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EF: Could you elaborate on VitalAire's footprint in South Africa?
IE: VitalAire is Air Liquide Healthcare's home healthcare activity. It has two subdivisions: respiratory, with 100 employees, and diabetes, with a team of 18 looking after 1,400 patients in South Africa and Namibia. In 2024, Air Liquide Healthcare supports 2 million people with chronic diseases worldwide.
Ethitech Health Innovation, a company acquired by Air Liquide two years ago in South Africa, was the previous owner of the diabetes division. VitalAire Diabetes is a new addition to the South African market. As a subsidiary of Air Liquide, it is well-positioned to provide quality healthcare services to those in need.
EF: Could you elaborate on your current priorities in South Africa?
IE: My top priority is expanding access to advanced diabetes technologies for people with type 1 diabetes in our country through a comprehensive and patient-centric approach.
We have established strong, ongoing relationships with key funders in South Africa. We actively engage with the public sector to address the challenges patients face during the critical transition from paediatric to adult diabetes care.
Specifically, we are sponsoring a pilot program led by Dr.Zaheer Bayat that provides free diabetes products to children during this transition period. The objective is to learn how to effectively integrate these often expensive technologies into the public healthcare system.
In parallel, we are pursuing a two-pronged strategy. First, we are working to source more cost-effective diabetes products to improve affordability. Secondly, we are exploring a value-based healthcare approach, where VitalAire takes on the risk and responsibility for delivering positive outcomes for patients rather than just selling products.
This value-based model provides comprehensive support, including education, training, and proactive care management, to ensure patients can effectively use the technologies and achieve better clinical and quality of life results. Simply providing the device is not sufficient - patients need the proper support to use it successfully.
Our vision is to deliver true value to patients and funders. By taking a more holistic, outcomes-driven approach, VitalAire aims to improve diabetes management and reduce long-term complications for people with type 1 diabetes in South Africa.
EF: What does value-based healthcare mean to you, and how do you see the receptiveness of the South African market to this approach?
IE: We started this approach two years ago, and it is still relatively new for funders in South Africa. However, we have already achieved success with two funders. Over six months, our patient cohort observed a 1.5% reduction in HbA1c levels - a blood test to diagnose and monitor diabetes. This demonstrates the potential value of our proactive management strategy.
Conducting pilot studies like the ones we are currently running allows funders to see tangible results. These studies help reduce reluctance by showcasing the positive outcomes and proving the effectiveness of our approach. A common concern among funders is that they already pay doctors for patient management. However, doctors in South Africa are often overwhelmed with administrative tasks and time constraints. By partnering with doctors, we can assist them and encourage the market to adopt this value-based healthcare approach and risk-sharing model.
Additionally, during a value-based healthcare conference I attended last year in Milan, Italy, a professor highlighted the importance of patient involvement in this model. He used the example of oncology, where patients are asked for consent not only to complete forms but to contribute data that can help improve future care for others with the same disease. This emphasises the role of patient data in demonstrating value to funders and enhancing quality of life. By involving patients in this process, we can gather the data required to show funders the benefits of our approach and ensure better outcomes for everyone involved.
To truly understand the value for the patient, it's important to ask questions that delve into their quality of life. Understanding these aspects helps highlight the real benefits for the patient. It is crucial to frame these questions to motivate patients to respond.
Getting buy-in from both doctors and patients is essential. To enhance patient engagement, we have a dedicated role called the Patient Experience Lead in our organisation. Interestingly, four of us in the company, including myself, live with Type 1 diabetes and use the products ourselves. This personal experience informs our approach and allows us to provide peer-to-peer support, which many patients prefer over speaking with a nurse or doctor. They often feel more comfortable talking to someone who truly understands their experience. This shared understanding helps us address the nuanced aspects of living with diabetes, ultimately improving patient outcomes and satisfaction.
EF: Could you elaborate on specific initiatives to promote awareness and education on delivering the best treatment possible for somebody with Type 1 diabetes?
IE: We conduct quarterly workshops for doctors interested in insulin pump therapy, in South Africa. A significant change over the past five years has been the integration of AI and data analysis into our training. Our software programs now generate comprehensive reports highlighting trends, such as recurring nighttime hyperglycaemia. This AI-driven analysis helps doctors quickly identify patterns and make informed decisions.
In the past, some doctors were hesitant to treat patients with Type 1 diabetes using these advanced technologies. They were concerned about losing control, as these devices give patients a high degree of autonomy. However, our new software systems simplify the process by providing doctors with easy-to-read reports, making it easier to analyse data and adjust treatment plans. Our training focuses on the practical use of these devices.
