Gregg Masters 00:07
This is PopHealth Week on HealthcareNOW Radio. I’m Gregg Masters Managing Director of Health Innovation Media and the producer co-host of the show. Joining me in the virtual studio is co-founder and principal co-host at PopHealth Week Fred Goldstein, president of Accountable Health, LLC. PopHealth Week engages industry leadership and stakeholder voices spanning payer, provider, patient, vendor and regulatory communities in population health best practices and strategies connect with us at www.popupstudio.productions or following direct message me on Twitter via Greggmastersmph. And that’s Greg with two G’s. On today’s episode, our guest is Mark Clements, MD Ph.D., a fellow in the American Academy of Pediatrics, serving as the Chief Medical Officer at Digital Health innovator Glooko, a market leader in the diabetes data management solutions space. And with that introduction, Fred, over to you.
Fred Goldstein 01:15
Thanks so much, Gregg and Dr. Clements, welcome to PopHealth Week.
Mark Clements 01:18
I thanks so much. I really appreciate the opportunity to be here.
Fred Goldstein 01:21
Yeah, it’s a pleasure to get you on today we’re going to discuss some interesting things around remote patient monitoring etc.. But before we get into that, give us a little bit of your background and experience.
Mark Clements 01:29
Sure, I am a pediatric endocrinologist, I’m a practicing clinician, I’m also a clinical researcher and clinical trialist. I practice in a setting where we provide care for about 2400 youth and young adults with type one and type two diabetes. I joined Glooko as the chief medical officer in 2019, and served on the Medical Advisory Board for over four years before that.
Fred Goldstein 01:55
Fantastic. So why don’t you give us a bit of background on Glooko before we get into some of their work? Sure,
Mark Clements 02:00
you know, Glooko was formed in approximately 2010 as a connected device company, really trying to solve the problem of how to get data out of those pesky blood glucose meters, and into software that would allow one to visualize one’s own data and share those data with their trusted health care provider. Over time, we have really grown far beyond that we’ve got over 250 connected devices on our platform. So we are a data integration system. We are a system that enhances the therapeutic alliance between an individual with diabetes and now other chronic diseases and their trusted health care provider. And we are also working on population health management tools and precision behavioral engagement tools, etc. So we’ve really evolved,
Fred Goldstein 02:56
and in terms that it sounds like you’re device agnostic in terms of people can come with any device and link up to your system.
Mark Clements 03:03
That’s right, we link up with over 95% of devices in the diabetes marketplace.
Fred Goldstein 03:08
Got it? And how long has Glooko been around since approximately
Mark Clements 03:12
2010.
Fred Goldstein 03:13
So 12, 12 good years so far. That’s right. Interesting. And early on. Obviously, there’s been a lot of change in terms of both the technology and the analytics, etc. Is that an area you focused on? Is this companies move forward?
Mark Clements 03:25
Sure. We’ve seen an evolution from blood glucose meters to continuous glucose monitors to programmed insulin pumps to artificial intelligence-driven insulin pumps that automatically deliver insulin to smart connected Bluetooth insulin pens. We’ve been there for all of it.
Fred Goldstein 03:45
Wow. And is your typical client provider practices? Are you selling to payers? Both? How does that work?
Mark Clements 03:55
Yes, traditionally, our clients have been providers, but we are also beginning to partner with employers and payers in the marketplace. We also have an interesting clinical research vertical. So we are partnering with device manufacturers and life science pharmaceutical companies because we’ve realized that this connected care platform really helps clinical trials that need to be decentralized in a post-pandemic world that need to provide more remote touchpoints with their participants, etcetera. And of course, we’re entering a brave new world of remote patient monitoring, and many clinicians and health systems around North America and in fact around the world are trying to wrap their heads around how to deliver care more remotely and to monitor patients even when they’re not in clinic.
Fred Goldstein 04:48
And when you’re talking about these clinical trials, is that specifically focused in diabetes are you doing other areas as well are looking into that?
