The MM&M Podcast recently featured David Weingard, founder and CEO of Cecelia Health, who spoke about how digital health is powering pharma patient support. He also gave a preview of a panel he’s moderating on the future of value-based reimbursement at MM&M’s May 8 conference. The following interview has been condensed and edited.
Marc Iskowitz: Your company, formerly named Fit4D, appeared on our radar when you won MM&M’s shark tank at our inaugural MM&M Transforming Healthcare conference in 2015. You have a very interesting background in terms of how you got into the digital health and diabetes space. Tell us about that.
David Weingard: The day that Cecelia Health began as an organization was the day I walked into a doctor’s office with no energy. One hundred fifty-nine pounds on a good day, I was down to 129 lbs. and the doctor told me I had Type 1 diabetes. I have no diabetes in my family, I’ve been an athlete my whole life, and I was in shock and really needed help. I went to the local hospital whose next diabetes training classes were months away. There’s a lot of stuff on the Internet, but it really wasn’t personalized to me.
It made me realize that this great lady Cecelia, who gave me the personalized education, support, and compassion that I needed—wow, if we could scale her using technology, we could really create incredible change for the 30 million people in the U.S. and the half-billion in the world with diabetes. We’ve been innovating now for 11 years and, thankfully, have helped hundreds of thousands of people thanks to her inspiration.
Iskowitz: And Cecelia Health does tech-enabled, scalable, real diabetes care coaching for patients with diabetes.
Weingard: Yes, we engage with patients every day. Our clients include pharmaceutical and device companies whom we help solve for initiation, persistency and the brand experience, which results in improved patient health. And also, health plans or providers, which are struggling to achieve quality measures and lower costs. And they need a scalable way to engage with their patients to improve health and realize those outcomes.
Iskowitz: You mentioned objective measures that are going to help digital health gain traction. Along those lines, can you give us an idea of how the reimbursement picture for digital health has evolved over time, from when you first started to where we are now?
Weingard: We’ve seen tremendous acceleration in the payer market the last four or five years. We’ve also seen it on the other side for pharmaceutical companies. With risk being shifted to the health plans and to the providers, they need to solve for outcomes. There’s dollars at stake for poor quality measures. If a diabetes patient’s blood sugar is out of control, it not only costs the health plan and the provider money, but there are government measures called Star and HEDIS (Healthcare Effectiveness Data and Information Set), which are bonuses paid on the quality of service in the health of the patients.
And so, that really created a momentum within the industry for the health plans to look for outcomes. What creative ways can they adapt their current system and infrastructure to achieve better outcomes, improve quality, and lower costs? Every health plan that we work with has a rich care management and disease management program. They don’t necessarily have the depth of expertise around diabetes, which requires a lot of personalized intervention.
Diabetes is a job no one wants. Someone gets diagnosed or they get a poor blood sugar reading back from their A1C test, and they may or may not take their medication. Fifty percent of the patients actually drop off their medications in the first six months. They may feel overwhelmed and they may be in denial.
A lot of pharma companies are relying on an outdated model—having an agent who’s reading a script answer an inbound call. That’s not what patients are really expecting in 2019.David Weingard, Cecelia Health
That’s a lot of overhead for a provider who only has six or eight minutes with a patient. And for the provider to be able to let them know about Cecelia Health and for a health plan to be able to reimburse for that is a win for the whole ecosystem. It’s a win for the patient with their health and their sense of empowerment. It’s a win for the provider for their quality measures and the bonuses that they receive. And it’s a win for the health plan for quality measures and for also lowering associated costs.
On the other side of the market, the pharmaceutical companies and device companies… when we started working with them, they were basically engaging with patients through their websites and maybe some digital tools that are on their website. And they realized that that’s great, though it’s not enough.
