Bringing value-based precision digital health care to COPD and Asthma. Interview with Susa Monacelli, General Manager of Propeller Health.

Today, there are more than 500M people suffering from chronic respiratory diseases globally. Novel DTx personalized patient management programs aimed at changing behavior and influence of the disease can play an invaluable role in assisting patients and in most cases help them manage their conditions more effectively every day. In a candid conversation with Susa Monacelli, General Manager of Propeller Health, a leader in digital health and therapeutics for asthma and COPD, we talked about the company’s footprint in bringing value-based precision digital health care across all the stakeholders in this space, dived into their business model and some very exciting partnerships with a leading Pharma company and a multi-state US Health system, as well as looked at the future of data-driven precision medicine.

Research2Guidance: As a leader in digital health and therapeutics for asthma and COPD, what is the footprint you would like to leave in this space

Susa Monacelli: I love that question. I think that any chronic care journey is very lonely, and it is a very individual experience for each person. As a society and as a healthcare system, we really have not been able to tailor that journey. We have “A” solution, which is “take a pill” or in this case “take an inhaler” and then we kind of leave the person with his / her own device.

I think the footprint I would love for Propeller to be is that we finally be able to align values from patients getting improved clinical outcomes, quality of life and better financial results for themselves with what providers offer. And not only just as a transaction but with a tailored touch that motivates and rewards for doing the extra work and then align that with payors, who are able to recognize that they can offer a better care for lower cost because of all these elements aligned correctly. Ultimately Pharma companies will benefit too and will get greater medication adherence that really works for the patients.

It is not just an impact on the patient but setting an example to the healthcare system of how you can align that value for much better outcomes across the board.

Research2Guidance: This sounds fantastic. How do you help patients today manage their moments better with your service offering?

Susa Monacelli: At Propeller, our mission is to uplift every person with chronic disease so they can take control of their health and live a better life. The platform includes FDA cleared medical devices, consumer apps, live support and coaching, and access to clinical data for provider monitoring throughout each care journey. Our sensors can be attached to patient inhalers, and as they continue using their medication as prescribed, data can be gained outside the physician office and shared with their care teams and family.

It is like baking a cake with different ingredients. If you bake a cake with only one ingredient, flavors are not going to be very diverse. In my opinion, if you take hardware and software and you combine it with a service to motivate and encourage patients to stay on track, you start to really address the multitude of needs.

We facilitate a tailored digital experience with a human touch used by patients, caregivers, providers, payers, pharmaceutical companies and other healthcare organizations across the US, Europe and Asia.

Research2Guidance: It is interesting, as Propeller has started as a sensor company, but it seems like you are going beyond the device and more into precision care management.

Susa Monacelli: I think we have really come to understand that it is not enough to just throw a device to a patient, there is so much more involved to really ensure that adoption and to really positively impact the health outcome.

Right now, we are moving more and more into this world of care management leveraging these tools of hardware and software alongside that personalized care experience for the patient. And this is the trend I am also seeing in the industry, all three components becoming closer and closer in its integration. I believe this is how healthcare will change over time and for Propeller that is a big part of our transformation and how we think about our partnerships.

Research2Guidance: What makes you stand out?

Susa Monacelli: For us at Propeller there are couple of things that set us apart

10-year journey, over 100 000 patients, Precision digital health care management

We have been on a ten-year journey, and over 100 000 patients have trusted us to help them manage their asthma and COPD. We are no longer a startup company. At Propeller, we started to build that next layer of really bringing a precision digital health solution to market.

We have started to use the data to personalize our approach. One person might be someone who needs to be pinned every morning “Hey, did you take your meds”, another person might be somebody who will go crazy if s/he gets this every morning, but if s/he had a medical question, s/he would like to be able to reach out and ask that question immediately.

We take all these years’ experience, the breadth of connected devices that we now have (we are able to reach in the US nearly 80% of medications in asthma and COPD space) and leverage this data to offer clinicians, regardless of what medication the patient is on, that signal. This is hugely valuable, and it becomes about these smaller ingredients in the mix.

Value based partnerships with health systems and payors

We have the data, and we have begun moving into value based types of relationships with health systems and payors. And that puts us in a different conversation with these stakeholders than companies in an earlier stage of or in the same space but with less experience.

ResMed and global presence

Propeller is not a small company. We are part of ResMed. We have the ability to be global, whether we are facing regulatory markets outside the US, whether we are challenged with distribution or manufacturing, we are talking about a company that has been in business for 30 years with deep sleep and respiratory expertise, and it is in 140 countries already.

I can’t be more excited about our opportunities when it comes to truly building the foundation around value-based care and making that alignment across all the stakeholders happen but in addition to that being able to take that to broader markets.

