Updated to include comments from David Kaplan.
Managing a chronic illness can feel like a full-time job. Between juggling multiple appointments with an array of specialists and following a meticulous care plan, patients dealing with conditions like diabetes have a lot on their plate.
Medtech titan Medtronic (NYSE:MDT) wants to help change that. The company’s CEO Omar Ishrak has placed his faith in value-based care as the future of healthcare. And the company points to its work with Diabeter, a chain of diabetes clinics in the Netherlands that it acquired in 2015, as evidence of its progress toward delivering more value for patients.
Sue Willman has been a part of Medtronic’s effort to boost patient outcomes and lower costs across the healthcare system. Over the course of her 25 years in medtech, she has learned that there are two key elements to promoting good health for a patient.
“You really need a good care plan, which usually comes from the provider, and you need adherence to that care plan,” Willman, who is VP of global integrated care solutions for Medtronic Diabetes, told Drug Delivery Business News. “A lot of my career had been focused on adherence to the care plan without any real closed-loop processes back to the clinician. So what intrigued me about the Diabeter clinic solution is leveraging all the patient engagement activities I was using, like remote monitoring and behavior coaching, but also getting that information back to the clinician so they could adjust the care plan.”
Diabetes is a data-driven disease. But the way that doctors care for patients with diabetes in the U.S. is still largely divorced from the array of technologies available on the market, like glucose monitors that can track historical trends.
“Today, care is very episodic. A patient goes in, sees the doctor, and that’s it. The doctor tells you what you’re supposed to do and then you come back 90 to 120 days later, and they ask you if you did what you were supposed to do — and there’s no evidence or insight.”
In Medtronic’s Diabeter clinics, diabetes specialists collect data from patients’ connected devices continuously between visits. They feed the data through an algorithm that creates a profile for each patient, giving the doctor a dashboard with which to organize their patients.
“That’s how they know, from a population perspective, which patients to pay attention to and how, whether it be a call or a text to say, ‘Hey, you need to come into the office. This isn’t something we can manage over the phone,'” Willman explained.
In most healthcare systems, patients with Type I diabetes are cared for by endocrinologists, and patients with Type II diabetes are seen by their primary care doctors. But at the Diabeter clinics, patients are treated by a multi-disciplinary team of specialists who focus specifically on diabetes and related conditions such as hypertension and stress.
And while patients in the U.S. have to coordinate scheduling appointments across multiple offices to see a psychologist or a nutritionist, Diabeter clinics have centralized those resources, so it’s all under one roof.
The clinics across the Netherlands serve more than 2,200 patients with Type I diabetes, but the company envisions later expanding its services to include people with Type II diabetes.
“Our vision for Type II is that you would add things related to screening for cardiovascular problems, you’d have podiatry, you’d have screening for neuropathy and more,” Willman said.
Medtronic’s Diabeter clinics have been in place in the Netherlands for 10 years, and since 2015, they’ve grown from two clinics to five locations. The company is in active discussions to bring the diabetes care model to other countries, and Willman noted that most partners are excited about the clinical results that the model brings for patients — but they worry about reimbursement.
“In most markets, you’re reimbursed for seeing the patients in the office. What they’ve developed in the Netherlands is a bundled payment for out-patient services to allow for them to manage the patients based on how they see fit and to support the cost of those in-between office visit contacts,” she said. “When we go to other countries, they’re all for the model. But the trick is, how do you take the model and ensure that you can cover your costs.”
When angling to bring the model to a new region, Willman and her team use the region’s data to show that while they may pay more money to manage each patient upfront, the healthcare system will ultimately save money thanks to decreased hospitalizations.
But David Kaplan, director of corporate ratings for S&P Global Ratings’ healthcare group, pointed out that focusing a health economics argument around preventative care doesn’t always pan out the way companies hope.
“While preventative care is good for health outcomes, the expansion of preventative coverage to a broad group often doesn’t fully offset the cost savings on a system-wide basis, so that becomes a net increase in cost,” he said.
Ultimately, Willman argues that the benefit to implementing this type of care model falls squarely on patients.
“We say that 90% of diabetes is managed by the patients. They go to the doctor, sure. But they have to make hundreds of decisions every day of what they’re going to eat, how it’s going to affect their schedule, etc. All that burden is placed on the patients,” she said. “This is a way to give them support with enabling technology between office visits, as well as a unique patient experience with 24/7 support so that they have that safety net while they’re outside of the office.”
Medtronic has proven itself more willing to embrace value-based care compared to some of its medical device peers, Kaplan added.
“Presumably because they view the shift as inevitable and they would rather be ahead of it,” he explained, “whereas the financial incentive in the near term would be to leave things status quo.”
The medtech giant’s interest in the Diabeter clinics is in-line with a trend emerging across the rest of the industry, Kaplan said.
“While these clinics are unique in terms of their focus on diabetes, there are many companies trying to coordinate the care of patients with chronic conditions, as it is widely recognized that the episodic nature of the healthcare system, especially in the U.S., is not adequately meeting patient needs,” he said.
