Omada: preventing diabetes through digital therapeutics
Omada tackles diabetes through a digital therapeutics program that helps patients to change their habits
As the old saying goes, “an ounce of prevention is worth a pound of cure”. Traditionally, healthcare issues have been treated after the patient becomes ill instead of preventing the problem in the first place. Less than 5% of the U.S. budget on health care is spent on prevention, according to Don Wright of the U.S. Department of Health and Human Services [1]. The problem with this is that treatment is very costly. According to the American Diabetes Association, the total cost of diagnosed diabetes in 2012 was $245 billion dollars, which includes $176 billion in direct medical costs and $69 billion in reduced productivity [2]. These numbers do not reflect all the non-financial issues, such as the physical and emotional pain of the patient.
One of the main reasons why treatment is much bigger than prevention is simply because achieving system-wide prevention is very hard. However, new technologies are allowing healthcare to move towards this direction. One example of this is Omada Health, a San Francisco based company that helps people with pre-diabetes to change their eating and exercise habits in order to reduce the risk of contracting diabetes. To do so, Omada created a four-month program called “Prevent” which is divided in four phases: Eat Better, Move More, Prepare for Challenges and Reinforce Habits.
Eat Better is designed to improve nutritional habits by creating awareness about the nutritional characteristics of what the patient is eating, instead of counting calories. To keep track, patients send a picture of what they are eating to an assigned coach, who gives them feedback on how to make the meal healthier. In addition, patients receive a wireless scale that is synced to their account to keep track of their weight.
Figure 1: Omada’s wireless scale
In the second phase “Move More”, the goal is to exercise for at least 150 minutes every week. After completing this second phase, patients start the “Prepare for Challenges” phase in which they learn problem solving skills targeted towards not sliding back into unhealthy habits. In the last phase, patients practice how to deal with negative influences in order to maintain their new healthier habits.
In a study made by professors from the University of California, 187 participants started the program and 155 completed it. Starters lost 4.7% weight while completers lost 4.9% after 1 year. Patients also reduced their A1C (glucose blood level) level by 0.40%. These results were maintained after two years. [3]
Clients and investors believe that these results are promising. In a C series round led by Norwest Venture Partners, Omada raised $48 million from returning investors such as Andreessen Horowitz, US Venture Partners and Rock Health, bringing total funding to $77.5 million. Even three Omada’s customers joined the investment: Kaiser Permanente, Humana and Providence Health & Services. [4]
Thanks to these results, Omada is also able to tie more than half of their fees to success milestones such as weight loss. Omada works with big companies, where they find employees in risk of contracting diabetes. While companies absorb the cost of the program for their employees, they also receive discounts from insurance providers. Omada is working with more than 20,000 patients from 30 companies. [4]
Moreover, the effectiveness of the program will continue to improve. Omada has access to data from tens of thousands of enrolled patients, which allows them to make continuous improvements. Omada could adopt wearable devices to measure additional reference points about the habits of its patients and thus have more data to analyze.
Omada still faces many challenges. According to another study made with the Veterans Health Administration, some patients found the program too impersonal [5]. I believe that such a titanic goal as losing weight and changing lifestyle habits would be greatly aided by a face-to-face interaction with a coach in addition to the online communications. The challenge is in scaling this solution in a cost-effective manner. However, as helping a patient avoid diabetes represents huge monetary savings, it may be worth it to test “brick and click” models and measure if the incremental effectiveness justifies the additional expense.
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- Global Health Report, “Prevention vs. Treatment: A False Choice”, published January 29, 2009, http://globalhealthreport.blogspot.com/2009/01/prevention-vs-treatment-false-choice.html, accessed November 2016.
- American Diabetes Association, “The Cost of Diabetes”, published October 21, 2013, http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html, accessed November 2016.
- S Cameron Sepah, PhD; Luohua Jiang, PhD ; Anne L Peters, MD, “Long-Term Outcomes of a Web-Based Diabetes Prevention Program: 2-Year Results of a Single-Arm Longitudinal Study”, published October 4, 2015, http://www.jmir.org/2015/4/e92, accessed November 2016.
- Forbes, “Omada Health, Which Pioneered Digital Therapeutics, Raises $48 Million In Series C Round”, published September 16, 2016, http://www.forbes.com/sites/zinamoukheiber/2015/09/16/omada-health-which-pioneered-digital-therapeutics-raises-48-million-in-series-c-round/#38f312f459a7, accessed November 2016
- Tannaz Moin, MD, MBA, MSHS; Kristyn Ertl, BA; Jessica Schneider, MD; Elena Vasti, MPH; Fatima Makki, MPH; Caroline Richardson, MD; Kathryn Havens, MD; Laura Damschroder, MS, MPH, “Women Veterans’ Experience With a Web-Based Diabetes Prevention Program: A Qualitative Study to Inform Future Practice”, published May 25, 2015, http://www.jmir.org/2015/5/e127/, accessed November 2016.
