Digital health is empowering patients like never before forcing healthcare systems to market directly to patients. This focus on the patient is being sped in part by the increasing cost of healthcare and changes in health insurance coverage models. This change is forcing many consumers who opt for high deductible emergency coverage to take greater responsibility for their health and to seek care options. When developing solutions for patients, it is imperative that healthcare providers adapt in at least three ways:
1. Provide solutions at the patient’s location,
2. Provide tools that empower self-care while giving autonomy,
3. Provide solutions that develop social connectedness and engage consumers with their social network.
Consumers are the drivers of change today, and the healthcare system needs to adapt and meet their demands. The days of health systems dictating and institutionalizing care are being replaced by meeting the needs and catering to the patient.
Here are three ways healthcare systems must adapt to the consumer:
1. Delivering solutions to where patients live requires meeting patients at their location, and not expecting them to come to you.
An example of this is the trend towards delivering medications directly to the patient's home. This will result in improved adherence, compliance and outcomes. Another example is providing routine and urgent virtual care visits using teleconference technologies. As much as 70% of care can be provided remotely from the comfort of a patient's home. Allowing the patient's existing primary care doctor to care for their patients virtually will enable them to treat and diagnose most health conditions. Virtualizing primary and specialized care services will allow for better care coordination while ensuring a patient-centered focus.
Virtual care will help contain costs. Currently, 44% of people don’t go to the doctor when sick or injured because of the cost burden, and 40% don’t get necessary tests or treatments. This results in people getting progressively sicker until which time they are forced to urgent care centers and emergency rooms where the cost of care skyrockets. The cost of an in-person doctors visits may cost $125, compared with less than $50 for a telemedicine visit.
As more care is provided virtually both using passive monitoring technologies and active virtual care visits, digital health technologies will allow the healthcare system to evolve from two to three 20-minute clinic visits a year to 24/7, 365 days of continuous care and management run by nurse practitioners and clinical pharmacists. Only in the event of emergent, acute care events will patients need to go to a facility for care.
In anticipation, health systems are already decentralizing their services from large hospitals to smaller more geographically spread micro facilities to serve patients and lower operating costs. These new facilities allow patients to get their blood tests and x-rays at a fraction of the cost of going to the hospital.
Large employers such as Apple and Amazon are taking the employee's healthcare into their hands by developing their private provider networks and allowing care to be delivered directly in the workplace. At the same time, pharmacies such as CVS are merging with healthcare providers to provide primary care in local communities ensuring patients are not lost to competing healthcare providers. These changes are resulting in more care being delivered to patients at their location.
2. Provide tools that empower consumers to self-care while giving them autonomy from the health system.
New digital health tools are allowing consumers to learn more about their medical condition and treatment options. A new class of ‘drugs’ called digital therapeutics is being developed that would enable patients to self-manage and treat diseases such as diabetes, hypertension, depression, and COPD. Coupled with IoT devices and mobile apps, patients will increasingly self-track and monitor their health while simultaneously being remotely monitored by sophisticated predictive machine learning analytics to prevent complications.
Wearable heart rate monitors like the Apple Watch are already saving lives by allowing the detection of pre-diabetes, atrial fibrillation, and deteriorating health conditions days in advance by measuring changes in heart rate.
Today’s health system struggles with prevention and managing chronic disease. This is evident by the fact that chronic disease accounts for over 80% of all healthcare expenditures and 70% of all deaths in the USA. The health system needs to bring the cost and responsibility of treating and managing chronic conditions in focus. “Over the next 10-15 years there will be a scientific wellness industry in contrast to the disease industry and the market cap will far exceed that of the disease industry,” said Leroy Hood, Chief Science Officer at Providence St. Joseph. “ The contrast between 20th and 21st Century medicine is striking, 21st is proactive, focused on individual wellness, creating medicine that is preventive, personalized and participatory, and reverses rising cost trends.
New reimbursements experiments are underway and chronic care monitoring payment models continue to emerge. Reimbursement is increasingly being redirected from fee for services models that reward providers for delivering more services to value-based care that reward providers with incentives that keep their patients healthy and reduce visits to traditional medical facilities. Today, approximately 30% of all healthcare payments are tied to such alternative payment models. Additionally, employers are increasingly offsetting the cost of healthcare to their employees.
