Scaling behavioral change and reducing diabetes at the population level were major themes of the meeting.
At the d17, the Executive Innovation Lab on Diabetes and Prediabetes presented by the diaTribe Foundation, a unique gathering of professionals in diabetes care and beyond—from the realms of advocacy, research, public policy, technology, design, the pharmaceutical industry, and even Hollywood—fostered an atmosphere of creativity and collaboration to think about this big problem in new ways. The group met September 27-28, 2017, and The American Journal of Managed Care® (AJMC®)had the opportunity to take part.
Two major themes of d17 were addressing diabetes and prediabetes at the population level and scaling behavioral change—featuring insights from Stanford behavior scientist B.J. Fogg, PhD. AJMC® caught up with Kelly Close, founder of the diaTribe Foundation and founder and president of Close Concerns, to share some takeaways from this one-of-a-kind event:
1. Next steps for reducing diabetes at the population level
Coming out of d17, “We’d love for type 2 diabetes and prediabetes to be a national conversation,” Close said. Doing this will require addressing barriers related to behavior change, stigma, social norms, public attention, and systems—and especially reimbursement. “We’d love to prompt far more attention on prevention, both of type 2 diabetes as well as prediabetes,” Close said.
2. Making behavioral change scalable
“We’re very focused on reducing friction in the system and making things magnitudes easier for patients,” Close said. Behavioral change means knowing where you are so you can figure out where you want to go, Close said, and much of this means making reimbursement work: things like smoothing out Medicare coverage for continuous glucose monitoring (CGM) and getting coverage for new devices that offer calibration, fingerstick-free CGM are important.
“A third example is getting therapies to people seamlessly, particularly those that are cardioprotective, renal protective, don’t prompt hypoglycemia, and do prompt weight loss,” Close said. She also pointed to getting better education for medical, nursing, and pharmacy students, as well as current professionals, rethinking the way we teach nutrition to children, and understanding what studies are needed, “so we can dispense with arguing about missing data.”
3. In the short term …
“We are thinking about leadership, particularly in light of Harvard historian Nancy Koehn’s new book, Forged in Crisis: The Power of Courageous Leadership in Turbulent Times, Close said. Participants at d17 received copies of the book, which had an official release date of October 3, 2017. “We all need to think about our contributions to greater leadership and to what we should all be doing less of as well—and where systems should be doing less, and where they should be doing more,” Close said. “A far greater focus on behavior is on the list, and we’ve just distilled all of speaker Stanford’s BJ Fogg’s learnings for the group. Stay tuned!”
4. Benefits of the diverse group of stakeholders
Close said that bringing professionals “who do not look or sound like each other,” and came from different backgrounds and age groups helped break down hierarchy, which she found “thankfully absent.” This dynamic was essential for the working group format of the meeting, which asked participants shut off cell phones and computers and brainstorm on solutions—pushing the envelope was encouraged.
“No one even realized there was no hierarchy until the last day of the gathering, when someone mentioned it, in awe,” Close said. “That was pretty great.”
5. Who would Close like to see next year?
One missing ingredient: payers, but not for lack of trying. A major payer representative was a no-show. The tech world was represented, but Close wonders if there should be even more next year.
“We should think about systems delivery—whether or not that’s an area of deep focus or whether we should focus on other groups, because that one is so complicated!” Close said. For next year, she would like to hear progress reports on how different stakeholders have worked with each other, and with the diaTribe Foundation. “We’d love to see more large foundations,” she said.