There needed to be a personalized human interaction, because the people who were proactively coming to those sites and using those tools were the ones who are somewhat engaged, but 90% of the people are not engaged. They’re the ones walking out of a doctor’s office not understanding what to do with their medication or dropping off. And so, we add value by proactively reaching out to patients, building trust, educating them in a scalable way, and getting them to initiate and persist on the medication.
Larry Dobrow: You’re a decade into doing this. During this period, we’ve seen any number of health startups, both in diabetes and elsewhere, kind of surge for a little while and then–poof–disappear. What are some of the most important lessons you’ve learned and why has Cecelia survived where so many others have kind of petered out?
Weingard: That’s a great question, and I think first of all our mission and purpose. Our “why” is that we’re here to improve the people’s health with diabetes and associated chronic conditions, cardiovascular or obesity. And so, we come into work charged up to make a difference in the world and people come to our company to have an impact and do good, and help people every day. So having that core purpose has made a huge impact on our longevity, our growth, and our success.
The other part is that we’ve developed a culture that’s very results-based, efficient, and compassionate to our patients and partners. We go the extra mile for our clients and we work as a team, and that culture we bring alive—it’s not just on the wall.
We use it to make decisions every day. When people go through the interview process, they start to realize that we’re serious about it and they self-select whether this is something that excites them or something that they are not going to rise up to. And so, what results from this is an incredible team that is living a culture that is aligned with a purpose. And that, combined with a market trend where diabetes, unfortunately, is becoming—it already has been—an epidemic the last few years. The predictions are that one in three people in the U.S. will have diabetes in the next five years. So, those core values that we have as a company, our mission and then the market, which not for all good reasons, is growing, has really contributed to our success.
Dobrow: One in three is an incredible statistic. Along those lines and building on that last answer, how do you keep scaling this up? If the numbers are going up, so too is Cecelia, I would imagine. How do you keep growing this and how do you grow in a way that makes sense for the company and especially for its patient base?
Weingard: The core of what we do is bringing the power of the human touch to people. Because we realize that, again, a very small percentage of people will proactively use an app or technology on their own. And 18% of the people are costing 40% for the health plans. They need that human touch. So, we’ve invested for the past 11 years in our technology platform, also named Cecelia in her memory, where we figured out how to programmatically engage patients who are in denial and do it in a very scalable way, and also use the optimal mix of human and digital touch.
So, there are patients who need a lot of high touch, more telephonic or video, and some that can have an optimal mix of email, texts, and online support groups in addition to that personal touch. So, we figured out the cadence, we figured out the level of intervention of digital vs. human. We’re also applying real-time insights via machine learning, artificial intelligence to the hundreds of thousands of live recordings that we have of calls, so that we continue to optimize the patient engagement. So, again, it’s the human touch and the power of this clinical expert at the center, though behind the scenes technology is really driving our efficiencies and our outcomes, and our scale.
Dobrow: How big is the company now? How many people do you have under the roof?
Weingard: We’re closing in on 200 people now across the U.S. We’ve been live with English language since the beginning, and about four years ago we added Spanish language capability. Which means culturally sensitive Spanish language, so that we have more Mexican-Spanish in California, more Dominican-Spanish here in New York City, Cuban-Spanish in South Florida, and this year we added Chinese and Vietnamese, as well.
Iskowitz: And you mentioned that you work with several pharmaceutical companies and that the Cecelia Health platform is really embedded within a couple of their patient support systems.
Weingard: Right. It’s incredibly hard to figure out how to bring the human touch in a way that’s scalable and [retains] the multichannel aspects of the patient experience. And a lot of the pharma companies are relying on probably what are outdated models today, which involves having an agent who’s reading a script answer an inbound call. That patient experience is not what patients are really expecting in 2019. They’re expecting somebody to help them at a deeper level, build trust, help them in a journey. And they’re looking for guidance and support from the pharma companies, not only about the drug, but how they are going to lead a healthier life.
