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Population Health Management

Digital Therapeutics

The transition from volume to value is driving interest in population health strategies.

Healthcare's ongoing transition from "volume to value" is driving interest in population health strategies that improve patients' health and complement in office care.  This is especially true for patients in the early stages of chronic conditions.  For these patients health self-management outside of a traditional healthcare setting is a major determinant of disease progression and short and long-term costs. But how do we effectively and efficiently engage these tens of millions of patients?  A key component of that answer is the growing use of digital therapies -- defined as web, mobile, wearable and other digital technologies combined into an intervention to support healthy behaviors and provide therapeutic impact.  Such therapies offer patient engagement and health behavior change in cost-effective modalities. In addition, a growing number of patients expect modern digital interactions and such tools from their providers. 

SEE ALSO: Consumer Apps Raise Questions

In March, the CDC recognized the first set of digital Diabetes Prevention Programs.1 This recognition had previously only been available to in-person providers. The CDC's actions signal the maturity of evidence-based, rigorously developed digital therapies. Over the last few years researchers and companies have been leveraging online tools and interventions to engage and impact patient behavior. In many cases, these solutions have been rigorously studied and proven effective. For example, Dr. Kate Lorig at the Stanford Patient Education Research Center first translated her proven Chronic-Disease-Self-Management programs to digital delivery almost 10 years ago.2 She has run numerous trials on these digital versions demonstrating patient engagement and their efficacy. Stanford's Internet Diabetes Self-Management Program was evaluated as part of a randomized-controlled trial in 2006-2007 and demonstrated improved patient activation, self-efficacy and A1C outcomes.3

However, the real key to effectively employing digital therapies as part of a population health strategy is to fully embed them in the population health services.  It is not enough to make them available digital therapies and hope that patients enroll. Effective population health strategies should (1) segment the population based on clinical and utilization characteristics; (2) determine the needs of the targeted segment; (3) determine the specific approaches to be used based on patient characteristics and need;  and (4) identify and measure the outcomes to evaluate and scale the chosen approach. The investment to implement, rollout and integrate the programs should be spread across a suite of digital therapies that offer programs for the entire targeted population.

Digital Therapeutics For example, to impact the Emergent-Risk population (those with one or more pre-chronic or early-stage chronic conditions), strategies should focus on four interconnected elements:

  1. General outreach and education leading to increased activation and engagement
  2. Enhanced lifestyle management leading to improved nutrition, increased physical activity and obesity reduction
  3. Effective stress management leading to mental fitness and less depression
  4. Enhanced chronic condition self-management leading to improved short- and long-term health and utilization outcomes.

An integrated approach to the Emergent-Risk population would deploy these services broadly to the eligible population. The outreach would educate while offering patients the support of lifestyle, stress and condition management. An organization should provide multiple options, which can be tailored to the unique characteristics of each patient. Technology has the ability to allow extensive personalization and self-tailoring of the users' experiences. This population strategy, leveraging a suite of digital therapies on a platform of outreach and assessment will ensure a strong business case for the initiative. Starting with the population ensures significant engagement and population level outcomes, and leveraging technology ensures the programs' cost-effectiveness. This is already happening on a small scale and will happen more in the near future.

Adam Kaufman is CEO of DPS Health.

References

  1. CDC. Registry of Recognized Programs. Available at: https://nccd.cdc.gov/DDT_DPRP/State.aspx?STATE=OTH.
  2. Stanford School of Medicine. Internet Self-Management Programs. Available at: http://patienteducation.stanford.edu/internet.
  3. Stanford School of Medicine. Better Choices, Better Health -- Diabetes or Healthier Living With Diabetes. Available at: http://patienteducation.stanford.edu/internet/diabetesol.html.

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