Oviva Diabetes Support & Prevention: person-centred, evidence-based remote services to prevent and treat type 2 diabetes (#2727)

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Idea Description
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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 / 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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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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Innovation 'Elevator Pitch':
OurPath is a 3-month online programme to help you build healthier habits and reduce your risk of Type 2 diabetes. We provide: health-tracking technology, personalised health coaching from a dietician 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 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 which would ultimately require increased GP time to manage.
OurPath provide a 12 week behavioural change programme for people at risk of, or already 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 10 others similar to the user)
• Personalised health coaching from a registered dietitian
• Tracking technology (smart weighing scales and a wearable activity tracker).

The programme is already being trialled as part of NHS England's digital diabetes prevention programme and across the extremely diverse area of 6 CCG's in North West London. Following positive outcomes data and feedback from the NWL team, we are looking to open up OurPath to the rest of the country.
We are proposing a pilot project to deliver the OurPath programme to 500 people at risk of developing type 2 diabetes in the west midlands. The project will demonstrate the outcomes of the OurPath programme in the local population in order to enable future widespread commissioning.

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 a rate of knots, around £1million per hour.
Clinicians have welcomed the recent focus on in-person prevention with open arms but the needs of their local populations are changing. They lead busy lives, work 9 to 5's and have children to pick up from school, making it difficult to attend face to face programmes. We intend to provide a solution for the NHS by offering easily accessible, online, 24/7 support from a registered dietician 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 reducing risk of type 2 diabetes. 
According to Diabetes UK research: for every 1kg of weight lost a person's risk of diabetes is reduced by 15%. This emphasises the need for prevention and adapting the current strategies to align with the evolving needs of local populations. Only by making prevention as accessible as possible can we hope to help patients make sustained lifestyle change a reality. This accessibility is something we have already demonstrated we address in our trial 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%. Compare this to the reported in-person programme attendance of 20-40% and for us, this is proof that digital works. Citing our research published in the Journal of Future Healthcare shows we have also demonstrated mean weight loss of around 8.1% of total body weight, and the preliminary weight loss and HbA1c outcomes from our real-world NWL trial are even more positive. 
Through reducing body weight and HbA1c levels we are drastically reducing the risk of type 2 diabetes. 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 estimate a return on investment within 2 years and savings for the NHS of £1000+ per patient over the following 5 years. 
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. The only silver lining to this explosion in type 2 diabetes is that it's entirely preventable through diet and lifestyle change. 
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. 
Reading through the West Midlands 2016 Pledges to Improve Local Diabetes Care Diabetes UK document shows the quality and commitment of the local health service. To quote one pledge: “Prevention, prevention, prevention! Better targeting of patients with impaired glucose tolerance (IGT) to help themselves where possible and improving access to lifestyle services when required”. OurPath aligns completely with this and is a proven lifestyle service, demonstrating improved outcomes and patient-self care in a real-world patient population similar to the West Midlands. We propose working alongside these passionate people at the clinical coalface, 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 projections for type 2 diabetes diagnoses 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 6 CCG's in North West London to trial the programme in patients already living with type 2 diabetes. In October 2017, Partha Kar, associate director of diabetes for NHS England, announced a local commission for OurPath to provide a pilot service to patients living in the Portsmouth area. On world diabetes day in November 2017 Simon Stevens also announced that OurPath was to be one of 5 digital providers offering a digital alternative to the in-person national diabetes prevention program (NDPP). Following great feedback from clinicians and patients, we have the ambition to roll out the programme nationwide for people at risk or already living with type 2 diabetes. We hope to work closely with the academic health science networks across the country to help achieve widespread lifestyle change across the UK.
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): 
2 years
Ease of scalability: 
Simple
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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Innovation 'Elevator Pitch':
Changing Health address signficant barriers to access by providing X-PERT diabetes education on line together with personalised evidence based telephone coaching to enable sustained behaviour change leading to improved clinical outcomes.
Overview of Innovation:

Changing Health offers the 1st evidence based digital education and personalised support programme for people living with Type 2 diabetes. Our digital diabetes prevention programme is currently under evaluation by Public Health England to be launched in September.

Our high quality service is based on evidence gathered from research led by Prof. Michael Trenell’s team at Newcastle University and the Newcastle Hospitals NHS Foundation Trust, conducted over 8 years and funded largely by the NIHR and MRC. This background has been licenced to Changing Health and combined with other state of the art structured education.