And we’ve heard incredible patient stories, some of them tearjerkers in terms of how people’s lives have changed. Because not only did they not take their medication, but they were lost. They didn’t understand what to do. And just talking to somebody who’s a clinical expert who’s not just reading a script, but really delving into what’s going on, what are the barriers, what’s happening in their world, what are the social determinants of health. That really has made all the difference and created an incredible brand loyalty for pharma, as well as business results.
Iskowitz: Having worked on the inside, providing patient support, what would you say is missing from a lot of patient support programs? How can pharma better address the social determinants of health?
Weingard: Well, it’s interesting. There seems to be a range of innovation vs. risk when you look at different pharma companies. And the marketing department usually wants to drive more patient interaction and do more innovative things, and then they have to put these concepts through the regulatory process. And different pharma have different rules and regulations about what you can say, what are the guardrails. And we found that over time, as we build trust with the pharma company and they see that the number of adverse events and the safety events are all within a tolerable level, that the wider conversation with a patient is a benefit to them.
They’re not only getting better business results, but the patients are happier. They’re finding the conversation more meaningful rather than, as we just talked about, just getting scripted answers. So, what we’ve learned with pharma is let’s start working together as a partnership, let’s show the value to the regulatory and compliance teams that the patients really respond positively. And over time start to widen the guardrails of patient engagement to include as much patient behavioral health or mental health as they are comfortable with so that they have a rich experience.
What’s also going to drive the acceleration of this is a lot of the risk-based contracts that have been coming out over the last few years where the pharma companies are on the hook for delivering outcomes for their health plans. It’s very hard to do that in a silo where I’m just looking at getting patients initiated and persistent, and at the end of three months I don’t know what happened. So, they’re really getting more and more accountable for value and for that they’re going to need to figure out—and we’re helping some of them figure out—how we widen those guardrails so that we can have richer conversations with patients.
Iskowitz: Speaking of an acceleration in value-based contracts, we’ve also observed a widening in terms of the breadth and depth of therapeutic categories that such contracts are expanding into. Touching upon other diabetes news, this week Eli Lilly is releasing an authorized generic of one of their insulins, and I just wanted to get your take on that.
Weingard: I can only commend Eli Lilly for what they’re doing. We have a big challenge in this country. The drugs are expensive, insulins are expensive, and without insulin people die; it’s that simple. So they’re taking an innovative step in providing an insulin that will keep people alive. It’s a complicated situation for them because they have an insulin portfolio and the other pharma companies have an insulin portfolio, and they need to regain the investment that they made in developing that portfolio. So, it will be very interesting to see how the landscape unfolds. In the end though, I’m a patient with diabetes and I applaud any company that’s going to go out of their way to look after the patient.
Dobrow: Your company came on the scene when digital health was nowhere near what it is right now. As we head into sort of an unofficial digital health season with our own Transforming Healthcare conference, South By Southwest, and even digital pharma get-togethers, give us your state of the union for digital health right now.
Weingard: It’s an incredible time for digital health. Not only do we have some of the innovation we were talking about and the economic drivers across payer and pharma, devices are becoming much more intelligent and connected to the internet. So, for example, in diabetes we’ve had insulin pumps for the last 15 to 20 years, now the data is being aggregated so that we can do a richer coaching and we can provide real-time insights to patients and the care team. The same thing with sensors—Dexcom, which actually will be a speaker at the MM&M conference, Abbott FreeStyle, and Medtronic all have sensors that read blood glucose data in real time, and that’s available to the coaching. And you may see in two or three years finger sticks about to go away.
Right now I went from four thousand times a year testing my blood sugar to zero. That’s a game-changer in my life. And Medicare just covered reimbursement for CGMs about a year ago. I think the health plans are just starting to catch up and realize this will be a health game-changer for their patients. And now they’re starting to realize the importance of getting these patients initiated and persistent on these devices. That’s the innovation piece.
