Weight loss and reversing Type 2 diabetes cost-effectively through eHealth coaching

Dr Carl J. Brandt, PhD, GP, Co-founder

2

Rune Bech, co-founder,Director

Co-founded NetDoctor, SlankeDoktor and SundhedsDoktor .

Former digital officer of Danish broadcaster TV 2 and Saxo Bank

Master in Broadcast Journalism, Danish School of Journalism.

Dr. Carl Brandt, PhD

GP, co-founder

Co-founded NetDoctor.com, SundhedsDoktor and SlankeDoktor

Practising general practitioner and science/research personality within healthcare and lifestyle interventional programs

1998: NetDoktor.se

B2C. Health information portal with a leading market position in UK, Germany, Denmark and Sweden.

Founded NetDoktor.se in 1998 – in 2015 Liva Healthcare

2015: livahealthcare.comB2B. A personal lifestyle coach

in the pocket of the patient.

Leading market position in Denmark and UK

Digital Individualized and Collaborative Treatment of TD2 in General Practice Based on Decision Aid

By Prof. PhD GP Jens Søndergaard, Prof. PhD Michael Hecht Olsen, PhD Jens Steen Nielsen, PhD GP Carl J. Brandt, Prof. PhD GP Jette Kolding Kristensen, PhD Peter Gæde, PhD Camilla Sortsø, PhD Sonja Wehberg, Prof. PhD GP Dorte Ejg Jarbøl, Prof. PhD Jesper Bo Nielsen.

Supported by the Steno Collaborative Grant

Scientific team

DICTA

The Liva platform at a glance

Participant appA personal coach in the pocket

Coach dashboardScalable personal e-coaching

Outcomes dashboardReal time/world outcomes data

Users Weightloss Staytime Staytime

Usersinintervention

KG Staytimeactiveusers

Staytimeallusers

Newusersmonthbymonth

Disease Gender Agegroups Education

1 2 3

Particpants Health Coaches Commissioner

The Liva platform makes personal empathic coaching scalable, and payor executives can track outcomes and ROI in real time.

Confidential

The Platform Evidence Key Customers

Users maintained 7 kg of weight loss after 20 months1

€2,000+ saved in societal costs per year per diabetic2

3-500 patients managed per health professional3

Liva’s platform combines personal healthcare

professionals with an advanced tech platform, promoting stronger user

engagement and healthier individuals

1. Brandt et al., “Sustained Weight Loss during 20 months using a personalized interactive internet based dietician advice program”, International Journal on Advances in Life Sciences, 20112. Institute of Applied Economics and Health Research, “Liva Healthcare Cost Effective Analysis”, 20173. Liva Healthcare, “Best Practice Guidelines”, 2017

TechnologyRelationship

Liva’s mission: To drive outcomes via lifestyle coaching

6

1 Slowing the progression of lifestyle diseases

or…

2 Stopping the progression

or even better…

3 Reversing the diseases when possible

Confidential

Danish health authorities with Liva in operation

7

Confidential

NHS England works with Liva on diabetes prevention

+

1

2

Pilot (pre-diabetes prevention)Began December 2017 for 18 months5,000 pre-diabetic patients5 provider selected

Full scale nationwide diabetes prevention• Begins July 2019• 200,000 pre-diabetic patients per year• 5 providers selected

Confidential

Pilot: NHS England selected Liva from 87 providers

9

87 30 14 LIVA+4

Pre-qualification 1st selection 2nd selection Winner Feb. 2017 May 2017 Aug. 2017 Nov. 2017

Confidential

200,000 pre-diabetic patients a year in new NHS programme

10

NHS Diabetes Prevention Programme• 200,000 pre-diabetics per year• 20% will be pure-play digital initially• Full nationwide roll out from July 2019• NHS success criteria: 4-6% reversal

(HbA1c below 42)• 5 providers selected (Liva + 4)

Confidential

Gävleborg Region first to implement Liva in Sweden

11

Diabetes gets expensive if the patient ignores lifestyle

1. Sortsø et al., “Societal Costs of Diabetes Mellitus in Denmark”, Modern Economy, 2015

€0

€5 000

€10 000

€15 000

€20 000

€25 000

€30 000

€35 000

Diabetes patients without complications Diabetes patients with minor complications Diabetes patients with severe complications

Soci

etal

Co

sts

per

Pat

ien

t

Healthcare incl. pharmaceuticals and nursing services Productivity loss Additional costs

€6,197

€32,232

€14,080

55%

20%

25%

Share of patients:

• A diabetes patient with severe complications costs €32,000 per year

Confidential

56,40%

14,70%

17,10%

11,70%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Lifestyle intervention Standard treatment

Discontinue medication

Reduce medication

Diabetes can be reversed for 56% of patients via lifestyle change

56% of diabetics can be

reversed

Authors: Mette Yun Johansen, MSc; Christopher Scott MacDonald, MSc; Katrine Bagge Hansen, MD, PhD; Kristian Karstoft, MD, PhD; Robin Christensen, PhD; Maria Pedersen, MD, PhD; Louise Seier Hansen, MSc; Morten Zacho, MSc; Anne-SophieWedell-Neergaard, MD; Signe Tellerup Nielsen, MD, PhD; Ulrik Wining Iepsen, MD, PhD; Henning Langberg, DMSc; Allan Arthur Vaag, DMSc; Bente Klarlund Pedersen, DMSc; Mathias Ried-Larsen, PhD

Source: JAMA. 2017;318(7):637-646. doi:10.1001/jama.2017.10169

• A study in Journal of The American Medical Association (JAMA) by Professor Bente Klarlund Pedersen from the University Hospital of Copenhagen showed that type-2 diabetes can be rolled back through lifestyle intervention for 56% of patients.

