Oviva Diabetes Support & Prevention: person-centred, evidence-based remote services to prevent and treat type 2 diabetes (#2712)

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Innovation 'Elevator Pitch':
Oviva Diabetes Support and Prevention are QISMET-accredited education and behavioural change interventions for people with or at risk of type 2 diabetes, which have demonstrated signficant improvements in uptake and clinical outcomes.
Overview of Innovation:
Oviva’s services for people with or at risk of type 2 diabetes are now available in 18 CCGs across England, and have demonstrated improved uptake and outcomes in comparison with traditional models of care.

Oviva services offer accessible, evidence-based, personalised care
All Oviva services combine:
  • High-frequency, 1-to-1 coaching from a diabetes specialist dietitian to drive behaviour change and tackle psychological barriers, delivered over the telephone or using the Oviva app.
  • Supporting materials for participants to access in their own time, including videos, podcasts, and written guides, which explain more about type 2 diabetes. Participants retain access to resources for life, and they are available online or as hard copy booklet and/or DVD. All Oviva resources reflect NICE and NHS guidelines and are reviewed by a clinical advisory board regularly.
  • Optional use of the Oviva smartphone app, which participants can use to maintain a food diary and access learning resources. This app links to the dietitian’s electronic patient record to enable the dietitian to provide feedback.
  • Activation call from Oviva patient pathway coordinators, who are trained in motivational interviewing and focused on driving uptake.
This approach is tailored to meet the needs of different patient cohorts, as described below.

Oviva Diabetes Prevention: an 8 week intensive education and behaviour change programme with follow up care at 3, 6 and 12 months, focused on weight loss and reducing HbA1c levels (for patients with non-diabetic hyperglycaemia). This service has recently been adopted as part of the NHS Diabetes Prevention Programme in England, and real world data will be available for analysis soon.

Oviva Diabetes Support: an 8 - 10 week QISMET-accredited structured education and behaviour change programme, focused on supporting patients to meet diabetes treatment targets, lose weight, and develop sustainable self-management skills. Real world data demonstrates an average HbA1c reduction of 13mmol/mol at 6 months, weight loss of -4.5%, whilst patients report that their average confidence in managing their diabetes increased from 4/10 to 8/10 (clinical outcomes from 85 patients). Uptake in 1453 referrals is c.70%, compared with c.30% in traditional models.

Oviva Diabetes Support has now been selected by NHS England to join the NHS Innovation Accelerator and the Digital Diabetes Coach Test Bed.

To view our Information Pack - click here.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
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Innovation 'Elevator Pitch':
Oviva Diabetes Support and Prevention are QISMET-accredited education and behavioural change interventions for people with or at risk of type 2 diabetes, which have demonstrated signficant improvements in uptake and clinical outcomes.
Overview of Innovation:
Oviva’s services for people with or at risk of type 2 diabetes are now available in 18 CCGs across England, and have demonstrated improved uptake and outcomes in comparison with traditional models of care.

Oviva services offer accessible, evidence-based, personalised care
All Oviva services combine:
  • High-frequency, 1-to-1 coaching from a diabetes specialist dietitian to drive behaviour change and tackle psychological barriers, delivered over the telephone or using the Oviva app.
  • Supporting materials for participants to access in their own time, including videos, podcasts, and written guides, which explain more about type 2 diabetes. Participants retain access to resources for life, and they are available online or as hard copy booklet and/or DVD. All Oviva resources reflect NICE and NHS guidelines and are reviewed by a clinical advisory board regularly.
  • Optional use of the Oviva smartphone app, which participants can use to maintain a food diary and access learning resources. This app links to the dietitian’s electronic patient record to enable the dietitian to provide feedback.
  • Activation call from Oviva patient pathway coordinators, who are trained in motivational interviewing and focused on driving uptake.
This approach is tailored to meet the needs of different patient cohorts, as described below.

Oviva Diabetes Prevention: an 8 week intensive education and behaviour change programme with follow up care at 3, 6 and 12 months, focused on weight loss and reducing HbA1c levels (for patients with non-diabetic hyperglycaemia). This service has recently been adopted as part of the NHS Diabetes Prevention Programme in England, and real world data will be available for analysis soon.

