One of the most transformative shifts seen in the health care industry today is the digitization of products, services and commerce, leading to democratizing health information exchange. Frost & Sullivan highlights key areas that focus on improving patient engagement, with notable companies in each of these areas to indicate the kind of efforts they are undertaking.
In 1970, economist George Akerlof published an article titled “The Market for Lemons: Quality Uncertainty and the Market Mechanism,” in which he used the used car market to highlight the problem of information asymmetry. Akerlof argued that information asymmetry tilts any business transaction to one side, leading to unfair and uncertain outcomes such as opaque pricing, poor choices and customer frustration. He termed these bad outcomes as “lemons,” which are prevalent in inherently opaque businesses where one party operates from a higher information plane than the other and therefore has a strategic advantage. Akerlof would go on to win the Nobel Prize in Economics for this seminal idea.
It is tempting to view health care as a “lemon market”—one that is consistently loaded against patients, often resulting in poor outcomes and high medical costs. Indeed, information asymmetry forms the shaky bedrock of the U.S. health system’s pricing policies. Many of today’s raging debates about high insurance premiums and exclusions from coverage can be traced back to this phenomenon.
The Rise of Healthcare Consumerism: Patients or Consumers?
In some ways, the root of this problem can be traced back to the confusion in defining the end users in the health care industry. While conventional terminology refers to them as patients, emerging trends and practices urge them to be called consumers. The term patient indicates passivity—a sense of being taken care of rather than being actively included in the health care process. A consumer, on the other hand, is more engaged in the process, more informed and aware of the choices, and an equal contributor to the transaction at hand.
Jeff Margolis, CEO of Welltok, a prominent digital health company, characterizes the situation thusly: a patient is also a health care consumer, but a consumer is not necessarily a patient. The happy middle ground is an engaged patient. The big challenge for health care professionals and providers is to improve communication between them and their patients so that there is greater transparency, more cooperation, and proactive participation in the treatment process.
Patient Engagement: The Changing Nature of Patient Participation
One of the most transformative shifts seen in the health care industry today is the digitization of products, services and commerce, leading to democratizing health information exchange. This movement entails broad cultural and economic shifts that motivate people to take a proactive role in all aspects of their health care, including the selection of health plans, providers and treatment options; tracking their health status via personal health records, wearable sensors and in-home monitors; and directly contributing to and/or accessing personal health data from providers, payers, testing labs, pharmacies and other organizations.
Frost & Sullivan highlights key areas that focus on improving patient engagement, with notable companies in each of these areas to indicate the kind of efforts they are undertaking.
According to the World Health Organization, 50% of patients with chronic illnesses do not take medications as prescribed. Medication non-adherence is responsible for more than 125,000 deaths annually in the United States; between 33% and 69% of medication-related hospital admissions are because of poor adherence. Poor adherence leads to more complications and higher hospitalization rates, and causes a high economic burden on the global healthcare system: an estimated $290 billion annually.
Proteus Digital Health (Redwood City, Calif.) is an early entrant in the digital health space. The company’s flagship Proteus Discover platform consists of an ingestible sensor, a body-worn patch and an application interface that together provide the patient and the physician with insights into the patient’s health. Foremost among these insights is whether the patient is complying with medication prescriptions and how the patient is responding to the treatment regimen.
AiCure (New York) leverages the omniscience of smartphones to track and encourage medication compliance. A patient, especially one who is on an experimental medication or has enrolled in a clinical trial, is provided access to a portal through a mobile app. The patient can record, through selfies, every time the prescribed medication is taken; the app identifies the patient and the medication, and records the act of pill swallowing as visual proof of adherence. This is the starting point for the many insights that a researcher or a physician can derive. The patients themselves get timely reminders of medication schedules, clinic visits, and special dietary and exercise instructions.
Chronic Disease Management
Engaging patients suffering from chronic disorders such as diabetes or cardiovascular disease should not stop with sending reminders and alerts. The requirement is constant emotional support: encouragement about lifestyle choices, community involvement and information about the disease complexities.
Mountain View, Calif.-based consumer health company Livongo Health has developed a smartphone-connected blood glucose meter that automatically uploads a patient’s readings to a smart cloud platform, making it accessible online. Using cloud-based analytics platforms, Livongo delivers real-time, personalized and actionable insights to the patient and the physician and, depending on access permissions, also to family members, care coordinators and population health managers. During emergencies, such as critically high blood glucose levels, Livongo provides patient support through an on-call team of certified diabetes educators. These experts get in touch with the patient within 3 minutes of receiving a troubling reading and proactively help in problem-solving and decision-making. Livongo Health’s program has been cleared by the U.S. Food and Drug Administration and is the first-of-its-kind health program to receive the American Association of Diabetes Educators’ Diabetes Education Accreditation Program seal of approval.
Behavioral and Mental Health Management
Management of mental health has all the challenges that physical and physiological diseases have, with the additional burden of social stigma, a negative perception of psychological therapies, and the underlying difficulty in accepting one’s own mental health disorder.
Dublin, Ireland’s SilverCloud Health has developed a web-based platform to deliver customizable, guided and modular programs. True to the nature of cloud-based services, the SilverCloud Health platform can be accessed through computers, smartphones, and tablets. Based on an individual patient’s condition, an 8- to 10-week program is designed; participation is conducted via the patient portal. The aim of these modules is, with a help of a dedicated therapist, to guide patients through mental and emotional exercises that will help them understand and reflect upon the thoughts that affect their moods and behaviors. According to Ken Cahill, CEO of SilverCloud Health, the team has considered four features as key to the platform: interactivity, personalization, professional support, and a sense of virtual social networking. These features inject a sense of engagement and “gamification” into the therapy program. Gamification refers to applying the usual elements of playing a game into particular areas of life—in this case, therapy and learning.
The Road Ahead
The internet has become the lowest common denominator in the delivery of health care services. However, the utility of digital services is far from saturated; in fact, the elasticity of the internet is put to a test as patients find new concerns with which they need help. Emboldened by their experience as customers in the online shopping, entertainment and consumer markets, patients are becoming more demanding in the health care industry as well. In turn, they are increasingly recognized as equal partners in the treatment process.
The next wave of innovations—wearable devices, head-mounted displays for virtual reality and artificial intelligence—will further reduce the gaps in delivery and further increase patient engagement.
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