Mark Clements 04:57
A lot of the trials are in diabetes, but we are not necessarily exclusive to diabetes. So glucose turns out to be a pretty important output for a lot of diseases in terms of safety monitoring, etc. And as I mentioned, we are expanding our focus beyond diabetes into neighboring conditions
Fred Goldstein 05:17
is this is the is the Glooko system sort of a plug and play you you take the monitoring information, the devices feed it in, and then they just plug into your system and can feed that data into their electronic health records, etc.
Mark Clements 05:30
That’s correct. We have a variety of mechanisms to consume data into the Glooko system, we have an in clinic transmitter, that makes it really simple instead of a tangle of cables and different software to try to get device data into software systems. We have simplified that you lay a device on a simple transmitter box in the clinic, you plug it in or it is read wirelessly. You don’t even have to have a connection to your hospitals, WiFi or computer systems that can go to Glooko right over the cellular network. And then it’s available for clinicians to visualize
Fred Goldstein 06:10
and are you doing the wraparound say care management services? Or is that typically done by the provider in your model.
Mark Clements 06:16
So historically, we have provided the data to enable providers to provide the wraparound care services. However, we have a number of business partnerships that do allow us to provide care management solutions. As I mentioned, it has been challenging for health systems to pivot to provide chronic care management and remote patient monitoring services because one has to redirect or reallocate the effort by a lot of clinic staff in order to make that happen. So it is possible for a company like Glooko to assist in that with the actual clinical expertise from some of our partners.
Fred Goldstein 07:01
And that, you know, there are a lot of players have you seen this space? Diabetes is a huge problem in the United States around the world growing like crazy. How? How do you differentiate your services from some of the other providers out there?
Mark Clements 07:14
That’s a very good question. I think that strengthening the therapeutic alliance between the person with diabetes or another chronic disease and their trusted health care provider is in our DNA, you will find that a lot of other solutions disintermediate, the health care team, they sort of operate in a parallel universe and they don’t report back to the trusted health care provider. Glooko never wants to disintermediate the medical home, we want to actually strengthen and enable the medical home.
Fred Goldstein 07:53
And in terms of the data, you gather, obviously the lot of useful information in this stuff as it comes in. How do you sort of sift that or to ensure that providers aren’t overloaded with information as well, as I know you talked about doing some predictive work, and maybe you can discuss that as well?
Mark Clements 08:10
Sure, the Glooko summary reports really provide a mechanism for providers to follow the decision making heuristics that are natural. So we really have a deep understanding of how providers think. We can start at the very surface level, and raise some general risk metrics so that providers can see how much time an individual is spending with high blood sugars and low blood sugars. We can also help the provider at a glance to see how much insulin is being used for meals for corrections for basal insulin. And then the provider can start to drill down, can drill down into a modal day report that helps the provider see what the patterns of rise and fall are before and after meals, overnight while sleeping, etc. And then one can drill down even further into daily patterns and even hourly patterns to see how specific behaviors are eliciting specific responses. For instance, you know, what is the glycemic content protein and fat, fat content of a meal? When did exercise occur? How did that impact the glycemic response etc. So we really start at the 10,000 foot view and help the provider follow the decision making it’s really natural to drill down into the specific behaviors that are getting the responses.
Fred Goldstein 09:39
And do you have results Dr. Clements outcomes that you’ve reported based on the use of your system?
Mark Clements 09:45
We do we did conduct a clinical trial. That clinical trial has been presented at some major diabetes conferences and we do see significant results when glucose mobile app and clinician platform are paired with a remote patient monitoring program, which essentially means that there are the opportunities for visits on a weekly or bi-weekly basis during the treatment portion, we see a significant reduction in hemoglobin A1c the major biomarker for diabetes, glycemic outcomes. We also see improvements in the average glucose and the time spent in the hyperglycemic, range, etc. And if we look at individuals who begin with a very high hemoglobin A1c, above what one would consider the average for the population, we see an even bigger improvement. So I think that we’ve got strong outcomes from our clinical trial that cause us to really endorse the product we’ve created for individuals and their providers.
Fred Goldstein 10:58
And have, have you been able to take any of that outcomes data and begin to correlate that with utilization or cost for services?