In a move that will put more control in the hands of consumers, CMS is changing ‘meaningful use’ EHR requirements to ensure patients have access to their medical data by requiring providers to equip patients with access to their electronic health records on the day they leave the hospital. CMS also requires increased transparency to cost and quality of treatment options. This isn’t being lost by the likes of Apple who just recently empowered consumers with access and control of their medical information from their iOS devices. Despite the challenges faced in creating personal health record solutions, Google with over 80% of the smartphone market is sure to follow. This is giving patients control of their medical record by providing them the ability to share their information with any healthcare provider they wish.
Data collected from a patient in a hospital is only valuable for predicting readmissions during the seven days that follow their discharge from the hospital. Similarly, a single blood pressure measurement in the doctor’s office or hospital is not reflective of the patient's life. Recent data points to 30% of patients being diagnosed with white coat hypertension, where their blood pressure readings are artificially high when taken in a doctors office versus at home. A study of over 64,000 patients over five years showed that blood pressure taken at home was a stronger predictor of cardiovascular deaths then doctor’s office readings. Other studies have shown that hypertension can be controlled remotely as well, if not better, then when done face to face in a doctor's office.
Patients must continue to be monitored from their homes to predict better and prevent rehospitalization. Solutions must be user-friendly and fit into their daily routines as much as possible. The fact is that life happens outside of traditional care settings and to better understand and intervene, patients must be monitored and cared for in their environment.
3. Provide solutions that engage consumers with their life, friends, and family – not with the healthcare system.
The healthcare system wants to engage their patients, but patients are not necessarily interested in engaging with them. Instead, patients want to learn more about themselves and engage with their loved ones. They want to get the most out of life and ‘disengage’ from the healthcare system. As a result, healthcare providers need to enable solutions that allow their patients to be more socially engaged. The AHA recently launched a patient-centered strategy focused on addressing the specific needs and preferences of the aging population.
Mental health is essential and in many cases more important than our physical health. Today 18% of people have a mental health condition. Loneliness is at epidemic rates. Recent research shows lack of social connections is more dangerous than smoking 15 cigarettes a day and worse than obesity - increasing the chances of early death by as much as 50%. Suicide is now the second leading cause of death for people between the ages of 10-34, and the 4th leading cause of death for people between 35-54 years old, after accidents.
People’s behaviors and choices in life are the most significant contributors to the development and progression of most chronic diseases. With less than 3% of American’s living a ‘healthy lifestyle’, most people are kicking the can down the road. They say they will follow a diet next year or begin exercising soon, but fail to follow through. They don't see the immediate consequences of their behavior. Controlling chronic diseases can only be done by empowering patients to better care for themselves. By giving immediate feedback on how behavior is affecting their health, they will better understand and be motivated to make improvements in their lifestyle.
For example, a continuous blood pressure device that informs a smoker that after just half a cigarette their blood pressure increases to 180/110 will more likely cause a change in behavior. Likewise, providing feedback to a patient with heart rhythm problems that indicates that after one drink that their heart rhythm is adversely affected, will cause them to quit drinking sooner.
Research by the United Health Foundation shows that so-called social determinants of health, including poverty, unstable housing and lack of social support, influences 50 percent of health outcomes. Healthcare systems need to develop solutions that connect patients with their family and support networks while still being able to unobtrusively monitor changes in a patient’s health. The IoT revolution, the use of Amazon’s Alexa and similar interactive digital assistant solutions will significantly change the way patients interact with their healthcare providers and support networks.
When focusing on medication adherence, providers need to identify the personal issues that contribute to nonadherence. Several studies have shown that reminding patients to take their medications is ineffective because of secondary reasons such as side effects, cost, and convenience. Currently, between 20%-50% of patients are noncompliant, contributing to 125,000 deaths per year and costing between $100-$300 billion dollars annually.
With increasing consumer care options, healthcare systems need to do things differently by creating solutions that motivate patients to make meaningful behavioral changes.
Healthcare will be delivered more from an Amazon model, where consumers will have an increasing choice of services with more transparency into price and quality. Healthcare systems must begin to adapt to the future where consumers will dictate and control the services they receive. Digital health technologies will help drive the change and force healthcare system and their preferred vendors to work together to empower consumers with choices that delight and engage them as passive recipients in the care and management of their health. Because more then anything, we want a health system the works for us, allowing us to live longer and more fulfilled with the people in our lives.
This article was inspired in part by Hugo Campos who spoke at the Quantified Self Cardiovascular Health Conference in San Diego CA.