Diabetes Prevention
How can people have a better understanding of diabetes and its risks, knowledge of the things they can do to avoid developing diabetes, and support to stay healthy? 

Ideas (Wellness and prevention of illness)

Innovation 'Elevator Pitch':
Liva helps people prevent and reverse chronic diseases and manage lifestyle challenges by scaling meaningful human relationships using technology. At the same time, Liva drives efficiency and reduces costs for healthcare providers and payers
Overview of Innovation:
Liva Healthcare is a proven solution provider for NHS England, Healthier you, Digital Diabetes Prevention Programme pilot. 
  • An advanced yet intuitive digital platform fully approved for use with the NHS (a service user app (front end), and a dashboard command (backend) for health coaches)
  • A patient centric approach in platform and programme design
  • An expert coaching team with significant experience in impacting lifestyle change
  • Individualised coaching services delivered predominantly digitally, but with a differentiating, relationship-building face-to-face Initial Assessment.
  • A structured education approach encompassing a modulated library of content with individualised lifestyle advise, provided by a leading general practitioner in diabetes management.
  • An evidence-based and approach to behaviour change and diabetes management.
  • Strongly governed clinically by frameworks and evidence-based care pathways. 
  • A proven and effective team of experts who ensure optimal standards of implementation.
  • An attractive solution that is economically sustainable with staged fee structures linked to continued engagement.
  • Clinically proven, with users maintaining 7kg of weight loss after 20 months and €2,000+ savings in societal costs per year per diabetic. 
  • Scalable and efficent with more patients to be handled with less resources. 
Liva has achieved success through refining and adjusting the programme based on clinical evidence, coach feedback and patient evaluation.  We base the programme and all of its interventions on the acknowledgement of the reality of people’s lives, working on their terms, not ours.
  • Liva’s design philosophy is about intuitive solutions, easy to understand and use, even for non-digital natives.
  • It offers access across all popular platforms such as iOS and Android in addition to any computer or tablet. It has been particularly important for us to design with lower socio-economic groups in mind so - for example - dietary tracking can be done via simple photographs of meals rather than calorie counting. The same intelligence applies to the option of sending video messages as an alternative to text options in order to lower a barrier for usage.
  • Liva has established protocols to deliver appropriate levels of intervention based on need with specific emphasis around fluid, rolling engagement monitoring and to help service users get back on track and recover their progress if newly developed behaviours are disturbed. 
To find our more please visit: www.livahealthcare.com
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: 
Wellness and prevention of illness / Clinical trials and evidence / Digital health / Innovation and adoption
Benefit to NHS:
Tackling chronic diseases
Liva Healthcare tackles chronic lifestyle diseases such as Type 2 diabetes, obesity and heart disease by connecting patients with a personal health coach through an app to track and monitor the patient’s health goals. The app is based on strong evidence that has shown lifestyle interventions, delivered digitally, can lead to long-term lifestyle change. These changes can prevent the onset, and even reverse the diagnosis, of lifestyle diseases such as Type 2 diabetes.
 
Digital innovation for the NHS
Liva Healthcare helps NHS prevent Type 2 diabetes. The NHS chose Liva as a provider for the pilot of the digital stream of its Healthier You: NHS Diabetes Prevention Programme, whereby GPs can refer patients at risk of developing Type 2 diabetes to use the Liva app. Patients using this service have already been reporting weight loss of up to 14Ibs in weight in under 8 weeks, improved health and some are no longer pre-diabetic! 

Driving change through the power of relationships 
Liva Healthcare's innovative platform has been built with both patients and healthcare professionals in mind. For digital health to be effective, research has shown algorithms aren’t enough. Liva Healthcare’s service is built on the evidence that creating close relationships between healthcare professionals and their patients can lead to long-lasting behaviour and lifestyle change. Liva Healthcare’s technology therefore facilitates healthcare professionals in doing their jobs, rather than aiming to replace them.
 
