Continuous Remote Care: Enabling lifestyle interventions that last

Existing models of care often fall short in addressing what is needed to make lifestyle interventions work for patients with chronic illnesses. As an investor in Virta Health, we have been excited to see how the team continues to push the boundaries of virtual care to create transformational health and economic outcomes for patients and payers. In this piece, Dr. Robert Ratner, Chief Medical Officer of Virta Health and former Chief Scientific and Medical Officer of the American Diabetes Association, describes how continuous remote care helps sustain lifestyle interventions that lead to chronic disease reversal.

I’m looking forward to appearing with Dr. Ratner and other industry leaders as a featured speaker at Virta Health’s Beyond Telemedicine conference on September 29-October 1. Free to all registrants, the conference will explore the most pressing issues facing our nation’s healthcare system today, and how we can advance technology to make the greatest impact tomorrow.

By Dr. Robert Ratner, MD, FACP, FACE
Chief Medical Officer, Virta Health

Nutrition plays a critical role in management of type 2 diabetes. Done well, adherence to certain dietary patterns will help people with type 2 diabetes improve their blood sugar levels, perhaps to the normal range, and even eliminate the need for ongoing medication use.

In medical parlance, these dietary patterns are called Medical Nutrition Therapies (MNTs), and are considered first-line therapies for type 2 diabetes treatment by the American Diabetes Association, which I had the opportunity to lead for five years as the Chief Scientific and Medical Officer.

Virtually all people have tried some version of these MNTs to manage their diabetes. For those who do see early success, a specific problem arises, especially for those on diabetes medications. Success from a nutritional intervention leads to lowered blood sugar, and without adjustment of medications, induces a glucose plunge into the hypoglycemic range. This is a patient nightmare, and one of the worst calls a doctor can receive—that their patient has symptomatic hypoglycemia and is experiencing a life-threatening situation as a result.

The potential of hypoglycemia therefore becomes a negative motivator for both patient and provider to pursue lifestyle changes. It’s not surprising, then, that people with diabetes frequently claim that nutrition changes don’t work for them; after all, if they become hypoglycemic, the appropriate therapy is to eat more carbohydrate!

How, then, do we ensure that lifestyle interventions like MNTs are consistently followed to promote sustained health? And second, how do we safely de-prescribe medications when the MNT renders them unnecessary?

A Changed Care Paradigm: From Episodic to Continuous
Models of episodic care at brick and mortar clinics, and even most telemedicine models, fall short in answering these questions. The ongoing behavioral nudges required for sustainability and the proactive medication management for safety are unachievable with the limited interaction and clinical review between visits seen in these models.

Shifting our thinking to continuous, virtual models of care, however, opens a host of new possibilities for sustained health improvement. In fact, it is this approach—called Continuous Remote Care—that is the optimal way of instituting successful lifestyle changes, achieving weight loss, improving glucose control, and aggressively reducing diabetes medications to prevent hypoglycemia.

Although complex under the hood, Continuous Remote Care can be succinctly characterized in the following way:

• Patient biometric and symptom data are assimilated by AI-enabled clinical platforms to alert clinicians to those patients for whom medication adjustments or other interventions may be indicated.
• Technology enables frequent, two-way, asymmetric communication between patient and provider which creates the necessary conditions for cementing behavioral modifications.

Communication can be initiated either by the patient when concerns or questions arise, or can be driven proactively by the provider or coach based upon biometric data submitted from the patient remotely. For example, a patient who consistently logs low blood sugar readings might be contacted with guidance to lower a medication dose, or remove it altogether.

Continuous Remote Care in Practice
Virta Health provides one example of how different and effective this clinical model can be. In peer-reviewed clinical data, three out of four patients remained with Virta at two-years, and experienced nearly a one point drop in HbA1c (blood sugar) on average. Their diabetes-specific medications were cut in half, and the daily dose of insulin was reduced by 81% on average. Weight loss was 12% (30 lbs), with 75% of people losing and sustaining at least 5% weight loss, and more than half of people maintaining 10% weight loss.

Achieving these results requires a high-touch model—the Virta clinical team often interacts with patients multiple times per day. In fact, in Virta’s commercial population¹, the highest quartile of patients averages four touch points per day with their clinical team in the first six months of treatment. Days with double-digit interactions are not uncommon. Importantly, this communication can be initiated by the patient or by the clinical team, depending on the situation and need.

Models of Continuous Remote Care are designed to scale. They can optimize the frequency of care team-patient contact without overcommitting resources to patients easily achieving their goal, or withholding resources for those having more difficulty.

Additionally, the merging of medical and behavioral workflows means patients receive targeted care that takes multiple forms: nutritional advice, medication management, symptom management, encouragement, and much more. This combination makes safe, sustained outcomes, including diabetes reversal, possible.

Lifestyle interventions can be powerful therapeutics, but only if followed carefully. Models of technology-powered Continuous Remote Care open up this reality and create new opportunities in how we treat patients living with chronic illnesses.

Taking advantage of these opportunities is paramount if we intend to create a healthier society. The COVID-19 pandemic has exposed the fragility of our nation’s cardiometabolic health, revealing the stark limitations of episodic clinic visits, while also accelerating the implementation of telehealth visits. Let’s not repeat the limitations of the past by making telehealth episodic as well.

Footnote

¹ Virta’s commercial population includes patients offered Virta through employers, health plans, and government entities