What is Driving the Digital Health Revolution?- Value-Based Care
Health care is on the verge of a major paradigm shift, resulting in better patient outcomes at a lower cost. Patients receive more effective care, employers experience reduced premiums and payors realize substantial savings. This is the only way to sustain our healthcare infrastructure in a rapidly aging society.
— Terry Fagen, President, Medipense Inc.
Value-based care is a healthcare model which rewards value, the end result, over the traditional fees for medical services. The focus of this type of care is the patient and what the patient needs, rather than the traditional supply driven system of what the physician does.
We must shift the focus from the volume and profitability of services provided — physician visits, hospitalizations, procedures, and tests — to the patient outcomes achieved.
— Porter, Michael E., and Thomas H. Lee. “The Strategy That Will Fix Health Care.”
Harvard Business Review 91, no. 10 (October 2013): 50–70.
The old way of providing healthcare is quickly fading. Exorbitant costs for care, medications and equipment in a for-profit healthcare business model simply can not, and should not, be maintained in an aging society with more than 10,000 people turning 65 each day. Healthcare costs in the United States are rising two to three times faster than the rate of inflation. Added statistics like 50% of people do not remember what their physician told them; 10–30% of hospital admissions are due to medication non-adherence; 55% more emergency room visits for diabetics who do not have, or cannot afford health insurance, all indicate the unsustainability of the current model. We need to provide better care at a lower, affordable cost.
The emergence of Accountable Care Organizations (ACO) is certainly a step in the right direction. These alliances of doctors, hospitals and other health care providers deliver and coordinate care for their patients, with a mission to provide better outcomes at lower cost. Think cost-effective care. At a recent conference in Philadelphia (MedCity Converge, July 2016), United Healthcare discussed how incentivizing members to pay more attention to their health, through wearables and other means, significantly reduced premiums to employers and employees and increased their profit thought cost of care reduction. It is less costly to motivate a patient with a $1500 incentive, than to spend $10,000+ for an ER visit.
It’s kind of like an alarm system for your home. If you have one, your insurance premiums are reduced. If you have a health wearable, your health insurance is reduced.
Aetna, Accountable Care Solutions, with 35 Million members, indicated that value-based care could result in a 20% reduction of healthcare costs. Where they are currently offering 40% value-based solutions, the goal is to reach 76% by the year 2020. So folks, the data is in! Paying better attention to your health, results in better health. [Infographic: Quality of care versus quantity of service]
Dr. Eric Topol nicely explains in his book “The Patient Will See You Now: The Future of Medicine Is in Your Hands”, that people, patients and caregivers need to have access to information — code, data and research to make the best decisions. Better decisions by all players will make value-based payments successful. I surmise that capturing, reporting, consolidating, validating and presenting the data, at the desired level of understanding of the audience, is a challenge of the new digital health realm.
Enter Digital Health
Digital health is the latest terminology used to describe new tools and devices, artificial intelligence (AI) and augmented reality supporting healthcare in one form or another. The myriad of connected devices (50 billion are expected by 2020), wearables, portals and the IoT have also spawned a new generation of early adopters — the elderly. Where millennials may use these devices primarily as fitness sensors and trackers, seniors tend to use them as health monitors. As a sidebar: The market has also shown that fitness wearables are usually short-lived, with only a small portion of users sticking to them longer term. However, fitness device manufacturers have quickly adapted to the new digital health market, because results have shown that similar wearable health devices are in fact used long term. Users tend to stick with them, providing opportunities for upselling and upgrading.
So the question remains: how can digital health help?
First, we need patients to want to use them. Second, we want healthcare providers to recommend their use, monitor the results and maintain communication with their patient.
I’m reminded of 2 characteristics of a good digital health, medical device:
- Simplicity — the device must not only be simple to operate, it must also simplify an action, reduce errors and promote consistency. Using a pill dispenser as an example, these features would include reminders to take pills, follow-up with caregivers when not taken, confirmation and feedback when medications are taken. Dispense the right pills, in the right quantity, with instructions, at the right time to the right person.
