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Evidence-Based Diabetes Management
WellDoc's BlueStar Seeks to Empower Patients With Type 2 Diabetes Through Real-Time Coaching, Provider Feedback
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A multi-layered partnership with the American Association of Diabetes Educators is just one of the strategic steps in the past year for WellDoc, which offers a suite of digital diabetes products, including one with an insulin bolus calculator.
It's one thing to give people with type 2 diabetes (T2D) information on their blood glucose trends and send them on their way. It’s quite another to give them access to real-time coaching and let them share their data by pressing a button, possibly heading off an episode of hypoglycemia.
This more intense level of support is the idea behind WellDoc’s BlueStar digital diabetes products, which look like apps on a smartphone but have FDA clearance to do much more.1 BlueStar is on the comprehensive end of an array of solutions in diabetes self-care, which address what clinicians say is their biggest challenge: what happens between visits.
Harnessing technology to give patients advice in the moment, to record what they eat in real time, or to automatically take their blood sugar may do more than remove the guesswork for physicians. There’s hope that if technology usage becomes the norm in diabetes care, patients will finally connect the dots between specific foods and behaviors and the effects on their health. Today, BlueStar offers 3 products: the flagship product that connects patients with T2D with coaches and caregivers, a prescription-only product that features an insulin bolus calculator, and a consumer-focused lifestyle app, available through Samsung Health.1
Over the past year, WellDoc has made a series of moves to reach a wider audience and bolster key partnerships, most notably with the American Association of Diabetes Educators (AADE).2 The biggest change came in January, when the FDA allowed WellDoc to offer the mainstay BlueStar app without a prescription, which opened the door to reach patients directly through health plans and wellness programs.3
These changes position the company to not only deliver better care, but also to help physicians make strides toward population health as they face new requirements under the Medicare Access and CHIP Reauthorization Act (MACRA). Since September 2016, WellDoc has also:
• Finalized a commercial partnership with LifeScan, a Johnson & Johnson company, that allowed BlueStar to integrate its digital platform with LifeScan’s OneTouch VerioFlex glucose monitoring system and the OneTouch Reveal digital system.4
• Announced a far-ranging partnership with AADE that puts the professional association’s curriculum on the app.2 WellDoc unveiled a second piece of the partnership at AADE’s annual meeting in August, when it launched its Diabetes Digital Health Learning Network to share best practices for gathering patient health data to improve population health.5
In a wide-ranging interview with Evidence-Based Diabetes Management™, WellDoc vice president of clinical advocacy, Malinda Peeples, RN, MS, CDE, FAADE, a past president of AADE, described the evolution of the WellDoc platform as an “interventional solution,” compared with the “trackers” that some patients with T2D use.
Although BlueStar “looks and acts like an app,” Peeples said, “We have real-time feedback messaging based on when people enter data. Then we have trending messages that are looking at patterns and are engaging patients in self-management and problem-solving around those patterns. We’re also providing weekly summaries.”
Patients can examine their diet, activity, and sleep to change behavior or reach out to their doctor if they need help. There’s also a 12-week self-management curriculum and a resource library within the app, she said.
Janice MacLeod, MA, RDN, LDN, CDE, director of clinical innovation for WellDoc, said the individualization of the feedback is key. “The individualization is not just in the messaging. As BlueStar is learning and growing with the patient, it’s also individualizing the prompts and reminders of what to track and when. And then the [care] team gets the information it needs.”
WellDoc has learned plenty about how patients with diabetes respond to mobile technology compared with other forms of learning, Peeples said. “For us, the exciting part of the mobile platform is that it has forced us to be smart about that. How do you display a nugget of content on a screen that someone can read in 30 seconds?”