Oviva Diabetes Support: an 8 - 10 week QISMET-accredited structured education and behaviour change programme, focused on supporting patients to meet diabetes treatment targets, lose weight, and develop sustainable self-management skills. Real world data demonstrates an average HbA1c reduction of 13mmol/mol at 6 months, weight loss of -4.5%, whilst patients report that their average confidence in managing their diabetes increased from 4/10 to 8/10 (clinical outcomes from 85 patients). Uptake in 1453 referrals is c.70%, compared with c.30% in traditional models.

Oviva Diabetes Support has now been selected by NHS England to join the NHS Innovation Accelerator and the Digital Diabetes Coach Test Bed.

To view our Information Pack - click here.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach
Benefit to NHS:
Oviva Diabetes Support and Prevention benefit the NHS by widening access to effective care, and generating improved patient outcomes for people with or at risk of type 2 diabetes. In turn, this drives efficiency savings in terms of avoiding preventable utilisation of services in primary and secondary care, along with medications and treatment costs associated with disease progression and diabetes complications.

As described in the overview, service uptake is c.71%. By contrast, the National Diabetes Audit indicates that uptake of structured education for people newly diagnosed with type 2 diabetes is c.7.4% (2.9% in the West Midlands), and uptake of the National Diabetes Prevention Programme is 49%. Increased accessibility and flexibility enables people unable or unwilling to access traditional face-to-face courses, along with supporting commissioners and clinicians to meet targets associated with attendance at diabetes structured education included in the NHS Improvement and Assessment Framework and Quality and Outcomes Framework.

Moreover, real world data (85 Oviva Diabetes Support patients) demonstates an average HbA1c reduction at c.6 months of 13mmol/mol, and bodyweight loss of 4.5%, supporting the achievement of diabetes treatment targets (also included in the Improvement and Assessment Framework and Quality and Outcomes Framework).

These clinical outcomes can drive a return on investment for CCGs; Frontier Economics modelling indicates that based on existing clinical outcome data, provision of Oviva Diabetes Support for 500 participants achieves £219k of year 1 savings, rising to £550k by year 5. This is comprised of avoidance of 72 admissions, 100 outpatient and 280 GP visits, along with avoidance of more than £17k of prescribing costs. Targeting the service at patients receiving or likely to need high cost medications (including insulin, SGLT-2, and GLP-1) could drive additional savings of more than £800 per participant per year.

Oviva Diabetes Support and Prevention also offer commissioners a 'payment by engagement' cost model, ensuring that commissioners only fund the service for active participants. This contrasts with the block contract model of traditional face-to-face group courses, which offers commissioners limited recourse to challenge poor uptake locally.
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
By providing an accessible, flexible and effective approach to improving outcomes for people with type 2 diabetes Oviva Diabetes Support and Prevention can impact on the WM population (7.7% of whom have type 2 diabetes, and 11% of whom are likely to be at risk) beyond the local health economy by:
  • Reducing the need for people with or at risk of type 2 diabetes requiring time away from work to attend education courses or future appointments associated with the treatment of complications, thus contributing to maintaining productivity and the local economy.
  • Providing participants with personalised and remote care widens access to cohorts identified as less likely to attend traditional programmes, such as working age men, BME groups, or rural communities, particularly essential in diverse populations such as the West Midlands. Evidence of accessibility can be seen in the success of Oviva Diabetes Support in areas such as London and Devon.
  • Reducing the impact on the environment associated with delivery of traditional models of care, which drives a number of journeys for patients and staff and the environmental costs associated with physical premises.
  • Improving outcomes enables people with type 2 diabetes to remain in work; Diabetes UK has estimated that the costs of reduced productivity at work due to people with diabetes not working because of death or poor health, or working at a lower level of productivity are estimated at nearly £9 billion.
Current and planned activity: 
Oviva Diabetes Support is currently in pilot or commissioned in the following areas: North West London collaborative of CCGs, South West London collaborative, NEW Devon CCG, Chiltern and Aylesbury Vale CCGs, Swindon CCG, Somerset CCG, Leicester, Leicestershire and Rutland CCGs, and Salford CCG. Oviva Diabetes Support will soon be available to self-referral nationally as part of the Diabetes Digital Coach Test Bed. Oviva Diabetes Support is supported through NHS England through the NHS Innovation Accelerator, and has been rewarded a research grant via Innovate UK and the digital health catalyst to evaluate our clinical outcomes with King's College London.

Oviva Diabetes Prevention is part of the NHS England Healthier You - Diabetes Prevention Programme digital stream, recently launching in North West London, Somerset, and Chiltern and Aylesbury Vale CCGs.

