Imagine a diabetes clinic based around continuous glucose monitor (CGM) data that only required two in-person visits initially, before providing patients personalized service via texts, videos, or whatever channel works for the customized diabetes care management they might need.
Even more eye-popping: During in-person visits, if desired you could easily spend more than an hour working with healthcare experts who actually understand the diabetes data they're analyzing!
We were excited to welcome Steady Health at our recent D-Data Exchange technology forum in the Bay Area, held just prior to the big ADA SciSessions in early June. Presenting there was Co-Founder and CEO Henrik Berggren, a Swedish native who’s lived with type 1 diabetes for about two decades now. That diagnosis derailed his military career with the Swedish Navy, and he fell back on his passion for engineering and technology that led him to the USA in 2014.
It was his discovery and use of CGM that changed his own personal diabetes life, and from there he envisioned a hybrid in-person / virtual clinic that could focus on that continuous data stream to build an effective care model around. It would lead to personalized coaching with clinicians and trained coaches, as well as deep insights into CGM data that Henrik says one early Steady customer has already described as "diabetes care utopia."
We spoke with Henrik recently to learn what led him to create this unique clinic, and all about what Steady Health has to offer...
All About Steady Health, with Henrik Berggren
DM) Hi Henrik, when were you diagnosed yourself?
I’ve been type 1 for about 20 years, diagnosed in 2000 when I was 19. That was in Sweden where I’m from, but I’ve also lived in Berlin, Germany, for five years and came to the U.S. a little over five years ago and live in San Francisco now.
You were in the military at the time?
Yes, the Swedish Navy. I had been feeling pretty poorly over a few weeks prior, but thought I had an extended cold. Then I started in the Navy, and actually got a bit better because it’s very exercise-intensive and I was on a regular schedule with food and routine. But when I went to the infirmary for a test after the first few weeks serving, they did a fingerprick, and the reading was... probably in the 300-500s. And that was it. I had to quit the military service and be admitted to the hospital.
I was there for a couple weeks as they monitored me, and I had to start training on injections, finger-pricking, diet, and all of those things. I was definitely bummed, knowing that my military career was over, because I was pretty excited to be there. They had some interesting leadership training that I’d been looking forward to, but never got to experience.
And that shook up your life, of course...
Yes, it’s certainly a traumatic experience, to be diagnosed with a chronic condition that you have to live with for the rest of your life. So I had to go figure out something else to do – aside from learning to live with this. Plus, I had a nurse early on who was very doom and gloom and said I could never have a drink or eat the things that you’d want to. That freaked me out even more.
Yikes, those scare tactics are no way to start out life with T1D! What happened from there?
Then I got to talk to some real professionals who were more optimistic, and reached out to some family friends who’d been living with diabetes and allowed me to have a better view of what was necessary and what was possible. During those years, I was using very traditional management tools like fingersticks and just trying to cope the best way possible, which wasn’t easy. I spent enough time fumbling around in the dark, honestly.
What career path did you decide to pursue?
I’ve been into technology since I was a teenager, more or less, so I’d already spent a lot of time teaching myself engineering and programming in school. I knew I wanted to go to engineering school and was well underway. I was out of the Navy and didn’t have anything to do, so my mom and dad were pushing me to get back on the horse. I started a junior engineering rotation at a firm in my hometown in Sweden. That was lucky, as it led to my getting a great mentor on the engineering side and I worked there for the next few years learning the ropes of engineering. I was trained as an engineer and later started a few companies before ending up at the file hosting service Dropbox in San Francisco, where I ran parts of the product management team. I stayed there until 2017.
How did you make the switch to diabetes and healthcare professionally?
After leaving Dropbox in 2017, one of the things I wanted to do was to take a year off. And during that time, I aimed to just learn what tools and tricks could I use to get to better diabetes management for myself. What I was surprised by was CGM, which I didn’t really know anything about at the time. I went to my endocrinologist and asked her, “What’s this thing called CGM?” I’m very fortunate to have had good insurance, but she had never recommended or told me about this before. I did all the research myself. It was this strange experience, realizing that I might not be getting all best advice and tools that someone with this disease should have if they want it.
