October 9, 2019
(Courtesy: Forbes online)
Propeller Health is a digital company that has positive clinical results as well as financial success. Last year Propeller was acquired for $225 million after being named a Most Innovative Company. It also has public health as a core mission. Business models that promote social initiatives may prove to be a successful formula for digital medicine.
Propeller was founded on the premise that digital approaches can help manage individuals’ respiratory status while also creating public health benefits. In 2006 David Van Sickle was working as a disease detective at the Centers for Disease Control (CDC). He wanted to pinpoint asthma outbreaks in real time and create a system that could predict exacerbations. Having worked in respiratory epidemiology for years, Van Sickle recognized that approved treatments weren’t helping patients optimally control their symptoms.
“We worried that doctors were unaware of how well their treatments were working,” says Van Sickle. “Medical teams lacked information about what was really happening outside the clinic.” Because they rely on retrospective questions such as “how often have you used your inhaler over the past 30 days,” physicians often had an incomplete understanding of disease patterns.
Van Sickle believed inhaler sensors would be able to gather information on medication use that was not being obtained through office visits. He co-founded Propeller and developed a platform using a small chip that attaches to an inhaler and pairs with a mobile app to automatically track medication use and provide personal insights. The system gathers real-world treatment data and empowers people to better manage their own illness with less effort while also making them citizen scientists and contribute to public health research.
In multiple clinical studies, the company has shown that its platform can lead to 58 percent improvement in medication adherence, 48 percent increase in symptom-free days and 53 percent reduction in emergency room visits. Propeller has helped people improve their individual treatment and data aggregation has led to wider community benefits.
The Propeller team got the opportunity to show how digital medicine can impact public health when it partnered with Louisville, Kentucky and helped address particularly notable respiratory problems. The city has 60% more asthma sufferers than the rest of the country due to the combination of heat, pollen and soot. Air quality is not evenly distributed leading to pocket of exacerbations caused by changes in microclimates, cyclical pollinating plants and regional urban heat islands. Yet these health problems were difficult to manage due to an inability to predict their location and timing
Putting health data to work
The AIR Louisville program helped accurately track where and when conditions developed for asthma exacerbations. The Propeller team designed a study that would help asthmatics get better control of their disease by recruiting 1,200 participants and giving them sensors that attached to their inhalers.
The Propeller data was used to examine how pollution levels corresponded with medication. Meredith Barrett, VP of Research at Propeller led the study and explained the team was able to look at “temporal and spatial signatures” of inhaler use and that the tracking system provided “better data than looking at just information about prescription refills,” which would have been the traditional way to indirectly measure symptoms.
The study showed a correlation between environmental factors like sulfur dioxide and ozone with episodes of asthma requiring emergency inhaler use. The asthma “hot spots” were located in the central and industrial West Side of Louisville, and some in the urban core. With the help of the Propeller platform, participants used rescue inhalers 78 percent less frequently. People in the program also had twice as many symptom-free days.
“We were overwhelmed by interest from participants in having their experience help others and contribute to something bigger,” says Barrett. “When we surveyed participants about why they joined the program, people did want to improve their own health, but the second most reported reason was to contribute their data to better understanding asthma in their community.”
Patients were looking to play a bigger role in their own health and also contribute to public welfare. “Digital health creates a feedback loop to patients by delivering insights on their disease while allowing us to collect better data,” says Van Sickle.
Building the future of healthcare
One of the more daunting gaps in medicine is the inability for physicians to positively influence behaviors that lead to persistent illnesses. Chronic diseases represent 86% of healthcare costs and are 7 out of the top 10 causes of mortality.
Most patients still say their doctor continues to be the most trusted source of health information. But various factors make it difficult for physicians to change behaviors that contribute to chronic diseases. Often doctors schedule short visits infrequently. A shortage of primary care physicians limits the ability to improve the health of communities through education. Furthermore, effective public health initiatives have to be based on accurate data which is challenging to collect.
Digital medicine can provide unique benefits. When patients carry a smartphone that alerts them to take medication or predict an exacerbation, they are more likely to feel in control of their day-to-day health. Patients that have the tools to self-manage disease also contribute to a wider network of data on respiratory disease, like the AIR Louisville program demonstrated.
Propeller’s model shows how digital medicine can be profitable. In 2019, Propeller was acquired for $225 million by ResMed, a connected health company that provides solutions and equipment for treatment of breathing and sleep disorders, such as apnea and chronic obstructive pulmonary disease. Public information indicates Propeller raised about $70 million, which suggests more than a three-fold valuation based on acquisition price. The company’s revenue model is based on partnerships with pharmaceutical companies, payers and health systems with no cost to the patient.
One of the biggest challenges for small companies is the ability to scale to large numbers of patients. Digital medicine can leverage public health initiatives to help grow quickly as well as deliver benefits.
“The border between personal and public health is artificial,” says Van Sickle. “When we traverse that border, we can help people while contributing to public health in a different and important way.”