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

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

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

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

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

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

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