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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
Liva Healthcare can reverse chronic lifestyle diseases, such as Type 2 Diabetes through digital lifestyle coaching. Liva is a hybrid model of technology and human intervention that drives long term behaviour and lifestyle changes
Overview of Innovation:
Founded in 2014, Liva Healthcare is an innovative digital health coaching platform for scalable lifestyle and disease management. 
Winner of 'Health IT Firm of the Year' at the HealthInvestor Awards 2018 and 'Healthtech Innovators of the Year - Europe at the Global Health & Pharma Awards 2018, Liva Healthcare is used by public healthcare, private insurance and pharma companies including NHS England, AXA PPP Healthcare and Copenhagen Municipality.
Liva Healthcare’s platform facilitates ongoing personalised health coaching through an intuitive app, building strong bond between coach, GP and patient. Its focus lies on tackling chronic illnesses, such as Type 2 diabetes, obesity and heart disease, by driving behaviour change.  
  
Currently being used in Denmark, UK and Sweden, the app is multilingual across several languages. It has proven to work efficiently across all socio-economic backgrounds and is capable of engaging groups normally hard to reach. It is based upon nine to 18 months of continuous patient engagement to make new habits and behaviours stick. One coach can manage 500 patients per year simultaneously without the loss of patient outcomes.
Implementation time from get-go is normally within weeks and the platform is available as a white-label SaaS platform, or as a turn-key solution, dependent on client specifications. 
Liva Healthcare has offices in Copenhagen, Denmark and London, 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)
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Innovation 'Elevator Pitch':
Liva helps people prevent and reverse chronic diseases and manage lifestyle challenges by scaling meaningful human relationships using technology. At the same time, Liva drives efficiency and reduces costs for healthcare providers and payers
Overview of Innovation:
Liva Healthcare is a proven solution provider for NHS England, Healthier you, Digital Diabetes Prevention Programme pilot. 
  • An advanced yet intuitive digital platform fully approved for use with the NHS (a service user app (front end), and a dashboard command (backend) for health coaches)
  • A patient centric approach in platform and programme design
  • An expert coaching team with significant experience in impacting lifestyle change
  • Individualised coaching services delivered predominantly digitally, but with a differentiating, relationship-building face-to-face Initial Assessment.
  • A structured education approach encompassing a modulated library of content with individualised lifestyle advise, provided by a leading general practitioner in diabetes management.
  • An evidence-based and approach to behaviour change and diabetes management.
  • Strongly governed clinically by frameworks and evidence-based care pathways. 
  • A proven and effective team of experts who ensure optimal standards of implementation.
  • An attractive solution that is economically sustainable with staged fee structures linked to continued engagement.
  • Clinically proven, with users maintaining 7kg of weight loss after 20 months and €2,000+ savings in societal costs per year per diabetic. 
  • Scalable and efficent with more patients to be handled with less resources. 
Liva has achieved success through refining and adjusting the programme based on clinical evidence, coach feedback and patient evaluation.  We base the programme and all of its interventions on the acknowledgement of the reality of people’s lives, working on their terms, not ours.
  • Liva’s design philosophy is about intuitive solutions, easy to understand and use, even for non-digital natives.
  • It offers access across all popular platforms such as iOS and Android in addition to any computer or tablet. It has been particularly important for us to design with lower socio-economic groups in mind so - for example - dietary tracking can be done via simple photographs of meals rather than calorie counting. The same intelligence applies to the option of sending video messages as an alternative to text options in order to lower a barrier for usage.
  • Liva has established protocols to deliver appropriate levels of intervention based on need with specific emphasis around fluid, rolling engagement monitoring and to help service users get back on track and recover their progress if newly developed behaviours are disturbed. 
To find our more please visit: www.livahealthcare.com
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Wellness and prevention of illness / Clinical trials and evidence / Digital health / Innovation and adoption
Benefit to NHS:
Tackling chronic diseases
Liva Healthcare tackles chronic lifestyle diseases such as Type 2 diabetes, obesity and heart disease by connecting patients with a personal health coach through an app to track and monitor the patient’s health goals. The app is based on strong evidence that has shown lifestyle interventions, delivered digitally, can lead to long-term lifestyle change. These changes can prevent the onset, and even reverse the diagnosis, of lifestyle diseases such as Type 2 diabetes.
 
