Every few years something comes out that promises to change healthcare. The newest darling seems to be telemedicine, which stepped into the spotlight to meet a crucial need during the COVID-19 pandemic. But a recent tweet from Dr. Sachin Jain, CEO of the SCAN Group and the SCAN Health Plan, takes a sobering look at the effects of telemedicine with this meaningful invitation:
I like it when you’re tired of the crowd of “innovation” that constantly upholds the notion that “tele-health” (aka video visits) will save American health care from itself.
– Sachin H. Jain, MD, MBA (@sacjai) September 14, 2021
The responses to this tweet from insiders reveal a deep cynicism about the transformative abilities of telemedicine. And this skepticism is not new. In a 2017 article in the San Francisco business hours, Dr. Davis Liu said“If medicine continues to develop doctors on video in the next 5 to 10 years, then we have failed.”
Of course, telemedicine was absolutely essential during pandemic lockdowns. It can often improve health care by making it easier and more convenient to access providers. However, telemedicine cannot really transform healthcare because it is only an incremental improvement, not an innovation.
However you define it, real innovation requires a whole new way of thinking. So consider this: As telemedicine modernizes the doctor’s visit, what if we looked at digital health to change the way we care from “visit” to “continuous support”?
Think outside of the visit
Visits to the doctor – whether in person or virtually – will always be an important part of good health care. However, if you ask doctors what the secret to better patient outcomes is, most of them will say, “If only people would adopt healthier behaviors.”
It’s the biggest challenge we face in healthcare – and the reason we can’t afford to mix telemedicine and digital health.
Providers can offer the best advice, recommendations, and resources to help patients. Yet even the best of intentions find it difficult to change their habits when the doctor visit is over and they return to all the whims of their daily lives. Simply changing the care location from inpatient practice to video does not solve this fundamental problem.
Ultimately, telemedicine is still a visit to the doctor. It is still a periodic, synchronous, often quite short, individual event. In addition, the necessary context is often lacking.
People rarely develop diabetes, heart disease, or other medical conditions just because they don’t have enough doctor visits. Health often arises as a result of numerous daily actions that people take. Healthcare providers can guide these decisions, but ultimately, patient behavior must change before outcomes change. And the tools to influence this behavior are unfortunately usually not available to the providers.
Digital health has the power to redefine the way we think about health care in the context of everyday life and people’s choices. It can do more than that Page? ˅ Care; it can develop a lot nature care by making it continuous, scalable, personalized and multi-conditional. Digital health enables us to utilize a portion of the health value that cannot be achieved either through face-to-face visits or through video visits alone.
Reimagine the nature of grooming
Most people acknowledge that the US healthcare system is getting lackluster results given its huge spending. And most would agree that the answer to rising health care costs and deteriorating health does not just lie in more visits from care providers. Instead, we need to rethink how we can support patients in ways that enable quality clinical care.
Embedding digital health in the patient experience can completely transform the nature of care by enabling something many providers have wanted for decades: a way to help people make day-to-day decisions that affect outcomes. When digital health technologies deliver specific interventions to improve health, they are sometimes referred to as digital therapeutics.
As with most innovations, there is still no broad consensus on how to define these concepts. But the Digital Therapeutics Alliance provides a useful working definition: “Digital therapeutics deliver medical interventions directly to patients using evidence-based, clinically evaluated software to treat, manage, and prevent a wide range of diseases and disorders.”
In other words, care can be provided continuously or at the times most important in the lives of the people who receive it. As a result, these technologies can play a driving role in helping people make better decisions about where life is lived – such as when deciding whether to play sports or watch TV, buy products or pastries, meditate, or smoke a cigarette. This is what generates potential value and raises digital health via “creeping incrementalism” to a real “innovation” status.
There is no analogous correlate for digital health. There is no face-to-face version of it. Instead of helping a patient from a doctor for a unit of time, digital tools enable supportive relationships to be used on a large scale. A single provider or coach can help thousands of people, and those who use these services can get the right, most helpful mix of digital and human support when and where they want it most.
For example, what if a digital therapy platform could identify which patients had previously set themselves the goal of eating healthier breakfasts, but were making high-carbohydrate decisions at breakfast this morning and now have high blood sugar levels? What if there is a subgroup within that group that prefers short messages with a soft but prescriptive tone, delivered on a particular channel with five or fewer alternative options?
Imagine the impact of a personalized message to each of them the next morning that basically says, “I see you had a hard time reaching your breakfast goal yesterday, so I thought I am offering some healthy options that You can try it out today. How else can I support you? ” Although this is a very simple example, it quickly becomes clear that these interventions go far beyond what is possible with a discreet visit to the provider.
Fake ‘platforms’ abound
As with all innovations, there is one important caveat to keep in mind.
Dr. Jain precisely states that, despite its benefits, telemedicine is not going to revolutionize healthcare. In truth, digital health will not revolutionize healthcare either – unless it learns to integrate and become multi-condition until it creates added value for every stakeholder it touches. This includes patients, service providers, payers and employers, as well as competitive digital therapy solutions.
Nowadays, if everyone likes to refer to technologies as “innovations”, then they like to refer to their favorite technologies as “platforms”. Everywhere you come across this or that “platform”. But real platforms add value to all participants – and by that simple standard, almost every one of them crosses the threshold.
Platforms create added value for everyone. For this reason, you can download the Google Maps app on an Apple iPhone, for example. Apple knows that the value of a competitor’s app on the phone outweighs the value of a fully closed ecosystem. Digital health can foster the same kind of platform effect – but only if solutions work together to create value for all, and not like their current proprietary walled gardens approach.
If you can native Providing data and information to everyone involved, even competitors, then creates added value. Patients have information, health coaches, and other tools right at their fingertips to adopt healthier behaviors in the moment. Providers have the data and information they need to help their patients become healthier and get reimbursed for them. Health plans can prevent costly services through cheaper, proactive interventions. Employers can attract more productive and engaged employees at a lower cost. Other digital health companies can even grow faster by accessing shared value.
That is the real potential of integrated digital health with multiple diseases.
Transformation through digital health
There is plenty of room for more value in healthcare. In fact, doctors are often as frustrated as their patients, knowing that it is difficult to change all of the daily habits that lead to good – or bad – results. Telemedicine is sometimes an incremental improvement over face-to-face visits alone, but it’s still another form of synchronous doctor visits.
Therefore, to unlock more value, we need to re-evaluate the visit construct itself. We need to think about how we can provide all health care in the context of people’s daily life.
Digital health and digital therapeutics take a radically different approach to treatment. Instead of one provider helping a few people with some of their health, digital therapeutics enable one person to help thousands of people in the ways that matter most to them.
No solution has all the answers. Personal visits to the doctor as well as telemedicine visits offer clear advantages. However, highly integrated, multi-condition digital health can create unprecedented value because it is scalable, can be deployed regardless of schedules, and relies on the devices people already use in their homes and workplaces. If it is properly constructed, it can be integrated into existing care processes. It enables personalized solutions to achieve superior results on a large scale.
When Dr. Jain is right that American health care must be saved from itself – and I think it is – it stands to reason that we cannot do this by changing care locations. We need to change the way we care, and digital health will be a key component of that transformation.
About the author
Dr. Omar Manejwala is Chief Medical Officer at DarioHealth, a digital therapeutics company that provides solutions for various chronic conditions such as diabetes, hypertension, weight management, musculoskeletal and behavioral health within an integrated technology platform. He holds an MBA from the University of Virginia Darden School of Business and an MD from the University of Maryland School of Medicine. Dr. Manejwala is a specialist in psychiatry, addiction medicine and medical management.