Device, medication and co-packaged product

The last thing is that we now have been with a key pharma partner in multiple countries where we co-package our device with a medication. This collaboration marks the first time a digital health tool has been packaged and prescribed alongside an inhaled asthma medication.

A study published on Propeller digital companion paired inhaler devices in this partnership has shown 34% lift in average adherence (42% interim results) for medications and that is exciting, and it is truly creating results and breaking that digital health boundary.

And this is new. Companies are exploring, testing and what is different about us is that we are actually doing it and now we also have the results that show incredible impact.

Research2Guidance: Quite compelling points. What is your business model?

Susa Monacelli: Our business model is B2B2C.

We partner with different healthcare & life-sciences stakeholders to ultimately improve the life quality of people living with chronic respiratory disease.

• We enable Pharma & MedTech companies to rapidly create and launch digital medicines for multiple conditions.
• We help Hospitals & Health systems with data and insights to adjust treatment decisions, and reduce costs associated with asthma and COPD. Propeller is clinically proven to improve patients’ outcomes, just some numbers, to give you a better idea — up to 58% improvement in medication adherence, up to 18.5% reduction in asthma rescue inhaler usage, up to 57% reduction in asthma related Emergency Department visits.
• We support clinicians to provide personalized care for their asthma and COPD patients.
• We offer a new solution for respiratory care for independent clinics, physician groups and health systems to provide remote therapeutic monitoring for eligible Medicare patients that may be reimbursable under the new RTM codes.

Research2Guidance: How do you ensure your commercial success in the US and internationally?

Susa Monacelli: I will give you an example with the US as it is the more complex model and this is our foundation, where we started.

In the US, one can go independently on our website, and it will link him / her to Walgreens to purchase the device.

To achieve higher outreach to patients and clinicians, one pathway is via our partnerships with large hospital systems. We have done integration with Cerner and with EPIC through Redox and this is very important. Today, we can communicate with physicians through their preferred EMR systems and enrolling a patient can be done in just a few minutes.

Another pathway is via our partnerships with payors. They may want to offer a care management program to their members and then there is a sign-up process for the eligible people.

One really needs to know what works for each channel and this has been such a huge part of our foundation, especially in the last five years.

We also collaborate with life-science companies who want to offer a digital solution to people who are on their medications. Some of them are experimenting with these types of programs to see what the impact is and they sponsor these digital initiatives.

Our larger client is in 18 countries, and they offer the co-packaged experience, particularly in Europe and in Asia. In this case, we are talking about different regulatory markets, in which we have to navigate different requirements. In all markets the physician will prescribe the medication and when you go to the pharmacy to pick up your medicine instead of just getting your inhaler you will get the co-packaged product with Propeller.

At present, this is our international strategy.

Research2Guidance: When it comes to healthcare, prevention is so important and being able to get an earlier diagnosis of the disease and of course the right treatment matters. What kind of opportunities have opened up in the past few years when it comes to preventive care in Asthma and COPD?

Susa Monacelli: I am so passionate about what we are doing because I feel like we are having an incredible opportunity to prevent adverse events from happening. It is a bit different from pre-diagnosis. Propeller has not yet moved that much in having patients diagnosed earlier, but it is something that we are actively talking about, and we think about partnerships in that space.

What we have done though is we have started to look for indicators that warn us early as far as week or two in advance that somebody is exacerbating.

Today, air pollution is associated with a higher incidence of COPD and asthma, so one of the features that we now have in our app is that the user is able to see the air quality in the area so that one can be much more proactive with one’s dosing based on that metric alone. We think this is the future where we are headed, really identifying what these indicators are and how we can better use them so instead of ending up in the hospital, we can prevent that.

To give you an example, when you think of the pediatric population, parents want to have visibility on “Is my kid taking his/her control medication, which is what makes life a lot better or is he/she suddenly started to use their rescue inhaler a lot”. Through Propeller parents can know what their child is doing and how well that child is, tracking on their kid medication gives them a peace of mind and allows them to get ahead of the problem before they end up in the hospital.

This is how we think of prevention today at Propeller, this is how we predict and how we support patients with data to take the right actions to prevent exacerbation.

Research2Guidance: This is awesome. Generally, we know what we should do and what we should not do, data alone might not be able to motivate us, when we do not “feel like it”. If we look at medication adherence the rates are still low. How do you encourage and motivate people to change their behavior, embrace new habits and consistently take better care of themselves?

Susa Monacelli: Great question.

At Propeller we ask ourselves “How can we shift a behavior enough to create a better outcome? What is the minimum amount of effort for the maximum value?” If you are a COPD patient and you make 2000 steps a day, can we support you to do 2500 steps per day? Daily small consistent actions lead to better outcomes, and we understand “minimum engagement for maximum outcome” and we stick to that. The challenge is to reach the patient when he / she is emotionally open to that.