Digital innovation for the NHS
Liva Healthcare helps NHS prevent Type 2 diabetes. The NHS chose Liva as a provider for the pilot of the digital stream of its Healthier You: NHS Diabetes Prevention Programme, whereby GPs can refer patients at risk of developing Type 2 diabetes to use the Liva app. Patients using this service have already been reporting weight loss of up to 14Ibs in weight in under 8 weeks, improved health and some are no longer pre-diabetic! 

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

Critical Success Factors in preventing Type II Diabetes

Patient-centric thinking to deliver accessible technology and expertise
It is in the experience of Liva that changing behaviour requires a patient-centric approach, hence why we have made this the primary goal of both the coaching platform and service user programme including the app. We find it of crucial importance to: -
 
  • Establish a relationship of trust and empathy between service user and health coach
  • Set realistic goals
  • Support continuous motivation
  • Provide supporting education
  • Ensure that all touch-points between service user and health coach are as simple and intuitive as possible. 
Liva has achieved success through refining and adjusting the programme based on clinical evidence, coach feedback and patient evaluation.  We base the programme and all of its interventions on the acknowledgement of the reality of people’s lives, working on their terms, not ours.
  • Liva’s design philosophy is about intuitive solutions, easy to understand and use, even for non-digital natives.
  • It offers access across all popular platforms such as iOS and Android in addition to any computer or tablet.
  • It has been particularly important for us to design with lower socio-economic groups in mind so - for example - dietary tracking can be done via simple photographs of meals rather than calorie counting. The same intelligence applies to the option of sending video messages as an alternative to text options in order to lower a barrier for usage.
  • The programme can be made available in any language for a diverse population wherey English isn't necessarily their first language
  • Highly trained lifestyle coaches are recruited to match the demographic area being served.
  • Liva has established protocols to deliver appropriate levels of intervention based on need with specific emphasis around fluid, rolling engagement monitoring and to help service users get back on track and recover their progress if newly developed behaviours are disturbed. 
Current and planned activity: 
Liva Healthcare - over the course of 16 years - has provided more than 140,000 service users individualised programmes for sustained, lifestyle improvement. Since July 2016, Liva Healthcare has established a UK presence, and formed an operational, nationwide network of health coaches with extensive experience of digitally-delivered behaviour-change techniques. In addition, Liva Healthcare is a proven solution provider for NHS England, Healthier you, Digital Diabetes Prevention Programme pilot. Currently bidding with face to face partners for the National Diabetes Preventon Pilot and continues to provide the lIva 
What is the intellectual property status of your innovation?:
Liva Healthcare has complete ownership and proprietary use of all:  
  • Technology 
  • Content
  • Evidence of cliincal outcomes in assocations with leading institutions.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
6-12 mon
Ease of scalability: 
Simple
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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.
Online Discussion Rating
5.00 (1 ratings)
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':
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':
Improve patient comms, increase PROMs returns, decrease DNAs, improve patient engagement
Overview of Innovation:
ADI's MyPathway platform connects patients to healthcare providers, to facilitate increased patient activation, informed choice, and participation in their own care; to help support behaviour change and adherence to treatment in conditions from MSK to diabetes; and to provide data-driven personalisation and optimisation of services. MyPathway is an intelligent patient communications engine that connects patients digitally to services. It delivers unprecedented levels of patient uptake and engagement by automatically orchestrating, tailoring and synchronising all digital interactions to each patient's clinical events, patient health data, etc. to give immediacy, relevance and value to each interaction.
 
http://mypathway.healthcare/short-introduction-video/
 
MyPathway has already been proven in Musculo-Skeletal (MSK) clinical applications, having been chosen in December 2017 by Sheffield CCG through an OJEU procurement as the preferred solution to serve all their MSK patients (47,000 referrals per year). It has been highly successful, with \>50% of all patients referred already using MyPathway. This has reduced admin costs within the MSK Single Point of Access by 12%, as well as reducing the average time between referral and confirmation of first appointment from 12 days to 5 days, and increasing the rate of PROM return from around 2% to 45%, opening the way to outcomes-based contracting and data-driven service improvement.
However, MyPathway is not specific to MSK, and its rules-engine based architecture means that it can be easily adapted by healthcare providers to any clinical need where digital patient engagement can help improve outcomes and/or reduce costs of delivery.
E.g. MyPathway is also being used by Leeds CAMHS service, and in Barcelona's Hospital Clinic in support of their "pre-habilitation" programme preparing people for elective cardiac surgery. ADI are also in discussions with Diabetes UK and the team responsible for the DiRECT diabetes programme who recently demonstrated that their structured, supervised nutritional intervention programme resulting in weight loss of \>10kg produces remission for a significant fraction of people with diabetes Type 2.
 
