How [Lark is] Leading Chronic Disease Management and Prevention [and] Disrupting the Diabetes Space
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Interview with Cameron Jacox, Vice President of Growth at Lark Health
There are hundreds of millions of patients globally suffering from chronic diseases with millions having prediabetes and just a small percent of those being aware of their health condition. According to the Centers for Disease Control and Prevention, just within the USA, six in ten Americans live with at least one chronic disease and 90% of the nation’s $3.3 trillion in annual health care expenditures are for people with chronic and mental health conditions.
Preventing illness and reducing the risk of getting a chronic disease is possible through lifestyle changes. Obesity and excessive weight are linked with a wide range of chronic diseases, such as diabetes and hypertension. Healthy eating and physical activity, for example, can help a patient hold normal blood sugar levels or prevent type 2 diabetes. In the global digital health market, some healthcare providers work with payer organizations to push digital services to address this increasingly costly chronic diseases burden.
What are the key drivers for success in this market? Who is paying for digital health preventive services? What are the trends in the digital chronic conditions / diabetes management area of the future? Can AI health coaching and a personal nutritionist in the pocket help one improve health outcomes and stay healthy?
To dive deeper into the digital chronic diseases solutions market and to discover the market readiness for diabetes prevention services, we talked to Cameron Jacox, Vice President of Growth at Lark Health – one of the global leading chronic disease management and prevention platforms.
Enjoy the interview.
Research2Guidance: As a short introduction to Lark Health, could you please share the story behind it and what is the service offering?
Cameron Jacox: Lark Health is the leading personalized chronic disease management and prevention platform in the world. The combination of cutting-edge AI health coaching with behavior change design and smart connected devices to manage diabetes, hypertension, anxiety, prediabetes, and smoking cessation, creates the most cost effective, scalable, and personal chronic disease management solution.
The company was founded in 2012. Close to 4 years were spend on R&D and today, Lark Health is the fastest growing company in the diabetes and hypertension disease management space, as well as the 2nd largest diabetes prevention program provider in the USA. We’ve helped over 2 million members lead healthier lives while managing their diseases.
Research2Guidance: What is your business model and how do you engage with users/customers?
Cameron Jacox: Lark’s business model is B2B2C. Our primary customers are health plans, PBMs, and large, self-insured employers. We’re there for those companies looking to manage the costs associated with chronic conditions and help their members live healthier lives.
At present, we work directly with 3 of the 6 largest health plans in the USA, and all together with 11 health plans. Our digital disease management platform is also used by more than 200 employer groups. Over 2 million people over the last 5 years were engaged with our 1-to-1 AI health coaching and devices. The 24/7 health monitoring helps us deliver an evidence based, personalized care experience to every Lark user.
We offer value-based performance pricing, so we only get paid if members engage and achieve better health outcomes. To get a better understanding of our reach – Lark’s health coaching and connected device clinical programs (prediabetes, diabetes management, hypertension management, weight-loss, smoking cessation, etc.) combine hardware, software, and coaching as a covered benefit for over 10 million consumers in the United States.
We have different partnerships that could also allow consumers to self-pay for our digital solutions and / or ask if their health insurance can cover it. A good example of this is our partnership with 23andMe which is a direct to consumer company and has about +4M clients. We have integrated genetic test results as it relates to nutrition and food sensitivities, as well as other markers into our diabetes prevention coaching, making it hyper-personalized and even more effective, as upcoming studies will show.
Research2Guidance: What is your value proposition and how it differs from your competitors?
Cameron Jacox: Our main competitors are Livongo and Omada, yet we differ quite dramatically in the fact that we take a fully integrated approach with clients. We integrate into their care management systems rather than acting as standalone siloe. We also limit the extent to which we charge for outsourcing human capital such as health coaches and nurses when clients already have them on staff. We take a much more technology forward approach to utilizing conversational artificial intelligence instead of relying so heavily on scaling up human coach-based call center models. So while our outcomes are typically equivalent or superior across programs (namely Hypertension, Diabetes and Prediabetes), our overall model is much more collaborative, integrative, and flexible.
When it comes to Lark’s value proposition, we understand that managing chronic conditions, especially diabetes, is hard, and so for us there are a couple of key components:
- By using our mobile app, connected glucometer, and unlimited strips, members are able to chat 1-to-1 with Lark any time of day and get guidance on nutrition using voice enabled feedback through the phone and get insights on their meals, tracking activity, stress and loneliness, in-depth medication adherence which means tracking / analyzing the data and making sure that our users are taking their medications and number of other things, especially blood glucose. Our latest data shows a 1.1 point reduction in A1c among members.
