Virta Health CEO Sami Inkinen on changing patient behavior: 'We're cutting down trees in the wrong forest'

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Changing patient behavior is notoriously difficult. So when Virta Health released a study last March that found it could reverse Type 2 diabetes in some patients through dietary changes alone, the results were met with a healthy amount of skepticism. Participants had only been tracked for 10 months; even if the findings were replicable, could they be sustained long-term?

Earlier this month, Virta released its one year clinical trial outcomes. The answer, at least for the first 12 months, appears to be yes. Published in the peer-reviewed journal Diabetes Therapy, the study found that by the end of the first year, participants lost an average of 12% of their body weight and lowered their HbA1c from 7.6% to 6.3%. Sixty percent of participants were able to reverse their Type 2 diabetes and of the 30% of those who were on insulin, 94% had decreased their dosage or eliminated it entirely.

To be clear, the study wasn't perfect. It wasn't randomized, and of the 349 Type 2 diabetes patients who enrolled, 262 elected to be part of the intervention group that participated in Virta's program, leaving 87 who opted to receive typical care and treatment options. What's more, no socio-economic data was provided and the majority of participants were white.

Despite these caveats, the results were impressive. For Virta founder Sami Inkinen, they were further validation for his own dramatic dietary transformation. Inkinen was inspired to start the company, which launched last year, after realizing that despite being in peak physical shape, he was pre-diabetic. In response, he adopted a ketogenic diet -- low in carbohydrates, moderate in proteins, high in fat -- and watched his blood sugar normalize.

Virta Health is focused on helping patients manage their diabetes by transitioning to a ketogenic diet. (The most important tenet is to limit carbohydrate intake, which can cause glucose levels to spike.) To facilitate the shift, patients are provided with around-the-clock support team, which includes a health coach and a physician. Access to the platform, including all required equipment, costs $370 a month. (While a few employers cover Virta, it is not covered by any major health plans.)

The platform is designed to be personal, flexible, and adaptable. Close to real-time biometric data is collected via devices that record blood sugar, ketones, and blood pressure, which allows physicians to remotely manage medication, and patients understand how particular foods affect their physiology.

MM&M spoke with Inkinen about Virta's mission and why the company has been successful in changing patient behavior when so many others have failed.

This interview has been edited for clarity and length.

What is Virta's mission?

When we were starting the company, somebody told me that if we could reverse Type 2 diabetes for one year safely and systematically, that would be the biggest blockbuster drug in history. And that's what we set out to build with Virta: create a treatment that could reverse Type 2 diabetes.

What are the most important results from your one-year clinical study?

That we can reverse Type 2 diabetes and the results last past one year. The study also found that we reversed or improved four other chronic diseases associated with type 2 diabetes: blood pressure, heart disease, inflammation, and obesity. We estimated the medical and pharma cost savings at almost $10,000 per patient in the first 24 months, which is, of course, important in capitalistic society.

Are you in conversation with payers about covering Virta given the estimated savings?

There are a number of employers, including Nielsen and Purdue University, who already pay for Virta treatments for their employees. We have agreements with a couple health plans, although [payers] don't jump all at once.

In the study, 83% of participants remained on the platform after one year, and 60% showed hemoglobin levels below the diabetes threshold. Those are impressive figures. How did you achieve them, when so many other digital tools fail to change patient behavior?

Everybody else is cutting down trees in the wrong forest. People think the solution is known: to be healthy, you need to exercise more and eat less. You just have to figure out the right behavioral change trick to get lazy people moving. But that's not a solution.

The biggest thing I've learned is you have to address human biology directly and fix the biology with the right treatment. Then behavior change becomes more likely. You also have to deliver instantaneous results. Imagine that [you] try coffee for the first time in your life. You think, ‘Wow, this feels amazing.' What are you going to do the next morning? You're going to ask for another cup of coffee! Compare that to, if you drink something that makes you icky and horrible and someone comes and says, ‘I have this app that will remind you to take this icky and horrible thing every day for six months.' Maybe you'll take it because it promises to make you feel better in six months, but maybe not.

The most important thing is to deliver results that patients can fundamentally see.


Ok, but how to you achieve these results in a way that's sustainable long-term?

We have to get thousands of details right. Staring with, we do not fundamentally change someone's existing lifestyle or identity. Let's say we get a patient who is vegetarian for religious reasons. We do not tell that person to eat bacon and eggs for breakfast. We say, ‘ok you are vegetarian, that's great, let's run you through our individualized treatment while respecting decision about your lifestyle or religion.'

It's also about outcomes. With Virta, the outcome is not that you have a wedding in three months, and so you suffer until then to look great in the photos. The outcome is to make people feel better on a day-to-day basis, get them off their medications, and give them their energy back. If people feel physically better, suddenly what you ask them to do becomes a thousand times easier.

If you tell people to eat steamed spinach for the next three months, yes, you will probably be successful with 0.1% -- but not much more than that.

As part of the Virta program, patients have near-constant access to a health team that includes a nutrition coach and a physician. How important is this support system, and how frequently do patients rely on it?

Patients' frequency of interaction changes over time. For the initial few months, which we call the diabetes reversal phase, patients check in with their coaches more than once a day on average.

The ability to put our algorithms and doctors in the pockets of patients in a near real-time basis is hugely powerful. With software and machine learning, we can give superpowers to our team members. That's the beauty of having all the data from our patients in a digital format. We run our data models through each patient several times a day. We've built models that allow us to predict if someone is going to have issues or is more likely to drop out. Often times, these things are very counterintuitive. A high level of early success is not a good predictor of long-term success, for example. The data provides insights, we take them, and adjust our practices accordingly.

Are there any other foundational flaws you see in the way most companies and organizations approach changing patient behavior?

In healthcare in general, I would say companies are too focused on features and not sufficiently focused on outcomes. They're selling shiny objects. Step trackers and so forth deliver zero outcomes. It's a complete waste of money and it's a distraction.

Patients care about results. Our patients don't come to us and say, ‘how many times do you send me a reminder text message,' or ‘what does the user interface look like?' They come and say, ‘how quickly can I reverse type 2 diabetes and how will I feel? How much money will it save me?' I would want the healthcare and healthcare technology conversation to be much more about outcomes and real results. Everything else is just vanity.

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