Driving efficiency and patient outcomes
Liva Healthcare can demonstrate fantastic real-world results for patients and healthcare services.
  1. Liva Healthcare’s platform enables more patients to be handled with less resources. Using the Liva Healthcare service, health professionals are able to work with up to 400 patients without impacting patient outcomes.
  2. On the Liva programme, clinical research found Liva users maintained 7kg of weight loss after 20 months.
  3. The Liva Healthcare solution has been found to create €2,000+ savings in societal costs per year per diabetic.
Liva offers a turn-key solution with a flexible deployment approach adaptable to local CCG needs and requirements. 
 
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
The convenience of digital and powerful tech combined with the motivating power of frequent human-to-human interaction​.

Critical Success Factors in preventing Type II Diabetes

Patient-centric thinking to deliver accessible technology and expertise
It is in the experience of Liva that changing behaviour requires a patient-centric approach, hence why we have made this the primary goal of both the coaching platform and service user programme including the app. We find it of crucial importance to: -
 
  • Establish a relationship of trust and empathy between service user and health coach
  • Set realistic goals
  • Support continuous motivation
  • Provide supporting education
  • Ensure that all touch-points between service user and health coach are as simple and intuitive as possible. 
Liva has achieved success through refining and adjusting the programme based on clinical evidence, coach feedback and patient evaluation.  We base the programme and all of its interventions on the acknowledgement of the reality of people’s lives, working on their terms, not ours.
  • Liva’s design philosophy is about intuitive solutions, easy to understand and use, even for non-digital natives.
  • It offers access across all popular platforms such as iOS and Android in addition to any computer or tablet.
  • It has been particularly important for us to design with lower socio-economic groups in mind so - for example - dietary tracking can be done via simple photographs of meals rather than calorie counting. The same intelligence applies to the option of sending video messages as an alternative to text options in order to lower a barrier for usage.
  • The programme can be made available in any language for a diverse population wherey English isn't necessarily their first language
  • Highly trained lifestyle coaches are recruited to match the demographic area being served.
  • Liva has established protocols to deliver appropriate levels of intervention based on need with specific emphasis around fluid, rolling engagement monitoring and to help service users get back on track and recover their progress if newly developed behaviours are disturbed. 
Current and planned activity: 
Liva Healthcare - over the course of 16 years - has provided more than 140,000 service users individualised programmes for sustained, lifestyle improvement. Since July 2016, Liva Healthcare has established a UK presence, and formed an operational, nationwide network of health coaches with extensive experience of digitally-delivered behaviour-change techniques. In addition, Liva Healthcare is a proven solution provider for NHS England, Healthier you, Digital Diabetes Prevention Programme pilot. Currently bidding with face to face partners for the National Diabetes Preventon Pilot and continues to provide the lIva 
What is the intellectual property status of your innovation?:
Liva Healthcare has complete ownership and proprietary use of all:  
  • Technology 
  • Content
  • Evidence of cliincal outcomes in assocations with leading institutions.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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Simon Pickup 01/10/2018 - 16:14 Publish 1 comment
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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 / Wellness and prevention of illness / Digital health / Innovation and adoption / Person centred care
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
4.60 (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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Olivia Hind 23/02/2018 - 20:22 Sign Posted Login or Register to post comments
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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Michael Whitman 23/11/2017 - 16:32 Publish Login or Register to post comments
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Innovation 'Elevator Pitch':
Milestones DM2 combines nutritional and digital innovation to help people with T2DM lose at least 15kg of bodyweight, which will improve diabetes treatment targets, reduce complication rates and generate NHS cost-savings.
Overview of Innovation:
The challenge:
Diabetes costs the NHS £10 billion a year, approximately 10% of the entire NHS budget, much of which is spent treating complications that can be prevented through good diabetes control defined as achieving ‘treatment targets’ in blood glucose (HbA1c), blood pressure & cholesterol. Most T2DM patients do not achieve these targets, but weight loss can help.

