Holiday letter, service with a twist, new locations and more….
Vdex Diabetes:
Letter to employees and shareholders ~ Bill McCullough
Foundational Thinking
This video is a TED Talk given by the restaurant owner, Will Guidara, about how he transformed his business employing a concept called “unreasonable hospitality”. It’s a good story and one that I want to use as the basis for improving Vdex. That’s not a criticism of Vdex. I know we’re already good at what we do. However, so was Guidara’s restaurant. Now, I want us to be great! I want us to provide the best diabetes care in the world…and then do even better than that! This video describes some foundational thinking and guidance about how we get there.
www.youtube.com/watch?v=bwcyXcOpWVs What is Care?
We at Vdex provide diabetes care, but what does “care” mean in this context? Yes, we want to help our patients bring down their HbA1c levels. Yes, we want to reduce the likelihood of long-term complications from uncontrolled blood glucose levels. But,I submit what we really do, if we do our jobs well, is give our patients more life, a longer life, and a better life. More time with their kids, grandkids or spouse. More time to pursue their dreams. More beautiful sunsets. More strolls on the beach. That’s what we really do. That’s what care means in this context. We can’t lose sight of that.
Mr. Guidara realized his restaurant was in more than just the food business. Sure, they served people food, but they were also in the business of making people feel like they belonged. His restaurant was creating memories, not just feeding people. Similarly, I believe that we are more than just a healthcarebusiness.
A Service Business, With a Twist
We are a service business, just like a restaurant; we don’t manufacture anything. The patient’s experience about the service largely defines the perceived quality. There are some objective standards in a diabetes, like HbA1c and triglyceride levels, etc. that are key markers of quality, but how a patient feels when they come in contact with us is still hugely important in their evaluation of “quality.” Or, to put it another way, how you make a patient feel, the customer/patient experience, will go a long way toward the patient’s evaluation of our service. Your personal touch matters. You have a big influence on the outcome. And, that’s true of everyone who reads this, whether administration or provider. How a patient’s phone call is handled, affects that evaluation the same way that getting their HbA1c down does.
In addition, the nature of our treatment is such that the patient has a large role to play in achieving a “quality” result. In other words, the “twist” in our service is that the patient’s cooperation and buy-in helps affect “quality.”
Compliance
In medical parlance, people with uncontrolled diabetes are referred to as “non-compliant.” It’s interesting because this label puts the responsibility for being uncontrolled on the patient, not the provider or practice. The uncontrolled patient has presumably “not complied” with the provider’s recommendations. This thinking is anathema to good care. It’s a not-so-subtle way of blaming patients for their problem. How likely is a patient to want to cooperate with someone who blames him/her for their problem? How likely would you?
We need the patient to cooperate in his/her care to get the best results. We need a great relationship with the patient. This is our secret sauce. This is why the relationships between provider, clinic staff and patient are so important. That’s inherent in our model of care and it’s just one reason why each new patient appointment is an hour long.
Our Model of Care is Already Good, But it Can Be Better
The Vdex model of diabetes care has been validated as superior to the traditional models of care, whether compared to an endocrinologist or PCP. We routinely see multi-point drops in HbA1c with patients who come to us from the “care” of another. As proud of that as we should be, we can do better. The fact is, today the bar is set very low with diabetes care. The American Diabetes Association standards direct providers to get a patient’s HbA1c below 7. Yet, a normal HbA1c is between 4.5 and 5.6. We know even if one gets a patient’s HbA1c to around 7, damage is still occurring, the disease is still progressing. At that level, we are still just managing the decline of a patient.
It’s not hard to be better than that. Our aspirations have always been higher. Rather than simply “improve” a patient’s care, we should look to assist each patient to get their HbA1c level as close to normal as possible, while maintaining safety. The real goal should be HbA1c levels below 6. At those levels, we can arrest the progression, avoid complications and give people back years of life.
Yet, as soon as you say that to any “expert” in the field, you get pushback. There are the fears of hypoglycemia, the suggestions that in older patients, a slow decline is ok or the shifting of responsibility in saying that patients won’t do what needs to be done to get there. I wonder how they might feel if it were their loved one suffering with blood sugar control?
Think Differently
And, that’s where the video comes in. The restaurant video describes thinking differently about one’s particular field with the result that you provide a greater experience for the customer. This equates to a deeper relationship with the customer. Mr.Guidara says, “it’s not rocket science.” “It just requires caring a little more,” “trying a little harder.”
The essence of how/why Vdex works is the relationship with the patient. How can we deepen that? How can we so wow them with their experience that they feel inspired to work even harder, along with us to control their disease? Obviously, I don’t have the answer. And, there’s not just a single answer anyway.
But, that’s what I want you to start thinking about…
Think about how we can be better, and do better; how we can elevate or improve our processes; how we can provide a level of service that transcends what we’re doing today. See what you can come up with. And, everyone can contribute. It doesn’t matter if you’re the most experienced provider or the newest hire who helps out in the marketing department. Everyone can contribute.
Unique Opportunity
We sit in a unique position in our field. The scope of the problem we treat is massive. Diabetes is literally the largest health care problem in the world. It is foundational to so many other problems that we often hear more about, like heart disease. The fact is that much of heart disease is directly related to an absence of blood glucose control.
Somewhat surprisingly, despite being the biggest disease on the planet, diabetes has seen very little improvement in the past thirty years while other diseases have seen dramatic progress. Yes, there are new therapeutic agents that have come out recently, like Ozempic, but that has been the case for many years. There have been more than 100 new FDA-approved therapeutic agents that have come to market in the past 20+ years and yet population-wide HbA1c levels are largely unchanged. Think about that: despite 100 new tools, we’re not doing a better job controlling the disease than we were 20 years ago. We at Vdex can change that; we are changing that; and, we are virtually alone in our pursuit. There are fewer specialists treating diabetes than even a few years ago and the trends are all in the wrong direction.
This is our opportunity. If we do our jobs well, we’ll give a gift of almost immeasurable value to the world. We may have started in Alamogordo, New Mexico but we will blanket the state by the end of 2025. We’ll expand beyond New Mexico in 2026 and ultimately across the country. Diabetes is mushrooming out of control all over the world. There’s no reason to confine our treatment to the United States only when so many are in need of help.
I feel a little like Vdex is a top fuel dragster at the starting line of the drag strip and the light just turned green.
~Bill McCullough, CEO Vdex Diabetes
