I was thinking about all of the various research that we’ve supported over the years and also how we’ve talked about many different ways to use it. Sometimes I talk to people that get excited about physicians finally getting access to patient data in the field but I know that is a minority view. Sometimes the focus has been on status notifications to remote caregivers which is simply a near real-time copy of patient data sent to somebody who cares. In more recent times there has been a lot of discussion about social networks and keeping in touch with your online community but this is usually based on ‘data’ that you would type in yourself be that on a website or on your phone. In 2004 I wrote a paper titled “The Real-Time Virtual Loop” which described a roadmap of services once devices were connected into a virtual ecosystem for patient-centric health care.

What prompted me to start thinking about this was the lightning fast process of designing and implementing the first game of Mystery BGee which ended January 31st. As I said back in that paper, profound impact can be directed at patients as well as supporters once you have data in the centralized system. Because data collection is simple, frequent and reliable it’s a catalyst for what you might want to do with it. If it was hard to get at a game like Mystery BGee would be impossible or you would only get one winner - that one person who is willing to do whatever it takes to get their data from point A to point B.

The promise of connectivity is really more about implementing hunches at the speed of thought. After all, this is behavioral change we’re talking about so it’s more like pushing a wet noodle than ordering up a blood draw and a lab test. Our hunch was that we could reward a specific behavior:

- check blood sugar often and make sure we have your data (this part is easy because they are already doing it and it only takes a few seconds of their time anyway)

And that would result in two things:

- more people would perform the behavior
- people would receive positive reinforcement for the act of performing that behavior

In addition, because of the specific rules of the version we ran in the January edition of the game, people would know that in order to increase their odds of winning that they should check blood sugar more frequently than normal and they should use their GlucoMON daily. The GlucoMON usage frequency is an interesting one since most people only use it once a week for pattern management and education. The daily users are those people, usually kids at school, who need to use it for keeping mom apprised of the situation.

The other element to consider here is where the number crunching or feedback happens. For example, if you develop the world’s most sophisticated handheld device or turn a cell phone into a bg checker, you still might not get timely access to the data at the centralized management center where analysis across a community or population takes place.

Here’s the point of this post. While the example might be a diabetes game called Mystery BGee, the important thing this illustrates is that health care innovation can now go from a hunch to being live in a community of patients in less than an hour. Without a connected community already in place and easy to use technology at the patient’s fingertips, you can forget about these kinds of advances or micro tests. You also get to find out if your hunches are a hit or a flop within a few hours or days - adjust them and see what happens - repeat. Compare that to the typical clinical trial that takes months to plan, lots of money to finance and years before anyone ever gets to read about it.

So when we talk about connectivity in health care and all that goes with it, we need to make sure that the freedom to innovate is protected. We also need to make sure that the innovators have access to these platforms and communities and that’s why Diabetech has always had an open model - it’s available to anyone. So not just connectivity because we can, Connectivity because it will help us realize major advancements in self-care that have been promised for so long in the field of chronic disease management yet seldom delivered.

Once again, Diabetech® technology is at the forefront of innovation when it comes to engaging people in their own diabetes care.

Mystery BGee™ participation is easy.

So easy in fact that you don’t have to do anything to win. Just check your blood sugars as normal and connect regularly with your GlucoMON®- ADMS™. GlucoDYNAMIX™-ADMS does the rest. Each day, the system picks a random blood sugar number. Then it looks at the active patient profiles and stored patient health records including blood sugar results. The mygluco community member with the blood sugar result on that day that matches the Mystery BGee number or is the closest one to it Wins.

For more on Mystery BGee go here.

Walmart, Macy's, Best Buy Gift Cards - we call it GlucoCASH

So what’s a Differential Premium?

First of all, I was introduced to the combination of these two words by a health insurance executive during an employer focused health benefits conference back in 2005. Essentially, if you don’t take the actions prescribed for your own care or engage in acts that put you at high risk (ie - smoking) you should pay a higher health plan premium than your counterpart who is taking care and avoiding high risk behavior.

I also happen to remember that old life insurance check list asking me to confirm whether or not I’m an avid skydiver. Of course my premium would be higher. So the fact is that differential premiums have been around for a long time. Only now they are making their way into Health insurance.

Done right I agree with this concept. If you’re the person that goes the extra mile to take care of yourself while the guy in the office next to you always makes the unhealthy choice, why should you both pay the same premium?

However, it all comes down to the accuracy of some process that verifies your promise to be ‘compliant’ and/or that you can prove that you are not engaged in those high risk behaviors… like skipping your meds. How do you prove that you don’t smoke? How are those who decide how much your monthly premium is going to be actually verifying their information?

In a recent post by Amy over at diabetesmine I learned about a new health plan option for some of United HealthCare’s large employer clients (like AT&T for example).

The data from our randomized, controlled clinical trial for AT&T from 2006 - 2007 demonstrated that everyone wins when it’s easy. The difference is in how we go about rewarding for those desired behaviors that lead to lower costs and more productive employees.

If you’re an employee or dependent of one of these large companies, you will probably be very interested to read how Diabetech’s technology makes proving your participation easy while at the same time puts money in your pocket. In the video from United, I’m concerned that their ‘tracking site’ might be a major pita (email me if you want to know what the ‘a’ in pita stands for but here’s a hint: p=pain, i=in, t=the) and that it may be missing the mark when it comes to how their system looks at your data.

We implemented our diabetes programs based on input from large employers, physicians and actual employees with first hand knowledge of what it’s like to get that phone call from the health plan nurse. We decided that eliminating unwanted phone calls from the health plan would be a big win (picture a dark room and a swinging lamp over your head while sitting on the world’s most uncomfortable chair) as long as we can still get insight via trusted data from the patient. Since then a growing number of health plans are also appreciating the fact that our system can help them eliminate unnecessary calls and reduce the time spent on those times when they do call. We also placed the emphasis on easy to digest education by automatically delivering timely, relevant profile-based diabetes education as well as optional reminders. Your data in our programs also supports the determination of who qualifies for GlucoCASH (gift cards from the likes of Walmart, Macy’s, Best Buy, etc…) and for how much $$$. All the while making every day diabetes care easier vs. those employees who don’t have access to our programs. The proof behind these claims including significant reductions in A1c and high participant satisfaction is well documented on our clinical trial experience pages here.

Perhaps one of the biggest reasons for having a program like this from an independent third party like Diabetech vs. your health plan is to maintain privacy and independence from your employer. After all, HIPAA was supposed to be all about making your health benefits Portable thus allowing employees a certain degree of independence from their employers.

So to all those people who have the option to enroll in these new diabetes specific health plans, make sure you tell your employer that you want access to Diabetech’s programs which are now being covered by a growing number of health plans some of which have integrated our program with their own. Our programs are also eligible for coverage through Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).

Ultimately, a combination of reduced out of pocket expenses and just in time behavior triggered rewards helps to ensure that everyone concerned wins. The key to all of this is making sure that the program content is accurate, relevant and useful and most of all - easy for the patient!