Yesterday we published the first half of our comprehensive behind-the-scenes interview with Joslin Diabetes Center CEO John Brooks III -- who by the way took part in the 2012 DiabetesMine Innovation Summit.

Today, we continue talking with John, learning more about the legendary center, and digging into all the current 'hot buttons' in diabetes innovation and care:

 

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DM) How much of Joslin's focus is pure research?

JB) About 40% of our total focus is research — of that, 40% covers type 1 diabetes and the balance is type 2 and some crossover complications. We also now have a new emphasis on wellness and prevention. We have about 300 people here: 31 principal investigators in 8 major sections, doing about $40M in research.

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... and patient care?

We have about 25,000 patients in Boston, of whom roughly 40% are type 1, pediatric to geriatric. That includes about 2,500 young adults predominately with type 1. They're managed by 60 clinicians. There's a lot of crossover between our research and clinical care.

DM) What would you say is the 'core change' aimed for in Joslin's current strategic plan?

I think the plan anticipates the impact of funding cuts from NIH and the impact of sequestration. If we can be innovators, show that we're thinking out of the box -- and trying to bring practical solutions to bear -- we can re-energize donors on the philanthropic side. So part of the plan is to make sure we have a more diversified economic base. We need to innovate to stay financially sound, so we can deliver great care in a cost-effective manor.

The plan also stresses collaboration, and leveraging technology. The idea is to make sure that in 5 years, Joslin not only continues to have great reputation, but people get invigorated by our efforts to catalyze and inspire them to think differently about how to make a real dent in this disease -- recognizing that type 1 is growing at a rate of 3% a year, and we obviously we know the true nature of the pandemic in type 2.

What about the notion of a "patient-centered medical home"? Is that how Joslin operates?

Here in Massachusetts our healthcare system already has many elements of that, so we're ahead of the rest of country.

At Joslin, we're looking at lots of different care models. We're constantly evaluating: how do we best help people diabetes? Are we looking at a more integrated PCMH model? Absolutely we are going to do that — we want to take care of people soup-to-nuts.

For the details, you'll have to get back to me in summertime... We're currently evaluating the best way to do it, and how to get payors interested in supporting it. For example, how do we prove that Joslin involvement in other PCMH efforts is clinically beneficial?

You seem to be expanding worldwide. How exactly is Joslin's expertise being 'exported'?

In the old days, we'd send people out to different parts of a country to help set up clinics. The new model is to set up joint ventures. So we're hiring people in that country to manage a new diabetes center of excellence. These partners will help us expand. We've learned that we need to have people from within the country, there working with the system in that environment. We're just on the verge of signing joint venture agreements in India, China and the Middle East.

Our new Office of Commercialization & Ventures is helping these regions and companies get access to our tools -- working on advancements in kidney biomarkers, better products for opthamology treatments, retinopathy, brown fat and other areas of expertise.

Are you concerned about changes coming with the new Affordable Healthcare Act?

The Act has elements of accountable care organizations, and the idea there is to have a healthcare provider manage a population of patients and be able to demonstrate that with more coordinated care, better use of electronic medical records, and so on, they can do a better job of keeping people in better health.

So the idea is to focus on patient surveys, to show that patients are happy getting the care they want and need.

What it boils down to is that everyone's worried about losing patients. If you're making all these investments in coordinated care, the last thing you want is to have patients go elsewhere for their care. So if hospitals do a good job, there are economic benefits. If they don't do a good job, there are economic penalties. I think everybody right now is trying to figure that out.

From a Joslin standpoint, we do worry about losing patients, and we worry that if other clinics refer patients to us, they might worry about losing those patients. The idea with 'Joslin Inside' is not to have our local collaborating partners think we're co-opting their patients. We're really thinking, 'Look, they're your patients and we don't want to do anything but help you take care of your patients.' And if we can do that, we can share some of the resulting economic benefits. Now the patients don't necessarily need to come to us, but we're helping these clinics give their patients the best possible diabetes care.

Is it going to get harder for patients to get coverage for pumps, CGMs, or other treatment options?

It's complicated. It depends if their coverage is coming from a healthcare exchange, from their employer, from the government...

But there have already been a few States that have questioned the value of CGM, so your point is a valid one: if payors are under pressure to keep costs down, are they going to make some short-sighted decisions?