Oviva is keen to explore opportunities for adoption of our service in the West Midlands.
What is the intellectual property status of your innovation?:
All intellectual property is owned by Oviva.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':
Oviva's Diabetes 800 programme has shown 55% remission rate amongst patients, delivered at <50% cost (compared to a face-to-face programme) with a 100% remote & digitally enabled model. Per patient, this is an in-year cost-saving of £1472.
Overview of Innovation:
In the West Midlands, each CCG spends in the region of £10m on Diabetes Medication each year. Diabetes 800 is a programme which puts Type 2 diabetes into remission, and therefore removes the need of often unpleasant, and expensive medication for the patient. The programme achieved remission in 55% of patients, and is deliverable at <50% of the cost of a face-to-face comparable service. Diabetes 800 is a fully remote clinical service delivered 1-to-1 by diabetes specialist dietitians and diabetes specialist nurses over 12 months. The objectives are to help patients achieve remission, reduce medications, lose weight, and improve their health. It starts with a 12 week very low-calorie (800kcal/day) diet to achieve >15kg weight loss, followed by 9 months of personalised nutrition and behaviour change support. The in-year cost saving per patient is £1472.

Using one West Midlands CCG as an example, £7m is spent each year on diabetes medication. To date the CCG has spent near zero on Type 2 diabetes remission. If Diabetes 800 was available for all patients in the CCG, the cost saving is estimated to be: >£24,000,000. Type 2 diabetes remission programmes have not been routinely commissioned due to a lack of evidence and a lack of clinically proven programmes, as a result the funding opportunites are challenging. Although Oviva is working with CCGs across the UK to develop cost-saving programmes. 

The Oviva Diabetes 800 programme was developed by an expert panel of specialist clinicians, including Professor Rachael Batterham (University College London Hospital) and Dr Michelle Harvie (Manchester University Hospitals) and based on the DiRECT study and published principles from Diabetes UK.
The service has been evaluated in a clinical trial in Manchester, due for publication in March 2020. Six month outcomes show 100% of participants stopped or reduced diabetes medications, 9kg weight loss and a 55% remission rate. Oviva is leading an Innovate UK project, implementing Diabetes 800 to 300 patients. This is due to begin in January 2020 to help generate further evidence to guide commissioning.
 
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption
Benefit to NHS:
NHS patients:
  • Potential for people with type 2 diabetes to achieve remission and improvements in their quality of life and psychological wellbeing from 15kg of weight loss
  • Reduced medication burden and risk of complications from their conditions
NHS commissioners:
  • NHS savings with reductions in medication & clinical services use
  • Estimated savings are approx. £1,500/patient in year 1
Primary care:
  • GPs and Practice Nurses will be inspired by new lifestyle-led ways of managing type 2 diabetes rather than a medication first approach – helping transform the NHS’s approach to care
  • Reduced demand on primary care due to better health in participants
Leadership of the UK/NHS in the emerging scientific field of type 2 diabetes remission:
Type 2 diabetes remission is a new science and by undertaking this work the UK/NHS will be a world leader in real world implementation – which can be shared both more widely in the NHS but also internationally
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
West Midlands Population:
  • The West Midlands has over 280,000 people living with diabetes, and one of the highest prevalence rates nationally
  • There is the potential for these people with type 2 diabetes to achieve remission and improvements in their quality of life and psychological wellbeing from 15kg of weight loss
  • There is also the benefits of a reduced medication burden and risk of complications from their condition
Current and planned activity: 
Current
  • Ongoing Diabetes 800 RCT in Manchester (due for publication in March 2020)
Planned
  • Innovate UK Diabetes 800 project launch in January 2020
  • Programme launch on 1st January 2020 in a number of CCGs where early adoption has been see
Development Support
  • Where CCGs have an absence of funding allocation for Type 2 diabetes remission, support is necessary to assist in the roll out of cost-saving measures
What is the intellectual property status of your innovation?:
Oviva UK Limited owns all of the intellectual property (IP) for the Diabetes 800 programme. 
 
