Diabetes is an epidemic, with tens of thousands of new patients developing the disease every year.
Perhaps more than any other condition, diabetes requires people to gather, monitor and understand statistics about their own health. People with type 1 and type 2 diabetes monitor their blood glucose levels, the results of their AlC tests, and the nutritional components of the food they eat. Many people who are newly diagnosed with the disease feel like they have been thrown into a new world of numbers.
But what if new solutions came along which, by gathering and communicating data, made it easier for people with diabetics to monitor and manage their health? What if instead of concentrating on numbers, people were freer to simply exercise, eat well, and focus on healthy behaviors?
John Brooks is the CEO of Healthcare Capital, LLC, a consulting company that advises companies that are developing advanced, disruptive health care solutions, especially for diabetes.
Over the years, John has co-founded seven life sciences companies, including Insulet, developers of the Omnipod® insulin-delivery device. He is also co-founder of Prism Venture Partners, a $1.25 billion venture capital firm. John has previously served as Chair and then President and CEO of the Joslin Diabetes Center, a Boston-based diabetes research, clinical care, and education organization. Earlier in his career, John was the Emerging Business Group General Manager at Pfizer/Valleylab, and President/General Manager at Pfizer/Strato.
Today, John is Chairman of the Board of Cellnovo Group SA, a French company that is developing pioneering systems for mobile diabetes management. John is also the Chair of Thermalin, a Cleveland-based company working on next generation insulin analogues and Chair of the College Diabetes Network, a non-profit organization that provides peer support to young adults with type 1 diabetes on college campuses across the US. He also serves on the board of Hygieia Inc., an Ann Arbor-based company that is developing new digital insulin titration systems for people with type 1 diabetes.
John’s achievements, impressive though they are, don’t tell the story of how he came to care so deeply about people with diabetes, or why he has devoted his life to combatting the disease. I am honored to share these excerpts from a conversation I had with him recently.
Kevin Pereau: How did you come to do so much to help people with diabetes?
John Brooks: My involvement began 25 years ago, when our three-year-old son was diagnosed with type 1 diabetes. At that point, I made it my life mission to understand as much as I could about diabetes, and to try to make an impact on the lives of people who were living with it. I have spent the last quarter century overseeing diabetes companies, investing in diabetes companies, advising diabetes companies, and founding them. I had the opportunity to run the Joslin Diabetes Center, and now I am on the boards of several companies in the diabetes space.
Kevin Pereau: There is so much happening with diabetes care. Where do you think the greatest potential lies to improve care?
John Brooks: I like to get involved in companies that have real transformative potential to impact the delivery of patient-centered diabetes care. The key issue is that we must confront the lack of effectiveness and efficiencies in the current health system and we need to make investment and improvements that will help us get ahead of the global diabetes pandemic that we are facing.
I focus on companies that have real disruptive capabilities and that are bringing new solutions to advance diabetes care.
Kevin Pereau: What important trends have you seen come along in the last decade?
John Brooks: I would be remiss if I didn’t mention Insulet, a company that a partner and I started. We were co-developers of the disposable OmniPod® device, which delivers insulin as needed, when needed. I am now building on that theme with my efforts at Cellnovo, where we can use Bluetooth and sensor inputs to support real time, “closed loop” insulin and diabetes care optimization. The data analytics/machine learning aspects of these systems will provide predictive and adaptive insights that will enable people with diabetes to live healthy and productive lives without the worry and hassles of today.
Now, we have wearables, sensors, novel delivery systems, “Internet of Things” devices, and all kinds of apps and solutions that can be used to help people manage chronic conditions like diabetes, and other co-morbidities such as heart disease. Yet to make progress we need to move beyond thinking that we can just throw technology at health care problems. In the pre-digital health era and even today, the doctor had only a short time to try to figure out what was going on with a patient. Depending on the kind of specialist that physician was, he or she would map out a care plan, write a prescription, send the patient home, and then schedule another appointment 90 to 120 days out. In the interim, there wasn’t a lot of involvement or interaction between the physician and the patient. Unfortunately, the next interaction could occur when a patient showed up in an emergency room.
That is now starting to change. Physicians are increasingly able to gain insights that have been derived from the ongoing data coming from their patients. There is more personalization. They can monitor patient activities, medication adherence, and then provide meaningful and timely feedback. If a patient is not taking their meds, or not taking the right amount of insulin, or not exercising, the care team and the family will know in real time and can provide feedback via a text message, an email, or a call from a coach. The cloud-based platform could also send an alert that goes to the patient’s family members.
What I like about the last 10-15 years is that individuals are being able to get recommendations and feedback, making it easier for them to engage more fully in managing their condition, but in a way that suits them. They understand they have a chronic condition and they want to know how to improve their health without having their condition overwhelm them. This is an entirely new way of getting better outcomes from connected care.
You know, when the health care industry started out gathering data, they thought that if they just pushed it out to doctors, clinicians and their teams, they would figure out how to use it to improve patient care. Now we know that will never work, and it will never result in better care. We are now able to gather data and turn it into what I call actionable, intelligible information that can help inform the patient and the care team. Thanks to artificial intelligence, the use of databases and algorithms, and other advances, care teams and health coaches are being alerted if they need to intervene in a patient’s care. Plus, there is the important psychosocial aspect, whereby the patient’s friends, family members and social circles get involved in helping the patient to do what he or she should.
We are beginning to understand how we’re going to achieve better clinical outcomes and by measuring them, these improvements will lead to cost savings, cost avoidance, and better overall care.
Kevin Pereau: Will the gathering of patient data lead to better outcomes not just for individual consumers, but also for groups of individuals who are dealing with diabetes and other diseases?