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: 
Mental Health: recovery, crisis and prevention / 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:
MyPathway helps improve communications with patients as they move through their treatment or between services. Keeping the patient informed of their care helps improve compliance, reduces DNA's and improves overall outcomes. 
MyPathway reduces the need for paper based communication therefore reducing administration processes, improving efficiency and saving costs on paper, printing and postage.
MyPathway enables improved data collection, which allows better reporting on an individual clinician level. This can help with performance management, reporting on service outcomes for ease of local auditing and demonstration of KPIs achievements to commissioners. The reporting engine can be tailored to each service's need 
MyPathway can be used across a wide variety of services and if a patient is being seen by more than one service they can view all services on one timeline. 
MyPathway also helps to reduce the waiting times for the patients, as administration is streamlined and as a combination of referral and fast digital PROM returns enable "right first time" appointments, making better use of clinical and patient time. The patient is also informed of progress along the pathway in a more timely fashion.

Information is easily and instantly shared to the patient, either by auto-trigger according to pathway requirements or pushed to the patient by the clinician via the clinical portal. This information could include maps to clinic locations, information about the clinic, the service or the procedure, self-help media and educational videos, information about the organisation, qualitative questionnaires such as Friends and Family Test etc.

MyPathway also supports Virtual Clinics, allowing patients to be assessed remotely, with f2f appointments only being made where necessary.

Digital information available on a portable device is available to service users at the touch of a button and increases their compliance with their rehabilitation, promotes and sustains lifestyle change and self-management if they live with a chronic condition. Improved self-management leads to wider health economic savings such as reduced GP appointments and reduced prescribing.

Results to date have shown up to 44% take-up of the digital option; PROM/PREM return improvements from <2% to 35%; reductions in patient processing time from 7 days to 1 day; reduction of patients in the administartive booking system from 641 to 58
 
Online Discussion Rating
6.00 (2 ratings)
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
MyPathway can help to keep the population of the West Midlands informed and involved in their own health. It will allow patients to hold a toolkit to their health and a one-stop visual record of their appointments and interactions with the service. 
Appointments appear in the timeline and give patient notifications and reminders to attend, links to addresses, contact numbers, booking systems, clinic and procedure information, maps and other useful information. This reduces non-attendance and makes it easier for those unable to attend to cancel and change appointments in a timely manner.
According to NHS England 6.9 million outpatient hospital appointments are missed each year in the UK, costing an average of £108 per appointment. Reducing DNA’s and short notice cancellations will enable services to be more effective, efficient, increase capacity, save money and ensure people complete their course of treatment.
Using MyPathway to support those who live with long term conditions gives them all the information needed to remind them how to manage their condition as well as the tools to track their symptoms such as blood pressure or blood glucose which will automatically feedback to the clinical portal for their clinician to use at their next appointment.
Wider economic benefits of improved health and sustained lifestyle change are well documented and MyPathway can play a key role in changing the dynamic of healthcare. Keeping the patient informed of where they are in the care pathway, engaging the patient by connecting them with their clinician or service, receiving pathway specific information and resources, patient reported outcome measures (PROMs) and allowing the recording of condition specific data such as weight, peak expiratory flow scores and medication usage etc. will allow the patient to understand and better manage their condition as well as being more engaged in their health. 
Current and planned activity: 
ADI have several digital products which are at various stages of commercialisation. MyPathway is currently deployed at scale, city-wide in Sheffield, with over 10,000 active users. Roll outs in North West Boroughs and Hospital Clinic of Barcelona are also underway. MyPathway is ready for wide scale roll out across a range of service areas, including Hepatolgy, Cancer Service, Fracture Clinics, Diabetes etc.

Our other products are:
PainSense: an online chronic pain management tool, deployed in Leeds and and nationally through Pain Management Solutions. Painsense is avialble for wide-scale rollout.

LMSU! (LetMeShowU): supports children & young people with severe disabilities (and their families) in communicating with their carers, peers, education providers etc. The App is in beta-test in Leeds and ready for other test sites.

StepUp! has been developed to support CAMHS services. Again in pilot in Leeds, we are looking for other CAMHS services who would be interested in testing StepUp!
 
What is the intellectual property status of your innovation?:
Advanced Digital Institute owns all intellectual property of MyPathway. Any third party licensing agreements for the use of information, questionnaires or outcome measures will incur additional costs. 
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
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