Silicon Valley mHealth company Glooko is rocketing forward in the mobile diabetes management space since its inception less than 3 years ago, boasting multiple FDA clearances, wide-ranging industry partnerships and a growing base of patient users and healthcare provider subscribers.
Just last month, Glooko won FDA clearance for the 2nd generation of its iPhone diabetes management app and launched the 1st subscriber portal at San Diego’s Scripps Whittier Diabetes Institute.
Not content to idle over its recent milestones, the company plans before the end of this year to release a Bluetooth-based data connection system, launch a version of its app on the Android smartphone market and integrate insulin pumps into the fold.
"We go at Silicon Valley speeds here," CEO Rick Altinger told MassDevice.com in an in-depth phone interview. "Our goal is really to transform the way that patients and the healthcare team interact and manage diabetes."
Glooko’s Diabetes Management System is comprised of a $40 cable, available directly to patients, that connects with an iPhone application that’s free on the iTunes market. The system is unassuming in appearance, but its secret strength is in its compatibility with a wide range of popular blood glucose testing systems.
"Part of the special sauce inside of this cable is fairly complicated electronics that let us connect and communicate with lots of different meters and devices," Altinger told us. "We have a couple of different kits that bring the data in, and then translate it into more of a standard format.
"It’s the same for all the different meters, whereas the alternative is that they have to try and get the data with proprietary software out of the different meters and then you end up with lots of different formats," he added. "It’s a real challenge."
“We go at Silicon Valley speeds here.” – Glooko CEO Rick Altinger
Glooko has partnered with a swath of diabetes device makers in order to gain access to their data specs, in some cases signing simple licensing agreements that grant them rights to the data and in other cases penning more in-depth deals that include sponsorship from the manufacturers. Those larger deals include a pact with Roche (PINK:RHHBY), 1 of the largest diabetes monitoring device makers in the world, as well as with WalMart for its ReliOn meter.
A few thousand patients have purchased the cable directly and are already using the application as an alternative to manually logging their blood glucose levels, Altinger told us. Even as a stand-alone device, unconnected to a larger clinic or health system portal, patients can use the app to collect their data and print out a log-book to share with caregivers. The 1st generation of the app got 4.5 stars, out of 5, from iTunes reviewers.
"Our business model is to get patients to use it, like it, and that’s 1st and foremost the key," Altinger said. "Step 2 is working with providers and clinicians in bringing value to them and, in conjunction with that or shortly thereafter, the health plan, the payer, the coaches."
Engaging the healthcare continuum, cutting the cost of care
Patients are Glooko’s primary focus in terms of its development strategy, but the company’s financial outlook depends on engaging other elements of the healthcare system. Glooko’s newest FDA win green-lighted some important software updates, but it also granted the company permission to launch its healthcare provider portal.
A major selling point for Glooko is that its management system can help healthcare providers find and target diabetes patients who risk developing complications. Hand-logged glucose diaries are notoriously unreliable and incomplete, making it a challenge for any diabetes clinician hoping to glean trends, but data pulled straight from a testing device can produce a much better picture of a patient’s blood glucose profile.
Diabetes is an expensive and pervasive disease, and patients who experience complications end up costing the healthcare system nearly twice as much per year, on average, compared with patients who don’t have issues. If clinicians can target those patients before they become problematic, they may save an average of about $9,000 per patient per year.
"What we’re solving for is finding that high-dollar patient, that patient that has complications and risks."
"So how do you find those patients that are out of control?" Altinger said. "What we’re solving for is finding that high-dollar patient, that patient that has complications and risks, and to do that, given that these patients have a lot of preferences as to what meters they use, you need a platform that connects to all these different devices, brings data, puts it in the cloud, and then lets you look at it in the back end to understand it and drill in on the at-risk patients."
The "provider dashboard" Glooko markets to clinicians and health systems features automatic sorting that highlights patients with red flags in their data logs, such as those with spikes in their blood glucose levels. The idea is to reach out to those patients before they end up in an emergency situation.
Although patients aren’t the key financial lynch pin in Glooko’s model, they’ve already played a role in spreading word-of-mouth about the program. Some are such fans of the software that they’ve become self-appointed evangelists, taking their apps and their logs to their healthcare providers and urging them to adopt the program for all their patients.
"We don’t advertise to patients with diabetes, but they found out about it and it has let us sort of solve the chicken-and-egg syndrome," Altinger said, noting that at least 1 major healthcare system has contacted the company after learning about the program through a patient.
