018. Is the CMS’ call for more evidence legitimate, or is this barrier emblematic of others that digital health has encountered?

  CHEW: One of the greatest innovations in the digital approach or the diabetes prevention approach has been the CMS program that will go into effect next April. As you may know, at this stage [the CMS is] approving and reimbursing DPP programs that have been approved or certified by the CDC. They are still getting comments for digital diabetes prevention. We feel very strongly that the evidence base for seniors is already strong for diabetes prevention. We’ve published 2 articles on the effectiveness of the Omada program with results that are even better than the YMCA program’s, which is the basis for the CMS program. The second [study’s results] showed that the return on investment is even sooner than the 1-to-2-year time frame for seniors.11 So overall, we feel the evidence base is there.   Most important, if the CMS benefit is to [reach] its full realization for seniors, we have to access seniors who may not have the ability or the desire to go to a face-to-face program once a week. We have to be able to provide access digitally for those participants, and we also have to recognize that there’s only a very thin slice of time you spend in a face-to-face program, whereas in a digital program, it’s constantly accessible—when you need it and where you need it.

  EBDM™: Where do you see digital health and the DPP heading in the next 5 years?

  CHEW: The next 5 years are going to be very important as we go forward in digital health because we will get a critical mass of experience. It will become even more clear that diabetes prevention is needed. The CMS program and the MACRA and MIPS initiatives to encourage screening, I believe, will make it easier for physicians and other healthcare providers to recognize and refer patients with prediabetes. 

References

  1. Omada Health adds Dr. Paul Chew as chief medical officer, Tom Schoenherr as chief commercial officer [press release]. San Francisco, CA: Omada Health; January 6, 2017. http://omadahealth.com/news/omada-health-adds-dr.-paulchew-as-chief-medical-officer-tom-schoenherr-as-chief-commercial-officer. Accessed January 6, 2017.

  2. Heart disease fact sheet. CDC website. http://cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm. Updated August 18, 2017. Accessed August 20, 2017.

  3. National Diabetes Statistics Report, 2017. CDC website. http://cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Published July 18, 2017. Accessed July 18, 2017.

  4. Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. doi:10.1056/NEJMoa012512.

  5. Smith A. Research emerging that links insulin resistance to cognitive decline. Am J Manag Care. 2016;22(SP7):SP264-SP266.

  6. American Diabetes Association. Economic costs of diabetes in the United States. Diabetes Care. 2013;36(4):1033-1046. doi: 10.2337/dc12-2625.

  7. The National Diabetes Prevention Program. National Association of Chronic Disease Directors website. www.chronicdisease.org/mpage/domain4_ndpp. Accessed August 20, 2017.

  8. Payne M. History lessons in innovation: digital behavioral medicine can address the diabetes “double epidemic” facing Medicare and America’s seniors. Am J Manag Care. 2016;22(SP7):SP275-SP276. 

  9. Su W, Chen F, Dall TM, Iacobucci W, Perreault L. Return on investment for digital behavioral counseling in patients with prediabetes and cardiovascular disease. Prev Chronic Dis. 2016;13:E13. doi: 10.5888/pcd13.150357.

  10. Chen F, Su W, Becker SH, et al. Clinical and economic impact of a digital, remotely-delivered intensive behavioral counseling program on Medicare beneficiaries at risk for cardiovascular disease [published online October 5, 2016]. PLoS ONE. 2016;11(10):e0163627. doi: 10.1371/journal.pone.0163627.

  11. Castro Sweet CM, Chiguluri V, Gumpina R, et al. Outcomes of a digital health program with human coaching for diabetes risk reduction in a Medicare population [published online January 24, 2017]. J Aging Health. 2017. doi: 10.1177/0898264316688791.
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