It comes back to the benefit of metrics. Can we show that people on a CGM -- and also being treated to help translate the information into real-time care plans -- better manage their disease? Can we go back to payors, employers, or whoever's footing the bill, and show benefits like fewer ER visits, less absenteeism, better productivity?

The real answer is that this new healthcare environment requires metrics, analytics, analyses, and cost-effective studies showing better outcomes.

If we want to deliver care using technology, or using new approaches like newer insulins or taking different types of drugs while taking insulin, we're going to have to show that it's impactful -- that it's not only safe and efficacious, but that it can also take costs out of the equation.

If we can help illustrate the value of some of these new CGMs, new incretins, tools, and apps, we feel confident we can get the support and help get coverage. We see that as part of our role.

Let's address the notion of empowered patients/ patient-centeredness. What is Joslin doing to involve actual PWDs (people with diabetes) in its approach and future planning?

Great question. Cathy Carver, who's been at Joslin for 9 years, reports to me and is responsible for advocacy and planning, just concluded the 3rd meeting of our Patient Advisory Council. We take a cross-section of patients and share with them what we're doing in our patient portal — in terms of access to labs, scheduling appointments, secure email interactions with doctors, etc. We're also creating new online solutions and educational materials.

The Council is made up of about 10 people -- a mix of type 1s, type 1 parents and type 2s. We ask them: How are we doing? What are we doing wrong? I would say they're holding us to the task of making sure we are patient-centered.

We also have a Clinic Advisory Committee and their job is to focus more on: Are we doing a good job of caring for our patients? Are we communicating well with parents in the pediatric division?

My hope is that we're not just saying a bunch of things here. We have this environment here of: Let's do it. We learn, continue to get feedback... try new things...

On that note, Joslin is hosting its second annual huge Diabetes + Innovation event this year, including payors, industry folks, researchers and government officials. What do you hope to accomplish? Is there a call to action?Joslin Innovation 2013

The call to action was really catalyzing our thinking around a focus on prevention and wellness. We have a new Center for Integrated Health and Wellness here, where we're working with food companies and exercise companies.

Joslin was one of the lucky recipients of money from the Massachusetts Life Sciences Center for infrastructure improvements, and right now we are undergoing a two-year renovation where we're upgrading all of our labs. But most importantly, we've always had a gym here to help educate people on how to exercise for their diabetes, and we're adding to it and expanding it into a full exercise physiology lab so we can study the direct impact of diabetes and exercise.

One special area of interest is in type 1 — there's been very little study on the impact of exercise, hypoglycemia events in exercise, etc.

We're also building a metabolic as well as a demonstration kitchen, so we can actually study at a science level food, nutrition, the microbiome and how ingredients affect glycemic levels. We can use that to understand the effects of different food substitutions and ingredients -- in both type 1 and type 2.

There's some thinking that maybe the microbiome could be a generator of some of the inflammatory processes or the autoimmune processes... it's all speculation right now, but we're innovating to better understand the effects.

executive portraitsWhat about a call to action in terms of awareness and education?

We're working with ADA and JDRF to help bring more awareness and education to our Congressmen and Congresswomen. I've also tasked our education group to think about better educational programs for primary care doctors who really see the majority of type 2 diabetics.

We're working to help our affiliates to turn into more of an interactive network so they can better communicate and utilize their capabilities.

We want to encourage more efforts here around an improved patient portal: more ways to blog and support disseminating information and ideas.

We're going to have another innovation program where we want to try to influence our government officials and our legislators, and hopefully get other organizations to think about working collaboratively to solve real problems.

I'm excited because we know there are a ton of things to be done, and hopefully I can provide a little bit of the enthusiasm and vision to empower our team to hopefully make a big difference.

There are so many empowered patients out here as well who might like to help -- especially when it comes to encouraging innovations. Are they welcome to contact Joslin?

Absolutely. I don't want to just be an academic medical center that's off doing our thing, unconnected to people and patients ... we're all about: let's try it! At the end of the day, we're not going to lobby change, we're going to have to prove that innovation and technology lead to positive, permanent benefits. We're happy to work with patients on proving the value of new solutions.

Thank you, John Brooks III, for being such a hands-on leader. We're definitely feeling like the Joslin legacy is in good hands!

{click here to learn about getting involved in Joslin clinical trials, and here for the Joslin blog; see also, interview with John Brooks III on a recent Diabetes Social Media Advocacy (DSMA) podcast}

 
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