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':
OurPath is a 6-month online behavioural change programme for people to build healthier habits and manage type 2 diabetes with fewer medications. We provide health-tracking technology, coaching from a dietitian and evidence-based structured education.
Overview of Innovation:
The health needs of the UK population are changing and the way we interact with healthcare is evolving. Nationally, the internet is being used to manage our lives, changing the way we shop, bank, watch TV and communicate. The West Midlands has one of the highest rates of type 2 diabetes and pre-diabetes in the country. Many of these people may benefit from digital services that may help them manage their lifestyles, preventing them from moving into higher risk stratification levels and increasing medication burden which would ultimately require increased GP time to manage and increased costs.
OurPath provide a 6-month behavioural change programme for people living with, type 2 diabetes. The programme helps people to change their behaviours for the long term and improve their health outcomes. The programme delivers:

• Evidence-based structured education on nutrition, exercise, sleep, stress management, and positive psychology
• Peer group support (an online group of 13 others similar to the user)
• Personalised health coaching from a registered dietitian
• Tracking technology (smart weighing scales and a wearable activity tracker).

The programme has been adopted across more than 50 CCGs and is available through NHS England's diabetes prevention programme. We’ve seen uptake rates of >70% and completion rates of 80%, average weight loss of 6.2% at 2-years post-intervention and an average HbA1c reduction of 12.7mmol/mol at 6 months. 40% of participants achieved a HbA1c below the diagnostic threshold for type 2 diabetes. 
We are proposing a project to deliver the OurPath programme with the objective of reducing anti-hyperglycaemic medication spend through dietary and lifestyle change across the West Midlands. The ambition is that the programme will provide in-year savings whilst also improving patient outcomes. 
This model is being implemented across the 8 North West London CCGs as part of their multi-faceted remission programme.