Medical technology meets consumer technology
Glooko exists, both physically and rhetorically, at the convergence of 2 high-tech, high-impact, high-dollar industries. Headquartered in California’s Silicon Valley, the company is surrounded by some of the biggest names in both medical devices and consumer technology, and it has a foot in each world. It’s a marriage that Altinger views as a coming paradigm shift for healthcare.
"The convergence of healthcare information technology and mobile technology that engages patients, the convergence of all that is really going to fundamentally change chronic disease in particular," Altinger said. "$245 billion a year is spent in diabetes, and to solve this you have to engage patients. To engage patients you have to use the devices that they’re comfortable with, which is the smartphone, and then you have to tie them in with their trusted healthcare clinicians and providers."
Altinger has been in the healthcare industry for more than 15 years now, much of it associated with Internet-centric applications, so he understands both sides of Glooko’s personality. Hybrid devices that occupy the space between mobile technology and medical technology are still rather few (there are about 75 FDA-cleared medical mobile apps, Altinger told us), but both regulators and healthcare providers are ready for more.
"The FDA is wanting companies like us to march ahead and be part of the ecosystem," Altinger said. Among physicians, he added, "we’re being welcomed."
“The convergence of healthcare information technology and mobile technology that engages patients is really going to fundamentally change chronic disease in particular."
That’s a nice change of pace for Altinger, who cited his days working with electronic medical record systems, when getting buy-in from physicians was like "pulling teeth." Doctors have been much more open to Glooko, he said.
"In my 1st week at Glooko I went down to Scripps. They were using our product in a light way and they had some feedback and I wanted to see our product getting used by real professionals," he reminisced. "We were demo-ing the product to a number of different nurses and physicians and when I showed them the feature were you can synchronize and pull data from multiple meters into the same data set and create 1 report, an endocrinologist literally looked across the table at me and said, ‘Wow, that gives me goosebumps.’"
Altinger laughed, "Okay, I think we got something here!"
Bright horizons for Glooko
Blood glucose meters may be Glooko’s launching pad, but the company has its eye on a larger prize, hoping to eventually integrate the entire diabetes management continuum. Glooko’s already in discussions with makers of insulin pumps and continuous glucose monitors, hoping to incorporate more of a diabetic patient’s self-monitoring suite into a single data management platform.
"Coming soon are pumps and continuous glucose monitors," Altinger said. "We have contracts signed with some companies – I’m not at liberty to disclose the names yet – but some major players in the industry, multiple of them, to deploy our technology to bring in data."
"We’re hoping by the end of the calendar year to have our 1st pumps integrated and to bring in the basal and bolus insulin data from them. In some cases there’s an integrated pump and meter, and we would bring all that data in at the same time and make it available to a healthcare team on the back end," Altinger said.
The system currently works via a cable that connects a glucose meter to an iPhone, but the company expects within the next 4 months to release a Bluetooth version that would allow the smartphone app to automatically collect data from the glucose meter without a physical connection.
In August, Glooko hopes to release a version of the its logging app for Android phones. The Android app is fully developed and undergoing user testing in a clinical testing setting, Altinger noted, but the device is awaiting FDA approval.
In managing the various stakeholders, from patients to caregivers to entire health systems, Glooko has to strike a balance between sometimes contrary interests. The latest version of the smartphone app allows users to more easily share their logs and readings in real time, as patients had requested, but it also includes an alert to warn users that their doctors aren’t obligated – or perhaps even likely – to view the data or act on it in real time.
"Providers are very sensitive to, ‘Don’t let the patients just push this data on me whenever they want, I don’t want them to assume that I’m going to look at it in real time’," Altinger said. "They would just get overwhelmed and there would be liability issues associated with that."
The company has also provided requested updates to streamline the patient-side work flow and is working on simpler system for clinicians, who want to add PDFs of the patient logs to electronic health records.
For the time being, Glooko’s looking to prove its concept and demonstrate that it’s a benefit to all patient and healthcare stakeholders, especially as measures prescribed by the Patient Protection & Affordable Care Act further incentivize preventive care.
"Really proving this out over time is critical, and there’s some research and such that we want to do to demonstrate more numerically how this has an impact," Altinger said. "As providers become increasingly at risk and they are more and more incentives associated with the Accountable Care Act and such, they’re interested in keeping patients out of the hospital and keeping them well. They need tools like this to monitor patients at home and help reduce the complications of diabetes and lower costs."
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