The second part that we focus on is thinking differently about patients and this is where our precision piece comes into play.

Let’s say you have “Y” and “X” axes. Your Y axes is your propensity to engage, or your motivation level and X axes is the severity of your condition. And we have different combinations:

• One can be very severe and highly motivated, and this individual needs a little bit of nudging and support, but he/she can usually do pretty well. And sometimes it is a bit more complex, and he/she needs more personal engagement, so that is where we will have a coach working with him / her.
• Then we have highly motivated patients, but they are not that severe. In this case it might be appropriate to just have some digital nudging that keeps them on track. A reminder might be sent if we see that they have not been taking their control medication.
• We also have patients who are not severe and not motivated and there is not much we can do with them.
• And then we have patients who are not motivated but very severe and this is the group that we want to pay particular attention to. First, we need to work on their motivational level and help them change that state, if we can. Here we can apply more of the coaching and in-person touch. A coach will reach out to the patient and will try to build this individual relationship, to the point where, when one sees Propeller is calling, he / she knows that he will talk to John, for example. John not only asks about the medication and why it is not taken, but asks more personal questions about the environment, family, all these factors that can affect the behaviour. John is interested in the patient’s life and his / her daily moments.

I think healthcare systems are pretty new to this, and there is a long way to learn. At Propeller, we have started thinking about our population differently, thus figuring out what works for various types of people, as experience is different even though the condition might be the same.

Research2Guidance: And data here can play a key role. What are some of the most interesting or rewarding partnerships you have entered in the past few years?

Susa Monacelli: In general, for me the most rewarding partnerships are the ones that open the door and really allow data to flow. I can’t improve our programs unless I know, for example, that the patient has ended up in the hospital or how much his / her medical bill is. How can I impact something that I can’t see?

Data partnership is not complete if it is just with one entity. Even if we partner with a large national payor, we get only their data, so just a part of the whole picture. We can do a lot with it, but so much more can be done if we also get the EMR data and this makes partnering with let’s say an integrated regional payor (“payvider”) very interesting, because they have both sides of the equation.

When it comes to our partnerships, in addition to the pharma partnership for co-packaged experience I talked about earlier, our partnership with a multi-state US health system is another great example of the role of data.

This health system’s medical groups have utilized Propeller Health’s solution for many years — at one of the medical groups, asthma patients enrolled in the program who used Propeller’s inhaler sensors saw asthma-related emergency room visits decrease by 54% and combined asthma-related emergency room and hospitalization events decrease by 57% during the 365 days post-enrollment when compared to the one-year period before enrollment.

We then integrated the Propeller platform with their EHR system, streamlining workflows and putting real-time data, alerts, and messaging in front of clinicians so that they can make informed decisions on treatment. Clinicians can now identify and enrol patients who could benefit from access to Propeller, and remotely monitor their patients through data visualizations and notifications embedded into their EHR workflows, making it easier for them to identify patients who need clinical intervention.

Research2Guidance: Fantastic results. In your opinion, what is the future of data-driven precision medicine?

Susa Monacelli: I tend to think of it in several layers for better or worse.

From a medication standpoint I believe in precision medicine. I believe that the future is going to be more tailored combinations of medications for individuals. We have seen this when one pill has multiple medications in it.

I think there is going to be what I call precision care management, which is really leveraging coaches, certified educators all the way to nurses and physicians and being able to figure out what the individual needs. “Is it a medical issue that you need a clinician to manage, is it a motivation piece where you need a coach to take care of it, what one really needs?” I think we are going to see more and more growth in precision care management.

And when you start to imagine how much data goes behind the scenes, I think the third is knowing what data signals you need for whom. And I think this is where precision digital health comes into play, where you need to be able not only to leverage the precision care management and precision medication but using those digital signals to really form that care and help create the right path to get the best outcomes.

And this is where I see Propeller really being the forerunner in the market.

Research2Guidance: What is ahead of Propeller Health?

Susa Monacelli: At the core and at the heart of Propeller is the patient and that is where the journey starts. I have always dreamed of having the ability to ultimately make it easier for the individuals to take care of themselves. As we started our conversation today chronic conditions are hard and people are left in this really vulnerable position, and we are changing that.

What I am thrilled about and excited to be a part of is that as we are building this data and platform, we are getting better and better, and we will be able to deliver that precision digital health care. And we are also working really hard leveraging remote therapeutic monitoring, leveraging some of the new tools that are emerging in the market to create that alignment to unify the value across different stakeholders. And as this is building, we see an opportunity for bigger impact across greater populations and beyond the US. I feel like we are in a really strong position not only from a data science point but with all the years of experience, we are now able to bring that scale to market. More to come from us, I promise.

Research2Guidance: Susa, thank you very much for this insightful and lovely conversation. We wish you and Propeller Health’s team to stay healthy and have a lot of success.