Value Beyond the Pill USA

Dec 3, 2014 - Dec 4, 2014, Philadelphia

2-day conference on how you can provide value beyond the pill in order to move from a product-focussed to a customer-focussed business

Smart inhaler initiative takes off

Digital health applications are beginning to transform the healthcare landscape. Nick de Cent talks to Boehringer Ingelheim's Larry Brooks and Propeller Health’s David Van Sickle about an innovative COPD project.

Propeller Health is one of the many specialist technology players that have really helped the digital health sector take off over the past couple of years. The company is collaborating with Boehringer Ingelheim as part of an innovative project that ticks several in-vogue boxes, including patient empowerment, a greater focus on patient outcomes, improving communication between patients and physicians, and generally providing a value-added service.

BI’s Director, Business Model & Healthcare Innovation, Larry Brooks is working with Propeller Health CEO David Van Sickle to address the needs of individuals with chronic obstructive pulmonary disease (COPD). The condition is a significant issue: according to the World Health Organisation, this chronic and debilitating disease affects some 65 million people worldwide; currently responsible for 5% of all deaths globally, COPD is on track to be the third leading cause of death globally by 2030.

Not surprisingly, rival pharma companies are vying to produce a cocktail of drugs that will help control the condition effectively. Just as importantly, however,any potential solution needs to consider the way the medication is delivered. Then, issues such as adherence, timing and frequency of medication and dosage come increasingly into play.

Better quality of life

Digitizing the delivery mechanism opens the door to such possibilities along with avenues of research that were previously closed. According to Van Sickle, the combination of a smart inhaler fitted with sensors, mobile apps and a care team dashboard for tracking medication use and other risk factors not only reduces the cost of care, it also delivers better quality of life for individuals with chronic respiratory disease.

“We’re really excited to partner with Boehringer Ingelheim to bring these tools to people with COPD,” Van Sickle tells eyeforpharma. “There’s a lot of opportunity to provide meaningful support in their daily lives.”

The new digitized Propeller sensor for BI’s innovative soft mist inhaler incorporates quite complex technology – the kind that you might find in your smartphone, Brooks explains. “A special tube goes on the bottom part of the existing inhaler. It has a microphone that listens for the click as you turn the device; an infrared sensor detects movement, while an accelerometer lets the device know when it has been picked up. The three datapoints triangulate and detect inhaler actuation.”

Combine this sensor with a Bluetooth connection and the GPS capability of today’s smartphone, and you have a system that is able to track the time and location when patients take their medication; it gets even smarter when you also include further relevant data such as real-time air quality and weather stats from The Weather Channel. As with many other digital health applications, users can check their progress via an app, which encourages them to adhere to the medication regime; moreover, because patients are better able to monitor their condition, they can potentially avoid attacks and hospitalization.

The system can also foster better communication between physicians and patients: while the app improves self-management, thanks to the dashboard the doctor can, when necessary, also have a “frank and quick conversation about risk and impairment and how therapy might be adjusted to ensure that treatment is helping to relieve symptoms and improve quality of life", Van Sickle explains.

Furthermore, better health outcomes also mean reduced costs for payers. By digitizing the inhalers and turning them into smart devices, Propeller helps care team members look after more patients, improving efficiency. “We can help care managers and physicians quickly identify people who aren’t doing well".  The system provides the appropriate, proactive alerts but, conversely, also identifies when a regime is going well.

Research potential

We expect to gain novel and meaningful understanding of community patterns of respiratory diseases and to put that information to work in the future".

There are potential research benefits too. “Certainly a lot of data will come out of it,“ Brooks indicates. He suggests that data from the devices can be merged with more granular weather patterns, pollen counts, and immunology data to build up a comprehensive picture of the factors that influence COPD. Propeller captures this information through its partnership with The Weather Channel and is also looking at more detailed personal air-quality monitors in a project with the City of Louisville.

Van Sickle adds that the device can facilitate clinician research in terms of outcome measures. “We expect to gain novel and meaningful understanding of community patterns of respiratory diseases and to put that information to work in the future".

