Interview with Zach Henderson, Chief Commercial Officer at Glooko

The pandemic positioned Telehealth and Remote Patient Monitoring solutions as a key element of healthcare services to drive quality population health outcomes and reduce care costs. With rules and regulations rapidly changed to enable the coverage of these solutions, over 217m diagnosed diabetics with access to smart devices and 1.5b overweight people globally could potentially connect to their healthcare teams and get personalized care remotely. One of the leading market players who is improving the lives of people with diabetes and obesity and those who care for them by simplifying collaboration and delivering actionable insights is Glooko. In a candid conversation with Zach Henderson, Chief Commercial Officer at Glooko, he shared with us how their innovative software platforms empower diabetes management and reduce costs associated with it, the ways the company assists providers in claiming reimbursements for remote patient monitoring, chronic care management or digital health solutions, as well as the market trends and what is next for Glooko after closing recently a $30 million Series D funding round.

Research2Guidance: As a short introduction to Glooko, could you please share the story behind it and what Glooko’s service offering is?

Zach Henderson: Glooko is the world’s largest digital health and remote patient monitoring company for diabetes and obesity founded in 2011. Our mission is to improve health outcomes by connecting patients with their healthcare professionals, enabling telehealth, remote patient monitoring, clinical research, and improved collaboration.

Our app-based platform is designed as a central hub for patients’ connected monitoring devices, be it blood glucose monitor, CGM, smart insulin pen or pump, connected weight scale, blood pressure cuff, fitness trackers and other disease-relevant devices to be synced and shared with the patients’ healthcare providers. It does not matter whether the patient visits the clinic in person or remotely, which was the primary approach during COVID-19. Glooko was still able to connect doctors and their patients remotely, so that the latter can receive personalized medical support based on real-time data and actionable analytics. Glooko is also interoperable with other platforms, for instance Electronic Health Record (EHR) systems and clinical platforms to ensure patients’ continuum of care.

Glooko is deployed in 27 countries and is available in 20 languages around the world.

Research2Guidance: Quite an interesting company. What is Glooko’s unique value proposition and how do you differentiate your service offering from your key competitors?

Zach Henderson: It starts with our mission: focusing on enabling and improving the connection between the practitioner and the patient. Our solution is device and platform agnostic unlike several other players in the market who mandate use of certain devices. Glooko syncs with 95% of all diabetes devices globally, delivering integrated insights and RPM capabilities in a user-friendly platform. This approach allows the physician and patient to make the final decision on their care.

For instance, if you are a person with type 1 diabetes, you and your endocrinologist have worked for years to determine the right mix of devices and medicines that best fit your situation. You may have a certain CGM, a certain insulin pump and a certain insulin pen and you and your doctor have calibrated for your treatment. We understand and we support that with our BYOD (bring your own device) model. We improve health outcomes by building connections that are tailored to each patients’ situation and treatment plan. It is not only a matter of collecting the data, but also unlocking the power of all these data and bringing personalized insights to the provider and the patient. We offer analytic tools, algorithms, and clinical decision support for all persons with diabetes.

Certain health plans/countries may reimburse for certain devices differently than others, so we are also supporting that decision making process.

At Glooko, we also empower patients’ self-care journey with real-time data and insights, so they can better understand what is impacting their health. For instance, our food database in the app includes over 500,000 items allowing patients to check their caloric intake, how much glucose they are consuming, how many protein mgs, fats, etc. each meal carries. Our app has great NLP (natural language processing) capabilities. For example, I could say “cheeseburger” and the Glooko app will recognize this food item, find the nutritional details in the database and add it to the patient’s record. It can also be used to scan barcodes to find the food item and also enables entering medications. Our solution can sync with Apple Health, and it is compatible with fitness trackers such as Fitbit and Strava. The beauty is that patients can sync readings from multiple, varied devices.

Research2Guidance: Fact. The aggregation of all health and even lifestyle data is important to help improve the daily moments of patients with chronic diseases. Glooko connects to various BGM and CGM devices, such as Ascensia’s BG meters (Contour / Eversense) and Dexcom’s CGM (G6). Could you tell us in a few words how this integration works?