Despite our efforts, there is a significant need for more diabetes educators in South Africa. This responsibility ideally falls to academic institutions, such as the Centre for Diabetes and Endocrinology (CDE), to train diabetes nurse educators. Currently, we provide training on our products and assist with data analysis and settings adjustments to achieve optimal clinical outcomes. However, comprehensive training on diabetes as a disease is still a pressing need in South Africa.
EF: How are you leveraging AI, and can you elaborate on the product portfolio driving growth in South Africa?
IE: AI and Big Data are revolutionizing diabetes care by enabling more precise and personalized care plans. AI algorithms can analyze patient data to recommend setting changes and optimize. When discussing our products, we currently offer an advanced hybrid closed-loop system. This system predicts future blood glucose levels and adjusts basal and bolus insulin accordingly.
We also supply the Dexcom G7 continuous glucose monitoring (CGM) system. This real-time CGM predicts future glucose levels and provides alerts for potential highs and lows. For example, if your glucose level is at five and might drop to 2 in the next 20 minutes, the system will alert you so you can take action before experiencing a low. These alarms serve as a crucial safety mechanism, and clinical studies have shown significant improvements in HbA1c and Time in Range outcomes for users of CGM systems. We aim to introduce these advanced technologies to the public sector.
Currently, only one medical aid in our country covers continuous glucose monitoring, which limits access to these technologies. We are working with patient advocacy groups and engaging with key stakeholders to pressure funders and improve access. Despite the integration of AI in all our software systems, navigating the reimbursement landscape is a complex and ongoing process.
EF: How can we promote an open dialogue to get aligned on the future of healthcare, especially now during times of transition?
IE: We need to increase our efforts and foster more collaboration within the healthcare ecosystem. By working together—medical device companies, insulin manufacturers, and other stakeholders—we can discuss with the government and funders. This collective approach can facilitate more open conversations, involving more stakeholders and shifting the focus from company’s interest to patient outcomes.
When considering the public sector, it is crucial to prioritise patient outcomes Nonprofit organisations often run trials for continuous glucose monitoring (CGM) in state settings, but it is not enough to sponsor a limited number of people. We need a broader and more sustainable approach. One key aspect is education. We must educate nurses in hospitals about diabetes and the latest technologies available. This knowledge will empower them to provide better care and support for patients. By ensuring healthcare providers are well-informed, we can improve the overall management of diabetes in the public sector.
However, it is important to recognise that not everyone in the public sector can access a smartphone, which is often necessary for using these devices. To address this, we supply receivers—dedicated devices that work with the CGM for those without compatible smartphones. The next challenge is managing the data from these devices. The doctor needs access to the data and knows how to interpret it. We have partnered with our respiratory division in VitalAire to facilitate this through the UNJANI clinics initiative. These clinics provide patients with access to oxygen, and now we are integrating diabetes care into their services.
We are equipping these clinics with computers where patients can download their CGM data. This allows doctors, even those located far away, to access and analyse the data remotely. For example, a patient in Nelspruit can visit a UNJANI clinic to upload their data, and a doctor in Pretoria can review it without the patient needing to travel long distances for appointments.
Additionally, we are developing training videos for patients in their home languages. Language can be a significant barrier, especially when dealing with a new and overwhelming diagnosis like Type 1 diabetes. Providing educational resources in patients' native languages helps them better understand their condition and how to manage it, ensuring they receive the full benefit of the technology.
EF: What would be your advice to other people aspiring to be healthcare leaders on the best way to impact your community positively?
IE: Creating a collaborative and patient-centred culture within our company starts from the top down. It is about communicating with colleagues, engaging with patients, and prioritising patient care at every step. This approach is rooted in empathy and a genuine commitment to improving the lives of people with diabetes.
It is crucial to convey this value to patients, funders, and stakeholders. We aim to show them the significant impact our technologies can have on improving quality of life. This involves advocating for broader access to these innovations and ensuring they are recognised for their transformative potential. In fostering a culture of inclusivity, listening to diverse perspectives and engaging with stakeholders from different backgrounds is essential. This approach helps us better understand our community and the broader societal impact of diabetes care. By speaking with various stakeholders and embracing inclusivity, we can build stronger partnerships and drive meaningful change in diabetes management.
Effective diabetes care reduces the disease burden on individuals and healthcare systems, allowing more people to lead healthy and productive lives. Investing in healthcare infrastructure and services creates jobs and stimulates economic activity. Furthermore, addressing diabetes and other chronic diseases can significantly reduce healthcare costs and improve the quality of life, contributing to broader societal development.