- Need — there must be a real need from society or a patient population for the product, not simply a monetary one for the manufacturer. It must solve a problem. It must be cost-effective.
In addition, digital health has the utility of providing more information in less time, regardless of location. Just what does this mean? Wherever you are sick, you should be able to receive the same standard of care.
Physicians have been educated and trained over many years. They have read a hundred books, treated many patients and continue to maintain their certification though continuing medical education. However, specialization narrows their field of view towards their specialty. What if a physician, regardless of interest or specialty, had the knowledge of the entirety of medicine at their disposal? Could the result be better patient outcomes at lower cost? The answer may emerge from digital health. A few are described below to illustrate the point.
- IBM Watson effect: imagine reading millions of medical books, journals and physician notes, in real time, while a patient is describing their symptoms. If the results were available in 3 seconds, presented to the physician on his tablet for analysis and final determination, how valuable would that be? To a doctor in a rural town who now has access to the same database as an urban healthcare professional, the quality of care has just been equalized.
- iHEALTH View Wireless Blood Pressure Wrist Monitor: Measure your blood pressure with this sleek, easy to use, smart monitor. Clinically tested and FDA approved, secure, simple to use. Add a Wireless Smart Glucose Monitoring System which automatically keeps a history of your data and gives you the option to share your information with your doctor or caregiver.
- Hexoskin wearable clothing: Comfortably and continuously measure and capture vitals — Heart Rate, HRV (allowing to estimate stress and fatigue), Heart Rate Recovery, ECG, Breathing Rate (RPM), Minute Ventilation (L/min), Activity intensity, peak acceleration, steps, cadence and sleep positions.
- RxPense® medication management and remote monitoring solution: Robust and secure, connected and multi-lingual, RxPense® is an automatic pill dispenser which promotes medication adherence. Designed for Seniors (large touch screen, simple UI), Chronic Care Patients or those with complex medication regimens, RxPense® ensures the right pills are dispensed at the right time to the right person and notifies caregivers and health care providers when they are not taken as prescribed. Want to reduce hospital readmissions due to medication non-adherence? Want to ensure patients take their meds on-time, every-time? Want to monitor a patient before, during and after taking their meds? Want to reduce home, or patient room, visits? RxPense® is the solution.
In a value-based care environment, Payors will pay for reduced re-admissions, generic drugs and increased adherence, all factors proven to provide better outcomes at lower cost.
Risk: Information Overload — too much data being dumped on doctors
As patients, we need to be careful. Physicians are responsible for so many life and death decisions, diagnostics, data, patients and oh yes, coding! Just when do they have time to analyze patient generated data? Many physicians with whom I have spoken, say they do not have much spare time. Some physicians find patients bringing USB drives to their medical appointment, with the expectation to install, view and analyze this data on the spot — an impossible request.
We need to find a way to help doctors and other health professionals, assimilate all this data in an effort to speed diagnosis and provide better treatment options, better outcomes and better lives for all.
“Intelligent dashboards”, powered by self-learning, advanced algorithms, offer huge promise. The ability to filter data and highlight not only out-of-bounds anomalies but also identify trends that provide early indications of declining health states, based on multi-factorial data sets, can easily provide Key Performance Indicators (KPIs) of human health states. These KPIs can provide physicians with reduced datasets that focus only on those areas of real concern.
Value-based care empowers patients and enables caregivers to provide better care at a lower cost, resulting in better outcomes and better lives. Digital tools have evolved from their fitness roots into FDA approved health devices. These tools facilitate value-based care and payment models. A consumer who takes an active role in the monitoring of their own health, tends to remain healthier longer, and requires fewer, expensive emergency treatments at the hospital.
These value-based needs have spawned a new generation of AI tools, to facilitate diagnosis and treatment, sensors to monitor and better capture data and connected dispensers to ensure medication adherence and to correlate medication effectivity with sensor captured health data.
This push towards valued base care is not only driving innovation in the digital realm, it is also creating new challenges. With petabytes of patient data being generated daily, we need to turn our attentions to consolidation, perhaps expanding AI, to mine and make this data digestible in intelligent dashboards.