Zach Henderson: We have multiple methods of integrating with devices and platforms. Some of our integrations involve cloud to cloud connections, but we also support bluetooth integrations, have an API to support data transfers and even offer a small dongle that transforms older, non-connected devices into “smart” devices. This is especially important to bring Glooko to patient populations who may not be able to afford the newer “connected” devices but want to take advantage of Glooko’s insights and clinically proven results.

Research2Guidance: What is your business model?

Zach Henderson: Our business model is B2B2C.

Glooko is always free to patients. Any patient can download Glooko from the different app stores. To experience remote patient monitoring and get the highest value from Glooko, the patient needs to connect their Glooko account to their physician/care team’s Glooko account. Then the healthcare team receives near real-time data, alerts, and analytics to know what is going on in their patients’ world and can improve their standard of care.

At Glooko we have several revenue streams.

• Hospitals and Health Systems

We work with hospitals and health systems around the world. We typically charge a certain amount per patient per month for access to the Glooko Enterprise version. Healthcare providers then receive all the tools they need to effectively treat their patients. In certain countries (depending on the reimbursement regulations), we also assist providers in claiming reimbursements for remote patient monitoring, chronic care management or digital health solutions.

By using Glooko, hospitals and health systems are also able to improve their standard of care via more frequent and effective interactions with their patients. The standard of care in diabetes is an in person visit 3–4 times/year. With Glooko, interactions in person still occur at the same frequency, but also occur remotely for the other 8–9 months. This is a 3–4x improvement, and the patients appreciate the more frequent interactions with their care providers. In addition, Glooko provides alerts and guidance between remote and in person visits.

• Medical device companies and Pharma companies

We partner with global medical device and pharmaceutical companies to help them deploy their products around the world. Our partners then have access to our ecosystem of over 2.8M patients in over 7,500 clinics. These are mutually beneficial partnerships and a key part of Glooko’s model.

Glooko is also used by device and pharma sponsors and clinical research organizations to conduct clinical research. We offer them the “regulatory grade” Glooko platform for conducting these studies as Glooko is HIPAA, GDPR, ASIP and FDA 21 CFR Part 11 compliant along with ISO 13485. These designations help provide researchers with the confidence to leverage Glooko to collect their study data, either prospectively in a randomized clinical trial (RCT) or retrospectively using our real-world data (RWD) for their analyses.

• Payors/Employers

At Glooko we also partner with top payors and self-insured employers. Whether that is a private insurance company in the US or public national payer like the country of Norway, our partnership provides their members with a digital health and remote patient monitoring solution to improve outcomes and lower costs, all within the MLR. We have multiple peer reviewed studies demonstrating these improvements in outcomes.

Research2Guidance: Diabetes is a global epidemic which affects 463m patients. In our latest report on the Digital diabetes market, we report that between 2019 and 2024, the number of diagnosed diabetics with access to smart devices is set to increase from 109 million to 180 million, yet the user adoption rate still stands at a relatively low level. How do you engage with your customers?

Zach Henderson: Great question. I think you hit on something given the numbers you are quoting span geographies with highly varied access to smart devices, and even smartphones. In geographies like Western Europe and North America, the majority of the population has a smartphone. In other geographies, we see instances where only 20% of the population has a mobile phone.

On a macro level, our philosophy is to meet the customer where they are. In the countries where mobile phones are not as common, that translates to patients bringing their blood glucose meter to the hospital / clinic where the nurse plugs the device into a piece of hardware called the Glooko Transmitter that is installed in-clinics. All the patients’ data is synced and the physician (or the pharmacist in some cases) can see everything that has occurred over the last let’s say 2–3 days/weeks. And then based on these personalized insights, the physician can have an informed dialogue with the patient. We try to make it as easy as possible and as low cost as possible for patients to receive this frequent care. Even without a smartphone, patients can still get the benefit of Glooko via remote computer syncing of device data and/or our in-clinic solutions.