John Brooks: I was just reading about a pilot study that United Healthcare and Dexcom are about to do. About 10,000 people with type 1 diabetes will be given continuous glucose monitoring devices and their diabetes improvement results will be studied. It should be a real eye-opener. It will collect data about what happens to glucose levels when people in the study are sleeping, and what the effects of stress and exercise are. Patients will get a sense of, “this is me, and this is my personal disease,” and not something a patient never felt was relevant to them, based on general data or statistics.
We’re just starting to appreciate how we can use AI-enhanced technology to be far more proactive about helping to alleviate the challenges of people dealing with a chronic disease. We might even be able to start thinking about getting ahead of the curve by taking a more proactive role in helping pre-diabetic individuals; instead of making vague recommendations like “lose weight” or “eat less.” We will be able to identify people who have a genetic predisposition for developing diabetes and give them a wellness road map and recommend specific programs to encourage them to do the specific things that will help to prevent diabetes.
We’re just starting to understand and appreciate how to involve consumers, employees, patients, care providers, and communities to prevent and alleviate chronic diseases. We are starting to genetically flag if patients have a disposition to develop diabetes. The day will come when we will know which restaurants they’re going into, what they are eating, how much they are exercising, and have an opportunity to encourage them to do the things that will keep them well.
Kevin Pereau: That kind of proactive, preventative care is a far cry from waiting three months between doctor visits, and then discovering that something has gone wrong.
John Brooks: Yes, in the past we were applying an acute care model to a chronic disease. And as you know, chronic diseases are not best treated by a number of episodic meetings. With actionable, intelligible information, we are more able to help people deal with chronic conditions, 365 days of the year, 24/7. Yet we have a lot further to go. If someone is only seeing a care provider two or three times a year, we have the opportunity to do better and provide much better care. Remote monitoring, virtual visits, and smart devices and apps will make a real difference.
Kevin Pereau: I know that technology is changing fast, and everything we discuss today will probably change in a few years. Yet nonetheless, are there trends you would like to say are important?
John Brooks: As we have highlighted, technology is changing dramatically. You have Apple, Samsung and other consumer electronic or consumer-facing companies coming more into the diabetes space. We are seeing new apps and ways the Apple or Samsung Watch and mobile devices can be used. Google is developing miniature sensors that can be used to gather patient data. It seems that every major company is looking at the consumerization of health care, and Amazon has been suggesting that they want a greater role in health care. And clearly, more consumers are monitoring their health, exercise and diets and more on their smartphones. And storing and sharing data on the cloud is another part of it.
There is an opportunity to transform all this data into intelligence that can be used to help people be healthy. Digital health care is exploding. It seems like there isn’t a day that goes by when something new isn’t being announced. And more and more pharmaceutical, retail, payer, device, and provider organizations are recognizing that they need to be part of this revolution. They can no longer just think about where their customers are going to buy their next vial of insulin or strip. And the FDA is slowly but surely understanding that they must accommodate all these changes.
When you look at where my son started out with managing his type 1 diabetes, he was taking multiple injections of insulin daily. He was using meters that took about 30 seconds to do a blood glucose test. That was pretty challenging. We’ve come a long way, but we have a lot further to go. It requires thinking out of the box about people with diabetes and finding ways to help them during the course of their disease. And not just thinking that with a little bit of advice delivered once or twice a year, that patient is going to do a good job of managing a condition on his or her own. That was an approach that we can now improve with the appropriate deployment of tools, apps, solutions and devices, and the cloud, to help people over the rough spots and help them keep moving in the right direction.
Lilly just announced a strong desire to be in the digital, connected health space. Other drug companies are starting to realize that they need to provide complete one-stop solutions. They can’t just be thinking about selling a product. They are seeing that they need to help patients arrive at better care through cost effective solutions.
I believe that the providers’ economics, and how caregivers are compensated, should be focused on outcomes and on how well people are doing. We need to reward doctors for using digital tools. There are opportunities to engage patients at home, through telemedicine if you will, so we can allow people to be much more engaged in their health care but in a way that works for them.
Kevin Pereau: What do you think the larger impact will be of the merger between Aetna and CVS?
John Brooks: It could be transformative. When I had discussions with CVS many years ago, their plan was to have walk-in clinics that dealt with fairly minor issues. If somebody had a sore throat, had a rash, needed a flu shot, they could talk to a pharmacist or nurse practitioners at a CVS location. But I think the company now sees there is an opportunity to help people with chronic conditions including diabetes, congestive heart failure, and other long-term conditions. CVS may well be adding more health care professionals to their staffs.
If you think about diabetes, there are no “procedures” that need to be done, per se. Treatment is mainly about helping people understand the complexities of the disease and how various medicines, devices, lifestyle changes will help impact their condition. And we are discovering more and more that diabetes is not just about glucose. Thanks to the gathering of more data, caregivers will be thinking about sleep, stress, hormones, co-morbidities, and all the other factors that affect glucose levels.
It might be speculative but look at the transformation that Amazon has made in the retail space. A lot of people are thinking that similar changes are about to occur in health care, which has generally been behind the times. It was a major step forward to move from paper health records to computerized electronic health records (EHRs). We are now starting to ask bigger questions of the EHRs. In the past, the cardiologist would manage a patient’s heart disease and the endocrinologist would manage their diabetes. And now, thanks to sharing of patient data, there are a growing number of instances in which these specialists are talking to each other.
I love what I am doing. It is a great time to be in health care. I am encouraged by the fact that we are starting to embark on new ways to use analytics to drive real change, instead of just kicking the can down the road the way we have been in the past.
John L. Brooks III is CEO of Healthcare Capital, LLC, a consulting company that advises companies that are developing advanced, disruptive health care solutions, especially for diabetes. John has co-founded seven life sciences companies, including Insulet, developers of the Omnipod® insulin-delivery device.