Do you know if Omada has considered targeting patients who are risk for heart disease? According to the CDC one in four deaths in the United States are attributed to heart disease. Because most heart disease is associated with diet, exercise, and smoking habits, it seems like Omada’s preventative care technology could help reduce the prevalence of heart disease today.
CDC.gov. 2016. Heart Disease Facts & Statistics | cdc.gov. [ONLINE] Available at: http://www.cdc.gov/heartdisease/facts.htm. [Accessed 20 November 2016].
Yes, their longer term goal is actually to prevent all sorts of chronic diseases. As you mention, heart disease, together with diabetes, are the main cause of death both in the US and in Mexico, and both diseases have similar root causes. In that way, the company has a natural fit to also target patients in risk of suffering from a heart disease. I hope that they will be ready soon to launch this second prevention program.
Edmundo, tha’s a great discussion. I am sure there are a lot of opportunities for prevention, regardless of factors such as age, income, etc. We all know that many chronic diseases are the main cause for premature deaths among citizens around the world, especially in emerging economies, where the debate about prevention is still in early stages.
I think that companies such as Omada can play an active role not only on raising awareness around prevention but also on directly helping people to improve their health.
However, I am confident that governments should be part of this process and enable such initiatives to flourish at a larger scale. As you mentioned, there are high costs for scaling this therapeutic program, and the public officials could help to reduce the burden by, for example, providing tax exemptions for companies like Omada.
Mundo – thanks for an interesting post. One thing that stood out to me about Omada’s approach is in how they engage with their users. While there are many other companies that are focused on helping people change their eating and exercise habits, most of them are purely tracking applications (think: MyFitnessPal, etc). A common problem in preventative care is the fact that the benefits are not recognized for a very long time and so it’s very easy to “fall off the bandwagon.” Therefore, I really believe that Omada’s decision to include personalized coaching is a critical differentiator and a big factor in their success. I wonder if they can somehow use bots powered by systems like Watson to personalize their coaching even further, thereby sidestepping the need to move towards in-person coaching & allowing them to scale more effectively.
Very intriguing post. Preventative health care is compelling because of the obvious value proposition yet also challenging because of the difficulty in measuring its impact unless the effort is sustained and consistent. As with the general digitization trend in medical care, I believe a sustainable solution will require buy-in and cooperation across multiple stakeholders – medical practitioners, patients, insurance companies, and government – to take the necessary steps forward. As I was reading your post, I was thinking of how beneficial this sort of offering would be to everyone in some fashion and not just sufferers of a particular disease.
Edmundo – great post. I think this is an admirable initiative and a very smart concept. I strong agree with your idea that Omada should also require patients to wear health trackers to monitor resting heart rate, heart rate variability, sleep metrics and other stats on a daily basis. My biggest question is how is Omada motivating people to work out? I appreciate that coaches can provide feedback on diet via the pictures they are sent, but I am curious what measures can be taken to promote daily exercise and fitness. If clients relapse into poor eating habits and less exercise, what can be done? I’d also like to know more about the 155/187 patients that were in the program. Are these patients opting in? If so, is there naturally a higher success rate given that it is a proactive cohort? Once again, terrific idea – I look forward to learning more!
Great post Edmundo, very interesting read – this reminds me a bit to Stickk. I believe this is a great idea with a very noble intention, and if used properly, Omaha has the ability to have a significant impact on users. However, I struggle with the results of the study, and consequently of the application, given that although there was improvement, I wonder how effective the results were overall to reduce health issues (in this case diabetes). Reduction in the metrics mentioned by those amounts do not necessarily mean that people went from “unhealthy to healthy”. Moreover, I wonder if there is a way to not only measure results differently to truly understand its prevention impact, but also mitigate users from not completing the program. It makes me think about the ways Stickk used psychology to ensure that users remain loyal to their goals, and if there is away to adopt some of those approaches to make Omaha more effective.
Thanks for sharing! It’s always impressive to think about the impact that digital programs/apps/devices can have on health. I would be interested to know how of much of the weight loss results were due to the program or due to outside factors. Also, to address the impersonal feedback, perhaps the next phase could include customers describing their current status, what exactly they want to accomplish (results), and the based on an algorithm the program selects a plan that will meet the individuals target results.
Nice post. A question that comes up is around how to go about detecting pre-diabetes? I think that is an important step in increasing the number of people that Omada can sign up for its services. Maybe it should think about backward integrating into diagnostics. Also, I would be curious to know how it reinforces good habits and keeps a check on people?