As far as the conferences, four or five years ago there was a different pace than we have now of events every week in the digital space. We started off this year as part of StartUp Health at the JP Morgan Healthcare Conference, and 3,000 people came through the building over two days. It was an incredible experience—the thought leadership, and the energy that was there over two days.
And you see these events now, whether they’re in big cities like Boston or Austin or down here in New York City like the MM&M conference, they’re happening on a very regular basis and I think that’s only going to accelerate companies and people getting to know each other, figuring out how to work together, how to solve for the patient in an economically viable way.
Dobrow: Give us a little bit of a preview of the panel that you’re putting together for our own MM&M Transforming Healthcare conference.
Weingard: Well, true to some of the themes we’ve been talking about today, we’re actually going to have Novartis represent pharma there talking about the innovation and risk-based agreements that they can talk about publicly regarding their Entresto drug. We’ll have Blue Cross Blue Shield Horizon there as the voice of the payer, and they are very value-based and very forward-looking as far as how to manage risk efficiently and provide value to their providers. We’ll also have Dexcom who is a leader in CGM technology (continuous glucose monitoring). And then, of course, I’ll represent the Cecelia Health team, where we wrap the service around a lot of these different components of the system. So, we’re really excited. I think it’s going to be a great session talking about value-based care and models that work in the real world.
Dobrow: Which actually provides a lovely segue into our speed round and the last couple of questions for you here. Your health tech/digital health role model, who is it?
Weingard: I would say the StartUp Health folks right away come to mind. I think that they really pioneered and really thought about how to make health moonshots programmatic and scalable, and we’re just really pleased and honored to be part of their system. They’ve been great.
Dobrow: In your mind, what’s kind of the next big thing? Not just in diabetes treatment, but in digital health around diabetes treatment?
Weingard: What we’re seeing more and more is that diabetes can’t be treated in a silo. I talked to a chief medical officer and they’re interested in diabetes and obesity, and cardiovascular disease. They’re looking for those three…the most costly patient to be supported in a very streamlined and efficient way. So, although we do those three categories now as part of our basic “diabetes umbrella,” we’re launching cardiovascular- and obesity-centric patient engagement programs because the need is so high and it’s acute. The combination and the acceleration of people having these three conditions is really…it’s become such an important issue for CMOs and for providers.
Dobrow: For our final speed round question, we usually have one of our previous podcast guests suggest a question for you. In this case, Jeff Erb, who is the head of Healix, asks, what elements of your personal interest or background outside healthcare helps frame your perspective and approach within your career?
Weingard: I’m a triathlete. I’ve been a runner since I was 17, and I started doing triathlons about 22 years ago. And that takes a certain tenacity and organizational discipline to swim, bike, and run multiple times a week, and pull off these races. I liken starting Cecelia Health to the beginning of a triathlon where you just kind of jump off a boat and into the water. You just have to take the step and do it. So, I would say that that part of my life has really inspired me. And interestingly, my background in technology really helped realize what’s possible when you add the human touch through technology.
Dobrow: To extend the metaphor that you just suggested, if starting Cecelia Health was the start of a triathlon, where are you now? Are you running, are you biking, are you still swimming? Where are you in the next stage?
Weingard: There’s half a billion people in the world who need our help, so we are just at the beginning of the journey. Our dream is that everyone in the world will have access to coaching in a form that’s meaningful to them, whether it’s a human or an electronic touch that inspires them and empowers them in their day, because it’s tough. It’s a 24 by 7 disease, and people need that support, they need that empowerment.
Iskowitz: That’s a very noble ambition, and patients are lucky to have you leading this life-altering company that has their backs.
Weingard: Thank you.
MM&M Transforming Healthcare, which will include the aforementioned panel on value-based reimbursement, is coming up on May 8th in New York City. The Transformers and Catalysts Awards reception—honoring the Top Healthcare Transformers and Top 10 Innovation Catalysts of 2019—will take place the evening of May 7. Buy your tickets for the conference here and the awards reception here.