- Lark’s data scientists have built technology that hyper-personalizes the chronic care experience; for instance, the coaching finds correlations between all the above-mentioned factors to help better understand the members’ health over time. And the more one interacts with Lark, the more personalized evidence-based disease management or prevention program is offered to the user/patient. For example, one member may be much more sensitive to being sedentary for a period of time in terms of blood glucose being in control, whereas another member may be much more sensitive to the food he/she eats. So, the system starts to learn and compassionately coaches the members to make decisions that will help them live healthier and happier lives.
Research2Guidance: Besides diabetes care, Lark has a prevention diabetes program, hypertension care program and wellness. Do you have a different business model and strategy when it comes to targeting people with prediabetes / undiagnosed patients?
Cameron Jacox: First of all, in the US alone there are tens of millions of people with prediabetes, but only about 12% are actually diagnosed through a blood test, so most people are not aware of their health condition. At Lark, we are very good at enrollment, marketing and making people aware of the health risk. We offer a risk assessment which has about 12 questions related to family history, weight, etc.
In the last year alone, we have assessed more than 500,000 people for prediabetes, including through our 23andMe partnership. We can enroll those people directly into our program if they are at risk. The core message here is “you can prevent diabetes” and it’s a powerful one.
Research2Guidance: How do you reach out to undiagnosed patients?
We partner with national pharmacy chains and we work with pharmacists to educate the patients when they are picking their medication. We also partner with 23andMe, so all 4M of their customers received a new prediabetes risk score and they are given a next step to take an action, which is to use Lark. We also do advertisements and other things like that.
For prediabetes Lark is a covered benefit and it is covered by several health insurance companies. The member can check their coverage once they determine that they are at risk.
Research2Guidance: You have mentioned behavior change as part of your service offerings. Do you agree that behavior change can play a significant role in disease prevention and management of chronic conditions? Do you have studies / proof, for example, that it changes how people with diabetes take care of themselves?
Cameron Jacox: There are a couple of things. First of all, Lark is now the second largest diabetes prevention program in the US, and we achieved a full CDC recognition for our outcomes.
We have published a number of studies including a recent one showing an average of 4,3% weight loss in one year amongst participants in the diabetes prevention program. We have also shown that we have a higher program completion rates with 52% of people completing the program. We have shown outcomes in a number of other programs, including diabetes where our latest data study shows a 1.1 point A1c reduction in Lark for Diabetes.
We also have clear outcomes on hypertension. We are the first digital health company to publish hypertension outcomes, where we are showing a roughly 9 point reduction in systolic blood pressure sustained at 1 year. One can see that over 80% of members are still engaged and are checking their blood pressure at the 6 month mark – by far the highest engagement across disease management programs, which speaks to our consumer-friendly experience. So, these are some of our key outcomes.
Research2Guidance: What is Lark Health’s pricing model and are you planning to be more aggressive with it while entering new markets?
Cameron Jacox: We are less than half the price of our key competitors and we are the most scalable. It is very quick for us to scale up to an entire 6 or 7 figure population. This is one of our differentiators.
We have a global vision and we plan to expand to other markets – Europe, Asia, etc. Whether we will have a different pricing strategy from the USA will depend on factors like market penetration, competitors, targeted population, etc.
Research2Guidance: In your opinion, how willing are health plans to offer digital preventative services and what factors affect their decision to enter a partnership with a healthcare provider?
Cameron Jacox: That’s a great question. Health plans are increasingly willing to offer digital preventive services, with 6 of the 7 largest payors currently covering Diabetes Prevention Programs. The DPP market has rapidly consolidated, with the top 4 DPPs now enrolling more than 96% of all participants, and the remaining 1,000+ DPPs enrolling the other 4%.
As a result, health plans can now choose to contract with one or more of these 4 scalable, national, evidence-based programs to work with. Since DPP has been proven to lower costs in the long run, willingness to invest a bit up front is strong. With Medicare and Medicare Advantage, however, Lark holds a unique advantage. Our pricing model is the only one that fits with these programs’ abilities to pay, being about half of the other 3 largest DPPs.
Health plans’ willingness to cover DPP has also been influenced, as with the rest of healthcare, by mandates. DPP coverage is mandated for most plans.
In terms of plans willingness to partner with a DPP provider, we’ve found it’s threefold:
- There has be a history of proven outcomes. Achieving Full CDC Recognition is a great start, but outcomes need to be published on an ongoing basis.
- The partner has to check off the key requirements around working with a plan such as past experience with large implementations, security and privacy standards, and ease of contracting. In the latter case, that means being able to bill through claims and to do so on a performance basis.
- Lastly, providers must be able to drive enrollment. We hear time and time again that, although they’ve contracted with a DPP, they’re not seeing any enrollment. That’s another value that Lark brings to the table, with by far the highest enroll
ment rates across covered populations utilizing our world-class growth and marketing technologies.