Of course, if patients can use our app, they can receive full remote patient monitoring and chronic care management support from their healthcare team. Physicians and care teams have predictive analytic tools in their version of Glooko that helps them identify high risk cohorts in their patient populations and provides alerts when the data shows they might need to intervene. On the patient’s mobile app itself, there are key visual elements that highlight areas of concern. For instance, if ‘time in range’ trends are not good. The patient may see a frowning face and suggestions on what he / she can do.

Recently, we have rolled out Care Programs which are step-by-step guides and insights for prediabetes, managing type 2 diabetes, newly diagnosed, etc. The aim is to help and support patients’ self-care journey by making it easier and more prescriptive with useful guidance. Also, we offer an FDA Class 2 clinical decision support algorithm that helps titrate long acting insulin so that nurse educators and endocrinologists do not have to be involved at every decision point. The algorithm does the work for the patient. Just another example where we are trying to engage with our customers to make it easier for the patient to receive high quality care.

Research2Guidance: This is all fantastic. In your opinion, why are solutions that have a proven impact on improving people’s lives not adopted faster? What are the main drivers of a larger acceptance and adoption of a digital health solution?

Zach Henderson: At a macro level, I think higher adoption of digital health and remote patient monitoring solutions is possible when the solution makes it easy for the patient to engage with their care teams, meets the patient wherever they may be and empowers their self-care journey, in short, the solution must reduce/remove friction. Multiple friction factors result in slower adoption including patient onboarding, ease of use for both patients and physicians and unfortunately socioeconomic factors. On the latter point, we have an innovative Social Responsibility initiative at Glooko to identify those underserved populations around the world and do our part to bypass the traditional adoption curve to accelerate availability of innovative solutions like Glooko. We know it will help patients live better lives. Be on the lookout for exciting announcements on this in the near future.

Research2Guidance: How many patients do you have? And in how many countries are you present?

Zach Henderson: Our global ecosystem counts more than 7,500 clinics and 2.8m patients. At the present moment, Glooko is available in 27 countries + 20 languages.

Research2Guidance: How do you decide which country to enter?

Zach Henderson: We have expansion plans to continue to grow globally.

As far as the decision process goes, we will often enter new countries with partners. For instance, Insulet is a partner of ours, as is Tandem Diabetes Care, Novo Nordisk, and many more.

If a medical device partner or a pharma company wants to deploy their device, insulin pump, etc. into a country and needs a digital health / remote patient monitoring platform/partner, they often invite us to join their efforts. Their sales force presents the whole package in the new market. It benefits both parties, we expand our market reach and global ecosystem together.

The other piece of the decision-making process for us relates to entering/expanding in markets where more and more public and private payers are now reimbursing more frequently for RPM solutions such as ours.

For instance, in the US the CMS has codified CCM (Chronic Care Management) and RPM (Remote Patient Monitoring) codes, in Germany you know there is the DiGA (Digitale Gesundheitsanwendungen) program, and in France they have rolled out the ETAPES (Expérimentations de Télémédecine pour l’Amélioration des Parcours en Santé) program. So, there are programs that have already been implemented and discussions are being held in many additional countries to reimburse digital health solutions and telehealth.

The payors, which in many cases are the national health systems, have realized it is much better to pay, say, $50 per patient per month, than reimburse for a $20,000 emergency room visit. Digital health solutions, telehealth, remote patient monitoring raise the standard of care for their members or citizens. The results from different programs prove that it is a smart investment to fund preventive care for patients, so they do not have as many episodic health problems that will cost the system quite a lot more.

At Glooko, we endeavour to improve health outcomes for people with diabetes, prediabetes and obesity while reducing costs associated with managing these chronic conditions.

We evaluate which countries are further along that reimbursement continuum to prioritize our rollout based on the readiness of the payors / health systems to partner with and invest in digital health and remote patient monitoring solutions. To your earlier point, this is a key element of accelerating the adoption curve.

Research2Guidance: You have different partnerships, for example, with Sanofi you collaborated last year and provided a Free Remote Care solution to share with medical clinics and people with diabetes. What makes a successful partnership?

Zach Henderson: I think if both parties are aligned around a common goal the partnership will be successful.