Working With Payers
Although technology holds great promise in diabetes care, WellDoc and other digital providers are new players in the reimbursement arena. Payers have years of experience evaluating drugs or devices, like insulin pumps or stents, but what is the best way to evaluate an app? BlueStar regularly presents evidence at the American Diabetes Association and other professional meetings, showing proof of patient engagement,6 or results from a pilot study with a patient-centered medical home (PCMH).7
For Peeples, BlueStar’s value isn’t just in what it can do for patients on an individual basis, but also in what it can do to help health systems gather information to improve population health. “We can provide summary data for all your BlueStar users,” Peeples said. Claims data won’t offer insight into what happens before patients end up in the hospital or the emergency department, but this type of data will, she said.
WellDoc’s work with payers includes the PCMH demonstration with Horizon Blue Cross Blue Shield New Jersey, which found that if practices can get patients to start using BlueStar, most will stick with it and see results. Of the 89 patients with T2D who were offered the opportunity to receive telephone coaching and use the BlueStar technology, 43 accepted. Of these, 86% both used the app and filed a report, known as a SMART report, with their doctor. Patients logged an average of 6.5 entries per week. For those active with health coaching (70%), the combination reduced glycated hemoglobin by 1.7%, from a baseline of 9.7%.7
Helping the Primary Care Physician
According to Peeples, the headwinds of MACRA have physicians looking for ways to help patients do 2 things: better manage their diabetes between visits and understand their disease so they can better engage their care team.
Peeples described a meeting with a primary care practice in search of a solution to “train” its patients with diabetes so that it could take some of the burden off the practice. “The practice needs to deliver the outcomes,” she said. The historic, paternalistic thinking in medicine is giving way to the realization that getting patients to take charge is in everyone’s interest. “We are underestimating the power of the individual patient,” she said.
References
1. BlueStar suite of products. WellDoc.com website. welldoc.com/product/bluestar. Accessed September 4, 2017.
2. WellDoc, American Association of Diabetes Educators (AADE) partner to incorporate AADE diabetes self-management education curriculum into the BlueStar digital therapeutic platform [press release]. Columbia, MD: WellDoc; January 4, 2017. welldoc.com/images/uploads/WellDoc_AADE_PressRelease_FINAL.pdf. Accessed September 4, 2017.
3. WellDoc receives FDA 510(k) clearance to offer a non-prescription version of BlueStar digital therapeutic for type 2 diabetes [press release]. Columbia, MD: WellDoc; January 19, 2017. welldoc.com/images/uploads/WellDoc_510K_Clearance_1.19.17.pdf. Accessed September 4, 2017.
4. WellDoc announces agreement with LifeScan Inc, a Johnson & Johnson Diabetes Care Company, to finalize commercial partnership to deliver combined, best-in-class digital therapeutic solution for patients with type 2 diabetes [press release]. Columbia, MD: GlobeNewswire; September 13, 2016. globenewswire.com/news-release/2016/09/13/871461/0/en/WellDoc-Announces-Agreement- with-LifeScan-Inc-a-Johnson-Johnson-Diabetes-Care-Company-to-Finalize-Commercial-Partnership-to-Deliver-Combined-Best-in-Class-Digital-Therapeutic-Solut.html. Accessed September 5, 2017.
5.Caffrey M. WellDoc, AADE launch diabetes digital health learning network. The American Journal of Managed Care® website. ajmc.com/newsroom/welldoc-aade-launch-diabetes-digital-health-learning-network. Published August 4, 2017. Accessed September 4, 2017.
6. Peeples M, MacLeod J, Taylor S, Shomali M. Population health diabetes education: the role of digital health and patient-centered health data. Presented at: the 77th Scientific Sessions of the American Diabetes Association; June 9-13, 2017; San Diego, CA. Abstract 1341-P. https://ada.scientificposters.com/epsAbstractADA.cfm?id=1
7. Tang PY, Peeples M, Duni J, Peskin S, MacLeod J, Kowiit S, Fisher ES. E-health assisted lay health coaching for self-management support. Presented at: the 76th Scientific Sessions of the American Diabetes Association; June 10-14, 2016; New Orleans, LA. Abstract 725-P. ada.scientificposters.com/index. cfm?k=56tfw2286n.