1-minute introduction to OurPath video: https://vimeo.com/199648301

www.ourpath.co.uk
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
The Diabetes UK 2016 state of the nation report states that 'type 2 diabetes is the fastest-growing health threat facing our nation.' With over three million people already living with the condition and many millions more at high risk. This high prevalence means treating type 2 diabetes absorbs NHS budget at an alarming rate, around £1million per hour.
We intend to provide a solution for the NHS by offering easily accessible, online, 24/7 support from a registered dietitian and other people taking the programme in their group. By combining support beyond the consultation with wireless healthcare tracking technology and a sustainable approach to diet and lifestyle change, we have created and demonstrated an effective, digital method of treating type 2 diabetes without the need for treatment intensification. 
This accessibility is something we have already demonstrated in North West London (NWL), a diverse area with similar type 2 diabetes prevalence and population challenges to the West Midlands. We achieved an uptake rate of over 70% from GP referral and a 3-month programme completion rate of over 80%. Through reducing body weight and HbA1c levels we are drastically improving the management of type 2 diabetes whilst also facilitating the deprescribing of anti-hyperglycaemic agents. This means the NHS is able to deliver better outcomes whilst also saving money on expensive medications, treating complications and in-patient bed days.
We are currently undertaking a further project in NWL with the clear objective of medication de-prescribing and diabetes remission. This project aims to reduce patient's weight and HbA1c in order to offset that which is obtained through the use of expensive medications. This will help improve self-management of type 2 diabetes whilst also reducing medication spend for local health economies.
Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
The West Midlands has one of the highest rates of type 2 diabetes in the UK and based on current trends the number of people diagnosed is predicted to reach 538,000 by 2035. NICE treatment algorithms for type 2 diabetes currently set a path to ever-increasing medication volume as their chronic condition continues to deteriorate with time. Lifestyle change programmes have the capacity to prevent this treatment escalation and reduce the medication burden for people living with type 2 diabetes.
By working with GP surgeries and community teams in the area we can also help to take some of the intense diabetes treatment workloads off these overstretched local services, freeing up more time to deliver better, more consistent care. 
The estimated total annual medication spend for type 2 diabetes (BNF 6.1.2) across the West Midlands is £54,802,592. Whilst pharmacological interventions certainly provide benefit to some patients there is a large population of individuals who can offset the effects of these medications through lifestyle change. 
OurPath aligns completely with this and is a proven lifestyle service, demonstrating improved outcomes in real-world patient populations. We propose working closely alongside primary care, providing their patients with continued support even after they have left the surgery. The task of changing a patients lifestyle for clinicians in any area is a difficult one. Unhealthy lifestyle habits have often been ingrained into peoples lives for decades and changing those behaviours in a series of infrequent 10-20 minute appointments can sometimes be an insurmountable task.  Patients have 24/7 access to their peer support group and our health coach team, who guide patients through our healthy recipes, structured education and exercise programme, teaching them new behaviours and embedding them into their daily lives.
Based on our positive outcomes data and uptake figures that we have already mentioned, we feel confident that we could make a tangible dent in the current prescribing spend for diabetes in the West Midlands area, drastically improving the future quality of life for the people enrolled in the programme.
Current and planned activity: 
In early 2017 OurPath was commissioned across North West London to trial the programme in patients already living with type 2 diabetes. 2 years on and OurPath is live in over 50 CCGs. We’re part of the national diabetes prevention programme and we're an active provider in the Wave 2 Test Bed projects, currently innovating care in North East Hampshire & Farnham. We're also rolling out a third phase project in NWL aiming to reduce type 2 diabetes medication spend and promote remission.
What is the intellectual property status of your innovation?:
All IPR has been developed internally and is owned by OurPath, including all technical and software IPR. 
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
Commercial information:
The OurPath programme is already is fully commerically avliable to private participants willing to make a lifestyle change. Expansion within the NHS is the next step and enabling people to access the programme free at the point of care has been the main ambition since our inception. One of our main priorities for 2018 is expanding into markets in the European Union. Lifestyle diseases in the EU are one of the main causes of mortality, affecting over 200 million people in the EU and costing more than €400 billion to EU health systems, OurPath are actively addressing the lifestyle disease epidemic using a holistic approach that combines the best in class health technologies, behavioural science research, live peer and mentor support, as well as targeted educational materials to provide a results-driven strategy that works for users – all on a digital platform. There are clear economic and social incentives to invest in a digital prevention programme that has the potential to be delivered at scale. The OurPath solution is:
  • Cost-effective for EU health systems, private providers, and individual consumers
  • Scalable for involved systems and businesses, on the basis there are virtually no barriers to adopt or uptake the OurPath programme
  • Comprehensive – where other platforms provide one dimension of a prevention or management service, OurPath delivers a holistic, complete experience to users
  • Accessible for all users given that the programme is delivered digitally, at a lower price-point than traditional disease prevention and management schemes
  • Proven – with backing from the results of clinical trials and decades of health and behaviour change research going into the programme
Measuring success with OurPath    
Lifestyles diseases such as T2D are highly quantifiable, where weight is an important risk factor. A reduction in weight of 5-7% can reduce risk of progression to T2D by over 50%. Given the quantified nature of the disease, the effectiveness of lifestyle intervention programmes can be easily evaluated, and its economic benefit quantified. The UK’s National Institute for Health and Care Excellence (NICE) have produced guidelines that state that any T2D preventative intervention achieving a 1kg weight loss is cost effective to the system if it costs £1000 or less. Clinical trials of the OurPath programme have showed an average 8.2% weight loss for those who completed the programme, and this was sustained after the trial. This gives us a clear benchmark of ‘value’ to the healthcare system at ~£600, but our expected charge is significantly less, ~£260. We expect our results to improve throughout the project and beyond as we further iterate OurPath’s platform. As we scale and iterate across more markets our intervention programme will become even more cost-effective.
Regional Scalability:
​The problem with introducing something across regions is making sure it doesn't negatively impact on the already overworked, understaffed organisations delivering primary care services. Driving adoption is a key KPI for regional scability and we have learnt from experience and feedback on how to implement the programme as painlessly as possible alongside existing care pathways. The programme requires no extra work for primary care and nurses have loved having something new and exciting to offer patients. We have been blown away by the adoption and feedback from across our other sites in the NHS such as 6 CCG's in North West London, 3 CCG's in the Portsmouth area and 2 STP areas. 
Measures:
OurPath will also collect the following data to measure health outcomes and predict long term cost effectiveness assessment:
  1. Weight (measured automatically via wireless scales)
  2. Activity (measured automatically via activity tracker)
  3. Wellbeing (measured with before and after wellbeing questionnaires)
  4. Engagement (measured by 'Core Actions' per day, such as messages sent to mentors, weigh-ins, and the reading of OurPath article content)
  5. Retention (measured by 'Core Actions' over time as mentioned above)
  6. We would prefer to work with GP practices to take before and after HbA1c assessments as well - which is particularly important for people at risk of type 2 diabetes.
Adoption target:
  1. Signing up and implementing a referral pathway across a minimum of 5 GP practices
  2. Onboard of 500 patients at risk type 2 diabetes to the OurPath programme
  3. Completion rate of at least 70% of the OurPath programme
  4. Of those who complete the programme, average weight loss of at least 4% 
  5. Minimum viability would be 350 participants (70%)
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