The Sanofi partnership is a great example of that: the partnership focused on improving the lives of people with diabetes and patients’ care was at the heart of this initiative at a time where virtual care for people with chronic conditions was so needed during the pandemic. While patients needed care, they could not visit their doctor as many countries were in full shut down.

And because there are not enough endocrinologists around the world, many primary care physicians treat patients with diabetes. Yet, many primary care clinics do not have access to a RPM platform like Glooko and could not monitor/treat their patients from home during COVID-19.

So, the decision to be there for the community, and to provide a free remote care solution during the pandemic came naturally and was our social responsibility. Sanofi’s US sales force helped increase awareness and introduced the benefits of using Glooko to healthcare providers. And hundreds of primary care clinics and health systems signed on to deploy our remote solution. This allowed them to sync patient’s data remotely and treat / provide medical guidance via text, phone, email and video portals bypassing the need for a clinic visit which wasn’t always possible during COVID-19.

At about that same time, we also offered Glooko more broadly as a remote care solution globally. In Italy, for instance, during the worst time of complete lockdown, our in-clinic syncing of data went to almost zero. The only way to receive treatment for many of the patients was to use the free Remote Care solution we offered. Some of these customers also upgraded to add access to all the remote patient monitoring capabilities. We are happy to share that many of them are still on this plan as they have seen the long-term advantages of it.

This was Glooko’s way to be there for the global diabetes community via a partnership with a common goal.

Research2Guidance: Respect to you and your team for offering your solution and right support to patients and their healthcare teams during the pandemic. In the past few years, we have seen some leading diabetes market players expanding into new chronic conditions and adding new types of services, thus creating integrated digital multi-conditional chronic care platforms. Do you think this is a successful strategy to increase market share and a company’s revenue?

Zach Henderson: I think it is a good strategy. If you look at the population of persons with diabetes, quite a few of them also have comorbid conditions such as obesity, and heart disease (the number 1 cause of death for PWDs). So, to properly treat people with diabetes in a holistic manner, the company’s solution / service should have the capabilities to extend to the cardiovascular side, weight management and lifestyle side. Glooko brings these capabilities to our clients.

It is not just a good strategy from a revenue standpoint, it is the right thing to do for the population we are serving. Glooko is expanding its already robust obesity capabilities in our platform by integrating additional devices including connected scales. Investing in our food database and exercise portion of our mobile app as well as integrations with platforms such as Apple Health was crucial. These platforms are already collecting many food and fitness data points, and now Glooko can integrate these data along with insulin, carbs, etc. and show all of these data points in a holistic way to endocrinologists, cardiologists, and the primary care doctors who manage more than just diabetes data to create personalized insights and care plans.

We support multi-conditional chronic conditions and are making moves to expand our capabilities in that area.

Research2Guidance: The pandemic has accelerated the adoption of digital health solutions into the healthcare system. How did you respond to COVID19?

Zach Henderson: It is in our DNA to build connections between the patient and the care team when it is needed, as often as it is needed, by using the right tools to bring vital real-time data and insights to both the patient and their care teams.

As I mentioned earlier, because we had developed Remote Patient Monitoring and Alerting capabilities prior to the pandemic, we were poised to help our patients connect virtually with their care teams regardless of whether they were in lock down and could not visit their clinic. During the height of the pandemic, Glooko responded by offering these enhanced capabilities for free to patients and providers around the world to facilitate remote care. In doing so, we found that we were increasing the standard of care.

Historically the standard of care for diabetes is a visit to your endocrinologist 3 maybe 4 times a year. But with remote patient monitoring technologies like Glooko, patients can see or be treated 12 times per year (every month) and in many cases be reimbursed for this improvement in the standard of care, an increase of 4x. The increase in adoption is partially due to the necessity created by the pandemic.

Research2Guidance: Do you think that after the pandemic the use of Telehealth and Remote Patient Monitoring will continue to be high?

Zach Henderson: I will answer it from an internal standpoint looking at our own data and what we see happening in the clinics and from an external point addressing what is occurring in the reimbursement landscape.