At the same time, the development team has been mindful of the need to ensure that the modified inhalers are easy to live with and so don’t discourage individuals from using them. Van Sickle acknowledges that a key design challenge was to “add electronics to an inhaler without changing the patterns of use” – a challenge which Propeller has successfully met and for which they received FDA clearance. Moreover, he is confident that the team has “met the design challenge regarding durability.”

The business arrangement between Propeller and BI has not been disclosed but, pending clearance of the system from the Food and Drug Administration, the companies anticipate going to market in early 2015.

The potentially sensitive nature of the data collected by the device means that there are privacy issues. The patient must be in control, Brooks insists.The current Propeller system is offered to individuals by their payer or physician, and each person has the choice of whether to share their data with family and their care team, and whether to contribute anonymized data to the community at large. Importantly, users will also have the option to turn certain features on or off – for instance, a patient can easily switch off thecollection of location data within the app. From a pharma perspective, the data is aggregated so companies are not looking at patient-level data.

Innovation team

So how did this ground-breaking project arise? Brooks is part of the Business Model & Healthcare Innovation team at BI, which looks at everything non-molecular. “It’s exciting,” he enthuses.

“Our group is charged with testing novel technologies to support our prescription medicine business in the longer-term.” The team has been around for three years.“We’re a small entrepreneurial group split between our global headquarters in Ingelheim, Germany and our US operating unit in Ridgefield, Connecticut.”

The group works with external collaborators on the majority of its projects – 90-95% are with companies that have an interesting new technology or approach. “A lot of companies we work with are start-ups but we also work with established companies. We don’t do too much in terms of developing on our own,” Brooks says.

The team works on small-scale pilot to validate new approaches. “Can we even get it to work?” Then they look at the business impact.

Brooks and his colleagues started talking about the inhaler project – which fits in with the organization’s adherence management program – in early 2013. The team is also looking at clinical decision support and mobile health.

“We’ve probably launched about 25 different projects in the past three years; some failed; some are on-going and some scaled. We talk to other pharma companies; this area is much more collaborative. We review what other peer companies would do; there are different approaches.”

So how does this cutting-edge group measure its success? They’ve borrowed a metric from the venture capital (VC) community: the number of projects that transition and scale to an internal group is an “exit.”

“The motivation is to select companies that have potential to impact the core business and validate this assumption via a pilot. If an idea is a ‘no-brainer’ they don’t need us.” The group operates like VCs but there is less due diligence; it’s “more of a learn-by-doing function,” Brooks suggests. However, it’s “not such a high-risk investment as an equity investment.”

Developing market

Brooks explains that the group was set up as a reaction to changes in the market: “external environmental factors – consumerism, standardization of care, fragmentation, the emergence of health IT in general, and the recognition that even in a pharma company we need something more holistic than just a drug alone.”

This need to adapt to market conditions has more generally helped drive a change in attitudes from pill-centricity to a wider move to sell outcomes. It has been no different for BI, Brooks acknowledges.

Looking forward, Brooks predicts that outside players will be disruptive to the current pharma commercial model. In particular, consumerization of healthcare will shape the landscape with telecoms and consumer-focused companies coming together to deliver “connected care.”

What will the landscape look like in five years’ time? “Everything in healthcare is very slow. Will it look radically different? Probably not in five years. However, consumer products will eventually merge into healthcare. This will transform how healthcare is delivered and managed outside the physician’s office,” Brooks concludes.

While many in pharma are waiting in the departure lounge for digital health to take off, some have yet to check in. Meanwhile, innovative projects like BI’s COPD initiative are already taxiing down the runway. Before long,pharmawill be facing its final call to get on board with digital.

Larry Brooks is Director Business Model & Healthcare Innovation, Boehringer Ingelheim and will be presenting at Value Beyond the Pill, USA 2014, December 3-4th, Philadelphia. For more information on his presentation, click here.

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Value Beyond the Pill USA

Dec 3, 2014 - Dec 4, 2014, Philadelphia

2-day conference on how you can provide value beyond the pill in order to move from a product-focussed to a customer-focussed business