Mark Clements 11:09
Yes, we’ve actually done some initial work, that work is being presented this year, so I won’t speak about it in detail. But you will see at upcoming meetings, we will be reporting on the fact that we can reduce the predicted rate of diabetes-related complications through the reductions in A1c. And that really becomes cost beneficial to clinics that are implementing the Glooko platform, or to payers that are paying for the Glooko platform, when it comes to the overall costs at one three and five years,
Fred Goldstein 11:50
as clinics or payers and the others begin to look into this. And and let’s say they’re saying, hey, we want to set up a, a much more broadly based diabetes care management program or chronic disease program, what are some of the things that they should consider or be aware of before they step into this space? .
Mark Clements 12:08
Sure, the first is that when you think about our platform as simply a data integration platform, historically has lived as a cost center on most diabetes centers budgets. But when you think about it as a tool, to allow your clinic to access the CCM or remote patient monitoring CPT codes, all of a sudden, it becomes a revenue center on your budget. And in order to shift the resources, the personnel resources in the clinic towards supporting chronic care management and remote patient monitoring, it’s really important to start small, and to create a roadmap so that you can slowly accelerate from zero experience doing remote patient monitoring visits, for instance, to making it a routine part of your weekly practice, it’s really difficult to go from zero to 100 in this work, just because it’s such a significant shift, and most clinics and hospitals aren’t used to implementing that kind of change management really rapidly, it can be very disruptive. So my recommendation is typically that systems implement quality improvement methods, they perform small tests of change, they track those tests of change in plan, do study act cycles, and that they really identify a clinician champion, or a diabetes educator champion in the clinic, who owns the process, who identifies the early adopters in the practice, who will test things out, kick the tires, etc. And then who will start to advocate for that change with some of their peers who trust their opinions.
Gregg Masters 14:01
And if you’re just tuning in, you’re listening to PopHealth Week on HealthcareNOW Radio. Our guest is Dr. Mark Clements, the Chief Medical Officer at Glooko, a digital health innovator and market leader in the diabetes data management solutions space.
Fred Goldstein 14:19
That’s That’s some great advice. And as you think about this, you obviously talked about the CCM codes and remote patient monitoring. It’s great to have CPT codes for these and Gregg and I have been discussing the whole issue of fee-for-service medicine for a long time. Obviously, you know, this is this is something that makes sense in a different way in a value-based model. And that gets back to your outcomes and costs. So I guess once we see some of the data you’re gonna put out, it may make sense then that you fund it off of that type of arrangement versus we need a code we got to bill for it
Mark Clements 14:48
absolutely this platform is really tailor-made for value-based care. I think it makes a ton of sense. The entire field of remote patient law Monitoring and chronic care management also just generally plays very well in the context of value-based care program.
Fred Goldstein 15:07
And that brings up another issue there, you know, remote patient monitoring companies for all kinds of different disease states or conditions. And as a practice looking at this, you suddenly say to yourself, well, how many of these different vendors do I have to bring in here is, are you looking to go beyond just diabetes and glucose management and begin to assist in other areas that might be beneficial to have these types of tools?
Mark Clements 15:33
We are, so we’re first looking at neighboring conditions. So you could imagine, for instance, that hypertension and cardiovascular disease are diseases that are really comorbid. With diabetes, they really affect a lot of individuals with diabetes, and they affect the practices and care teams that are providing care. And as a result, it makes the most sense for us to start with those conditions. And then to expand iteratively beyond those over time.
Fred Goldstein 16:04
That’s great. And in terms of the the end of the day, it’s the it’s the individual out there using the systems, what’s been the response from your patients, using these tools through the practice,
Mark Clements 16:14
you know, we number of years ago began to provide the Glooko mobile application freely on the App Store’s for individuals with diabetes, whether or not their healthcare systems subscribe, subscribes to the Glooko service. We also provide a number of digital therapeutics that can be prescribed by health systems, we have a mobile insulin dose titration system, for instance, for adjusting basal insulin and individuals with type two diabetes. And I would say that the persons with diabetes are most excited about the tools that allow them to see all of their data in one place, that allow them to really dive deep and understand what’s happening in their daily patterns of activity and their diet and how that influences their disease outcomes. So as a result, they get frustrated by the very siloed and segmented ecosystem created by by just having so many devices out there. And Glooko’s roll in bringing them all together, helps them I would say simplify in a very significant way, you know, they not only can track data from their diabetes, self-management devices, but we have really simple tools of voice to text tools for them to enter diet information and log their foods, they can connect their fitness wearable to the glucose system, so they can really start to see a lot of their activities of daily living in their habits in the context of their diabetes.
