The following is a guest article by Joseph Rubinsztain, MD, is CEO and Founder of ChronWell, based in Sunrise, Fla.
Within healthcare’s fee-for-service models, provision of care is a highly transactional arrangement—one that’s not favorable for the management of chronic conditions.
Primary care physicians generally receive lower reimbursements for consultation and treatment amid heavy workloads, while highly specialized clinicians are rewarded for procedure-based interventions. On the patient side, the number of people who are suffering from the effects of chronic diseases across the U.S. remain high: Six in 10 adults have a chronic disease, and four in 10 have two or more of them. Of those diseases driving the highest healthcare costs, prevalence is high:
- 40% of U.S. adults have obesity
- 45% of U.S. adults have hypertension
- An estimated 25% of U.S. adults have nonalcoholic fatty liver disease (NAFLD); and
- 5% have diabetes.
As these conditions drive expenditures in the trillions of dollars, providers continue to emphasize the importance of following treatment recommendations and enacting lifestyle changes that can improve patient outcomes. Unfortunately, maintaining the mantra “exercise and eat right” simply isn’t enough; patients require carefully constructed care plans with clear, personalized goals as well as more authentic and continuous connection with their providers.
Digital therapeutics, through a range of evidence-based interventions, have the power to improve outcomes and bind patients with their care teams through frequent communication, on-demand education, remote monitoring, coaching, digital assistance, care coordination and procurement of medical supplies. Digital health tools complement the human interactions that occur between patient and provider for a deeper understanding of both condition and the optimal treatment plan. These high-tech solutions are most effective at generating behavioral change when used in tandem with a “high-touch” approach that focuses on listening to understand patients’ key pain points and personalizing a care plan that truly fits their needs. High-touch care is no longer defined by the frequency of face-to-face visits, but rather by the ability of providers to customize treatment, connect with their patients, and offer ongoing support. As the digital therapeutics market expands to manage, treat and prevent disease, providers are delivering individualized care through strategic partnerships that enable them to provide a seamless care delivery experience for each and every patient.
Meeting complex needs
Healthcare providers are now seeking ways to deliver preventive and disease-specific management services that scale. Most chronic conditions require comprehensive treatment plans that include medications, monitoring, diet, education, exercise, and therapy. Under current reimbursement models, clinicians struggle to deliver or monitor these treatment plans in a cost-effective way. Partnerships enable them to support patient interventions through digital health tools. Personalized interventions reach patients in numerous ways: remote monitoring solutions, digital health coaches and dieticians, text reminders, educational videos and materials, customized fitness plans, and behavioral intervention techniques. By meeting patients in their lives consistently between visits, providers are able to reinforce positive behaviors, reinforce goals, and reward them when achieved. This has a lasting impact on health outcomes.
For chronic conditions like obesity, fatty liver disease, inflammatory bowel disease, and gastroesophageal reflux disease, for example, providers instruct patients to make specific and continuous lifestyle changes. Not surprisingly, compliance challenges to diet and exercise recommendations persist, and mixed outcomes reveal the weaknesses of traditional care management maintenance plans. Personalized lifestyle interventions built on a variety of patient data points, on the other hand, include tailored goals and guided treatments that drive higher compliance and better outcomes. These data points—which are comprised of clinical presentations, past medical histories, blood biomarkers, diagnostic and laboratory tests, and social determinants of health (SDOH), to name a few—provide clinicians and care navigators with the foundation on which to build both the treatment plan and a stronger care relationship.
Implementing plans for results
Digital therapeutics yield a merging of evidence-based information about protocols for specific conditions with the above individualized data points to generate effective, manageable care plans to match disease states. For example, for NAFLD, Stephen A. Harrison, MD, FACP, FAASLD, COL (ret.), one of the preeminent experts in hepatology and fatty liver disease, used published guidelines to co-design an algorithm for a treatment planning program that is cost-effective and non-intrusive for medical providers to implement. Once patients are enrolled, they receive an at-home blood testing kit and, depending on these results, they’re called in to the office for further diagnostic testing. The generated treatment plans are different for patients with mild forms of fatty liver (steatosis) than those with advanced forms (fibrosis or cirrhosis), and take into account comorbidities and SDOH as well. As all chronic disease management programs should, the program has very specific outcome measures, intervention strategies and endpoints to help mitigate risk, a level of specificity not typically available with standard chronic care programs.
To track treatment plan outcomes and adherence, physicians must have regular access to data on medication adherence, vital signs, biomarkers, and self-reported symptoms, to name a few. For patients with late-stage liver disease, physicians must carefully monitor weight, blood pressure, medication intake and blood lab tests to prevent hospitalization. If done manually, this surveillance can be quite time consuming. Alternatively, through automated reporting and alerts, providers can monitor in real time if their therapies are effective, adjust when necessary, and detect early signs of complications to prevent ER visits, hospital readmissions and medical service overutilization. When the remote monitoring solution indicates that the patient gained weight too fast or protein levels dropped and blood glucose or creatinine increased, the provider can adjust medications and diet (i.e. diuretics, carbohydrate and protein load) to improve cardiac and renal function. With a commitment to have these “eyes and ears” on patients, physicians are able to implement preventive measures and direct care cost effectively.
Realizing the benefits of value-based care
Having the ability to monitor chronic care patients closely with minimal physician effort will provide the means to shift fee-for-service models to value-based and patient-centered care. Digital therapeutics enables providers to scale both preventive services and disease-specific care management for better outcomes at the lowest possible cost. For the engaged patients who are experiencing seamless care delivery—not just at visits, but between them—they are gaining trust in the management of their condition with increased attention from their providers and the realization of results. The future is upon us, and evidence in support of digital therapeutics is accumulating quickly. Digital platforms will soon be prescribed as pharmaceuticals have always been, but more impactfully to generate improved outcomes with a focus on value and personalization.
About Joseph Rubinsztain, MD
As the CEO and Founder of ChronWell, innovation is high on Joe’s priority list. By the time ChronWell launched in 2017, Joe—a seasoned entrepreneur and leader in Healthcare Information Technology—was already shaking things up. His trailblazing can-do attitude has always pushed him toward fulfilling unmet needs. He founded gMed in 1997, a firm that was recently sold to Modernizing Medicine. Joe continues on a path of active investment and plays a strategic role as a sought-after board member for businesses, NGOs, and very focused on disrupting the Digital Health space.
ChronWell partners with leading specialists to deploy new clinical service lines driven by digital innovation to manage large at-risk populations. ChronWell’s disease specific programs identify patients who could benefit from unique intervention strategies and scale personalized care for many patients under physician supervision to drive optimal outcomes at lower cost.