Research2Guidance: There are already quite a few very good diabetes solutions (mobile apps packaged together with sensors or services), yet the penetration within the target group is very low. (Addressable market is more than 425M people, but less than 1% of them are using the available digital health solutions). Do you see a reason for that?
Cameron Jacox: In my opinion, even though there are a lot of players within the digital diabetes care area, it is a brand new space. There are enormous uncertainties. The second important point is that the reimbursement – providing these services through health insurance, is also a new concept in practice.
And I would say the 3rd thing is human nature in general. When health insurers or healthcare companies try to give to their members / consumers something new to change their behavior they don’t always adopt it.
At Lark, the way we approach those challenges is through a consumer first approach. For example, Google independently ranked our mobile app experience as one of the Top 10, and Apple did the same out of their millions of apps. So, we focus on consumer experience. For us it’s important to make this experience not only valuable in terms of the health outcomes, but enjoyable, very attractive so the user/customer will want to use it, and it is seen as something that is fun to interact with. We understand that not a lot of people want to be engaged daily with their health. The consumer experience is crucial to have a successful digital diabetes solution.
Research2Guidance: What challenges are you facing in the US and Canada?
Cameron Jacox: Frankly, we have a lot of success with Lark’s leading personalized disease management platform. Our success is based on offering a great consumer experience together with good partnerships with health plans, which makes us a valuable companion for managing chronic conditions and / or staying healthy.
However, to answer your question about the challenges – I would say the initial challenges comes from the very busy space. It is hard for a new market player to enter the space. It takes a long time to develop the trust and to build relationships with health plans and it also takes a long time to get clinical validation.
At Lark, we have subjected ourselves to a huge number of studies and we even more ongoing. The management team has put together an impressive health committee led by medical staff from Harvard and Stanford, including Dr. Robert Gabbay, who is the Chief Medical Officer at Joslin Diabetes Center, and others.
I believe assembling the right clinical team and getting the right clinical validation takes a long time and a lot of “start-ups” don’t make it, because it takes so long. All of these are primary challenges, but once a company is through them it can be a very powerful space to be in.
Another primary challenge is channel partnerships. We’ve built them very successfully, and they can be key to the reimbursement model and scalability.
Research2Guidance: What trends do you see in the digital chronic conditions / diabetes management area of the future?
Cameron Jacox: I think that continuous glucose monitoring instead of the finger prick is going to take off. We also see new technologies besides the finger prick blood tests that are coming out or are in early stage of R&D, so being able to monitor blood sugar more closely without the hassle is more and more possible to more people, especially when the prices for these technologies come down. In this respect, we’ve developed some very exciting partnerships.
The use of AI and the way we are applying it is going to be the only way to really scale a solution to enough people to make a dent in the problem, and increasingly the health plans are recognizing that. From a trend perspective we are also seeing an increasing recognition of the importance of personalization. Delivering standard content or tips is never going to be enough. Having a personalized approach instead of a standardized care plan for each member is a very big trend made possible by machine learning, AI, and our platform.
When it comes to prediabetes it has been a 10-12-year effort to educate the public and launch diabetes prevention programs. Last year (2018) was the first year when the number of new diabetes cases diagnosed in the US has declined. You can’t necessarily put exact cause and effect on it, but this data gives us a reason to be very optimistic about the digital disease management and prevention space.
Research2Guidance: What defines the success of a digital health solution?
Cameron Jacox: I think the success is defined by if people get healthier and if they stay healthier.
Research2Guidance: What are the most efficient distribution channels for digital health providers?
Cameron Jacox: In my opinion health plans, PBMs, and government entities are the most efficient distribution channels. A lot of companies have tried more direct to consumer approaches, but at the end of the day the most effective one is partnering with entities that allow for seamless billing and distribution. Health plans have the most aligned interest for their members to get and stay healthy, especially in Medicare Advantage, and a direct interest in the outcomes aligns the partnership.
Research2Guidance: What is next for Lark Health? Where do you see the company in the near future?
Cameron Jacox: We are continuing to scale our innovations in the US. We have also announced a couple of new behavioral health and chronic care programs and a number of new health plan partnerships. At present our focus is on growth and development. We plan to be a truly global disease management platform, and one which covers the whole person.
Research2Guidance: Thank you for your thoughts and insights, Cameron.
About Lark Health
Lark Health is the leading chronic disease prevention and management platform using proven, AI health coaching to deliver better health outcomes at scale. Lark uses cutting edge AI and connected health monitors, which can be combined with clinical resources, to provide real-time, personalized, 24/7 support and counseling to help users make healthier choices and manage their Diabetes, Hypertension, or Prediabetes. For more inf
ormation visit: https://www.lark.com/