Glooko and Joslin Diabetes Center partner to develop new mobile/web-based technology and decision support system – January 21, 2014

This morning, Glooko and the Joslin Diabetes Center announced an exciting partnership to jointly develop and deploy a new web/mobile-based diabetes management platform. The system will combine an in-development “Virtual Joslin” service with Glooko’s existing universal MeterSync download cable/mobile app/web platform (compatible with 26 glucose meters and 27 mobile devices; both Apple iOS and Android). Notably, “Virtual Joslin” will allow care teams to remotely monitor, coach, and guide diabetes patients between in-clinic consultations. In addition, the system will use pattern recognition algorithms to predict when patients are at risk for severe hypoglycemia or other complications, thereby triggering provider interventions. Joslin and Glooko are actively developing the first module and a concept is expected at ADA 2014 in San Francisco. The current assumption is that the first module will not require a new FDA 510(k) clearance (it will not give direct advice to patients or need a prescription), though this is still under investigation by Glooko’s regulatory team.

The Glooko/Joslin program will be offered to Joslin clinicians and patients across their network, which includes 17 affiliates with 44 locations nationally (a network of ~250,000+ patients). This new system will also help Joslin achieve its goal of extending its world-class clinical expertise beyond its current network – indeed, Glooko and Joslin will jointly provide the new diabetes management system globally to health systems, governments, and payers. The plan is to charge these entities a per participating member per month fee. We’re encouraged to see a business model behind the new platform, which is typically a rarity in mHealth.  

The need for a population management/decision support system has been a strong desire of diabetologists for many years, especially given the 24/7 nature of diabetes, the low frequency of clinic visits (four times per year at best), the numerical burden of trying to cut through the data clutter (hard for even the most experienced providers!), and low reimbursement rates for analyzing diabetes data. We think this system has a lot of potential to: 1) change healthcare delivery in diabetes through a tighter patient-physician feedback loop; 2) turn raw data into useful information to promote therapeutic changes; and 3) to avoid very costly complications that arise from severe, but preventable, events (particularly hypoglycemia).

In our view, the critical unanswered questions relate to sustaining patient engagement over time (the system will rely on patients regularly uploading meter data), ease of use (if it’s not mindlessly easy, it’s unlikely it will be embraced), regulatory requirements, and the reimbursement framework surrounding the system. More thoughts below…