Like I have mentioned, we have clients in Italy and in certain parts in the USA where in-clinic activities dropped to almost zero and the remote activity increased by 200% in some cases. When countries started to open back up, we saw in-clinic syncing coming back, but the remote syncing did not return to pre-COVID19 levels, it continued to grow from the heightened COVID19 base. This illustrates the dynamic that once patients and providers had a taste of remote patient monitoring and telehealth, both the clinic side and the patient side (and frankly the payer side as well) valued the benefits of the new remote model. The pandemic has forced the adoption of virtual care in a major way.

From an external angle, which is the acceleration in reimbursement and reduction of barriers for telehealth and remote patient monitoring, we have seen changes in the US, for example, regarding the rules that were temporarily relaxed during the height of the pandemic have now been made permanent. CMS has expanded the remote patient monitoring codes and reimbursement and they have provided additional clarifications to reimbursement qualifications making the codes easier to utilize. Not too long ago, there was one CPT code for remote patient monitoring. We now have over 20 for chronic care management, continuous glucose monitoring, RPM management and monitoring.

We see this same expansion of telehealth, RPM and digital health reimbursement in other countries in the world. For instance, Germany launched the DiGA program that provides reimbursement for approved digital health solutions via their Statutory Health Insurance companies. This program was in place well before the pandemic and it continues to expand.

On a global level, public and private payers are embracing reimbursement for these types of solutions more than ever. We see this continuing because it is the right thing to do for the patients, helps increase access to care and reduces costs associated with chronic care disease management.

Research2Guidance: Are there any specifics for the RPM reimbursement that you would like to highlight?

Zach Henderson: Yes, remote patient monitoring is a key part of our solution. We support the remote patient monitoring billing process by tracking the data and metadata needed for reimbursement and supporting any billing audit.

To give you a US example, supporting the current standard of care (3 visits/year), the provider would bill for the 3 months that a patient comes into the clinic via E&M codes. But for the other 9 months, the provider does not bill. At Glooko, we are not only raising the standard of care to be 4x what it was before by powering a remote visit and monitoring for these 9 months, but now providers in the US can bill for those 9 months if they meet the RPM criteria.

One of the CPT codes reimburses for activities related to the patient sharing their device data via a remote that syncs the process demonstrating that the provider is monitoring the patient. Having remote patient monitoring data and empowering a provider to be able to react and catch a negative health trend earlier is better for patients and lowers overall cost for the payers. This helps to reduce expensive events like hospitalization.

Research2Guidance: What trends do you see in the market?

Zach Henderson: There are a few major trends:

1. Telehealth and Remote Patient Monitoring are being rapidly adopted by both patients and providers.
2. Hospitals have realized that they can use additional tools for remote patient monitoring for chronic care management.
3. Payers are ready to partner with digital health innovators to offer better service to their members/citizens and reduce the cost of care.

Research2Guidance: What are the challenges that you are facing?

Zach Henderson: In my opinion, challenges always relate to reducing friction.

How can we make it easier for providers and payers to sign up? And how can we make it easier for patients to onboard the technology? How can we increase the slope of our adoption curve? We focus on those activities that reduce the friction.

A good example is our most recent software update/release in the US. We created an RPM billing capability to export data and metadata from Glooko to directly feed the revenue cycle management systems of health systems. Systems need evidence that they have met the requirements for these different RPM billing codes. So, instead of them manually searching Glooko to find the data for each individual patient each month, we provided a standard feed that goes directly into their billing system.

This illustrates how we have reduced the friction to make it easier to use, easier to adopt and easier to obtain the reimbursement that the clinicians are properly owed. We are going to continue to make investments in many ways to enrich the user experience and empower both patients and providers.

Research2Guidance: What is next for Glooko?

Zach Henderson: We recently closed our just announced $30M Series D in new funding, and with that investment we are investing in strategic initiatives such as continuing to expand the RPM capabilities, continuing to add comorbid conditions and expanding our already robust clinical research capabilities.

Research2Guidance: Zach, thank you very much for this great conversation. We wish you and Glooko’s team to stay safe and healthy.