Glytec, Voluntis, and Telcare to integrate with Onduo virtual diabetes clinic for pilots in T2D starting in early 2018 – November 30, 2017

Over the past three days, Telcare (BioTelemetry), Voluntis, and Glytec have announced plans to integrate into Onduo’s “virtual diabetes clinic” in type 2 diabetes pilots with “US providers and payers” beginning in early 2018. This will include

• Glytec’s FDA-cleared Glucommander Outpatient insulin dose titration platform (provider-facing decision support for basal, basal-bolus, and basal combinations);
• Voluntis’s FDA-cleared basal insulin dose titration app, Insulia (patient-facing); and
• Telcare’s cellular-enabled BGM (now owned by BioTelemetry).

There are no specifics to report on what payers will be included, the pilot size or outcomes, or reimbursement model. It’s possible that Onduo’s recently announced type 2 diabetes pilot with Blue Cross Blue Shield (BCBS) – slated to begin in 1Q18 in Arkansas, Georgia, and South Carolina – will be included in the list of participating programs. In the BCBS pilot (and presumably others), connected CGM (we expect Dexcom), apps, lifestyle, medication review, and Onduo medical experts will also be included in a package, and tracked outcomes will include clinical improvement, cost, and member experience.

Integration with these three companies products reflects Onduo’s mission to advance diabetes care through personal solutions, increased patient support, and improved convenience, partially by curating and tying together available offerings.  It’s a promising strategy, as the combined weight of Sanofi+Verily can get the attention of major payers, drive seamless integration, and deploy major investment to bring connected programs to scale in type 2.

We’re also glad to see Onduo pursuing a technology agnostic approach: both Glytec and Voluntis offer insulin titration software. Glucommander (Glytec) is positioned as provider-facing insulin dose decision support, while Insulia (Voluntis) is positioned as a patient-facing basal-only titration app. We wonder how Onduo will deploy and integrate the different software approaches…or is it the provider’s or payer’s preference? Onduo is also clearly committed to connected glucose monitoring in both BGM (Telcare in this case) and CGM (we believe Dexcom) formats. We wonder if Livongo will be added as another cellular-enabled BGM, as it is also a Voluntis partner. Presumably Onduo will decide how to deploy all the different glucose monitoring technologies, depending on a patients’ needs.

Following the BCBS announcement earlier this month, this is the second major update since Onduo was announced last September. Onduo’s vision resembles aspects of what Virta Health, One Drop, mySugr, and Livongo are trying to do – but potentially at bigger scale and with use of CGM/BGM, more medication optimization, and integration with payers/systems/HCPs. We like the multidisciplinary, all-in-one vision and look forward to hearing more specifics.

• Glytec and Voluntis have also established partnerships with other BGM companies, including Livongo, Ascensia, and AgaMatrix. Though the need for automated dose titration is obvious, we’ve sensed that the go-to-market/reimbursement approach for software has been a stumbling block. Can Onduo help these products get to scale and sold into major payers and health systems?
• Onduo has not yet announced a connected pen/pump to capture insulin dosing. Will this be added? We wonder if such a partnership is in the works, especially with Common Sensing – Sanofi has invested in the Cambridge-based company. We’d guess Common Sensing (or Companion Medical) would jump at the opportunity to be included in these pilots. It’s possible Onduo does not believe dose capture is required to titrate insulin in type 2. This arguably remains an open question in the field – can you titrate insulin effectively based on glucose data alone, or will significantly better outcomes come from passively-collected doses? All of the FDA-cleared basal-only titration apps (Amalgam Rx, My Dose Coach, Insulia) use manually-entered glucose data and manually confirmed insulin dose history – no insulin dose capture devices are part of these systems, to our knowledge.
• As a reminder, this is the second pilot announced in the past two months involving Sanofi, a payer, and disparate diabetes management components. In September, Sanofi and Innovation Health (Aetna + Inova Health System) announced a pilot in type 2 diabetes, which is already underway, leveraging (i) One Drop’s mobile app, coaching/education, and Bluetooth-enabled BGM; and (ii) Common Sensing’s Gocap for dose capture from insulin pens. How will the outcomes from these pilots differ? How is Sanofi deciding what goes into Onduo vs. its own efforts? We imagine the Onduo work will have a higher degree of personalization/integration/service offerings, but aren’t sure.  How will payers choose between the different offerings?
• Glytec’s and Voluntis’s CEOs emphasized the potential of what Glytec’s Mr. Bob Leonard referred to as the “best-of-breed matrix approach – synthesizing the most essential and innovative technologies and services” in their respective press releases.
  
  • Said Glytec’s Mr. Bob Leonard: “We firmly believe that this type of best-of-breed matrix approach – synthesizing the most essential and innovative technologies and services – will emerge as the most potent way to drive improvements in the quality, safety and cost of care for people living with diabetes.”
  • Said Voluntis’s Mr. Pierre Leurent: “This agreement with Onduo illustrates how digital therapeutics, life sciences and tech companies can form alliances to address some of healthcare’s major unmet needs.”
• Who else will compete with Onduo to combine connected glucose monitoring, insulin delivery, supporting software/apps, and coaching/healthcare experts? Perhaps the only company with all of these components in-house is Medtronic Diabetes, though it has not made a lot of external progress on its vision to become a “holistic diabetes management company.” Given its internal struggles to manufacture sensors at scale, to roll out the MiniMed 670G in the US, and to improve its professional CGM beyond iPro2, we believe it will take some time before Medtronic is truly ready. We’ll be interested to see if it ultimately competes with Onduo!

Close Concerns’ Questions

Q: What payers/providers will be included in these pilots? Is there any difference between these three pilots and the BCBS pilot? What are the outcomes and time horizon?

Q: How will Onduo deploy the different components in its “virtual diabetes clinic”? Who will get CGM vs. BGM?

Q: How will Onduo’s “virtual diabetes clinic” run on a daily, weekly, and monthly basis? How many touchpoints will patients have with healthcare providers? How will the Onduo care team work with patients’ existing HCPs, if at all?

Q: What is the payment and reimbursement model?

-- by Maeve Serino, Brian Levine, Adam Brown, and Kelly Close