How digital health apps are leading the fight against diabetes July 15, 2019

Chronic conditions like diabetes require constant monitoring between regularly scheduled doctor visits. Livongo, the first digital health company to go public after a years-long drought, is hoping to prove that technology can help better manage costly chronic illnesses.

The platform analyzes data to build a picture of a person’s patterns, while dietitians and physiologists give them real-time advice about diet, medication, and exercise by apps or text message. If a patient’s blood sugar is dangerously low or high, a coach will call to warn them within 60 seconds.

Livongo began its life as a diabetes monitoring company, but it has since expanded into hypertension, weight loss, and mental health. It has set its IPO price range between $20 and $23 per share and, if the underwriters exercise their overallotment option, the IPO could raise up to $283 million.

In terms of diabetes, the typical patient sees a provider maybe every three months. Disease management platforms like Livongo, Omada Health, and Onduo, are transforming that model by making it more automated, personalized, real-time, passive, and engaging.

Most digital health platforms for chronic diseases work similarly: they combine a connected device or app with remote support. However, there are key differences that could affect their effectiveness. Onduo, for example, is alone in having a network of doctors who can prescribe monitoring devices and medicines, as well as recommending lifestyle changes.

“If you only do lifestyle, then you are going to a gunfight with a knife,” said Onduo CEO Josh Riff. “Our patients need more than just a glucose meter and a step monitor.”

The biggest challenge for digital health startups is finding someone to pay for them. Health insurers are the hardest to convince to pay, either because they are skeptical about digital health’s benefits or because they see the startups as competition.

Bill Evans, managing director of Rock Health, said the “purists and scientists” were not pleased that they could not compare the platforms. But doing a pharmaceutical-style clinical trial is expensive and not necessarily easy to accomplish.

“Do you need a double-blinded, randomized, placebo-controlled drug trial for every single digital health innovation under the sun? The answer is almost certainly no. So what do you need?” Evans asked.

Patients are often recommended these platforms by their employers, not their doctors, so there is the potential to cut out the traditional care providers.

“The concern here is that it’s creating a parallel universe somewhat analogous to the sort of retail clinics setting up around CVS and Walmart,” said Dr. Robert Gabbay, chief medical officer at the Joslin Diabetes Center at Harvard. “I don’t think anyone thinks the world needs more fragmentation of health care.”

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