The service has been reviewed by NHS England Right Care, Public Health England, as well as other national stakeholders. Furthermore, it has undergone cluster based control trial, reviewed by NHS England and NICE, and submitted to be included in the first wave of approvals for mobile digital services.  Exclusive instant online access to X-PERT, the only Type 2 diabetes education programme proven to have clinically meaningful impact on weight and glycaemic control, together with ongoing learning via a referenced knowledge base. Re-designed for delivery through mobile and web apps, content is delivered in a variety of formats - including cartoon animations, interactive exercises and article text - supported by a personal coach.

Key features:
  • Evidence based behaviour change tools, including: the ability to create goals, make specific plans and self-monitor by tracking physical activity directly from the phone, record food intake, weight and other important data.
  • Communication with a personally assigned coach trained in evidence based behaviour change techniques, with the ability to book coaching sessions over the phone.
  • Online education modules in behaviour change for healthcare professionals, accredited by the Royal College of Physicians, equipping them with evidence based tools to help their patients better self manage. These modules are designed to be used alongside the aforementioned patient-facing tools, enabling HCPs to hold informed dialogue.
Recognising important cultural and linguistic diversity, Changing Health has collaborated with the South Asian Health Foundation and Diabetes UK to make services available in English, Punjabi, Gujarati (Bengali/Urdu dialects) and Polish languages.

The service is offered by the Modality Vanguard and is ready for wider adoption.



Evidence & Research
https://www.changinghealth.com/evidence.html
 
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 / Education, training and future workforce / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
Type 2 diabetes is characterised by progressive weight gain, driving the worsening of glycemic control. Changing Health directly targets this by providing evidence based weight management services through a digital platform. Excess weight is the greatest factor influencing the development of Type 2 diabetes, with over 80% of people overweight or obese. In the first five years post-diagnosis, a person with type 2 diabetes has a twofold increase in their risk of a stroke. They also have an ongoing risk of CVD twice that of a person without diabetes - and CVD is responsible for 52% of deaths in people with Type 2.

Changing Health’s service creates value for money by:
  • Delivering better health outcomes: Audit results demonstrate that X-PERT provides a sustained reduction in HbA1c (-6mmol.mol) and weight (-4.4kg).
  • Reducing spend: Over the first 6 months, X-PERT has been shown to generate an 8.3% reduction in prescribing costs equating to average savings in prescribing costs at £131,052 per 1,000 people attending, per year.
  • Improving care quality: Reducing variation in care through a standardised and proven approach, coupled with personalised coaching.
  • Opening access: Reducing barriers to access by making our services available anytime, anywhere, in English as well as the five most prevalent foreign languages.
  • Engaging patients in self-care: Providing patients with the education and tools to self manage their diabetes.
  • Supporting commissioning: Tracking outcomes easily and efficiently.
  • Providing the opportunity for effective investment of resources.
  • Supporting care teams: Providing evidence based online education modules, and freeing up healthcare professional time - such as enabling DSNs currently providing education to provide care and support to colleagues as well as patients.
  • Helping people early with their diabetes: The younger someone is diagnosed with diabetes, the greater their lifetime cost of their condition. This younger group are also more likely to access digital tools, creating an optimal method of engagement.
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Initial Review Rating
5.00 (2 ratings)
Benefit to WM population:
Public Health England estimate that there are 433,000 people with Type 2 diabetes in the West Midlands.

At current levels of attendance for education, there is a substantial unmet need addressed by our services for people with Type 2 diabetes. Today there is little, if any, coaching support to empower people to achieve the changes in behavious which are proven to improve outcomes. Changing Health offers the facility to address this need by substantially improving access: it has the capacity to do so across the West Midlands region.

Changing Health addresses signficant barriers to access of supported self management for patients with Type 2 diabetes, making information and evidenced based support available anytime and anywhere and in 6 languages, including 5 South Asian Languages (2 Bengali dialects, Punjabi, Gujarati and Urdu) and Polish. These will be phased in during the 4th quarter of 2017.

Changing Health is currently being used in Birmingham in conjunction with the Modality Vangaurd, working with the Connected Care Partnership https://modalitypartnership.nhs.uk
 
Current and planned activity: 
Changing Health's innovative service is currently deployed in 7 georgraphies including West and East London, Birmingham and Manchester.

Our prevention service is currently being evaluated by Public Health England and is expected to be deployed in September 2017.
What is the intellectual property status of your innovation?:
The intellectual property of our behaviour change techniqes has been licenced exclusively to Changing Health by the NIHR and MRC.

X-PERT Health has exclusively licenced its programme to Changing Health to be made available in a digital format accessbile via a mobile, tablet or computer.  
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
Regional Scalability:
Our ability to scale has been recently & satisfactorily tested by Public Health England. The digital elements of our service are designed for scale. We have capacity to provide personalised coaching services for up to 500,000 people.
 