NICE recommends T2DM patients with a BMI over 30kg/m2 be considered for bariatric surgery & that all patients referred to bariatric surgery enter a tier 3 weight management service to attempt medical management. However, provision of such services is variable & existing services are limited in accessibility & cost-effectiveness.



Our solution:
Milestones DM2 provides an effective alternative to traditional services utilising digital technology for a remote, high-frequency, multi-disciplinary service via initial face to face then phone calls, online learning and a smartphone app. This ensures lower delivery costs by not requiring continuous face-to-face clinics, increased accessibility and improved effectiveness as patients are provided with the high frequency support shown in clinical trials to be superior to low frequency care.
 
Milestones DM2 builds on evidence which has shown a medical weight loss programme using 8-12 weeks of 800kcal total diet replacement (TDR) followed by supported food reintroduction can achieve 15kg bodyweight loss, with 60% of those with T2DM for <4 years reducing and maintaining their HbA1c to <48mmol/mol at 9 months. **
 
As such, Milestones DM2 is delivered over 12 months by a remote multidisciplinary team (MDT) of diabetes specialist dietitians and nurses, along with psychologists, exercise therapists and endocrinologists.
 
The patient journey in 3 phases:

1. Eight weeks of an 800 kcal TDR (OPTIFAST® from Nestlé Health Science). Note that the option of intermittent TDR (2 days/week for 27 weeks) is available for those who cannot tolerate continious TDR (7 days/week for 8 weeks)
2. Four weeks supported food reintroduction
3. Nine months of maintenance
 
             

Patients receive weekly healthcare professional support throughout Phases 1 & 2 and then monthly during Phase 3. This is provided via phone calls and/or text and video support via the Milestones DM2 smartphone app (which can also be used for self-monitoring). The technology enabling remote care for Milestones DM2 is provided by Oviva UK Ltd, an SME focused on provision of digitally enabled dietetic services across 17 NHS CCGs.
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 / Patient and medicines safety / Person centred care
Benefit to NHS:
Alignment with strategic priorities:
 
Milestones DM2 is closely aligned to NHS strategic priorities, including the NHS England Five Year Forward View by reducing variability in quality and improving access to treatment in complex obesity. Furthermore, it helps drive significant efficiencies by ‘getting serious’ about preventing complications in obesity and diabetes such as heart disease and cancer, and innovates with a new model of care. Implementation will also support NHS commissioners and primary care to meet targets in the Improvement and Assessment Framework regarding diabetes treatment targets.
 
Improvement in clinical outcomes:
 
In its existing clinical services, Oviva UK Ltd, the provider of the technology and clinical services associated with Milestones DM2 achieves superior engagement from its high-frequency remote approach, with >90% programme completion rates. In turn, this achieves 7% bodyweight loss at 1-year in morbid obesity, vs. c. 0% in typical T3WM programmes. This drives improved management of diabetes, thus reducing patient risk of devastating complications such as amputation, sight loss and renal failure.
 
Cost efficiencies:
 
Frontier Economics completed a health economic assessment of potential cost savings for the Milestones DM2 programme, based on clinical outcome data to date. From this, estimated cost savings are at least £10,000 per patient in year 1 (through direct costs such as avoidance of bariatric surgery and reduced prescribing of medications), and £14,000 by year 5 (through indirect costs, such as service utilisation in primary, secondary and urgent care and treatment of complications).
 
Improved access and experience:
 
The remote nature of the service expands accessibility to patients that are less likely to access traditional services due to the time and cost required to attend face-to-face clinics, such as those of working age, people with caring responsibilities, mobility issues, or other characteristics associated with inequity in healthcare access – particularly as many existing Tier 3 services are only available on specific times of the day during the week. Mobilisation of the service includes engagement with ‘hard to reach’ groups, and Oviva’s existing services have uptake rates of c.90% and very low DNA rates.
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
There are an estimated 360,450 people in the West Midlands with diabetes, when adjustments are made for age, sex, ethnic group and deprivation. This is 8.1% of the adult population, higher than the average prevalence for diabetes for England of 7.4%.
 
