2019-06-04 Learnings and key success factors digital medical devices Milena Saleh

#DIGITAL #DEVICES #SUCCESS #LEARNINGS:
LEARNINGS AND KEY SUCCESS FACTORS
FOR THE ADOPTION AND CONTINUOUS USE
OF DIGITAL MEDICAL DEVICES
Milena Saleh, Director Digital Health, Sanofi Primary Care
June 4th, 2019, Digital Pharma Europe, Rome
MilenaSaleh2019©Allrightsreserved

DISCLOSURES
 This presentation is based on publicly available data from Sanofi and Onduo
 All clinical data is published
 I am an employee of Sanofi, and am not affiliated with Onduo
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#Digital #Devices #Success #Learnings: Digital Medical Devices –
Milena Saleh, June 4th, 2019 Digital Pharma Europe
Milena Saleh 2019 © All rights reserved

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Disruption vs.
Transformation

QUESTIONS I WILL ADDRESS TODAY
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Diabetes in the era of technology-enabled care
Overview of two digital diabetes programs
Learnings and key success factors
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1 IN 10 ADULTS HAS DIABETES; A SIGNIFICANT INCREASE IS
EXPECTED, ESPECIALLY IN LOW-/MIDDLE-INCOME REGIONS
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Source: IDF Diabetes Atlas, 8th Edition
Global prevalence of diabetes
among adults has risen / is rising
significantly
Nr people with diabetes (m)
Low/middle income regions show
the higher growth rates
Growth in number of patients 2017-
2045 (%)
425
151
2017
629
20452000
+3%
WP
35
1516
48
62
84
110
156
NACMENA SACA EURAFR SEA Avg
High incidence of diabetes
in global population
Nr people with diabetes (%)
90%
10%
Without diabetes
With diabetes
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LESS THAN 1 IN 10 PEOPLE WITH DIABETES ACHIEVE
SATISFACTORY CLINICAL OUTCOMES (“RULE OF THE HALVES”)
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https://www.novonordisk.com/content/dam/cities-changing-diabetes/Toolbox/RULE%20OF%20HALVES_INTRO%20MANUAL_200920171.pdf
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DIABETES MANAGEMENT IS COMPLEX AND REQUIRES
CONTINUOUS MOTIVATION & SUPPORT
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AADE.org.
Healthy eating
Being active
Taking medication
Healthy coping
Problem-solving
Reducing risks
Monitoring
?
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+ +
+ +
+ +
+

EFFECTIVE DIABETES MANAGEMENT REQUIRES A NEW CARE MODEL
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Visit
to doctor
Self-care
(BG-monitoring, medication, food, etc)
Visit
to doctor
Visit
to doctor
Virtual/F2F
Visit to Visit to Visit to Visit
to doctor
Virtual/F2F
Supported self-care + ongoing Rx modification
Intervention / coach
+ feedback loop
+ feedback loop
+ feedback loop
Traditional
Technology
-enabled
Care model How it looks like
Contacts with
doctor / care team
1 in 3
months
Weekly or
more
FUTU
Smart devices & apps
• Real-time BG & insulin
data
• Enable Rx modi-
fication remotely
Data analytics & algorithms
• Identify which patient require
high-intensity follow-up
Social networking
• In-between visits,
patients (educators)
coach each other
Educational Content
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THE TECHNOLOGY ENABLED PATIENT ACTION MODEL SUPPORTS DESIGN
AND IMPLEMENTATION OF EFFECTIVE DISEASE MANAGEMENT PROGRAMS
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Adapted from: Developing a Technology Enabled Model to Support Medication Taking Behaviors, Poster at the DTS 2018, Greenwood et al.
Initiation Toolkit:
Assessment
Clinical Inertia
Toolkit
Self-care Toolkit
“…Toolkits, designed to support
healthcare provider’s actions and
patient behavior changes, during
three phases of medication taking
behaviors (initiation, implementation,
persistence) are driven by the TES
engine. The proposed outcomes are
increased engagement, improved
experience and empowerment….”
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MY DOSE COACH OVERVIEW
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1
2
Sanofi internal