Fred Goldstein 17:51
You know, I’ve used a lot of these different tools just for fun not a diabetic, but you know, whether it’s the watches, or the different devices that have come out over over the decades, and, and particularly in terms of trying to log meals has always been just a problematic issue. You know, have you come up with some ways to simplify that?
Mark Clements 18:10
Well, I really recommend that you go out and try our user interface, because I think we have a best-in-class user interface for doing this. I think that they’re, we’re constantly watching the field as it moves forward. You know, there are academic researchers that are using things like remote food photography and tagged photos of meals. We found that so far, what’s really ready for primetime in the marketplace is just a very simple user interface to enter the names of your foods. And, you know, if you could open the Glooko app, and you can say, I had a cheeseburger and a side salad and it will pull both of those up. And you can say, Yes, that’s what I ate and login. That simple.
Fred Goldstein 18:56
Uh huh. Fantastic. Yeah, that was always something as I’m scrolling through different meal things, or different things you looked at the different apps trying to keep up with? That was always difficult. I did look at some of the photo ones and they struggled to in some sense.
Mark Clements 19:08
Yeah, well, it is important to distinguish that there are quite a few applications out there for individuals with diabetes or other chronic disease. And the vast majority of them on the app stores are not FDA clear. They’re not validated for safety. And the Uh huh. app is
Fred Goldstein 19:26
a that’s been a major, major issue. Obviously, there are 1000s of apps out there. Most of them are not built on anything really scientific to speak of. And people just download those things and then hope something works. Do you see and track things like this, particularly the ones that people are downloading themselves utilization over time and things like that?
Mark Clements 19:46
We can track utilization on the Glooko. platform, if that’s the question you’re asking. Yes, we so we can see what engagement looks like. And in fact, you asked a little bit earlier about predictive models. So one of the things we’re looking at, as you know, we are sitting on top of one of the largest repositories of daily diabetes self-management information on the planet. And one really wants to think about how we can utilize that information to improve the care of individuals, right. So one way, one example that we started with is that we can actually predict individuals that are likely to disengage with the mobile application. And we can surface that to their health care provider so that their health care provider can then decide whether to intervene and reengage them, which might help them become more successful, for instance, on a remote patient monitoring program.
Fred Goldstein 20:44
Sure, that’s a great example of that. And in terms of that data set, do you have that available for others to access or use? Or is that just internally done, you, for example, De-identifying the individuals and then having that data sold or used by others.
Mark Clements 21:01
So Glooko. uses the information on our platform for internal feature development, we never make data available, contrary to the terms of use on our platform. So it is the case that we want, you know, again, we want to support innovation in the diabetes field. And if the individual users Terms of Use suggest that we can deidentify information and learn from it, or share it with others, so that they can learn from it and develop new features, again, that will feed back into the diabetes ecosystem. Only under those circumstances, do we share information externally?
Fred Goldstein 21:45
That makes sense? Where Where do you see this field going through in the next five years? And what excites you the most about it?
Mark Clements 21:52
Well, I think we’ve come a long way from the discovery of insulin. We have seen, you know, the advent of glucose monitoring devices and insulin delivery devices, and even automated insulin delivery systems. I think the next frontier is behavior. We know that diabetes and other chronic conditions are managed 10%, at the physiologic level, and 90%, at the behavioral level. And I don’t mean to suggest that the burden of behavior is entirely on the individual with diabetes. When I say behavior, I mean, the behavior of the person with diabetes or chronic disease and the behavior of their healthcare team. So we think that we are sitting in a prime position to develop systems for precision engagement, precision engagement of the person with diabetes, or chronic disease and precision engagement of the health care team. Could we, for instance, in the future, see tools that help support individuals, before they’re about to come into clinic to see their trusted health care provider to prepare for that clinic visit? Could we help diabetes centers and other clinics, you know, send assessments or patient-reported outcomes surveys at just the right time, you know, in the context of their care journey, etc, etc. So I think we’re in a perfect position to do that. And those are the things we’re looking at today.
