December 3, 2020
How Welldoc’s Dr. Anand Iyer brought wireless technology to healthcare
20 years into a career in wireless telecommunications, Dr. Anand Iyer was diagnosed with type 2 diabetes and asked himself a question: We’ve done wireless in every other industry, so can we not do it in healthcare?
Anand joined Welldoc in 2008 when the health tech startup was in its infancy. Over the past 12 years, he’s helped transform the company into a global leader in digital health and chronic disease management. Anand played an instrumental role in launching Welldoc’s banner product, BlueStar®: the first FDA-cleared mobile prescription therapy for adults with type 2 diabetes.
At MATTER’s latest Tales from the Trenches™ moderated by VillageMD Co-founder and Chief Growth Officer Paul Martino, Dr. Anand Iyer discussed how he helped transform the company into a global leader in digital health and chronic disease management.
Here are our key takeaways. Responses have been edited slightly for length and clarity.
Bringing wireless technology to healthcare
“My background is in wireless telecommunications and electrical engineering. After getting my PhD and MBA from Carnegie Mellon University, I started to do advanced technology strategy consulting for one of the premier management consulting firms, PRTM, right at the dawn of 2G cellular speed.
“We started to quickly grow from just laying the pipe and foundation for this disruptive technology and quickly started to say: now that we have the pipes in place, what services can we add on top of that? And that quickly grew to things like automotive telematics, a RFID (radio frequency identification) policy for the Department of Defense, smart highways in India and more.”
“It was on that journey, around the 2002 timeframe, that I developed type 2 diabetes myself. I affectionately joke that there are two things that define me: one is good, which is that wireless is in my blood. One is not good, which is that there is too much sugar in my blood. Somehow Welldoc has managed to fuse the two together.”
“I affectionately joke that there are two things that define me: one is good, which is that wireless is in my blood. One is not good, which is that there is too much sugar in my blood. Somehow Welldoc has managed to fuse the two together.”
“Given my new diagnosis, I asked a simple question: we’ve done wireless in every other industry, so can we not do it in healthcare? Soon enough, we started to do things like automated tracing of equipment in a hospital, making sure that patient A in hospital bed A got medication so that you were reducing medication errors in hospitals. In 2005, I met an endocrinologist at a conference who was commiserating the state of diabetes management. There had to be a way to leverage mobile technology in the way forward. In many ways, that was it. I started consulting with Welldoc for a year and a half, and ended up joining the company in 2008.”
Rigor pays off
“There were certain things that we couldn’t take for granted when putting ourselves in the shoes of any one actor in the healthcare ecosystem — whether that be the payer, the insurer, the hospital system or the actual healthcare provider themself. For example,we wanted our products to have efficacy — to have proof that they actually delivered the intended value proposition. The gold standard for doing that is through a randomized control study, just like what would be used for a new drug or new medical device. Dr. Carl Sagan famously said, ‘It’s the absence of evidence, the evidence of absence’. In the simplest of terms, he meant that if you want to be a player, you better have evidence that your product will work and it works with an intended use.”
“After we had our baseline of evidence, the next checkmark was to ensure that our product was safe for people to use. At the time when we first created BlueStar, we were under the accessory rule. We were taking data from a predicate medical device — in this case, a class two medical device called the blood glucose meter. We took the data, interpreted it, analyzed it and provided real time coaching that was precise to the patient’s medication regimen, that was precise to their comorbid conditions, that was precise to their medical history and more. After that, we presented longitudinal insights. For instance, how the patient did with their glucose or medication adherence — and correlatively what happened — why the patient had glucose excursion.”
“Providing that level of information put BlueStar into the class two world, as we were giving higher risk guidance. In order to operate in class two, there’s a certain level of rigor. You have to have a quality management system in place. You have to have evidence that you actually follow the processes that you say that you measure. You have to continuously improve. It’s a culture of quality. Can you ensure product quality and safety for the patients? Can you ensure that you actually measure their data, monitor their progress and improve their quality of life continuously?”
“These practices soon became foundational to Welldoc and other healthcare startups in the late 2000s. Today, in 2020, these factors remain just as foundational as they 15 years ago: clinical trials, FDA clearance, cybersecurity, etc. The pathway was rigorous — just as rigorous as if you had brought a medical device or a drug to market. Why would you not apply the same rigor to bringing software to market if it’s going to treat, mitigate and manage a disease?”
“The pathway was rigorous — just as rigorous as if you had brought a medical device or a drug to market. Why would you not apply the same rigor to bringing software to market if it’s going to treat, mitigate and manage a disease?”
Evidence is key to improving health outcomes
“Today I would encourage entrepreneurs to take that same rigorous approach and take advantage of the fact that they can submit real-world evidence, take advantage of the fact that they can put lower risk products into the market to then help understand data, to make the claims they want to, and then submit, predict claims and elevate their class based on their core strategy and what they choose to do.
“Not everybody has to do it. There are plenty of digital health solutions out there that have been successful not using that pathway. What you do depends on what you want to do and where you want to make change. If you really want to make a difference in health outcomes, as well as financial outcomes, you have to go the extra mile. You may have to do things that the FDA considers to be slightly higher risk, which then puts you in a different risk category and therefore require classification.”
“If you really want to make a difference in health outcomes, as well as economic outcomes, you have to go the extra mile. You may have to do things that the FDA considers to be slightly higher risk, which then puts you in a different risk category and therefore require classification.”
Reaching patient populations where they are
“There are three main factors we consider and deliver on when developing the best product to reach our end user, the patient.”
“First and foremost is connectivity. This software is a medical device that uniquely works online and offline. Every other digital health solution in the market today requires you to have a live connection to the internet via WiFi or cellular connection or a phone call to a human being. That doesn’t work when you’re in a tall building in New York City on the 27th floor. It doesn’t work when you’re in an underground parking garage. It doesn’t work if you’re flying on an airplane. We had to make sure it works both online and offline, especially for outbound algorithms.”
“Next up is affordability. There’s a little bit of a misnomer in the industry that Medicaid patients won’t be able to use smart phones because they can’t afford it. Not only are smart phones often subsidized by state programs, but oftentimes these devices are the Medicaid population’s life line, as they use it for their phone, TV, computer and more. Believe it or not, we have found that in Medicaid populations cell phones are the most prevalent device, as they use it for everything. Their engagement is very high.”
“Third is accessibility. People think that their elderly loved ones won’t use an application. However, seniors are our highest engaged users, averaging app usage 38 to 44 times a week.”
“These are things that technology fundamentally enables. That’s what allows you to have the higher numerator and the smaller denominator, therefore, the fraction and value is higher.”
Characteristics of successful healthcare entrepreneurs
“Flexibility, adaptability and — most importantly to me — belief and passion in your mission are the most important characteristics of healthcare entrepreneurs. This is about changing people’s lives — it’s not fun and games. A lot of people suffer in very bad ways from these diseases, and we have a shot at helping them in ways that are friendly, fit into their lives and create change that traditional care can’t. We have a responsibility and duty to do so.”
“Be passionate about delivering that value proposition and be passionate about putting yourselves in the shoes of your ultimate end users, who are your patients and the providers that help them solve these healthcare conundrums.”