Diabetes

Uber but for prediabetes: Platform to deliver timely prevention

First Mile Care, a spinoff of the AMA-launched Silicon Valley innovation company Health2047 Inc., has an ambitious plan to create a digitally connected network of diabetes-prevention coaches across the nation’s 42,000 ZIP codes.

But when First Mile CEO Karl Ronn was asked if his company was starting by first building the technology platform or by developing the coaching network, he replied, “Neither.”

“We believe that the right place to start is with the physicians,” he said. That means helping them refer patients to the National Diabetes Prevention Program (National DPP) lifestyle change program,” Ronn said. “We need to build around” physicians and strengthen their foundation, he added.

The goal for First Mile is to simplify the often-complicated lifestyle-change program referral process and make the patient’s journey as seamless as possible.

The National DPP lifestyle change program is an evidence-based, year-long program that has been clinically proven to reverse prediabetes. The program is facilitated by a trained lifestyle coach in a group setting and uses a Centers for Disease Control and Prevention (CDC) approved curriculum. In 2018, Medicare began paying up to $670 over a two-year period to cover the cost of a patient’s lifestyle change program.

In comparison, medical expenses for people diagnosed with diabetes average $16,750 a year. That is about 2.3 times higher than for people without diabetes.

The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps clinical practices and health care organizations identify patients with prediabetes and manage the risk of developing type 2 diabetes, including referring patients at risk to a National DPP lifestyle change program based on their individual needs.

There are more than 84 million Americans with prediabetes. But despite their proven effectiveness, only 200,000 people have participated in a lifestyle change program.

“Our job is to find out why it isn’t scaling,” Ronn said.

Long goals tied to short drives

Ronn believes the key to scaling the CDC-recognized lifestyle change program is to make it “hyperlocal,” meaning classes have to be held within a 10-minute drive of patients’ homes and led by a coach with local knowledge of neighborhood resources who can foster community-based, peer-to-peer connections.

“We need to set up on-demand availability,” Ronn said. “We can meet you where you are and be convenient in location as well as in time.”

The AMA has partnered with several innovative organizations—including Omada Inc. and the YMCA of the USA—that are striving to prevent type 2 diabetes. First Mile Care is another example of an organization applying a creative solution to overcome barriers for patients and physicians.

AMA Executive Vice President and CEO James L. Madara, MD, in his address at the 2018 AMA Interim Meeting, noted both First Mile’s commitment to on-demand convenience and the challenge of getting patients with prediabetes into a lifestyle-change program.

“Using an Uberized approach—the right time, the right place and the right match—First Mile Care will build a network of 100,000 digitally certified lifestyle coaches across all 42,000 U.S. ZIP codes,” Dr. Madara said. “Diabetes prevention programs have existed for nearly a decade, yet less than half of one percent of people with prediabetes in the U.S. have completed such a program—and so an approach that is scalable and easier to access is desperately needed.”

Ronn said that First Mile is working to find a physician in the San Francisco Bay Area so they can launch the enterprise close to their headquarters in Menlo Park. The physician will help “fine-tune the model,” he said, adding that “discussions are going on across the country for other places we would add next.”

National network, neighborly focus

Finding coaches will not be a problem, Ronn added. To qualify for the position, candidates need to take a four-session, two-week class.

First Mile is looking for people who have experience and skill with helping others help themselves to reach personal goals. Community workers, nurses and teachers who are working part-time positions would be likely candidates.

“Coaches are there to help facilitate small, sustainable, incremental changes rather than preaching at participants,” Ronn said, adding that duties would include developing weekly action plans for participants.

Programs will be working from a common platform and best practices will be shared. But the key is to develop programs that will work for the particular prescribing physician’s patient population.

“We have to make it work at a neighborhood level,” Ronn said. And, he added, “we have to support the individual physicians—period.”