Prescribing software — The digital pill

What are digital therapeutics?

Digital therapeutics are Software solutions used to treat a specific medical condition — stand-alone or in combination with conventional therapies especially for major chronic diseases like heart disease, diabetes, high blood pressure etc. May or may not be approved by FDA or reimbursed by payors.

Digital therapeutics can administer multi-modal interventions using a software platform. I illustrate some examples in the figure below:

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Why now?

Most chronic diseases (defined as one lasting three months or more) can benefit from digital therapeutics. Almost 1 in 2 people in the US suffer from a chronic disease. Chronic diseases contribute to 70% of deaths and 85% of healthcare costs. Diabetes and heart disease alone cost 530 billion dollars to the taxpayers. An individual with a chronic disease is 5x more expensive to the society than a healthy counterpart. Not only this, multiple chronic conditions interact with each other leading to exponential increase in costs and average medical payments more than double when someone has two chronic conditions.

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Increasing awareness and adoption of technology have led patients to play a bigger part in their healthcare decisions. Patients prioritize improved access and convenience over human connection. Shortage of providers has led to increasing wait times for primary care visits. A patient has to wait, on an average, 19.5 days to get an appointment at a family practice.

How to win?

Product features

Patient engagement — Use proven behavior change principles and user centric design to engage.

Established clinical evidence — Garner support from publications, or independent organizations and conduct randomized clinical trials.

Line of sight to ROI — Collect data necessary to claim outcomes. Structure pay for performance contracts with customers.

Implementation strategies

−Work with an internal champion to drive adoption within the organization

−Target conditions with evidence-based behavioral or lifestyle solution

−Focus on organizations motivated to improve the overall health of the population as well as own the patient and provider population e.g. self insured employers or integrated health systems

−Integrate in users’ workflow — multiple chronic conditions should be managed in an integrated fashion

How to design an effective solution?

  1. Think BigIs there a critical mass of patients who can be enrolled?
  • Large economies of scale — pool resources, amortize costs.
  • Data informs and enables continual improvement of the program
  • Avoids selection bias and holds statistical power to claim outcomes
  • Results must be generalizable beyond the study population

2. Keep it simple Does the program design allow for lean management?

  • Use uncomplicated care pathways to help providers comply and coordinators oversee
  • Do not tailor treatments to multiple small subgroups of patients
  • Clearly define responsibility — one person takes ownership of care delivered to a given patient

3. Listen to patients’ needs — Is it reasonably straight-forward for patients’ to follow the program?

  • Interventions should be simple and easy to implement for vast majority of patients
  • Ongoing, disease specific coaching using proven behavior change principles
  • Single point of contact to avoid duplication of treatments or co-ordination issues
  • Patient segmentation and targeted incentive schemes to encourage compliance

4. Collect data — Do you have timely information for effective intervention?

  • Define metrics before launch — costs, outcomes, usage stats, satisfaction rates
  • Collect granular, longitudinal data, process promptly and establish pathway to intervention
  • Share with third parties for independent analysis, review and publication of results
  • Data feedback loop to enable continual program improvement

5. Win and let win — Are various stakeholders’ incentives aligned?

  • Align financial incentives — e.g. decrease in copayment rates, cost savings for payors, care co-ordination reimbursement for providers
  • Highlight non financial incentives — e.g. image and marketing advantage in a health system with competing payors, patient retention and higher patient satisfaction for physicians

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