Public Health England estimates 433,000 people with Type 2 diabetes in the West Midlands. At current levels of attendance of education, there is a substantial unmet need addressed by our services for people with Type 2 diabetes. Today, there is little if any coaching support to empower people to achieve the changes in behaviour which are proven to improve outcomes. Changing Health offers the facility to address this need by substantially improving access: it has the capacity to do so across the West Midlands. 
 
Together with Diabetes UK & the South Asian Health Foundation we are currently translating our modules into 5 South Asian Languages: 2 Bengali dialects, Punjabi, Gujarati & Urdu as well as Polish. These will be phased in during 4th quarter 2017
Measures:
Changing Health would report process and output measures:
  • Referrals received
  • Patients enrolling
  • Patients completing
  • Complaints received/resolved
  • Patients empowerment scores
  • Patient experience questionnaires
For people with Type 2 Diabetes would like clinicians to gather and report:
Weight and Hba1c at referral, after 6 months and 12 months.
 
The X-PERT reporting processes include other metrics including cholesterol and blood pressure. We’d welcome this being reported too.
 
The metrics for the Diabetes Prevention Programme are being developed by Public Health England. A substantial data set is already in place for the face to face programme. The digital dataset is yet to be determined. 
Adoption target:
433,000 people with Type 2 in WM. NICE/NHSE/DUK all advocate education and support with parliament stating that CCGs should plan for radical expansion and improved access.  The unmet need is substantial. As a digital and telephone service we can operate at scale. Capacity is likely to be set by the funding available.
 
Min level is 250 people per CCG
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Innovation 'Elevator Pitch':
MyDiabetesMyWay is a comprehensive self-management platform/ electronic personal health record, linking NHS data with home recorded data, empowering people with diabetes to take ownership of their disease, data and treatment.
Overview of Innovation:

MyDiabetesMyWay (MDMW) has been running since 2008 in NHS Scotland funded by the Scottish Government. It is a cost saving online web-based platform offered to all people with diabetes with over 35,000 registrants in Scotland. MDMW gives patients access to their institutional (NHS) health records, and integrates with home-recorded data, utilising algorithms and data linkage to drive highly tailored self-management advice and reports. MDMW has been evaluated with results published in peer-reviewed journals and is viewed as an international exemplar having won many quality awards including the European ehealth adopters award (2017), the Diabetes UK self-management award (2015) and a UK Quality in Diabetes Care award (2013). It has been shown to impact on clinical outcomes such as HbA1C and offers cost savings through reductions in complications and efficiencies in care for NHS providers. It is low costs - around £1 per diabetes patient (based on diabetes population size) per year licence cost, and can be rapidly scaled across regions and countries.
 
THE PRODUCT:
MDMW is a complete online diabetes self-management portal encompassing:
  • Around 200 digital educational resources (text, video, interactive content etc.)
  • Patient electronic health record access point (institutional NHS data)
  • Patient self-management decision support with data-driven tailored advice/web links
  • Personalised care planning documents
  • Personalised care quality reporting (against Diabetes UK 15 Care Measures)
  • Patient goal-setting tools
  • Communication tools; secure messaging with health care team, and peer discussion groups
  • Remote glucose monitoring support (allowing community upload and sharing of home blood glucose (sugar) readings and feedback (through integration with Diasend/GlookoTM).
  • External social media channels
  • Responsive and accessible web/mobile platform design
"Patient access to diabetes records through My Diabetes My Way has meant a step change in the care and understanding of my condition to a level that it has never been. I am much more in control of my condition but importantly I now understand the goals that I should be achieving and am able to have a constructive discussion with my consultant. "

MyDiabetesMyWay is now being rolled out in sites across NHS England.

www.mywaydigitalhealth.co.uk
www.mydiabetesmyway.scot.nhs.uk
debbie.wake@mywaydigitalhealth.co.uk
07904154101
 
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 / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
MyDiabetesMyWay is a novel patient facing intervention which can directly impact on clinical outcomes, quality of life, and improve efficiencies in service delivery. Diabetes is growing health problem with high treatment costs affecting 8-9% of the global population. Good patient self-management driven by education, empowerment and motivation is key to good outcomes. Diabetes spending will consume around 17% of the entire NHS budget over the next 10 years.  People with diabetes only spend a few hours per year with health care professionals. The rest of the time, patients self-manage their condition; includes blood glucose (sugar) monitoring, medication adjustment, appropriate daily foot care, weight management and correct dietary and activity choices. Self-management is key to reducing costly long-term complications such as ulcers, amputations, blindness, kidney disease, heart disease, stroke/ vascular disease, mental health disorders, sexual dysfunction and neurological complications. 
 