Sounds like CGM really changed your life…
Yes, definitely. After getting a CGM, I realized just how powerful having all this data can truly be. I really do think there are two separate pieces of value you get from a CGM:
- First, what most people use it for: the alarms and checking where you are right now, whether you need to eat something or take insulin.
- Second, retrospective analysis, which is a way to learn how food and exercise and medication impact your glucose levels and body. This is were I got most value from it.
I used that feedback loop to run different patterns of experiments – different exercises, various types of foods that I like, and so on, to try and better understand what my body can cope with really well, and areas that are more complicated. I used Excel mostly to keep track of all this.
That allowed me to live my life and control my diabetes in a simple and effective manner. In just in five or six months’ time, I made really remarkable progress... and am still making progress. I lowered my A1C about 20%, reduced my insulin doses about 50% and lost about 10 pounds that I’d been trying to get off. I was just feeling so much better, sleeping better, my mood improved, and I had more energy. I’d had no idea this was even possible, that you could feel this good while living with diabetes.
What was the epiphany you had then?
That if you can collect all the data you need, and then use that in clinical care to personalize treatment, the chance of success goes up dramatically. It all became clear when I started researching the overall state of diabetes care. We’ve really been doing so much development on the technology side, with CGM and insulin pumps and DIY looping. But the healthcare portion of it hasn't changed much.
The model of care delivery most doctors must utilize doesn’t allow for them to use data as extensively as they could. They have very little time, and don’t spend enough time on data review because of the reimbursement structure in the U.S., and they don’t even have that much training on this. The tooling is pretty fragmented, with every manufacturer making their own tools and clinical offices having to deal with all kinds of combinations for the hundreds of patients they have.
If I could team up with a doctor to streamline and vertically integrate the tools, the data and the actual care, maybe we could build a clinic that’s best in the world for using CGM data to analyze and coach people on getting better with their management.
So that led you to founding Steady Health?
Yes, it did. I came into this wanting to build a technology company while also having a direct impact on patients. What I realized was that just building a software company wouldn’t allow us to have a direct impact like that. So we decided early on that it had to be focused on the healthcare provider side, and those issues I mentioned: lack of training, limited time for providers, fragmented tooling.
The other reason was, as someone living with diabetes, I know there are so many companies and services out there trying to pitch the next “revolutionary app” or service. But what most of them don’t realize is they’re just adding more jobs for us to do. We already have a full-time job with diabetes, on top of whatever other jobs we have in life. So I wanted to build something that doesn’t just add more burden.
How would you approach that?
My goal was to improve the things that most patients are already doing today, like going to see their endo on a three-month or some routine. How can we make that experience better and more convenient? So that patients can get some of their time back and improve their diabetes management?
The pieces involve structuring a new care model that is more personalized and tailored to how people manage their diabetes each day. We’re relying heavily on CGMs to accomplish that by using the data to get unique insights into the lifestyle of every member. We can also do a lot of the care completely remotely, because of how connected we are with modern devices. We believe that this gives us a deeper view, allowing people to be more successful but spend less time on their diabetes.
How exactly does Steady Health work?
People come here to our clinic, just like you would with your normal endocrinologist. Then we take you through a two-week tracking period, where you give us access to your CGM data as well as other data sets involving food, activity, and medications. We then analyze that data up front, using a specialized toolset we’ve developed and have trained our clinicians to look for these specific insights within that data.
Then you come back in for 60-90 minutes, to sit with a clinician and review that data and those insights. We're really looking at what you’re eating, the blood sugars, and what impact that really has on your health… Asking how we can use that data so you can use it to make better decisions? We set up some specific goals to go over with you, very collaboratively, and hone in on what’s important to you. After that it’s virtual, so we can work with you on reaching those goals through the mobile experience.
