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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
Digital behaviour change platform for people with type 2 diabetes and prediabetes providing goal-focused education, personalised resources and support to implement a lower carbohydrate lifestyle.
Overview of Innovation:
The Low Carb Program is an award-winning digital health intervention for people with type 2 diabetes, prediabetes and obesity. The Low Carb Program provides the education, resources, and, most importantly, support required when reducing the amount of sugar (or carbohydrates) in the diet.

The platform is available in the NHS Apps Library and is an NHS Innovation Accelerator Fellow for 2019. The platform is QISMET approved to be provided as structured education for people with type 2 diabetes and prediabetes.
The platform comprises:
  • Education: members participate in a core 12-week structured therapeutic nutrition and wellness program, personalised to disease type and profile
  • Community peer support with over 400,000 members
  • Behaviour change mentoring, goal identification and setting
  • Library of personalised resources, including culturally-specific meal plans, food swaps and over 1,000 searchable recipe ideas
  • Data insights and AI-led feedback to support sustainable behaviour change
The Low Carb Program was developed with Dr David Unwin in 2015 (NHS Innovator of the Year 2016, RCGP National Champion for Collaborative Care in Obesity and Diabetes), and the feedback of 20,000 people with diabetes.

DDM is conducting a three-year study on a randomly selected cohort of people who joined the Low Carb Program. One-year outcomes have been published in JMIR Diabetes with two-year outcomes are currently under review. The first evidenced benefit is a 71% platform retention at 1-year, which is unrivalled for any digital platform. Engagement within the platform is critical as without engaging users, behaviour change is not possible. The retention evidenced by the Low Carb Program is pioneering.
For people with type 2 diabetes who complete the platform, outcomes are:
  • 7.4kg weight loss
  • 13mmol/mol HbA1c reduction
  • 39% place HbA1c under type 2 diabetes threshold, with 26% placing type 2 diabetes 'in remission'
Remission is defined as an HbA1c under type 2 diabetes threshold and on no medication or metformin only.
In addition, to this:
  • 40% of people on medication eliminate at least one treatment from their regime
  • 60% of people on insulin eliminate or reduce it from their regime
The Low Carb Program has tiered licencing costs, with a patient licence cost of £90, which lasts 3 years. Given the affordability of the platform the Low Carb Program offers significant cost-savings from the perspective of reduced medication through improved patient health and reduced GP burden.
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)
Similar Content3
Innovation 'Elevator Pitch':
Oviva Diabetes Support and Prevention are QISMET-accredited education and behavioural change interventions for people with or at risk of type 2 diabetes, which have demonstrated signficant improvements in uptake and clinical outcomes.
Overview of Innovation:
Oviva’s services for people with or at risk of type 2 diabetes are now available in 18 CCGs across England, and have demonstrated improved uptake and outcomes in comparison with traditional models of care.

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

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

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

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

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

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

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

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

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

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

Oviva is keen to explore opportunities for adoption of our service in the West Midlands.
What is the intellectual property status of your innovation?:
All intellectual property is owned by Oviva.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
Read more
Hide details
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
Read more
Hide details
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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