By 2030, levels of diabetes in the West Midlands are expected to rise to 488,711 people or 10% of the adult population, compared with 8% for. However, 80% of all cases of Type 2 diabetes are preventable.
 
Diabetes has a huge impact on life expectancy, with Type 2 diabetes reducing a patient’s life by up to 10 years. Both patients and the NHS bear the brunt of this disease, with an estimated cost of £10 billion for treating diabetes.
 
The indirect costs of diabetes (such as increased mortality and morbidity, work loss and the need for informal care) are currently estimated to be £13.9 billion per year, rising to £22.9 billion in 2035/6.
 
Deaths from diabetes in 2010/11 are estimated to have resulted in over 325,000 lost working years.*
Current and planned activity: 
Our approach to engaging with the NHS & other stakeholders has been to focus on working with the AHSN network to help us diffuse our innovation & better understand the needs of local NHS commissioners/providers. Through Oviva’s role in the Diabetes Digital Coach NHS England test bed we are hoping to offer Milestones DM2 to a number of patients to further demonstrate impact & a clinical trial is underway at University Hospital South Manchester
 
Support sought

- Identify opportunities to offer Milestones DM2 to patients in the region in order to improve health outcomes & demonstrate cost-savings
- Learn from WMAHSN's LTC Network regarding their work on the use of telehealth & telecare & how we might engage with this work stream

The programme is flexible & can meet local/regional NHS requirements as well as complement established NHS diabetes & weight management services. Milestones DM2 is delivered by Oviva UK Ltd meaning minimal impact on existing NHS resources in terms of cost or staff time
What is the intellectual property status of your innovation?:
Nestle Health Science and Ovivia UK Ltd’s IP will be preserved.
Milestones DM2 is the intellectual property of Nestle Health Science.

OPTIFAST® is a total diet replacement (TDR) for weight control. It provides all essential nutrients for the day and is for use under medical supervision only.
 
It is available as three easy-to-prepare shakes (chocolate, strawberry or vanilla), and a vegetable soup. Each OPTIFAST® sachet provides approximately 200 kcal per serving.
 
OPTIFAST® is bound by the EU FSMP (Food for Special Medical Purposes) Directive 1992/21 EC and is subject to FSMP regulators. It comes under EFSA control and is nutritionally complete
 
Nestle Health Science adheres to the National Dietetic Guidance set out in the 1991 Dietary Reference Values (DRV) DoH publication.
 
Technology provided by Oviva UK Ltd complies with all NHS data protection standards, and has IG Toolkit level 2 accreditation. All clinical staff involved in delivery are registered with the relevant professional body (e.g. HCPC, RCN, RCP), and undergo NHS pre-employment checks.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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Peter Swales 14/09/2017 - 17:48 Archived Login or Register to post comments
Innovation 'Elevator Pitch':
The Sound Doctor is the leading source of film and audio patient information in the UK, offering a coherent and authoritative learning programme encouraging effective self-management of diabetes.
Overview of Innovation:
The Sound Doctor's unique self-management library includes 60 short films covering all aspects of living with diabetes. The material is of exceptionally high quality and offers a structured programme of education, which can be a lifelong companion for people living with the condition. 

The aims of The Sound Doctor self-management programme are:
 
1. To reduce the number of avoidable admissions (and readmissions) to hospital
2. To reduce the need for face-to-face contact with clinicians (and to improve the quality of meetings which do take place)
3. To improve medicines management and compliance with medications
4. To improve the quality of care for patients (and patient experience of their care)
5. To help people get the most out of life through effective self-management

The diabetes library
Developed after consultation with Diabetes UK, leading clinicians and patient groups, the films offer detailed and practical advice about diet, activity, medicines, blood glucose monitoring and many other aspects of living with diabetes. The material is motivational, positive and reassuring. We include interviews from healthcare professionals that people will come across in the course of their journey, including consultants, GPs, podiatrists, dietitians, psychologists, specialist nurses, pharmacists and Diabetes UK. There is also reassuring advice from people living with diabetes about taking day-to-day control.