Can you describe the ‘mobile experience’ component?
We then coach you on those goals, through text messages and video for the next 6-12 months. We take pride that many of these goals are measurable, using data we get from the CGM. That may be better Time in Range, or fewer hypos, or whatever the goal may be that you want. We can keep track of that over time and keep you accountable, as well as outreach on other parts of life or reactively if anything comes up like needed prescriptions, or supplies. We do all of that, too. It’s like having your endocrinologist in your pocket at any time, but more like using us as a sounding board for your continuous care with your doctor.
We’ve been working on a pilot program for the past six months with a number of patients, and we’re now signing people up on a weekly basis. We are in growth mode now.
How is this different from other diabetes coaching services out there?
This is really a hybrid of some of the other coaching and mobile tools out there, with clinical care expertise. We’re taking the best parts from Livongo or One Drop, and really focusing on the deep analysis and tech angle of using CGM to personalize care. We really want to make a tailored program to each individual.
With so few people using CGM in the States and globally, how does that color Steady Health’s business model?
Of course, it does. We’re essentially building the entire company and services around CGM, and we’re counting on the growth that I believe we’ll see in CGM over the next several years. We believe, just like Adam Brown of Close Concerns/diaTribe has said, that we’re eventually going to look back on this time and cringe at ourselves for not rolling out CGM to everyone, not only those diagnosed but those with pre-diabetes.
We’re definitely banking the company and clinic on CGM becoming a completely ubiquitous piece of technology that more are going to have, especially as it becomes less expensive and more accessible. We are working closely with CGM makers to know what’s on the cutting edge, the improvements, but also staying close to Dexcom and all the other manufacturers that are going to be a part of this. All of us need to get to the next level of specificity when it comes to taking care of diabetes.
What’s your team look like currently?
We have 10 people, from clinical care team to engineers and others. Our clinical team includes endocrinologists on staff and certified diabetes educators, as well as care coordinators that are health coaches and admins in a hybrid role. They are on staff with Steady Health Medical Group. We might explore a different model at some point in future, if other clinicians and practices are interested in employing the “Steady model of care.” But that’s TBD and we’re not there yet. Right now, we’re exploring how to create a really good virtual care clinic model for people and building the software it’s based on.
Do you have plans to open other locations across the country?
Right now, we have one location in downtown San Francisco and we’re only taking people from California. We believe that probably we’ll continue to have a physical presence and will be expanding across states in the next couple years. But we’ll see how that evolves... We are exploring whether it’s going to be a mobile clinic, or partnering with primary care doctors to do the physical exam components while we focus on our personalized diabetes care remotely. Meanwhile, the doors are open to those in California, and we are looking for more patients.
What does the Steady Health service cost, and is it covered by insurance?
We function very similarly to your regular endocrinology clinic or specialist doctor visits. We charge your insurance company for in-person visits and your co-pay would be the same as seeing your regular endocrinologist. As a new member, you can expect those two visits within the first month of joining Steady. As a continuing member, you can expect at least one yearly visit. We will require an annual in-person visit, but you can visit us as your regular endocrinologist.
Without insurance, our out-of-pocket price is $300 per in-person visit.
To support our platform and tools, there is a membership fee of $59 per month. With a membership, you receive unlimited virtual access to our care team, use of the Steady app which provides an interactive way to track food, exercise, and medication, and help from our member guides who can assist with all of the administrative tasks related to your care.
What's the bottom line on creating this new type of clinic devoted to diabetes?
Overall, it's about changing the care model and personalizing it through CGM data. We want to provide that deep view for everyone who comes to us, and want it to allow people to have full lives and engage with their diabetes in a new way. One patient we have called it "diabetes care utopia," saying she'd never learned so much about her type 1 in the 35 years she's lived with it. That gets us really excited!
Thanks for talking with us, Henrik. We love your vision for a new type of care, and look forward to seeing how it grows and evolves.