MyDiabetesMyWay delivers cost savings and  better outcomes for patients, it also improves data transparency for practitioners across primary and secondary care and can reduce the need for face to face education and consultation, improving efficiency in working practices. Regular knowledge updates, feedback on results, motivational support and flexible access to health care staff are key to supporting patients, reducing costly clinic visits, hospitalisations and death due to secondary complications, leading to longer healthier lives with significantly reduced costs.
 
Technology approaches in diabetes care work well, particularly if they are personalised. Low cost population based solutions are appealing in the current climate of rising prevalence on a shrinking NHS budget.  Long-term conditions management needs to evolve to reap the potential benefits of data driven approaches. There is massive potential for wider lifestyle/ home monitoring/ institutional big data analytics to drive push notifications and automated decision support in real time to patients, which could transform care delivery. Our product development supports this evolution.
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
MyDiabetesMyWay is a novel patient facing intervention which can directly impact on clinical outcomes, quality of life, and improve efficiencies in service delivery. Diabetes is growing health problem with high treatment costs affecting 8-9% of the global population. Good patient self-management driven by education, empowerment and motivation is key to good outcomes. Diabetes spending will consume around 17% of the entire NHS budget over the next 10 years.  People with diabetes only spend a few hours per year with health care professionals. The rest of the time, patients self-manage their condition; includes blood glucose (sugar) monitoring, medication adjustment, appropriate daily foot care, weight management and correct dietary and activity choices. Self-management is key to reducing costly long-term complications such as ulcers, amputations, blindness, kidney disease, heart disease, stroke/ vascular disease, mental health disorders, sexual dysfunction and neurological complications. 
 
MyDiabetesMyWay delivers cost savings and  better outcomes for patients, it also improves data transparency for practitioners across primary and secondary care and can reduce the need for face to face education and consultation, improving efficiency in working practices. Regular knowledge updates, feedback on results, motivational support and flexible access to health care staff are key to supporting patients, reducing costly clinic visits, hospitalisations and death due to secondary complications, leading to longer healthier lives with significantly reduced costs.
 
Technology approaches in diabetes care work well, particularly if they are personalised. Low cost population based solutions are appealing in the current climate of rising prevalence on a shrinking NHS budget.  Long-term conditions management needs to evolve to reap the potential benefits of data driven approaches. There is massive potential for wider lifestyle/ home monitoring/ institutional big data analytics to drive push notifications and automated decision support in real time to patients, which could transform care delivery. Our product development supports this evolution.
Current and planned activity: 
MDMW is currently deployed throughout NHS Scotland. MyWay Digital Health are now implementing in sites in NHS England, e.g. Somerset and NW London. We have been selected to be part of the NHS innovation accelerator programme (one of 11 innovations in NHS England) and the Digital Health London accelerator, bot of which are supporting adoption.

We are continue to develop the product include the addition of Artifical intelligence, decision support and a corresponding clinician platform through Innovation funding.
What is the intellectual property status of your innovation?:
Intellectual Poperty for MDWM is fully assigned to the company from the University of Dundee for exploitation
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
Regional Scalability:
Implemented at scale across NHS Scotland since 2008 (currently> 35,000 registrants), Implementing in Somerset CCG and across NW London STP. Working on applications in Greater Manchester and other areas
Measures:
Previous Assesment in NHS Scotland:

MDMW clinical impact has been assessed (April 2017) using time-series analysis comparing HbA1c of active users with those in the inactive background patient population (control cohort) matched by age, duration of diabetes, socioeconomic status and gender (7147 interventions (registrants and active users) vs 36020 matched subjects). My Diabetes My Way (MDMW) users demonstrated a sustained 4 mmol/mol HbA1C reduction. Further health economic analysis based on UKPDS complications models and £1 per diabetes population annual charge/ 5-10% registration, suggests a return on investment of around 6:1. User surveys; 90% feel MDMW supports diabetes knowledge, self-management and motivation.

Ongoing Assessment:

- Identifying strategies/ barriers for successful implementation and uptake.
- Gather feedback on new product feature to assist in ongoing product development
- Assess changes in health outcomes, complications prevention and health economic benefits 
- Assess changes in working practices/ care delivery efficiencies e.g. impact on consultation numbers, face to face education, unnecessary screening tests


*Outcomes will be added to the health economic model
 

 
Adoption target:
We would aim to offer to everyone in the region with diabetes and rapidly onboard 5-10% of the entire diabetes population in your area in the first 12 months. Our intervention USP is low cost and scalability (at no additional per person cost).
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