• Liva has built the digital platform to do just that!

14

Personal relationships are key to succeeding with a lifestyle change

Ongoing personal e-coaching Asynchronous via app by text and video

Personal lifestyle planEach plan is tailored to the

individual participant’s needs

Easy lifestyle and goal trackingAutomatic tracking (e.g., steps) or easy manual tracking (e.g. meal photos)

Personalised contentMotivational material and other content is carefully targeted and timed

“A real personal coach in your pocket”Relationship based: Behaviour

psychology agreements and commitments

Health coach Participant

Support communityof fellow participants(peer-2-peer)

Scalable asynchronous e-coaching Data makes the intervention more

personal and the health coach bettersupported by AI and machine learning

Liva’s 9 months NDPP lifestyle intervention pathway

15

Q1 Q2 Q3

●●●●●●●●●● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

Weekly coaching Bi-weekly Monthly

Step 1: Relationship building

+Initial meeting with allocated personal coach• One hour one-2-one session• Live video or physical meeting• Relationship building and goal setting

Step 2: 26 Online coaching interventions via app

Coach Patient

Confidential

The Liva app - as seen from the patient

A personal coach in the pocketAsynchronous coaching

via app by text and video

Charts + tracking of vitalsTracking of up to 14 vitals

Health coach Patient

Support communityof peers (mentoring)

1 2 3

17

Liva participant app allows you to set and track relevant goals

18

Participant overview

Asynchronous video and text communication tools

Live video tool for ongoing interventions

Patient vitals and charts

Group mentoring tools

The Liva coach dashboard – tools to handle 3-500 patients per FTE

Content library (build as you go) for efficient

recycling

Liva in one slide: Scalable empathic digital health coaching

19

One health coach can manage 3-500 patients

Patient follows programme via app

Weekly advice from personal coach

Trackprogress

Peer supportgroup

Liva outcomes with pre-diabetic patients - real time/real world

38%pre-diabetics reversed

after 6 months*

Real world Liva data.

4,3 kgaverage weight loss after 6

months

Trend. Real worldLiva data

67%reduced HbA1c

after 6 months

Real world Liva data.

LIVA retention rates:• 3 months: 69%• 9 months: 63% *Blood sugar levels (HbA1c) driven below 42

Liva outcomes with 103 Type 2 Diabetes patients

6,8 kgAverage weight loss

after months

Real world Liva data*

2.667€saved per patient per year

Trend. Real worldLiva data*

4,8 kgAverage weight loss

in 7,4 months

Real world Liva data*

*Komkova A, Brandt CJ, Hansen Pedersen D, Emneus M, Sortsø C, Electronic Health Lifestyle Coaching Among Diabetes Patients in a Real-Life Municipality Setting: Observational Study, JMIR Diabetes 2019;4(1):e12140, DOI: 10.2196/12140, PMID: 30860486

LIVA Healthcare A/SRainmaking LoftDanneskiold-Samsøes Allé 41DK-1434 Copenhagen KDENMARKwww.livahealthcare.com

LIVA Healthcare UK LtdInternational House1 St Katharine's Way, London E1W 1UNUNITED KINGDOMwww.livahealthcare.co.uk

Thank you for your attention

Appendix

23

Monitoring

Peer to peer support

Patient

Personal health coaches1. SDCO basedNurse/Dietician/Physiotherapist2. GP based Nurse (optional)

Individualgoals and plans

Procedural knowledge

1. Individual digital coaching

Monitoring

Peer to peer support

Patient

1. Personal health coaches• SDCO based Nurse/Dietician/Physiotherapist• GP based Nurse (optional)

Individualgoals and plans

Procedural knowledge

1. Individual digital coaching

2. General practice• GPs dashboard integration of patient registered outcome measurements• Overview of patient registered outcome measurements

2. GP dashboard integration, (one click summary in EPJ)2. Integration into GP platform

Monitoring

Peer to peer support

Patient

1. Personal health coaches1. SDCO based Nurse/Dietician/Physiotherapist2. GP based Nurse (optional)

Individualgoals and plans

Procedural knowledge

3. Hospital hypertension and diabetes specialist

• Decision support by specialist recommendations

• Recommendations for treatment in accordance with algorithm

• Automatically delivered

1. Individual digital coaching

2. General practice• GPs dashboard integration of patient registered outcome measurements• Overview of patient registered outcome measurements• Decision-support by specialist

3. Specialist decision support to GPs

• Patient data is fed from the patient, the health coach and the GP summary page into an algorithm

• Based on the in entered data the GP will be given advice about optimal medication

• The GP then decides medication for the patient

Specialist anbefaling:T2D: LADA Metformin v

BT 165/98 Amlodipin v

LDL/HDL Simvastatin v

3. Specialist decision support

Liva offers two options: Full service or SaaS

Full service: Liva supplies coaching

Full-service: IT platform and coaching

SaaS: Use your own staff

Software-as-a-service, SaaS

Platform licenseCoaching included

Platform license only

White label/ownbrand

Disease agnosticStaff training

included3-500 patients per

FTE