MY DOSE COACH WORKFLOW
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HCPs: prescribe
and send a custom
dose plan to their
patients
Patients: record daily
fasting blood glucose in
the MDC app to start
getting insulin dose
recommendations.
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2
Sanofi internal

MY DOSE COACH APP
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2
Enter blood glucose Get dose reco Confirm dose taken Review progress
Sanofi internal

KEY RESULTS INDIA PILOT
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 Conducted in Apollo Sugar Clinics, in 2017
 137 patients, 12-weeks; HCP prescribed dose plan, patient used app to adjust dose
APP-based Approach to Basal Insulin Titration: Initial Results of the MyDoseCoach Pilot in India, Poster at the IDF 2018, Shah et al.
“Conclusions:
…This current 12-week pilot project
conducted in India, demonstrates
that the MDC app-aided titration of
basal insulin is an effective, safe,
and user-friendly technology-
enabled option for optimizing basal
insulin dose in patients with T2D…”
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OVERVIEW ONDUO VIRTUAL DIABETES CLINIC
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Onduo is a virtual diabetes clinic designed to bring the best, most up-to-date care to
people with diabetes – anytime, anywhere. Onduo is a joint venture of Sanofi and Verily
Onduo.com, accessed May 2019
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WORKFLOW ONDUO
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Patient
signs up,
gets
Welcome
Kit
Patient is
paired with
Coach
(app, text,
phone)
Patient logs
meals, BG,
medication
Patient gets
targeted
advice to
improve
self-care
Coach may
loop in
patient’s
HCP for Rx
change
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Adapted from Onduo.com, accessed May 2019

ONDUO APP
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1
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Onduo.com, accessed May 2019

KEY RESULTS US PILOTS
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 Data from 2018
 769 patients, enrolled in early pilots; patients logged meals, BG, meds and exchanged
messages with coach
“Conclusions (Close Concerns):
… the need for high-touch,
technology-driven care in diabetes,
specifically as a means of making
care more continuous (rather than
episodic), scaling experts, and
assisting the over-burdened PCPs
who deliver ~80% of outpatient
diabetes care.”
Glytec and Onduo Webinar, Virtual Diabetes Care: Unlocking the Keys to Real Results, May 2019, https://www.himsslearn.org/virtual-diabetes-care-unlocking-keys-real-results
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INSIGHTS PATIENTS
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 Eligible patient vs. activated patient
 Simplicity & ease of use
 High satisfaction
 Demonstrated clinical effectiveness
 Improved disease perception & engagement
 Patient support for repeated use
 Long term use is challenging
 Data analytics for continuous engagement
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INSIGHTS HCPS
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 High interest vs. product adoption
 Customer prioritization: early adopters, advocacy
 Fit to/improvement of current workflow
 Time constraints: easy to learn & easy to teach
 Multi-point HCP engagement & support
 Help HCP identify best patient profiles
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INSIGHTS PAYERS
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 High interest for innovation
 Limited / non-existing reimbursement
 Long lead time for reimbursement
 Payer “co-design” solution & metrics
 Reimbursement does not drive adoption
 Clinical data vs. real-life tool validation
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IMPLICATIONS: WHAT
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 Prioritize: HCP vs. DTC-driven
 Digital is a product in its own right
 Pilot vs. full-scale launch: resources
 Regulatory framework: co-promotion possible?
 Doctor-patient relationship transformation
 You are NOT alone – ecosystem fit
 AI & algorithms at the core
 Product scale-up: design and resources
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IMPLICATIONS: HOW
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 Execution: pharma or partner?
 Overall resource investment vs. engagement rate by channel
(HCP/DTC)
 Alternative activation channels?
 HCP usage model and frequency
 Sales force vs. dedicated experts, Training via MCE
 Customer-service mindset & capabilities
 Continuous patient enrollment improvement
 No IMS: new metrics
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2019-06-04 Learnings and key success factors digital medical devices Milena Saleh

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