The Wellthy approach to diabetes care

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This March, Mumbai-based Wellthy Therapeutics raised $2.1 million in seed funding, the first significant funding since its launch in 2015. The funding is proof that investors are willing to bet on its blend of health coaches, powered by AI, to coax behavioral changes in patients of chronic diseases. Does the startup have what it takes to make a real impact?

Abhishek Shah

It takes a village to manage an illness believes Abhishek Shah, CEO and Co-Founder, Wellthy Therapeutics. The statement is a nod to Hillary Clinton’s bestseller but that is exactly what Wellthy promises to do: build a virtual village around patients to help them defeat their diseases. As Shah points out, “Diabetes needs you to go beyond the pill or the diagnostic test.”

Described as an artificial intelligence powered software as a drug, this digital therapeutic company aims to solve better chronic disease management. The company blends Shah’s BS in Chemical & Biomolecular Engineering from Georgia Institute of Technology, with his family’s entrepreneurial background, to supply a solution to India’s growing disease burden linked to diabetes.

With fresh seed funding of $ 2.1 million from big names like Dr Ranjan Pai’s family office, Beenext Ventures, GrowX Ventures, Currae Healthcare and other strategic HNIs like Ashutosh Taparia and Karan Bhagat, Wellthy seems to have caught the rising tide of investor interest in health tech.

There is no doubt that diabetic patients in India need all the help they can get. With the breakdown of the joint family system, Indians are increasingly finding themselves coping with life changing diseases all on their own, without the traditional support systems of parents, grandparents. Patients find themselves coping with the stress of hectic work lives, unbalanced sleep schedules and no one to cajole them to change their lifestyles. The same is true for diabetics across the world.

Touted as ‘India’s first clinically tested diabetes ‘digital pill’ for physicians, by physicians’, the Wellthy Diabetes (WD) mobile app for patients with type II diabetes, was launched this February, at a conference held by the Maharashtra chapter of the Research Society for the Study of Diabetes in India (RSSDI).

Such interventions have made their debut in developed nations quite a while back and it seems India is catching up. In the US, WellDoc received FDA clearance of a non-prescription version of its BlueStar diabetes management system in January 2017, while FDA clearances for earlier prescription-only versions of the platform were received in 2010.

The field of prescription digital medicine in India is currently unregulated, and according to Shah, Wellthy will be working closely with regulators to regulate this new category. For now, the Wellthy Care platform and its Type II diabetes management programme have been endorsed as India’s first prescribable digital diabetes intervention by RSSDI.

The WD’s core differentiator

Consumers are spoilt for choice when it comes to health related app so what’s different about the WD app? Agreeing Shah says, “There are more than 300,000 digital health apps on the app store, and 3000+ just for diabetes.” Hence, his mantra has been about proving outcomes. “Only a handful of the available apps have shown and published real world clinical evidence. While most will choose fancy digital marketing and user acquisition strategies for downloads and upsell, the true digital therapeutics are focusing on outcomes and clinical evidence as their core differentiator.”

Shah explains that the launch came after they were able to prove outcomes clinically in their pilot programme. The interim results of this ongoing real-world pilot study showed that at the end of the 16 week programme, patients showed improvements in blood sugar control, measured as a drop in mean HbA1C levels (1.04 per cent), mean weight loss of 3.4 kg and savings of upto Rs.15,000 in diabetes-related expenses per year. Of course, there’s the mandatory caveat that results would vary from person to person, but these seem attractive outcomes.

These interim results have been presented at conferences as well. For instance, the 11th International Conference on Advanced Technologies & Treatments for Diabetes (ATTD 2018) this February, saw a poster board with the results of the study, ‘Effectiveness of a Digital Therapeutics for Improving Outcomes in South Asians Living with Type 2 Diabetes’. After a 16 week life style modification programme delivered through WD, the 39 participants reported a mean reduction of 0.61 per cent A1c post intervention. The paper concluded that WD was a clinically effective intervention for health insurers in South Asia to improve health outcomes and reduce risk for people with type II diabetes.

Besides RSSDI 2017, similar presentations have been made at International Diabetes Federation (IDF) 2017 and American Diabetes Association (ADA) 2017. Shah also informs that they are planning another trial, the #WeDiDiT (Wellthy Digital Diabetes Therapy) trial which is expected to start in H1 2018.