• Decision support in the first module of the Glooko/Joslin program will give final sign-off to the clinician. Suggestions around insulin/medication will likely come in the form of direct messages from the clinician rather than automated recommendations. We hope future systems would directly give patients advice, though that certainly comes with a much higher regulatory bar. In the interim, the modular, staged approach makes a lot of sense, particularly for a company as small as Glooko.
• For the system to work, patient engagement must be sustained over time – this is a core focus of Glooko’s product team. In the future, gamification and social integration will certainly play a factor. Nearer term, Glooko sees basic reminders and messaging as the first steps to consistent engagement, along with fitness/diet integration with other apps. Glooko plans to utilize a lot of the mHealth infrastructure to import crucial biometric data and engagement tools. However, the goal is an app environment that is diabetes-centric, as the engagement needs are so particular to diabetes.
• The Glooko/Joslin system continues a movement to re-envision the current model of diabetes care – quarterly clinic visits (at best) with little patient-provider interaction in between. Given the shortage of endocrinologists/CDEs and a reimbursement structure that is not designed for chronic disease management, the field is desperately in need of new tools and care delivery models. Enhancing connectivity and is certainly a key avenue in this vein. In the future, it may be that patients with diabetes come to clinic very infrequently (e.g., once per year), with more frequent email/phone contact in between. As our healthcare system shifts away from fee-for-service towards accountable care organizations and new payment models, Glooko/Joslin-like approaches seem increasingly logical.
• While industry has created amazing devices for patients, there is certainly a lot of room to improve on the software side. Just as IBM needed the MS-DOS operating system, we imagine better software and services will enhance the devices industry has built for patients. The efforts of Glooko, WellDoc, and Tidepool are very critical in this move to better software. At CES, Dr.Yan Chow (Director, Innovation and Advanced Technology, Kaiser Permanente) commented that “analytics” will be a key area for start-ups in the coming years – we certainly agree, particularly in diabetes.
• We are particularly excited about the impact the Glooko/Joslin and WellDoc BlueStar systems could have on severe hypoglycemia. In our view, severe hypoglycemia is a major unmet need in type 1 diabetes where better monitoring could dramatically help the healthcare system. A compelling oral presentation (279-OR) at ADA 2013 showed that hypoglycemia in type 1 diabetes in the US was associated with 20,839 hospitalizations and 284 deaths in 2009, with a total cost of about $1 billion (average cost per hospitalization was $46,039).
• Glooko and Joslin have not conducted any pilot studies of the system; however, the clinical expertise of Joslin should prove invaluable in this sense, particularly on the clinical workflow side. Everyone agrees that healthcare delivery must change, though new solutions will absolutely need to be designed with the clinician in mind. Technology can be a game changer, but it must be deployed with the appropriate training, should save providers time, engage patients, improve outcomes, and ideally save costs (or at minimum, be cost neutral). The Glooko/Joslin system certainly has the potential to do all of the above, though only time will tell if does.
• The universal nature of Glooko’s system has expanded over time, and we hope future generations might add compatibility with CGMs and activity monitors. Glooko’s system (MeterSync cable/mobile apps/web platform) is compatible with an impressive 26 glucose meters and 27 mobile devices (both Apple iOS and Android devices). Glooko also has a data downloading partnership with Asante’s Snap insulin pump – this is now behind schedule, as a release was expected in 4Q13. Glooko has expressed its commitment to expanding across more and more diabetes devices, and according to the company, insulin pumps and activity monitors are “on the horizon.”
• We look forward to seeing how the Glooko/Joslin system compares to WellDoc’s BlueStar. Certainly, one key difference is the audience – WellDoc’s BlueStar system directly gives patients advice, while the Glooko/Joslin system will require clinician sign-off in the first iteration. Another difference is that the Glooko/Joslin system would include people with type 1 diabetes, while BlueStar is currently only approved for people with type 2 diabetes (though we imagine WellDoc is working on type 1 diabetes as well). The Glooko/Joslin system also uses a pretty seamless way to upload meter data (via Glooko’s MeterSync cable), though we understand WellDoc’s long-term goal is to build device connectivity into BlueStar.
  
  • As a reminder, WellDoc closed $20 million in Series A financing on January 10 led by Merck’s Global Health Innovation Fund. The investment will fund a dedicated sales force to regionally rollout BlueStar, WellDoc's FDA- approved mobile prescription therapy for type 2 diabetes. This is great news for patients and for the diabetes community, who should now get much faster access.
• On January 14, Glooko announced that it raised $7 million in a Series A-1 round from several new investors. Newcomers included Samsung Venture Investment Company (SVIC) and Lifeforce Ventures. Other existing investors, including The Social + Capital Partnership, and entrepreneurs Sundeep Madra (of Pivotal), and Yogen Dalal (of the Mayfield Fund), also took part in the fundraising round. Glooko will focus these funds on bringing patient data and decision-making algorithms to health providers and payer groups – that has consistently been identified as a major need and was a clear theme at CES 2014. The investment from SVIC is particularly significant since the company is a leader in the mobile market, providing additional credibility to Glooko’s universal data downloading platform (compatible with an impressive 26 glucose meters and 27 mobile devices; both Apple iOS and Android). Glooko’s recently launched Android app has already received an update, as statistics are now available – great to see iteration already, a testament to how mHealth can really move at a fast clip.
• For more on Glooko, please see our coverage of the Android app launch in October and our trip to the company’s booth in the AADE Exhibit Hall.

Close Concerns Questions

Q: How will the Glooko/Joslin system compare to WellDoc’s BlueStar?

Q: How will the Glooko/Joslin platform be rolled out to other care teams and payers?

Q: How will HCPs be reimbursed for using the Glooko/Joslin system?

Q: How will Glooko and Joslin measure success? What are the key project milestones?

--by Adam Brown and Kelly Close