Fred Goldstein 23:25
Yeah, Dr. Clements, thanks for bringing that up. I think the behavior piece is the holy grail of population health, really. But in a broader sense, as we think about behavior, obviously, some of it has to do with the, you know, social determinants of health, where people live, what they can access, etc. How are you looking to address some of those issues in terms of access to this technology, maybe in disadvantaged populations?
Mark Clements 23:50
Yeah, so this is a topic that’s near and dear to my heart. So I’m very proud to say that Glooko. has a social responsibility group and program. And we are in fact, supporting several organizations out there that are serving underserved populations. So you know, populations that are receiving care, for instance, from federally qualified health centers. Glooko. has, you know, made our platform available to those centers that might not otherwise have access for their populations. I would also point out that as we explore precision engagement approaches on our platform, one of the no-brainer opportunities, to me one of the things that I’m very interested to see in the future and that I hope I can successfully pitch for is that we should have the opportunity on our platform for clinicians to screen their patients for social determinants of health, because there are digital tools out there that we can connect patients to, from our platform to help them find the resources they need in their own community? That to me is a sort of no-brainer. And something that we again, we don’t offer today, but I hope we can explore.
Fred Goldstein 25:13
It makes a lot of sense, particularly to think about this disease and its impact on disadvantaged populations in this country, just enormous. So the ability to get them access to services, like you have obviously can have a profound difference on that population.
Mark Clements 25:26
That’s right.
Fred Goldstein 25:28
Yeah. And just, you know, one final note, as as you grow this out, do you do? You’ve talked about expanding some are and you know, maybe the heart conditions, things like that? Are there other areas where you think nobody’s really taking a look at this yet, but it might have some benefit?
Mark Clements 25:50
Well, I think the the areas of behavioral health are probably the biggest ones, I think that there’s a deep tie in between health-related behaviors or health-promoting behaviors, and the mental health of individuals with chronic disease. So I would say that, looking eventually, at how we can address some of the mental health issues that interact with chronic physiologic disease, like diabetes, are going to be very important. And again, I think we’re perfectly positioned to do so. You know, I think that first we’re looking at conditions like hypertension and cardiovascular disease, but I think it’ll be a natural evolution.
Fred Goldstein 26:37
Well, that’s a fantastic way to end the show. I think we hit diabetes, social determinants of health, a little bit of health equity, and finally mental health as well, which are really key issues. Thank you so much, Dr. Clements, for joining us today. It’s been a pleasure.
Mark Clements 26:49
Well, I really appreciate your time. I thank you for the opportunity. I just want to say that I think all the individuals out there with with diabetes and chronic disease who are working so hard every day, to try to improve their health and all the care teams out there trying to help them. So thank you very much.
Fred Goldstein 27:07
It’s our pleasure. And back to you, Gregg.
Gregg Masters 27:11
And thank you, Fred. That is the last word on today’s broadcast. I want to thank Dr. Mark Clements, the Chief Medical Officer at Glooko.. For his time and many insights today, do follow his work on Twitter via @DrDrMark M A R K and @GlookoInc, that’s G L O O K O I N C, respectively, and on the web, via www.Glooko.com. And finally, if you’re enjoying our work at PopHealth Week, please like the show on the podcast platform of your choice. Do share with your colleagues and consider subscribing to keep up with new episodes as they’re released. We stream live on HealthcareNOW Radio weekdays at 5:30am, 1:30pm and 9:30pm. Eastern and for your left coasters at 2:30am, 10:30am and 6:30pm. Pacific for PopHealth Week. My co host Fred Goldstein. This is Gregg Masters saying please stay safe everyone. Bye now.