Getting on board WD

Currently targeting type II diabetes, doctors can now prescribe the WD app to their patients, who download it to smartphones. Once connected, patients sign up for a 16 week programme. Each patient is assigned a dedicated diabetes expert in addition to Carey, an AI powered health coach. Based on patient self-reported data on meals, blood glucose, physical activity and weight, the expert, along with AI augmentation like gamification etc, helps patients track and manage their diabetes better. Patients can chat with their personal expert and clear their diabetes-related questions and concerns, clearly something that they cannot do real time with their doctor beyond the consultation. (See screenshots from the WD app)

WD uses content developed along the guidelines of the American Association of Diabetes Educators (AADE) which had defined seven self-care behaviours (AADE7) as a framework for patient centered diabetes self-management education (DSME). Shah stresses that the interventions on WD, developed scientific collaboration with RSSDI, are customised for South Asians and this is crucial as the app marries global clinical protocols with knowledge of local food and life style habits.

WD is available on Google Play Store with limited access to some information. Shah specifies that the fully active version needs to be prescribed by a doctor, after which the patient gets a kit containing an activation code for the app, a glucometer with testing strips from a partner company. Shah emphasises that the app and the programme is built to augment and complement, not replace, the doctor’s role.

A win-win proposition …

The launch is typical of the cross sector collaborations that Shah has stitched up since he co-founded Wellthy in December 2015. He has worked in partnerships with stakeholders across the healthcare chain. Wellthy graduated from the Merck Global Digital Health accelerator, Swiss Re’ Global and ICICI Lombard’s Nova InsurTech accelerators. Though Shah doesn’t name names, Wellthy collaborated with an insurance provider for the study presented at ATTD2018 and hints that announcements are due with pharmaceutical and medical device companies as well as insurers.

As Shah puts it, “Every key healthcare stakeholder stands to benefit as patient outcomes improve. Our job is to help each one of these healthcare stakeholders improve their patient outcomes at an individual and at a population level and connect the dots between improvement in patient outcomes and economic benefit to the stakeholder.” While they have already achieved product market fit in this area, Shah promises that through 2018 more such partnerships will materialise.

Digital medical interventions promise benefits to each stakeholder. Patients could see better outcomes, quality of life, and  clinically validated tools to manage their care. All of which cold in time reduce spend on medication. Pharma and medical device companies get real world clinical evidence, better outcomes and  adherence. The Wellthy website has testimonials from both doctors and patients who were on the pilot trial. Shah refrains from spelling out details of his revenue model, only emphasising that, ”Wellthy is paid for positive outcomes.”

… with some challenges

But the benefits also come with some challenges in this nascent field. As Shah explains, “It’s a new category of medicine and it will take some time to generate and show clinical evidence. This makes patients and doctors less receptive to exploring this avenue and helping it find its place in standard healthcare. If the doctor is not convinced, you hardly have a chance of getting a patient to change their mind. So, you get a catch-22 situation: Because people are skeptical of something new and unverified, so to speak, they are hesitant to use it; but unless more people use it and more often, generating those trustworthy results is difficult.”

The second challenge is that in a digital market saturated with health and wellness apps, it can be daunting for a user to tell the difference between a “health app” and a prescription digital therapeutic like Wellthy. Because on the surface they appear to be the same, points out Shah.

But he is confident that these challenges can be addressed. “Trust and reputation come with time, perseverance and results. There are no shortcuts, he says.

“Providing clinical evidence is a must for any digital therapeutic that is serious about healthcare. Not only that, it must show clinically significant improvements, along with showing it repeatedly in real world settings. And clinically significant outcomes coupled with clinical evidence published in peer reviewed journals are the defining factors. Physicians, insurers, and pharma companies are wary of digital health products with tall claims and no data to back it up. And rightly so. Thus, demonstrating, with clinical support and evidence, what digital therapeutics are capable of is a necessary precursor to convince healthcare stakeholders,”he explains.

Beyond WD

A snowballing health epidemic, diabetes leads to other cardio metabolic conditions and chronic kidney disease. Shah says the $ 2.1 million seed funding will be used for product expansion – to further personalise the digital therapeutic for larger types of patient behaviours and expand the therapeutic portfolio across select cardio-metabolic conditions that are associated with diabetes. In fact, the next launch could be as early as May, though Shah clearly doesn’t want to spook things by giving too many details.

Also in the works is an extension of the skill building 16-week programme to a 36-week programme where the goal is to build habits. Wellthy takes forward the value proposition of  numerous chronic care clinics mushrooming in India and indeed globally. The challenge going forward will be to differentiate themselves from their peers. Not just to attract more funding but to also continue to get the buy in from doctors and show patients tangible outcomes.

Wellthy seems to have the right mix of scientific/ clinical expertise and business savvy. Let’s hope they can sustain themselves to the next level.