Your healthcare team in your pocket, available 24/7. The advice you need when you want it.

The films specifically address the causes of diabetes, the long and short-term complications and risks and more than half of the films detail steps that people can take to take ownership of the condition, improve their lifestyle and reduce the risks of complications. A list of content is available.

The Sound Doctor has a proven and demonstrable role in improving self-management, and has been exceptionally well received by patients.

The films are extremely well reviewed by healthcare professionals and other experts and, in evaluations, users overwhelmingly report increased knowledge and confidence as well as fewer visits to the GP and fewer hospital admissions. We have evidence that people change their attitudes and behaviour towards diet and exercise. We also know that the films improve people’s satisfaction with, and experience of, their care.
The Sound Doctor is currently being used in a number of CCGs and Hospital Trusts around the country as well as community pharmacies.
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 / Person centred care
Benefit to NHS:
Diabetes costs the NHS £10bn every year – mainly due to complications which can be avoided or delayed through effective education. People with diabetes are more likely to be admitted to hospital and have longer stays.
 
Those with diabetes may see their healthcare team only once or twice a year so effective self-management driven by effective information is essential.
 
The Sound Doctor library is not an ad hoc series of films touching on a few subjects that might be of interest to someone with diabetes. It is a comprehensive, structured education programme that can be a companion for life.
 
An evaluation carried out in West Leicestershire in December 2016 among long-term users of The Sound Doctor found:
 
96% of users understood their condition better
98% learned new information about their condition
96% felt more confident about managing their condition effectively
88% had a better understanding of their medicines (10%not applicable)
93% have changed their self-management technique
98% found The Sound Doctor easy to use
99% found it a useful addition to their healthcare
 
Crucially:
 
92% of users reported fewer visits to their GP
62% said they had been to hospital less often
 
 
Why The Sound Doctor?
 
80% of the cost of diabetes is spent on complications. The Sound Doctor films aim to reduce the likelihood of developing complications by delivering effective advice on diet, activity, medicines management, blood glucose monitoring, HbA1c and other aspects of  self-management including specific films on looking after your feet and eyes that can directly reduce the likelihood of amputation and blindness. There are sixty films in all. 
 
Self-management is the key to reducing the costs of treating many long-term conditions in a testing financial climate. The Sound Doctor is a class-leading information product that can achieve this.
 
“The quality of the product is, in my experience, unmatched anywhere in the world.”
Dr Charles Alessi, Senior Adviser Public Health England
 
 ROI
 
Costs are reduced in various ways including GP appointments at an average cost of £25 and hospital admissions for foot ulcers and amputation, dialysis, cardiovascular disease, sight impairment and neuropathy. Other benefits are derived from decreasing the number of bed days in hospital and increasing attendance and productivity at work.

For more information please contact Rosie Runciman: rosie@thesounddoctor.org (Tel) 01285 850887
Website: www.thesounddoctor.org
Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
All the benefits outline above apply equally to the West Midlands population. This is a versatile and scalable product which has been adopted in several CCGs and hospital trusts around the UK. 

We are particularly keen to develop our product and produce new material for and in the West Midlands as a local company benefiting from the Serendip programme at iCentrum.
Current and planned activity: 
When funds permit, The sound Doctor intends to continue producing new libraries of films addressing other conditions. In particular we plan a comprehensive package of films covering stress, anxiety and depression; alcohol; further musculo-skeletal conditions and weight management.

We are open to discussion on co-producing further, localised material on diabetes to reflect the West Midlands population more accurately.
What is the intellectual property status of your innovation?:
The Sound Doctor owns all IP in all products. Material is generally licensed to clients on an annual or monthly basis (min 12 months) and allows access for up to 100,000 users
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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Dominic Arkwright 26/05/2017 - 12:15 Publish Login or Register to post comments
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